Introduction to surgery of the hand

Question 1

What is the palmar fascia?

Answer 1

Tough layer anchoring skin to skeleton

Extension of forearm fascia

Question 2

What is the palmar fascia tightened by?

Answer 2

palmaris longus

Question 3

Give the clinical disorder of the palmar fascia

Answer 3

Dupuytren’s disease

Question 4

What is Dupuytren’s disease?

Answer 4

Thickening of fascia

Contracture

Question 5

List some risk factors for Dupuytren’s disease

Answer 5

Genetic
Smoking
Alcohol
Diabetes/epilepsy

Question 6

What is the clinical relevance of the flexor tendons?

Answer 6

Traumatic rupture

Trigger fingers

Question 7

Describe trigger fingers

Answer 7

Catching of tendons at A1 pulley
Degenerate nodule
Thickening of sheath

Question 8

What causes trigger fingers?

Answer 8

Overuse
Degeneration
Change of direction of tendon

Question 9

Name some nerve problems

Answer 9

Injury

Compression neuropathies

Question 10

Where is the median nerve tested?

Answer 10

Index finger

Question 11

Where is the radial nerve tested?

Answer 11

Web between d1 and d2

Question 12

Where is the ulnar nerve tested?

Answer 12

Little finger

Question 13

What is the carpal tunnel?

Answer 13

Osseous/ligamentous tunnel

Tendons and median nerve pass through

Question 14

What is the clinical significance of the carpal tunnel?

Answer 14

Carpal tunnel syndrome

Question 15

What is carpal tunnel syndrome?

Answer 15

Median nerve compression at wrist

Question 16

What are the effects of carpal tunnel syndrome?

Answer 16

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

Question 17

List the thenar muscles

Answer 17

Abductor brevis
Opponens
Flexor brevis
Adductor (ulnar)

Question 18

What is the function of the thenar muscles

Answer 18

Fine control

Species advantage

Question 19

List the signs of carpal tunnel

Answer 19

Thenar wasting

Loss of abduction

Loss of opposition

Question 20

What is cubital tunnel syndrome?

Answer 20

Ulnar nerve compression at elbow

Fascial compression @ 3 sites

Question 21

What is the effect of cubital tunnel syndrome?

Answer 21

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

Question 22

What muscles are involved in cubital tunnel syndrome?

Answer 22

Flexor digiti quinti
Abductor
(opponens)

Interossei

FCU, FDP (m/r/l)

Question 23

Describe the interosseous muscles

Answer 23

Palmar/dorsal
Insertion to proximal phalanx
Adduction/abduction

Insertion to extensor hood
Interphalangeal extension

Question 24

Which nerve innervates the interosseous muscles?

Answer 24

Ulna nerve

Question 25

List the signs of compression of the ulna nerve

Answer 25

Wasted hypothenar web spaces

Paradoxical wasting thenar

Forearm wasting

Clawing of digits

Question 26

Describe the extensor tendons

Answer 26

Extend MCP joints of fingers
Thumb tendons
Wrist tendons
Retinaculum

12 in all
Some multistranded (APL/EDC/EDQ)

Question 27

Describe de Quervain’s disease

Answer 27

Triggering and pain of thumb extensors

Question 28

What causes de Quervains disease?

Answer 28

Degeneration
Overuse
Ciprofloxacin - antibiotic
Anastrazole - breast cancer

Question 29

Describe ruptures of the dorsal extensors

Answer 29

Lacerations
Fracture

Synovitis
Arthritis

No triggering

Question 30

Describe the digital extensor hoods

Answer 30

Long extensors
Interossei
Lumbrical

Finely balanced

Complex multibundle flat tendon

Question 31

State the number of different bones within the hand

Answer 31

3 phalanges in fingers
2 phalanges in thumb
5 metacarpals
2 sesamoids in thumb
8 carpal bones

Question 32

Name some bone problems

Answer 32

Radial fracture
Scaphoid fracture

1st CMC osteoarthritis

Rheumatoid arthritis