Hand Surgery, C69 P578-585 Flashcards
Who operates on hands?
P578
Plastic surgeons and orthopaedic surgeons
What are the bones of the
hand?
P578
Phalanges (fingers)
Metacarpal bones
Carpal bones
What is the distal finger joint?
P578
Distal InterPhalangeal (DIP) joint
What is the middle finger joint?
P578
Proximal InterPhalangeal (PIP) joint
What is the proximal finger
joint?
P578
Metacarpal Phalangeal (MP) joint
What are the “intrinsic”
hand muscles?
P578
Lumbricals, interosseous muscle
What is ADDuction and
ABDuction of the fingers?
P578 (picture)
ADDuction is to midline and ABDuction
is separation from midline
What are the trauma zones
of the hand?
P579
(see picture)
Where is “no man’s land”?
P579 (picture)
Zone extending from the distal palmar
crease to just beyond the PIP joint (zone 2)
What is the significance of
the “no man’s land”?
P579 (picture)
Flexor tendon injuries here have a poor
prognosis; a hand expert needs to repair
these injuries
SENSORY SUPPLY TO THE HAND
What is the ulnar nerve
distribution?
P579 (picture)
(see picture)
SENSORY SUPPLY TO THE HAND
What is the radial nerve
distribution?
P580 (picture)
(see picture)
SENSORY SUPPLY TO THE HAND
What is the median nerve
distribution?
P580 (picture)
(see picture)
SENSORY SUPPLY TO THE HAND How can the radial nerve motor function be tested? P580
- Wrist and MCP extension
2. Abduction and extension of thumb
SENSORY SUPPLY TO THE HAND
How can the ulnar nerve
motor function be tested?
P580
- Spread fingers apart against
resistance - Check ability to cross index and
middle fingers
SENSORY SUPPLY TO THE HAND
How can the median nerve
function be tested?
P580
- Touch the thumb to the pinky (distal
median nerve) - Squeeze examiner’s finger (proximal
median nerve)
SENSORY SUPPLY TO THE HAND How can the flexor digitorum profundus (FDP) apparatus be tested? P581 (picture)
Check isolated flexion of the finger
DIP joint
SENSORY SUPPLY TO THE HAND How can the flexor digitorum superficialis (FDS) apparatus be tested? P581 (picture)
Check isolated flexion of the finger at the
MP joint
SENSORY SUPPLY TO THE HAND
Where do the digital
arteries run?
P581
On medial and lateral sides of the digit
SENSORY SUPPLY TO THE HAND
What hand laceration should
be left unsutured?
P581
Lacerations from human bites or animal
bites
SENSORY SUPPLY TO THE HAND
Should a clamp ever be used
to stop a laceration bleeder?
P581
No; use pressure and then tourniquet for
definitive repair if bleeding does not cease
because nerves run with blood vessels!
SENSORY SUPPLY TO THE HAND
What is a felon?
P582
Infection in the tip of the finger pad
(Think: felon = fingerprints = infection
in pad); treat by incision and drainage
SENSORY SUPPLY TO THE HAND
What is a paronychia?
P582
Infection on the side of the fingernail
(nail fold); treat by incision and drainage
SENSORY SUPPLY TO THE HAND
What is tenosynovitis?
P582
Tendon sheath infection
SENSORY SUPPLY TO THE HAND
What are Kanavel’s signs?
P582
Four signs of tenosynovitis:
1. Affected finger held in flexion
2. Pain over volar aspect of affected
finger tendon sheath upon palpation
3. Swelling of affected finger (fusiform)
4. Pain on passive extension of
affected finger
SENSORY SUPPLY TO THE HAND
Most common bacteria in
tenosynovitis and paronychia?
P582
Staphylococcus aureus
SENSORY SUPPLY TO THE HAND
How are human and animal
hand bites treated?
P582
Débridement/irrigation/administration of
antibiotics; leave wound open
SENSORY SUPPLY TO THE HAND
What unique bacteria are
found in human bites?
P582
Eikenella corrodens
SENSORY SUPPLY TO THE HAND
What unique bacteria are
found in dog and cat bites?
P582
Pasteurella multocida
SENSORY SUPPLY TO THE HAND
What is the most common
hand/wrist tumor?
P582
Ganglion cyst
SENSORY SUPPLY TO THE HAND
What is an extremely painful
type of subungual tumor?
P582
Glomus tumor (subungual: under the nail)
SENSORY SUPPLY TO THE HAND
What is a “boxer’s fracture”?
P582
Fracture of the fourth or fifth metacarpal
SENSORY SUPPLY TO THE HAND
What is a “drop finger” injury?
P582 (picture)
Laceration of extensor tendon over the
MP joint
SENSORY SUPPLY TO THE HAND What is the classic deformity resulting from laceration of the extensor tendon over the DIP joint? P583 (picture)
Mallet finger
SENSORY SUPPLY TO THE HAND What is the classic deformity resulting from laceration of the extensor tendon over the PIP joint? P583 (picture)
Boutonniere deformity
SENSORY SUPPLY TO THE HAND
Which fracture causes pain
in the “anatomic snuffbox”?
P583
Scaphoid fracture; often not seen on
x-ray at presentation, usually seen at a
later date (2 weeks) on x-ray
Can result in avascular necrosis
Place in a cast if clinically suspected,
regardless of x-ray findingsSENSORY SUPPLY TO THE HAND
What is the “safe position”
of hand splinting?
P583 (picture)
(see picture)
SENSORY SUPPLY TO THE HAND
What is Dupuytren’s
contracture?
P584
Fibrosis of palmar fascia, causing
contracture of and inability to extend digits
SENSORY SUPPLY TO THE HAND
What is Gamekeeper’s
thumb?
P584 (picture)
Injury to the ulnar collateral ligament of
the thumb
SENSORY SUPPLY TO THE HAND
How should a subungual
hematoma be treated?
P584
Release pressure by burning a hole in
the nail (use hand-held disposable
battery-operated coagulation probe)
CARPAL TUNNEL SYNDROME
What is it?
P584 (picture)
Compression of the median nerve in the
carpal tunnel
CARPAL TUNNEL SYNDROME
What is the most common
cause?
P585
Synovitis
CARPAL TUNNEL SYNDROME
What are other causes?
P585
“MEDIAN TRAPS”:
Median artery (persistent)
Edema of pregnancy
Diabetes
Idiopathic
Acromegaly
Neoplasm (e.g., ganglioneuroma)
Thyroid (myxedema)
Rheumatoid arthritis
Amyloid
Pneumatic drill usage
SLE
CARPAL TUNNEL SYNDROME
What are the symptoms?
P585
Pain and numbness in the median nerve
distribution
CARPAL TUNNEL SYNDROME
What are the signs?
P585
Tinel’s sign (symptoms with percussion
over median nerve), Phalen’s test
(symptoms with flexion of wrists), thenar
atrophy, Wartenberg’s sign
CARPAL TUNNEL SYNDROME
What is Wartenberg’s sign?
P585
With hand resting on a surface, the
fifth digit (“pinky”) rests in ABduction
compared to the other 4 fingers
CARPAL TUNNEL SYNDROME
What is the workup?
P585
EMG, nerve conduction study
CARPAL TUNNEL SYNDROME
What is initial treatment?
P585
Nonoperative, rest, wrist splint, NSAIDs
CARPAL TUNNEL SYNDROME
What are indications for
surgery?
P585
Refractory symptoms, thenar atrophy,
thenar weakness
CARPAL TUNNEL SYNDROME
What surgery is performed?
P585
Release transverse carpal ligament
