Lecture 8- Introduction to the Surgery of the Hand Flashcards
what is Palmar fascia?
- Toughened layer anchoring skin to skeleton
- Extension of forearm fascia
- Tightened by palmaris longus
- Duputyren’s disease occurs at fascia
what is Duputyren’s disease?
- Thickening of fascia
- Contracture
What are the causes of Duputyren’s disease?
- Genetic
- smoking
- Alcohol
- Diabetes/epilepsy
what are the flexor tendons?
- Superficial/deep
- Single/mass action and nerve supply
- Have flexor sheath
- Lumbrical muscles
What are the conditions associated with flexor tendons?
Traumatic rupture
Trigger fingers
Describe what trigger fingers are?
- Catching of tendons at A1 pulley
- Degenerate nodule
- Thickening of sheath
What causes Trigger fingers?
- Overuse
- Degeneration
- Change of direction of tendon
which nerves supply the hand?
- Median and Ulnar nerves
- Digital nerves to each finger and thumb
- Dermatomes
what can be the issues with nerves supplying to the hand?
- Injury
- Compression neuropathies
what is carpal tunnel syndrome?
-Median nerve compression at wrist
What is the function of the median nerve in the hand?
-Innervation of the 3 thenar muscles and sensory innervation in the radial half of the hand
Name the Four thenar muscles?
1) Abductor Brevis
2) Opponens
3) Flexor Brevis
4) Adductor (ulnar)
What is the purpose of these thenar muscles?
Fine control which gives us species advantage
-Gripping etc
What are the signs of the carpal tunnel?
- Thenar wasting
- Loss of abduction
- Loss of opposition
What is cubbital tunnel syndrome?
- Ulnar nerve compression at elbow
- Fascial compression at three sites
What is the function of Ulnar nerve?
motor innervation of forearm, hand muscles and sensory symptoms of the Ulnar half if the hand
Describe the interosseous muscles of the hand?
Two types: PALMAR -Insertion to proximal phalanx -Adduction and abduction DORSAL: insertion to extensor hood Interphalangeal extension
Innervated by the Ulnar nerve
What are the signs of ulnar nerve issues?
- Wasted hypothenar web spaces
- Paradoxical wasting thenar
- Forearm wasting
- Clawing of digits
what is the function of extensor tendons?
Extend MCP joint of the fingers
Name extensor tendons of the hand?
12 tendons in total
thumb tendons
Wrist tendons
Retinaculum
what is de Quervain,s disease?
Triggers pain of thumb extensor causing:
- Degeneration
- Overuse
- ciprofloxacin
- Anastrazole
Name some of the bone problems of the hand?
Radial fractures
scaphoid fratcures
1st CMC osteoarthritis
RA
