Introduction to surgery of the hand Flashcards
What is the palmar fascia?
Tough layer anchoring skin to skeleton
Extension of forearm fascia
What is the palmar fascia tightened by?
palmaris longus
Give the clinical disorder of the palmar fascia
Dupuytren’s disease
What is Dupuytren’s disease?
Thickening of fascia
Contracture
List some risk factors for Dupuytren’s disease
Genetic
Smoking
Alcohol
Diabetes/epilepsy
What is the clinical relevance of the flexor tendons?
Traumatic rupture
Trigger fingers
Describe trigger fingers
Catching of tendons at A1 pulley
Degenerate nodule
Thickening of sheath
What causes trigger fingers?
Overuse
Degeneration
Change of direction of tendon
Name some nerve problems
Injury
Compression neuropathies
Where is the median nerve tested?
Index finger
Where is the radial nerve tested?
Web between d1 and d2
Where is the ulnar nerve tested?
Little finger
What is the carpal tunnel?
Osseous/ligamentous tunnel
Tendons and median nerve pass through
What is the clinical significance of the carpal tunnel?
Carpal tunnel syndrome
What is carpal tunnel syndrome?
Median nerve compression at wrist
What are the effects of carpal tunnel syndrome?
Nerve function. 3 of thenar muscles & sensory symptoms in the radial half of the hand.
List the thenar muscles
Abductor brevis
Opponens
Flexor brevis
Adductor (ulnar)
What is the function of the thenar muscles
Fine control
Species advantage
List the signs of carpal tunnel
Thenar wasting
Loss of abduction
Loss of opposition
What is cubital tunnel syndrome?
Ulnar nerve compression at elbow
Fascial compression @ 3 sites
What is the effect of cubital tunnel syndrome?
Nerve function. Forearm & hand muscles, sensory symptoms ulna half of hand.
What muscles are involved in cubital tunnel syndrome?
Flexor digiti quinti
Abductor
(opponens)
Interossei
FCU, FDP (m/r/l)
Describe the interosseous muscles
Palmar/dorsal
Insertion to proximal phalanx
Adduction/abduction
Insertion to extensor hood
Interphalangeal extension
Which nerve innervates the interosseous muscles?
Ulna nerve
List the signs of compression of the ulna nerve
Wasted hypothenar web spaces
Paradoxical wasting thenar
Forearm wasting
Clawing of digits
Describe the extensor tendons
Extend MCP joints of fingers
Thumb tendons
Wrist tendons
Retinaculum
12 in all Some multistranded (APL/EDC/EDQ)
Describe de Quervain’s disease
Triggering and pain of thumb extensors
What causes de Quervains disease?
Degeneration
Overuse
Ciprofloxacin - antibiotic
Anastrazole - breast cancer
Describe ruptures of the dorsal extensors
Lacerations
Fracture
Synovitis
Arthritis
No triggering
Describe the digital extensor hoods
Long extensors
Interossei
Lumbrical
Finely balanced
Complex multibundle flat tendon
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
Name some bone problems
Radial fracture
Scaphoid fracture
1st CMC osteoarthritis
Rheumatoid arthritis
