Hand and wrist- muscles, tendons, nerves

Question 1

Describe how the FDP and FDS are examiend

Answer 1

FDP: ask the patient to actively flex at the DIP joint.
FDS: ask the patient to flex at the PIP joint while holding adjacent digits in full extension.

Question 2

Describe a challenge in managing injuries to tendons that are within tendon sheaths

Answer 2

Cut tendon ends can be sutured and will heal, but if the repair tissue scars the tendon to the sheath or the pulleys, tendon motion will be restricted and may cause joint contracture

Not a problem for tendons without sheaths

Question 3

Describe the process of tendon healing

Answer 3

• granulation tissue proliferation around tendon
• deposition of randomly oriented collagen fibrils
• formation of “tendon callus” around sutures
• collagen fibrils organize into longitudinal orientation

Question 4

It is important to provide enough tendon mobility to prevent _______ form forming, but avoid loads large enough to exceed the strength of the surgical repair

Answer 4

adhesions

Question 5

Give some examples of extensor tendon injuries

Answer 5

Mallet and boutonniere

Question 6

How to mallet injuries classically occur?

Answer 6

DIP is forcibly flexed and axially loaded, causing shearing of the terminal extensor tendon

Question 7

Bony mallet injuries that include ________ at the DIP may be treated surgically

Answer 7

subluxation

Question 8

What is the presenting symptom of a mallet injury?

Answer 8

unable to extend at DIP

Question 9

How are mallet injuries usually treated?

Answer 9

splinting

Question 10

________ deformity results from rupture of the central slip of the extensor tendon from its bony insertion during trauma

Answer 10

Boutonniere

Question 11

What is the classic boutonniere deformity?

Answer 11

PIP flexion and DIP extension

Question 12

What is the classic boutonniere deformity?

Answer 12

PIP flexion and DIP extension

Question 13

________ can also cause extensor tendon rupture

Answer 13

rheumatoid arthritis

Question 14

What are symptoms of carpal tunnel syndrome?

Answer 14

paresthesias or numbness in the median nerve distribution of the hand, aching in thenar eminence, weakness or atrophy of abductor pollicis brevis and oponens policis

Question 15

What are treatment approaches to carpal tunnel syndrome?

Answer 15

conservative- splinting

severe- surgical decompression

Question 16

What are symptoms of cubital tunnel syndrome?

Answer 16

paresthesia and numbness in small and ring finger, aching in the medial elbow and forearm, clawing of small and ring finger