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Section III Subspecialty Surgery P517 > Hand Surgery, C69 P578-585 > Flashcards

Hand Surgery, C69 P578-585 Flashcards

1
Q

Who operates on hands?

P578

A

Plastic surgeons and orthopaedic surgeons

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2
Q

What are the bones of the
hand?
P578

A

Phalanges (fingers)
Metacarpal bones
Carpal bones

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3
Q

What is the distal finger joint?

P578

A

Distal InterPhalangeal (DIP) joint

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4
Q

What is the middle finger joint?

P578

A

Proximal InterPhalangeal (PIP) joint

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5
Q

What is the proximal finger
joint?
P578

A

Metacarpal Phalangeal (MP) joint

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6
Q

What are the “intrinsic”
hand muscles?
P578

A

Lumbricals, interosseous muscle

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7
Q

What is ADDuction and
ABDuction of the fingers?
P578 (picture)

A

ADDuction is to midline and ABDuction

is separation from midline

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8
Q

What are the trauma zones
of the hand?
P579

A

(see picture)

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9
Q

Where is “no man’s land”?

P579 (picture)

A

Zone extending from the distal palmar

crease to just beyond the PIP joint (zone 2)

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10
Q

What is the significance of
the “no man’s land”?
P579 (picture)

A

Flexor tendon injuries here have a poor
prognosis; a hand expert needs to repair
these injuries

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11
Q

SENSORY SUPPLY TO THE HAND
What is the ulnar nerve
distribution?
P579 (picture)

A

(see picture)

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12
Q

SENSORY SUPPLY TO THE HAND
What is the radial nerve
distribution?
P580 (picture)

A

(see picture)

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13
Q

SENSORY SUPPLY TO THE HAND
What is the median nerve
distribution?
P580 (picture)

A

(see picture)

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14
Q 
SENSORY SUPPLY TO THE HAND
How can the radial
nerve motor function be
tested?
P580
A
  1. Wrist and MCP extension

2. Abduction and extension of thumb

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15
Q

SENSORY SUPPLY TO THE HAND
How can the ulnar nerve
motor function be tested?
P580

A
  1. Spread fingers apart against
    resistance
  2. Check ability to cross index and
    middle fingers
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16
Q

SENSORY SUPPLY TO THE HAND
How can the median nerve
function be tested?
P580

A
  1. Touch the thumb to the pinky (distal
    median nerve)
  2. Squeeze examiner’s finger (proximal
    median nerve)
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17
Q 
SENSORY SUPPLY TO THE HAND
How can the flexor
digitorum profundus
(FDP) apparatus be tested?
P581 (picture)
A

Check isolated flexion of the finger

DIP joint

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18
Q 
SENSORY SUPPLY TO THE HAND
How can the flexor
digitorum superficialis
(FDS) apparatus be tested?
P581 (picture)
A

Check isolated flexion of the finger at the

MP joint

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19
Q

SENSORY SUPPLY TO THE HAND
Where do the digital
arteries run?
P581

A

On medial and lateral sides of the digit

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20
Q

SENSORY SUPPLY TO THE HAND
What hand laceration should
be left unsutured?
P581

A

Lacerations from human bites or animal

bites

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21
Q

SENSORY SUPPLY TO THE HAND
Should a clamp ever be used
to stop a laceration bleeder?
P581

A

No; use pressure and then tourniquet for
definitive repair if bleeding does not cease
because nerves run with blood vessels!

22
Q

SENSORY SUPPLY TO THE HAND
What is a felon?
P582

A

Infection in the tip of the finger pad
(Think: felon = fingerprints = infection
in pad); treat by incision and drainage

23
Q

SENSORY SUPPLY TO THE HAND
What is a paronychia?
P582

A

Infection on the side of the fingernail

(nail fold); treat by incision and drainage

24
Q

SENSORY SUPPLY TO THE HAND
What is tenosynovitis?
P582

A

Tendon sheath infection

25
Q

SENSORY SUPPLY TO THE HAND
What are Kanavel’s signs?
P582

A

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

26
Q

SENSORY SUPPLY TO THE HAND
Most common bacteria in
tenosynovitis and paronychia?
P582

A

Staphylococcus aureus

27
Q

SENSORY SUPPLY TO THE HAND
How are human and animal
hand bites treated?
P582

A

Débridement/irrigation/administration of

antibiotics; leave wound open

28
Q

SENSORY SUPPLY TO THE HAND
What unique bacteria are
found in human bites?
P582

A

Eikenella corrodens

29
Q

SENSORY SUPPLY TO THE HAND
What unique bacteria are
found in dog and cat bites?
P582

A

Pasteurella multocida

30
Q

SENSORY SUPPLY TO THE HAND
What is the most common
hand/wrist tumor?
P582

A

Ganglion cyst

31
Q

SENSORY SUPPLY TO THE HAND
What is an extremely painful
type of subungual tumor?
P582

A

Glomus tumor (subungual: under the nail)

32
Q

SENSORY SUPPLY TO THE HAND
What is a “boxer’s fracture”?
P582

A

Fracture of the fourth or fifth metacarpal

33
Q

SENSORY SUPPLY TO THE HAND
What is a “drop finger” injury?
P582 (picture)

A

Laceration of extensor tendon over the

MP joint

34
Q 
SENSORY SUPPLY TO THE HAND
What is the classic deformity
resulting from laceration of
the extensor tendon over the
DIP joint?
P583 (picture)
A

Mallet finger

35
Q 
SENSORY SUPPLY TO THE HAND
What is the classic deformity
resulting from laceration of
the extensor tendon over the
PIP joint?
P583 (picture)
A

Boutonniere deformity

36
Q

SENSORY SUPPLY TO THE HAND
Which fracture causes pain
in the “anatomic snuffbox”?
P583

A 
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 findings
37
Q

SENSORY SUPPLY TO THE HAND
What is the “safe position”
of hand splinting?
P583 (picture)

A

(see picture)

38
Q

SENSORY SUPPLY TO THE HAND
What is Dupuytren’s
contracture?
P584

A

Fibrosis of palmar fascia, causing

contracture of and inability to extend digits

39
Q

SENSORY SUPPLY TO THE HAND
What is Gamekeeper’s
thumb?
P584 (picture)

A

Injury to the ulnar collateral ligament of

the thumb

40
Q

SENSORY SUPPLY TO THE HAND
How should a subungual
hematoma be treated?
P584

A

Release pressure by burning a hole in
the nail (use hand-held disposable
battery-operated coagulation probe)

41
Q

CARPAL TUNNEL SYNDROME
What is it?
P584 (picture)

A

Compression of the median nerve in the

carpal tunnel

42
Q

CARPAL TUNNEL SYNDROME
What is the most common
cause?
P585

A

Synovitis

43
Q

CARPAL TUNNEL SYNDROME
What are other causes?
P585

A 
“MEDIAN TRAPS”:
    Median artery (persistent)
    Edema of pregnancy
    Diabetes
    Idiopathic
    Acromegaly
    Neoplasm (e.g., ganglioneuroma)
    Thyroid (myxedema)
    Rheumatoid arthritis
    Amyloid
    Pneumatic drill usage
    SLE
44
Q

CARPAL TUNNEL SYNDROME
What are the symptoms?
P585

A

Pain and numbness in the median nerve

distribution

45
Q

CARPAL TUNNEL SYNDROME
What are the signs?
P585

A

Tinel’s sign (symptoms with percussion
over median nerve), Phalen’s test
(symptoms with flexion of wrists), thenar
atrophy, Wartenberg’s sign

46
Q

CARPAL TUNNEL SYNDROME
What is Wartenberg’s sign?
P585

A

With hand resting on a surface, the
fifth digit (“pinky”) rests in ABduction
compared to the other 4 fingers

47
Q

CARPAL TUNNEL SYNDROME
What is the workup?
P585

A

EMG, nerve conduction study

48
Q

CARPAL TUNNEL SYNDROME
What is initial treatment?
P585

A

Nonoperative, rest, wrist splint, NSAIDs

49
Q

CARPAL TUNNEL SYNDROME
What are indications for
surgery?
P585

A

Refractory symptoms, thenar atrophy,

thenar weakness

50
Q

CARPAL TUNNEL SYNDROME
What surgery is performed?
P585

A

Release transverse carpal ligament

Section III Subspecialty Surgery P517 (11 decks)

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