Introduction to surgery of the hand Flashcards

1
Q

What is the palmar fascia?

A

Tough layer anchoring skin to skeleton

Extension of forearm fascia

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2
Q

What is the palmar fascia tightened by?

A

palmaris longus

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3
Q

Give the clinical disorder of the palmar fascia

A

Dupuytren’s disease

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4
Q

What is Dupuytren’s disease?

A

Thickening of fascia

Contracture

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5
Q

List some risk factors for Dupuytren’s disease

A

Genetic
Smoking
Alcohol
Diabetes/epilepsy

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6
Q

What is the clinical relevance of the flexor tendons?

A

Traumatic rupture

Trigger fingers

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7
Q

Describe trigger fingers

A

Catching of tendons at A1 pulley
Degenerate nodule
Thickening of sheath

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8
Q

What causes trigger fingers?

A

Overuse
Degeneration
Change of direction of tendon

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9
Q

Name some nerve problems

A

Injury

Compression neuropathies

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10
Q

Where is the median nerve tested?

A

Index finger

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11
Q

Where is the radial nerve tested?

A

Web between d1 and d2

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12
Q

Where is the ulnar nerve tested?

A

Little finger

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13
Q

What is the carpal tunnel?

A

Osseous/ligamentous tunnel

Tendons and median nerve pass through

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14
Q

What is the clinical significance of the carpal tunnel?

A

Carpal tunnel syndrome

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15
Q

What is carpal tunnel syndrome?

A

Median nerve compression at wrist

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16
Q

What are the effects of carpal tunnel syndrome?

A

Nerve function. 3 of thenar muscles & sensory symptoms in the radial half of the hand.

17
Q

List the thenar muscles

A

Abductor brevis
Opponens
Flexor brevis
Adductor (ulnar)

18
Q

What is the function of the thenar muscles

A

Fine control

Species advantage

19
Q

List the signs of carpal tunnel

A

Thenar wasting

Loss of abduction

Loss of opposition

20
Q

What is cubital tunnel syndrome?

A

Ulnar nerve compression at elbow

Fascial compression @ 3 sites

21
Q

What is the effect of cubital tunnel syndrome?

A

Nerve function. Forearm & hand muscles, sensory symptoms ulna half of hand.

22
Q

What muscles are involved in cubital tunnel syndrome?

A

Flexor digiti quinti
Abductor
(opponens)

Interossei

FCU, FDP (m/r/l)

23
Q

Describe the interosseous muscles

A

Palmar/dorsal
Insertion to proximal phalanx
Adduction/abduction

Insertion to extensor hood
Interphalangeal extension

24
Q

Which nerve innervates the interosseous muscles?

A

Ulna nerve

25
List the signs of compression of the ulna nerve
Wasted hypothenar web spaces Paradoxical wasting thenar Forearm wasting Clawing of digits
26
Describe the extensor tendons
Extend MCP joints of fingers Thumb tendons Wrist tendons Retinaculum ``` 12 in all Some multistranded (APL/EDC/EDQ) ```
27
Describe de Quervain's disease
Triggering and pain of thumb extensors
28
What causes de Quervains disease?
Degeneration Overuse Ciprofloxacin - antibiotic Anastrazole - breast cancer
29
Describe ruptures of the dorsal extensors
Lacerations Fracture Synovitis Arthritis No triggering
30
Describe the digital extensor hoods
Long extensors Interossei Lumbrical Finely balanced Complex multibundle flat tendon
31
State the number of different bones within the hand
``` 3 phalanges in fingers 2 phalanges in thumb 5 metacarpals 2 sesamoids in thumb 8 carpal bones ```
32
Name some bone problems
Radial fracture Scaphoid fracture 1st CMC osteoarthritis Rheumatoid arthritis