Interval 9 Flashcards
How to diagnose & treat Dupuytren’s contracture?
It is a shortening, thickening and fibrosis of the palmar aponeurosis & fascia.
It is of unknown etiology with some hereditary predisposition.
Usually affects 4th & 5th digits.
It is painless but causes partial flexion at MP & PIP joints; can palpate raised ridges on medial palm.
Treatment is surgical excision to release the contractures.
The clinical importance of the anatomic snuffbox?
Distal radius & scaphoid articulate deep in snuffbox. Localized tenderness here suggests scaphoid fracture. Missed diagnosis is a common medico-legal issue since diagnosis by X-ray can be missed & aseptic necrosis of proximal fragment can occur since blood supply of scaphoid enters distally.
A-V fistulas for hemodialysis access can be surgically created here between cephalic vein & radial artery.
The anatomic cause of the hypothenar hammer syndrome?
The ulnar artery enters hand via Guyon’s canal between the pisiform & hook of hamate.
Repeated blunt trauma to the hypothenar region leads to ulnar artery damage and digital ischemia by striking artery against hook of hamate.
Usually seen in dominant hand of mechanics who use palm to push or hammer hard objects.
May have + Allen test.
Treatment= antiplatelet drugs; sometimes surgical revascularization.
How plantaris muscle rupture ( “tennis leg” ) can mimic DVT (deep vein thrombosis)?
The plantaris, which is absent in 5-10% of people, lies deep to the lateral head of the gastrocnemius.
During vigorous stretching as in tennis rupture can occur at the myotendinous junction causing calf pain & tenderness, usually in the 35-50 yr. old age group.
Can mimic calf vein thrombosis or a ruptured Baker’s cyst.
The anatomic mechanism of ankle fractures?
Often occur when foot is forcibly everted. This pulls on extremely strong deltoid ligament which shears off medial malleolus; talus then moves laterally, shearing off lateral malleolus ( “bimalleolar fracture”).
If posterior margin of distal tibia also breaks, then “trimalleolar”.
What Raynaud’s syndrome is?
A vasospastic disorder of digital arteries often triggered by stress & cold temperatures.
Associated with connective tissue diseases and lupus.
Symptoms= pain, numbness, paleness then cyanosis & swelling of fingers; can lead to gangrene & ulceration.
Treatment= warm fingers, calcium channel blockers, ? Botox, sympathectomy in severe cases.
The anatomic cause of hammer toe deformity?
Weakness of lumbrical & interosseus muscles causing marked dorsiflexion of proximal phalanx & middle phalanx is strongly plantar flexed at PIP joint with hyperextension of distal phalanx.
Leads to calluses & ulceration.
tenosynovitis
- inflammation of a tendon & its synovial sheath
- can spread to mid-palmar & Parona’s space between pronator quadratus muscle & flexor tendons if sheath ruptures
felon
closed space infection of the multiloculated volar compartment at tip of finger
extremely painful
Paronychia
superficial infection of soft tissue surrounding a fingernail
The significance of hamate fractures?
Usually in golfers who strike ground with club accidentally; also tennis players & baseball batters.
Can get avascular necrosis of the hook, sometimes requiring surgical removal of the fracture fragment.
Paresthesias ( pain, numbness, tingling ) may be present in 5th & medial side of 4th fingers secondary to proximity of hamate fractures to ulnar nerve which can be compressed in Guyon’s canal.
The pathophysiology of neurotrophic ulcers?
Usually seen in diabetics with peripheral neuropathy, they are punched out painless ulcers on foot, usually over a metatarsal head, tips of toes or hammer toe deformity.
Soft tissues are exposed to excessive pressure over bony prominences which patients cannot feel. Leads to infection & osteomyelitis.
Sometimes needs surgical resection of metatarsal head.
