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PHTY APPB > HT: Referral to Surgeon > Flashcards

HT: Referral to Surgeon Flashcards

1
Q

What makes up the carpal tunnel

A
  • Carpal bones
  • Transverse carpal ligament
  • 9 flexor tendons
  • Median nerve
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2
Q

Why is there night pain with CTS?

A
  • synovium more swollen at night
    + wrist slightly flexed
  • less room for the nerve
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3
Q

What are the signs of CTS?

A
  • Thenar muscle atrophy
  • APB weakness
  • Tinnels, phalens, durkans
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4
Q

When should you call hand surgeon for CTS?

A
  • Constant symptoms
  • Thenar muscle atrophy or weakness
  • “failed” conservative management - symptoms progressing, interfering with function
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5
Q

What is Cubital Tunnel Syndrome

A
  • Ulnar nerve compression at elbow

- Second most common neuropathy

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6
Q

What are the symptoms of cybital tunnel syndrome?

A
  • Medial/ Ulnar 1 and 1/2 digits
  • Pins and needles
  • Numbness
  • Pain
  • Sleep disturbance
  • Loss of dexterity
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7
Q

What are the signs of cubital tunnel syndrome?

A
  • Claw deformity
  • Interossei wasting
  • Wartenburg sign (LF abduction)
  • Weakness (test 1st muscle interosseus, abd index)
  • Altered sensation
  • Provocation test: tinel, forced elbow flexion
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8
Q

Conservative management of Cubital Tunnel syndrome?

A
  • Nerve gliding exercises
  • Avoid prolonged elbow flexion
  • Avoid pressure on cubital tunnel
  • Night elbow splint < 30deg flexion
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9
Q

When to refer for cubital tunnel syndrome?

A
  • Constant symptoms
  • Muscle atrophy or weakness
  • Rapid onset and progression
  • Failed conservative management
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10
Q

When to call a hand surgeon for trigger finger?

A
  • Failed conservative management
  • Ongoing symptoms despite splint/ 2 corticosteroid injections over 12 months

SAME CONCEPT FOR DEQUERVAINS

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11
Q

Whats conservative management of PIP joint injuries

A
  • Assess stability
  • Mobilise
  • Dorsal extension blocking splint
  • Buddy strap
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12
Q

When to call a hand surgeon for PIP joint injuries?

A
  • Unstable
  • Open injury
  • Incongruent reduction on X-ray
  • Pilon fracture
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13
Q

When to call a hand surgeon for a DIP joint injury

A
  • Irreducible dislocation
  • Open dislocation
  • Associated flexor digitorum profundus avulsion
  • Reduction not maintained by splint
  • Pilon fracture
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14
Q

When to refer to hand surgeon following mallet finger?

A
  • Delayed presentations
  • Large mallet fracture fragment
  • Joint subluxation
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15
Q

What is Rugger Jersey finger

A
  • FDP tendon avulsion at insertion
  • Forced DIP joint extension while FDP is contracting

ALWAYS CALL HAND SURGEON

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16
Q

What are different type of fracture displacements?

A
  • angulation
  • translation
  • shortening
  • rotation/ malrotation
  • Articular congruity
17
Q

Review table of type of fractures that need surgery

A

Aim to operate to improve position of fracture/ and or hold the fracture in position as it heals

18
Q

What are implant choices for stabilisation

A
  • K-wires
  • Screws
  • External fixators
  • Intramedullary Nail
  • Plates
  • Locking plates
19
Q

When to refer to surgeon for OA?

A
  • Surgery still symptomatic treatment
  • Failure of conservative management
  • persistent pain, stiffness and functional impairment
  • Arthoplasty
20
Q

What is paronychia?

A
  • Infection involving proximal or lateral nail fold
  • Refer to GP
  • +/- splint to rest area
  • Call hand surgeon if not responding to non-operative treatment
21
Q

What is a felon?

A
  • Infection of the pulp

- Call if not responding to conservative and tense pulp

22
Q

How to manage flexor sheath infection?

A
  • Infection of flexor tendon within finger
  • Semi-flexed, fusiform swelling, tenderness along flexor sheath, exquisit pain with passive finger extension
  • Always call surgeon
23
Q

Fight Bite: how to manage

A

Always call a hand surgeon

  • Septic arthritis
  • surgical exploration
  • Washout
  • IV antibiotics
24
Q

Skiers thumbs: when to call a hand surgeon

A

Grade 1/2: non operative, splint for 6 weeks
Strengthening at 6-8 weeks, with unrestricted activity at 12 weeks

Grade 3: surgery within 6 weeks

  • Immediate IPJ movement,
  • thermoplastic splint at day 3-5
  • start MCP movement at 3-4 weeks
  • Cease daytime splintat 6 weeks
  • Cease night splint at 10 weeks

PHTY APPB (10 decks)

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