Hand (RITA)

Question 1

What is the MOI for skiers thumb/gamekeepers thumb?

Answer 1

forced or repetitive radial deviation of dumb

Question 2

What are complications associated with thumb MCP joint injuries?

Answer 2

chronic laxity leading to DJD
decreased pinch and grip strength
pain

Question 3

What clinical finding is found with thumb MCP joint injuries when ulnar stress is applied to joint?

Answer 3

INSTABILITY

15* valgus deformity compared to uninvolved side

Question 4

What are treatments for thumb MCP joint injuries?

Answer 4

splint
cast
surgical repair of ligament

Question 5

What do you need to rule out for thumb MCP joint injuries?

Answer 5

avulsion fx of MC bone - check X-rays before stress testing

Question 6

What are indications for surgical repair of MCP joint injuries?

Answer 6

complete UCL rupture
UCL injury with fx that is rotated, displaced, or interarticular
Stener lesion

Question 7

What is stener lesion?

Answer 7

aponeurosis of adductor pollicis becomes interposed bw ruptured UCL of thumb and its site of insertion at base of prox phalanx

Question 8

What is the outcome of stener lesion?

Answer 8

UCL cannot heel spontaneously because the ligament looses contact with its insertion site

Question 9

What is primary surgical intervention for MCP joint injuries prior to 6 weeks post injury?

Answer 9

direct reinsertion of ligament onto bone

Question 10

For chronic instability or delayed repair, what is surgical intervention of MCP joint injuries?

Answer 10

tendon transfers or MCP joint fusion

Question 11

With UCL tear, what is prognosis 3 weeks after surgery?

Answer 11

96% full fxn

Question 12

If repair of UCL tear occurs > 6 weeks after injury what is prognosis?

Answer 12

poor

Question 13

The carpal tunnel is formed by?

Answer 13

carpal bones and 9 flexor tendons

covered by carpal ligament

Question 14

CTS is usually related to what conformation of the tunnel?

Answer 14

volumetric increases of contents of tunnel OR decreases of tunnel dimensions

Question 15

What are common causes of CTS?

Answer 15

structural/traumatic changes
underlying systemic/physiological disorders
repeated microtrauma due to repetitive use
pressures within tunnel with positions

Question 16

What is the pressure in the carpal tunnel with neutral wrist?

Answer 16

20 mmhg

Question 17

What is the pressure in the carpal tunnel with 20* flex at wrist?

Answer 17

35 mmhg

Question 18

What is the pressure in the carpal tunnel with 44* flex at wrist?

Answer 18

45 mmhg

Question 19

What is the pressure in the carpal tunnel with 20* ext at wrist?

Answer 19

30 mmhg

Question 20

What is male:female ratio of CTS incidence?

Answer 20

1:3

Question 21

What are risk factors for CTS?

Answer 21

repetitive use
force
posture/unaccustomed work activities
vibration/temperature
personal risk factors

Question 22

What is double crush syndrome?

Answer 22

peripheral nere phenomenon associated with two neurological involvements

Question 23

What is the most common double crush syndrome pathology combo?

Answer 23

CTS/TOS/Cubital tunnel syndrome

clinical evidence in 64%

Question 24

What is the incidence of CTS + TOS?

Answer 24

30%

Question 25

What is the incidence of CTS + cervical radiculopathy?

Answer 25

18%

Question 26

How is double crush syndrome diagnosed?

Answer 26

electrophysiology pahlens test tinel test semmes weinstein

Question 27

What are indications for surgical treatment of CTS?

Answer 27

> 6 month duration of symptoms not responding to conservative treatment severe symptoms interfere with sleep and fan clinical/electrophysio evidence of median nerve dysfxn

Question 28

To treat CTS, the _____ ligament may be released.

Answer 28

transverse retinacular ligament | arthroscopic or open

Question 29

A complication of CTS surgery is decreased grip/pinch strength an dexterity for up to ____ months.

Answer 29

25

Question 30

CTS surgery complications include:

Answer 30

``` decreased wrist/grip/pinch strength stiffness nerve adherence hypersensitivity pillar pain ```

Question 31

What is pillar pain?

Answer 31

pain on either side of the incision

Question 32

What factors interfere with surgical treatment success of CTS?

Answer 32

``` > 65yo severe pre-op symptoms poor ncv results hemodialysis ETOH abuse/smoking heavy labor poor mental health ```

Question 33

What is DeQuervain's tenosynovitis?

Answer 33

inflammation of tendon sheath of APL and EPB due to excessive friction bw two tendons

Question 34

What factors are associated with DeQuervain's tenosynovitis

Answer 34

``` DM hypothyroidism pregnancy RA Gender ```

Question 35

What are some differential Dxs for DeQuervain's tenosynovitis?

Answer 35

thumb CMC arthritis scaphoid fx entrapment of superficial branch of radial n radiocarpal dysfxn

Question 36

What are symptoms/clinical findings of DeQuervain's tenosynovitis?

Answer 36

decreased strength pain/swelling/heat at thumb base ℅ pain with resisted MCP thumb extension

Question 37

What sign might be positive with DeQuervain's tenosynovitis?

Answer 37

Finkelstein