Hand Teaching Dec 2020 Flashcards
Over the age of 50, OA of the thumb CMCJ occurs in: 1 in 10 women 1 in 4 women 1 in 20 women 1 in 8 women
1 in 4 women
Up to 8% of men and 25% of women over the age of 50 develop OA of the 1st CMCJ
Approx 20% of people will require some form of treatment
Yuan F, Aliu O, Chung KC & Mahmoudi E (2017) Evidence based practise in the surgical treatment of thumb carpometacarpal joint arthritis
The primary stabilizer of the thumb CMCJ is…..
Anterior intermetacarpal ligament Posterior Oblique ligament Deep anterior oblique ligament Anterior capito-metacarpal ligament Dorsoulnar Ligament
Deep anterior oblique ligament
OA of the wrist may be associated with…..
Paraesthesia over the dorsum of the wrist
Paraesthesia over the palmar aspect of the wrist
Paraesthesia of the thumb, index, middle and radial border of ring finger
Paraesthesia of the dorsum of the 1st web space
Paraesthesia of the ulnar 2 digits
Paraesthesia of the thumb, index, middle and radial border of ring finger
Osteophytes and/or inflammation due to arthritis can reduce the space within the carpal tunnel leading to symptoms of carpal tunnel syndrome
Which of the following is best treated with surgical excision?
Bouchard Node Mucous cyst Tophaceous lump Heberden's node Ganglion cyst
.Mucous Cyst
Mucous cysts are outpouchings of fluid from the DIPJ
If they leak they can lead to septic arthritis.
Treatment requires removal of the bony spur to reduce the risk of recurrence
According to the Watson classification, scapholunate advanced collapse (SLAC) stage 1 involves degenerative changes between which articulations?
Scaphoid and lunate Radius and lunate Scaphoid and capitate Radial styloid and scaphoid Capitate and lunate
Radial styloid and scaphoid
Watson Classification:
Stage I: between radial styloid and distal scaphoid
Stage II: between scaphoid and entire scaphoid facet of radius
Stage III: between capitate and lunate
Stage IV: pan-carpal arthritis
N.B. radio-lunate preserved except in Stage IV
The ideal position for a total wrist fusion for OA is:
30 degrees of flexion and 0 degrees of ulnar deviation
15 degrees of flexion and 15 degrees
o degrees of flexion and 20 degrees of radial deviation
10 degrees of extension and 30 degrees of radial deviation
20 degrees of extension and 10 degrees 10 of ulnar deviation
20 degrees of extension and 10 degrees 10 of ulnar deviation
Slight dorsiflexion and ulnar deviation improves grip strength (Hayden R, Jebson PJL, Wrist arthrodesis, Hand Clin 2005; 21:631-40)
However some controversy about degree of wrist extension : some studies say 0-15 is satisfactory
Pre-op consider providing patients with a wrist splint to simulate position of arthrodesis.
If bilateral wrist arthrodesis then:
- Fuse dominant wrist in extension to permit grip
- Fuse non-dominant wrist in 5-10 degrees flexion to permit toileting needs
All of the following structures are at risk during a trapeziectomy for CMCJ arthritis whilst utilising a dorsal approach except:
Radial artery Superficial radial nerve FCR tendon FPL tendon EPB tendon
FPL tendon
The following is true of a proximal row carpectomy (PRC) except:
Patients can commence immediate wrist ROM exercises post-op, unlike a 4 corner arthrodesis
Is indicated for patients with degenerative changes involving the capito-lunate joint
Potentially has fewer post-op complications and re-operation rates compres to 4-corner arthrodesis
It involves the creation of a new ‘radio-capitate’ articulation
The pisiform is frequently left preserved
Is indicated for patients with degenerative changes involving the capito-lunate joint
Due to formation of the new ‘radio-capitate’ articulation, arthrosis of either the capitate head or lunate fossa will cause persistent wrist pain
Complications of arthrodesis requiring further surgery:
- Non-union
- Hardware complications
- Dorsal impingement
Kay HF et al Proximal row carpectomy vs 4 CF J Hand Surgery Am 2020; 45: 427-32
Conversion to total wrist arthrodesis higher in patients with 4CF vs PRC - Rahgozar P et al. A comparative analysis of resource utilization between PRC and partial wrist fusion. J Hand Surg Am 2017;10:773-80
When performing a 4-corner fusion, which joints are NOT fused together?
Luno-triquetral joint Luno-capitate joint Hamo-capitate joint Hamo-triquetral joint Scapho-lunate joint
Scapho-lunate joint
A 4CF involves fusion between the capitate, hamate, lunate and triquetrum, after removal of the scaphoid
The joint first affected in a SNAC (Scaphoid non union associated collapse) wrist is:
Capito-lunate joint Radio-scaphoid joint Radio-ulnar joint Radio-lunate joint Scapho-trapezo-trapezoidal joint
Radio-scaphoid joint
Stage 1 SLAC wrist involves radial beaking in the radio-scaphoid joint
A ‘SLAC’ wrist will have:
A joint narrowing between the pisiform-triquetral joint
A DISI deformity
Always have a large gap between the scaphoid and the lunate
Can be treated with a PRC in stage 3
Often has an undiagnosed scaphoid fracture in the past
A DISI deformity - subluxation of the capitate onto the lunate leads to the DISI deformity
The dart throwers motion assesses which joint?
Scapho-lunate joint Radio-carpal joint Mid-carpal joint Capito-hamate joint Distal radio-ulna joint
.Mid-carpal joint
Kinematic studies have shown that there is almost no motion in the proximal row during the dart throwers motion with it almost exclusively originating from the mid carpal joint
