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Year 2 Medicine > Introduction to Surgery of the Hand > Flashcards

Introduction to Surgery of the Hand Flashcards

1
Q

Palmar fascia

  • Tough layer anchoring skin to skeleton
  • Extension of forearm fascia
  • Tightened by palmaris longus (apes)
  • … disease affects this
A
  • Tough layer anchoring skin to skeleton
  • Extension of forearm fascia
  • Tightened by palmaris longus (apes)
  • Dupuytren’s disease
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2
Q

Palmar fascia

  • … layer anchoring skin to skeleton
  • … of forearm fascia
  • Tightened by palmaris longus (apes)
  • Dupuytren’s disease
A
  • Tough layer anchoring skin to skeleton
  • Extension of forearm fascia
  • Tightened by palmaris longus (apes)
  • Dupuytren’s disease
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3
Q

Palmar fascia

  • Tough layer anchoring skin to skeleton
  • Extension of forearm fascia
  • Tightened by … longus (apes)
  • Dupuytren’s disease
A
  • Tough layer anchoring skin to skeleton
  • Extension of forearm fascia
  • Tightened by palmaris longus (apes)
  • Dupuytren’s disease
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4
Q

In Dupuytren’s disease, what thickens?

A

thickening of palmar fascia

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5
Q

Dupuytren’s disease

  • … of fascia
  • Contracture
  • G..
  • Smoking
  • A…
  • Diabetes/epilepsy
A
  • Thickening of fascia
  • Contracture
  • Genetic
  • Smoking
  • Alcohol
  • Diabetes/epilepsy
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6
Q

Dupuytren’s disease

  • What is the risk factor?
A
  • genetic - mainly men (90%)
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7
Q

Flexor tendons

  • Superficial/deep
  • Single/mass action & nerve supply
  • Flexor …
  • … muscles (unique)
  • Traumatic rupture
  • Trigger fingers
A
  • Superficial/deep
  • Single/mass action & nerve supply
  • Flexor sheath
  • Lumbrical muscles (unique)
  • Traumatic rupture
  • Trigger fingers
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8
Q

Flexor tendons

A
  • Superficial/deep
  • Single/mass action & nerve supply
  • Flexor sheath
  • Lumbrical muscles (unique)
    • Traumatic rupture
    • Trigger fingers
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9
Q

The flexor sheath can …

A

rupture - loss of grip function

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10
Q

… muscles on the flexor tendons

A

Lumbrical muscles on the flexor tendons

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11
Q

Trigger Fingers

  • Catching of tendons at A1 pulley
  • Usually due to degenerate nodule
  • Thickening of sheath
  • What causes it?(3)
A
  • Catching of tendons at A1 pulley
  • Usually due to degenerate nodule
  • Thickening of sheath
  • What causes it?
    • Overuse
    • Degeneration
    • Change of direction of tendon
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12
Q

Trigger Fingers

  • Catching of tendons at A1 …
  • Usually due to … nodule
  • Thickening of sheath
A
  • Catching of tendons at A1 pulley
  • Usually due to degenerate nodule
  • Thickening of sheath
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13
Q

Nerve & tendon injury

A
  • Neurovascular bundle
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14
Q

Tendons

A
  • Action of superficial flexor being pulled
  • Work individually to muscle belly
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15
Q

Nerve problems

  • … & … nerves - both on palmar side
    • … predominantly sensory with small motor component
    • … predominantly motor with smaller sensory component
  • Digital nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • Injury can happen
    • Compression neuropathies
A
  • Median & ulnar nerves - both on palmar side
    • Median predominantly sensory with small motor component
    • Ulnar predominantly motor with smaller sensory component
  • Digital nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • Injury can happen
    • Compression neuropathies
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16
Q

Nerve problems

  • Median & ulnar nerves - both on palmar side
    • Median predominantly … with small … component
    • Ulnar predominantly … with smaller … component
  • Digital nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • Injury can happen
    • Compression neuropathies
A
  • Median & ulnar nerves - both on palmar side
    • Median predominantly sensory with small motor component
    • Ulnar predominantly motor with smaller sensory component
  • Digital nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • Injury can happen
    • Compression neuropathies
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17
Q

Nerve problems

  • Median & ulnar nerves - both on palmar side
    • Median predominantly sensory with small motor component
    • Ulnar predominantly motor with smaller sensory component
  • … nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • Injury can happen
    • … neuropathies
A
  • Median & ulnar nerves - both on palmar side
    • Median predominantly sensory with small motor component
    • Ulnar predominantly motor with smaller sensory component
  • Digital nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • Injury can happen
    • Compression neuropathies
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18
Q

Nerve problems

  • Median & ulnar nerves - both on palmar side
    • Median predominantly sensory with small motor component
    • Ulnar predominantly motor with smaller sensory component
  • Digital nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • … can happen
    • Compression …
A
  • Median & ulnar nerves - both on palmar side
    • Median predominantly sensory with small motor component
    • Ulnar predominantly motor with smaller sensory component
  • Digital nerves to each finger/thumb
  • Dermatomes
  • What can go wrong?
    • Injury can happen
    • Compression neuropathies
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19
Q

Label the palmar and dorsal surfaces of the hand

A
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20
Q

Label the palmar and dorsal surfaces of the hand

A
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21
Q

Label the palmar and dorsal surfaces of the hand

A
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22
Q

Carpal tunnel

  • … nerve compression at wrist (compression neuropathy)
    • In the Osseous/… tunnel
    • Tendons and nerves here
  • Nerve function -> 3 of thenar muscles & sensory symptoms in the … half of the hand.
A
  • Median nerve compression at wrist (compression neuropathy)
    • In the Osseous/ligamentous tunnel
    • Tendons and nerves here
  • Nerve function -> 3 of thenar muscles & sensory symptoms in the radial half of the hand.
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23
Q

… … syndrome is the most common type of nerve compression syndrome

A

Carpal tunnel syndrome is the most common type of nerve compression syndrome

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24
Q

… nerve compression at the hand and wrist is called carpal tunnel syndrome.

A

Median nerve compression at the hand and wrist is called carpal tunnel syndrome.

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25
Q

Carpal tunnel

  • Median nerve compression at wrist (compression neuropathy)
    • In the Osseous/ligamentous tunnel
    • Tendons and nerves here
  • Nerve function -> 3 of … muscles & … symptoms in the radial half of the hand.
A
  • Median nerve compression at wrist (compression neuropathy)
    • In the Osseous/ligamentous tunnel
    • Tendons and nerves here
  • Nerve function -> 3 of thenar muscles & sensory symptoms in the radial half of the hand.
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26
Q

Thenar muscles

  • The thenar musculature consists of four short muscles located on the lateral (…) aspect of the hand.
  • These muscles include the:
    • … pollicis
    • abductor pollicis brevis
    • flexor pollicis brevis
    • … pollicis.
  • Responsible for fine control of the thumb
  • Species advantage (ability to oppose the thumb)
A
  • The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
  • These muscles include the:
    • adductor pollicis
    • abductor pollicis brevis
    • flexor pollicis brevis
    • opponens pollicis.
  • Responsible for fine control of the thumb
  • Species advantage (ability to oppose the thumb)
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27
Q

Thenar muscles

  • The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
  • These muscles include the:
    • adductor pollicis
    • … pollicis …
    • … pollicis …
    • opponens pollicis.
  • Responsible for fine control of the thumb
  • Species advantage (ability to oppose the thumb)
A
  • The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
  • These muscles include the:
    • adductor pollicis
    • abductor pollicis brevis
    • flexor pollicis brevis
    • opponens pollicis.
  • Responsible for fine control of the thumb
  • Species advantage (ability to oppose the thumb)
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28
Q

Thenar muscles

  • The thenar musculature consists of four short muscles located on the … (radial) aspect of the hand.
  • These muscles include the:
    • adductor pollicis
    • abductor pollicis brevis
    • flexor pollicis brevis
    • opponens pollicis.
  • Responsible for … … of the thumb
  • Species advantage (ability to oppose the thumb)
A
  • The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
  • These muscles include the:
    • adductor pollicis
    • abductor pollicis brevis
    • flexor pollicis brevis
    • opponens pollicis.
  • Responsible for fine control of the thumb
  • Species advantage (ability to oppose the thumb)
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29
Q

Thenar muscles

  • The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
  • These muscles include the:
    • adductor pollicis
    • … … brevis
    • flexor pollicis brevis
    • opponens pollicis.
  • Responsible for … control of the thumb
  • Species advantage (ability to … the thumb)
A
  • The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
  • These muscles include the:
    • adductor pollicis
    • abductor pollicis brevis
    • flexor pollicis brevis
    • opponens pollicis.
  • Responsible for fine control of the thumb
  • Species advantage (ability to oppose the thumb)
30
Q

Proximal to carpal tunnel

31
Q

Carpal tunnel signs (3)

A
  • Thenar wasting
  • Loss of abduction
  • Loss of opposition
32
Q

Thenar wasting, Loss of abduction and Loss of opposition are all signs of what syndrome?

A

Carpal tunnel syndrome

33
Q

Cubital tunnel syndrome

  • … nerve compression at elbow
    • Fascial compression @ … sites
    • Nerve only
  • Nerve function -> Forearm & hand muscles, sensory symptoms ulna half of hand.
A
  • Ulnar nerve compression at elbow
    • Fascial compression @ 3 sites
    • Nerve only
  • Nerve function -> Forearm & hand muscles, sensory symptoms ulna half of hand.
34
Q

Cubital tunnel syndrome

  • Ulnar nerve compression at …
    • Fascial compression @ 3 sites
    • … only
  • Nerve function -> Forearm & hand muscles, sensory symptoms ulna half of hand.
A
  • Ulnar nerve compression at elbow
    • Fascial compression @ 3 sites
    • Nerve only
  • Nerve function -> Forearm & hand muscles, sensory symptoms ulna half of hand.
35
Q

Cubital tunnel syndrome

  • Ulnar nerve compression at …
    • Fascial compression @ 3 sites
    • … only
  • Nerve function -> … & hand muscles, … symptoms ulna half of hand.
A
  • Ulnar nerve compression at elbow
    • Fascial compression @ 3 sites
    • Nerve only
  • Nerve function -> Forearm & hand muscles, sensory symptoms ulna half of hand.
36
Q

Muscles - Cubital Tunnel

  • … wasting - Flexor digiti quinti brevis - grip lost
  • Abductor
  • (opponens)
  • Interossei
  • Flexor carpi ulnaris and Flexor digitorum profundus (m/r/l) affected
A
  • Hypothenar wasting - Flexor digiti quinti brevis
  • Abductor
  • (opponens)
  • Interossei
  • Flexor carpi ulnaris and Flexor digitorum profundus (m/r/l) affected
37
Q

Muscles - Cubital Tunnel

  • Hypothenar wasting - Flexor digiti quinti brevis - grip lost
  • Abductor
  • (opponens)
  • Interossei
  • Flexor carpi … and Flexor digitorum … (m/r/l) affected
A
  • Hypothenar wasting - Flexor digiti quinti brevis
  • Abductor
  • (opponens)
  • Interossei
  • Flexor carpi ulnaris and Flexor digitorum profundus (m/r/l) affected
38
Q

Interosseous muscles

  • Palmar/dorsal sets
  • Dual Insertion to proximal …
    • Adduction/abduction
  • …. Insertion to extensor hood
    • Interphalangeal …
  • Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
A
  • Palmar/dorsal sets
  • Dual Insertion to proximal phalanx
    • Adduction/abduction
  • Tendonous Insertion to extensor hood
    • Interphalangeal extension
  • Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
39
Q

Interosseous muscles

  • Palmar/dorsal set
  • Dual Insertion to proximal phalanx
    • Adduction/abduction
  • Tendonous Insertion to … hood
    • … extension
  • Lose function of … nerve - lose ability to fully straighten proximal interphalangeal joints
A
  • Palmar/dorsal sets
  • Dual Insertion to proximal phalanx
    • Adduction/abduction
  • Tendonous Insertion to extensor hood
    • Interphalangeal extension
  • Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
40
Q

Interosseous muscles

  • Palmar/dorsal set
  • Dual Insertion to proximal phalanx
    • Adduction/abduction
  • Tendonous Insertion to extensor hood
    • Interphalangeal extension
  • Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
A
  • Palmar/dorsal sets
  • Dual Insertion to proximal phalanx
    • Adduction/abduction
  • Tendonous Insertion to extensor hood
    • Interphalangeal extension
  • Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
41
Q

Inter-osseous muscles

  • Label hypothenar, thenar and lumbricals
42
Q

Ulnar nerve signs

  • Wasted … web spaces
  • Paradoxical wasting …
  • Forearm wasting
  • Clawing of digits
A
  • Wasted hypothenar web spaces
  • Paradoxical wasting thenar
  • Forearm wasting
  • Clawing of digits
43
Q

Ulnar nerve signs

  • Wasted hypothenar web spaces
  • Paradoxical wasting thenar
  • … wasting
  • … of digits
A
  • Wasted hypothenar web spaces
  • Paradoxical wasting thenar
  • Forearm wasting
  • Clawing of digits
44
Q
  • To help you remember the hand sign associated with a nerve injury,
    • DR. CUMA
A
  • DR. CUMA
    • Drop = Radial nerve
    • Claw = Ulnar nerve
    • Median nerve = Ape (Apostle’s) hand
45
Q
  • DR. CUMA
    • … = Radial nerve
    • … = Ulnar nerve
    • … nerve = Ape (Apostle’s) hand
A
  • DR. CUMA
    • Drop = Radial nerve
    • Claw = Ulnar nerve
    • Median nerve = Ape (Apostle’s) hand
46
Q

The characteristic presentation of an … nerve injury is the “claw hand”. Individuals with this deformity have hyperextension of the metacarpophalangeal joints (due to the lack of innervation to the medial two lumbricals and the unopposed action of the extensors of this joint) and flexion of the interphalangeal joints of 4th and 5th fingers (due to the unopposed action of the flexor digitorum profundus).

A

The characteristic presentation of an ulnar nerve injury is the “claw hand”. Individuals with this deformity have hyperextension of the metacarpophalangeal joints (due to the lack of innervation to the medial two lumbricals and the unopposed action of the extensors of this joint) and flexion of the interphalangeal joints of 4th and 5th fingers (due to the unopposed action of the flexor digitorum profundus).

47
Q

The characteristic presentation of an ulnar nerve injury is the “claw hand”. Individuals with this deformity have … of the metacarpophalangeal joints (due to the lack of innervation to the medial two lumbricals and the unopposed action of the extensors of this joint) and … of the interphalangeal joints of 4th and 5th fingers (due to the unopposed action of the flexor digitorum profundus).

A

The characteristic presentation of an ulnar nerve injury is the “claw hand”. Individuals with this deformity have hyperextension of the metacarpophalangeal joints (due to the lack of innervation to the medial two lumbricals and the unopposed action of the extensors of this joint) and flexion of the interphalangeal joints of 4th and 5th fingers (due to the unopposed action of the flexor digitorum profundus).

48
Q

Extensor tendons

  • Extend … joints of fingers
  • Thumb tendons
  • Wrist tendons
  • Retinaculum
  • How many?
  • Some multistranded (APL/EDC/EDQ)
A
  • Extend MCP joints of fingers
  • Thumb tendons
  • Wrist tendons
  • Retinaculum
  • 12 in all
  • Some multistranded (APL/EDC/EDQ)
49
Q

Extensor tendons

  • Extend MCP joints of fingers
  • Thumb tendons
  • Wrist tendons
  • Retinaculum
  • How many?
  • Some … (APL/EDC/EDQ)
A
  • Extend MCP joints of fingers
  • Thumb tendons
  • Wrist tendons
  • Retinaculum
  • 12 in all
  • Some multistranded (APL/EDC/EDQ)
50
Q

Radial extensors

  • de Quervain,s disease - thickening of what?
A
  • de Quervain,s disease - thickening of retinaculum
51
Q

de Quervain,s disease

  • Triggering and pain of thumb …
  • Causes:
    • Degeneration
    • …
    • Ciprofloxacin
    • Anastrazole
A
  • Triggering and pain of thumb extensors
  • Causes:
    • Degeneration
    • Overuse
    • Ciprofloxacin
    • Anastrazole
52
Q

de Quervain,s disease

  • Triggering and pain of thumb extensors
  • Causes:
    • Degeneration
    • Overuse
    • What 2 drugs can cause it?
A
  • Triggering and pain of thumb extensors
  • Causes:
    • Degeneration
    • Overuse
    • Ciprofloxacin
    • Anastrazole
53
Q

Degeneration, Overuse and use of Ciprofloxacin or Anastrazole can cause what disease?

A

de Quervain,s disease

54
Q

Dorsal extensors

55
Q

Dorsal Extensors - Ruptures

  • Due to … or fracture
  • Synovitis, arthritis
  • No triggering like with …
A
  • Due to lacerations or fracture
  • Synovitis, arthritis
  • No triggering like with flexors
56
Q

Dorsal Extensors - Ruptures

  • Due to lacerations or …
  • …, arthritis
  • No … like with flexors
A
  • Due to lacerations or fracture
  • Synovitis, arthritis
  • No triggering like with flexors
57
Q

Digital extensor hood

  • Long extensors
  • … either side
  • Lumbrical
  • Finely balanced
  • Complex … flat tendon
A
  • Long extensors
  • Interossei either side
  • Lumbrical
  • Finely balanced
  • Complex multibundle flat tendon
58
Q

Digital extensor hood

  • Long …
  • Interossei either side
  • Lumbrical
  • … balanced
  • Complex multibundle flat tendon
A
  • Long extensors
  • Interossei either side
  • Lumbrical
  • Finely balanced
  • Complex multibundle flat tendon
59
Q

What is mallet finger?

A

It is caused by damage to the extensor tendon complex as it inserts onto the distal phalanx of any of the digits. The distal phalanx therefore lies in permanent flexion, and has the appearance of a mallet.

60
Q

Osteology - hand

  • 3 phalanges in …
  • 2 phalanges in …
  • 5 metacarpals
  • 2 sesamoids in thumb
  • 8 carpal bones
A
  • 3 phalanges in fingers
  • 2 phalanges in thumb
  • 5 metacarpals
  • 2 sesamoids in thumb
  • 8 carpal bones
61
Q

Osteology - hand

  • 3 phalanges in fingers
  • 2 phalanges in thumb
  • 5 …
  • 2 … in thumb
  • 8 carpal bones
A
  • 3 phalanges in fingers
  • 2 phalanges in thumb
  • 5 metacarpals
  • 2 sesamoids in thumb
  • 8 carpal bones
62
Q

Osteology - hand

  • 3 phalanges in fingers
  • 2 phalanges in thumb
  • 5 metacarpals
  • 2 … in thumb
  • 8 … bones
A
  • 3 phalanges in fingers
  • 2 phalanges in thumb
  • 5 metacarpals
  • 2 sesamoids in thumb
  • 8 carpal bones
63
Q

Osteology - hand

  • … phalanges in fingers
  • … phalanges in thumb
  • 5 metacarpals
  • … sesamoids in thumb
  • 8 carpal bones
A
  • 3 phalanges in fingers
  • 2 phalanges in thumb
  • 5 metacarpals
  • 2 sesamoids in thumb
  • 8 carpal bones
64
Q

Carpal bones​ - MNEMONIC

  • Some Lovers Try Positions, That They Cannot Handle
65
Q

Bone problems - Hand/wrist

  • … fracture
  • … fracture
  • 1st CMC osteoarthritis
  • Rheumatoid arthritis
A
  • Radial fracture
  • Scaphoid fracture
  • 1st CMC osteoarthritis
  • Rheumatoid arthritis
66
Q

Bone problems - Hand/wrist

  • Radial fracture
  • Scaphoid fracture
  • 1st CMC …
  • Rheumatoid arthritis
A
  • Radial fracture
  • Scaphoid fracture
  • 1st CMC osteoarthritis
  • Rheumatoid arthritis
67
Q

Bone problems - Hand/wrist

  • Radial fracture
  • Scaphoid fracture
  • 1st CMC osteoarthritis
  • … arthritis
A
  • Radial fracture
  • Scaphoid fracture
  • 1st CMC osteoarthritis
  • Rheumatoid arthritis
68
Q

Bone problems - Hand/wrist

  • … fracture
  • Scaphoid fracture
  • 1st … osteoarthritis
  • Rheumatoid arthritis
A
  • Radial fracture
  • Scaphoid fracture
  • 1st CMC osteoarthritis
  • Rheumatoid arthritis
69
Q

What is shown?

A

thumb base arthritis (osteoarthritis) - very common, predominantly women, not too painful, seen on X-ray incidentally

71
Q

Whats shown here?

A

Rheumatoid arthritis

Year 2 Medicine (162 decks)

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