Hand Surgery Flashcards
Who operates on hands?
Plastic surgeons and orthopedic surgeons
What are the bones of the hand?
Phalanges, metacarpal bones, carpal bones
What is the distal finger joint?
DIP (Distal InterPhalangeal) joint
What is the middle finger joint?
PIP (Proximal InterPhalangeal) joint
What is the proximal finger joint?
MP (Metacarpal Phalangeal) joint
What are the intrinsic hand muscles?
Lumbricals, interosseous muscles
What is adduction and abduction of the fingers?
Adduction is to midline and abduction is separation from midline
Where is “no man’s land” in the hand and what is its significance?
Zone extending from the distal palmar crease to just beyond the PIP joint.
Flexor tendon injuries here have a poor prognosis.
How can the radial nerve motor function be tested?
- Wrist and MP extension
2. Abduction and extension of thumb
How can the ulnar nerve motor function be tested?
- Spread fingers apart against resistance
2. Check ability to cross index and middle fingers
How can the median nerve motor function be tested?
- Touch the thumb to the pinky (distal median nerve)
2. Squeeze examiner’s finger (proximal median nerve)
How can the flexor digitorum profundus apparatus be tested?
Check isolated flexion of the finger DIP joint
How can the flexor digitorum superficialis apparatus be tested?
Check isolated flexion of the finger at the MP joint
Where do the digital arteries run?
On medial and lateral sides of the digit
What hand laceration should be left unsutured?
Lacerations from human bites or animal bites
Should a clamp ever be used to stop a laceration bleeder?
No.
Use pressure and then tourniquet for definitive repair if bleeding does not cease because nerves run with blood vessels.
What is a felon?
Infection in the tip of the finger pad.
Treat by incision and drainage.
What is a paronychia?
Infection on the side of the fingernail.
Treat by incision and drainage.
What is tenosynovitis?
Tendon sheath infection
What are Kanaval’s signs?
Four signs of tenosynovitis:
- Affected finger held in flexion
- Pain over volar aspect of affected finger tendon sheath upon palpation
- Swelling of affected finger
- Pain on passive extension of affected finger
What are the most common bacteria in tenosynovitis and paronychia?
Staphylococcus aureus
How are human and animal hand bites treated?
Debridement, irrigation, administration of antibiotics, leave wound open
What unique bacteria are found in human bites?
Eikenella corrodens
What unique bacteria are found in dog and cat bites?
Pasteurella multocida
What is the most common hand/wrist tumor?
Ganglion cyst
What is an extremely painful type of subungual tumor?
Glomus tumor
What is a boxer’s fracture?
Fracture of the 4th or 5th metacarpal
What is a drop finger injury?
Laceration of extensor tendon over the MP joint
What is the classic deformity resulting from laceration of the extensor tendon over the DIP joint?
Mallet finger
What is the classic deformity resulting from laceration of the extensor tendon over the PIP joint?
Boutonniere deformity
Which fracture causes pain in the anatomic snuffbox?
Scaphoid fracture.
Often not seen at XR at presentation.
What is Dupuytren’s contracture?
Fibrosis of palmar fascia, causing contracture of and inability to extend digits
What is Gamekeeper’s thumb?
Injury to the ulnar collateral ligament of the thumb
How should a subungual hematoma be treated?
Release pressure by burning a hole in the nail
What is carpal tunnel syndrome?
Compression of the median nerve in the carpal tunnel
What is the common cause of carpal tunnel syndrome?
Synovitis
What are causes of carpal tunnel syndrome?
MEDIAN TRAP: Median artery (persistant), Edema of pregnancy, Diabetes, Idiopathic, Acromegaly, Neoplasm (ganglioneuroma), Thyroid (myxedema), Rheumatoid arthritis, Amyloid, Pneumatic drill usage, SLE
What are the symptoms of carpal tunnel syndrome?
Pain and numbness in the median nerve distribution
What are the signs of carpal tunnel syndrome?
Tinel’s sign (symptoms with percussion of median nerve), Phalen’s test (symptoms with flexion of wrist), thenar atrophy, Wartenberg’s sign
What is Wartenberg’s sign?
With hand resting on a surface, the 5th digit rests in abduction compared to the other 4 fingers
What is the initial treatment for carpal tunnel syndrome?
Rest, wrist splint, NSAIDs
What are indications for surgery for carpal tunnel syndrome?
Refractory symptoms, thenar atrophy, thenar weakness
What is the surgical treatment for carpal tunnel syndrome?
Release transverse carpal ligament
