Hand-Nerve Facts Flashcards
Time to replantation
proximal to carpus
- warm ischemia time < 6 hours
- cold ischemia time < 12 hours
distal to carpus (digit)
- warm ischemia time < 12 hours
- cold ischemia time < 24 hours
Finger order for replant
thumb, long, ring, small, index
Replant monitoring (most reliable method and pulse ox number)
skin temperture most reliable
- concerning changes include a > 2° drop in skin temp in less than one hour or a temperture below 30° celcius
pulse oximetry
< 94% indicates potential vascular compromise
What is average motion after replant?
50% total motion
(tenolysis most common secondary surgery)
Treatment of reperfusion injury after replant
allopurinol is the best adjunctive therapy agent to decrease xanthine production
mechanism thought to be related to ischemia-induced hypoxanthine conversion to xanthine
Most common knuckle and side for sagittal band rupture (“boxers knuckle”)
Middle (~50%), radial (9:1)
most important flexor pulley in thumb
Oblique pulley
originates at proximal half of proximal phalanx
radial tunnel syndrome facts (4)
- pain only (no motor or sensory changes)
- maximal tenderness more distal than tennis elbow (4 cm distal to epicondyle)
- same sites of compression as PIN syndrom
- non-op at least 1 year
Which of the following is considered the most common complication of an extensive medial release for resistant medial epicondylitis?
Medial elbow instability
Vangsness CT Jr, Jobe FW: Surgical treatment of medial epicondylitis: Results in 35 elbows. J Bone Joint Surg Br 1991;73:409-411
To adequately expose the volar plate of the proximal interphalangeal joint of the finger, which of following
pulleys is typically incised?
Distal portion of C1, entire A3, and the proximal portion of C2
intrinsic muscles innervated by the ulnar nerve
palmaris brevis, hypothenar
muscles, all of the interossei, adductor pollicis, and the deep head of the flexor pollicis brevis
Which normal structures help compose the spiral cord seen in Dupuytren’s contracture?
pretendinous band, spiral band, lateral digital sheet, and Grayson’s ligament
NOT Cleland’s ligament
The transverse ligament of the palmar aponeurosis also not involved.
Origin and course of the palmar cutaneous branch of the median nerve (PCBMN)
originates from the radial side of the nerve and travels distally with the median nerve, radial to the palmaris longus, and ulnar to the flexor carpi radialis
extensor tendon zones of injury
joints are odd
Boutonniere Deformity
Zone III extensor tendon injury
rupture of central slip
open or avusion treat open (
closed treat closed ext PIP splint
reconstruction vs terminal tendon tenotomy (Fowler) if fails
swan neck deformity
Primary lesion is lax volar plate that allows hyperextension of PIP
Secondary lesion is imbalance of forces on the PIP joint:
- mallet injury
- FDS rupture
- intrinsic contracture (triangular = transverse retinacular ligament)
- MCP joint volar subluxation (RA)
five compression sites described in radial tunnel syndrome
distal edge of the supinator; fibrous bands superficial to the radiocapitellar joint; tendinous margin of the extensor carpi radialis brevis (ECRB); radial recurrent artery (leash of Henry); and the most common site of compression, the fibrous edge of the supinator (arcade ofFrohse).
steps releasing a PIP joint flexion contracture
release check rein ligaments; then accessory collateral ligament and volar plate; and finally the proper collateral ligament is then released off the proximal phalanx
treatment
Treatment
- nonoperative
reduce and buddy tape to adjacent finger (3-6 weeks)
indications: dislocation is reducible
- operative
open reduction and extraction of the volar plate
indication: failed reduction or open
treatment
nonoperative
splinting in extension for 6-8 weeks
allows central tendon to heal to avoid boutonneire
structures to go through to approach this injury:
adequate volar exposure of the volar plate requires resection of:
proximal portion of C2 pulley
entire A3 pulley
distal C1 pulley
indication to fix:
if > 40% joint involved and unstable
Rotatory PIP dislocation treatment.
open reduction
indications: required in most cases
one of phalangeal condyles is buttonholed between central slip and lateral band
try closed reduction first. traction to finger with MP and PIP joints in 90 degrees of flexion.
kleinert protocol
low force and low excursion rehabiliation
