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3: surgery > MSK Hand Teaching > Flashcards

MSK Hand Teaching Flashcards

1
Q

what is a Colles #

A

distal fragment of the radius is displaced dorsally
extra articular #
low energy injury
tends to be from FOOSH

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2
Q

what is a smiths #

A

volar displacment of the distal fragment of the radius
exta-articular #
fall onto flexed hand or direct blow to posterior hand
low energy injury

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3
Q

what is a bartons fracture

A

fracture-dislocation of radiocarpal joint

intra-articular fracture

The hand and the fragment of distal radius undergo a proximal and volar displacement.

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4
Q

what is a die punch fracture

A

intra-articular #
depressed fracture of the lunate fossa of the distal radius
also known as a bennets fracture
occurs due to vertical load through the lunate

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5
Q

what do you need to assess for wrist injuries

A

mechanism of injury
reason for fall
examine neurovascular status
soft tissue damage

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6
Q

when are CT and MRI suitable in wrist injuries

A

CT:
evaluate intra-articular involvement and for surgical planning

MRI:
soft tissue injury, ligamentous injury, nerve entrapment

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7
Q

what analgesic options are available for wrist #

A

biers block
haematoma block - LA introduced to haematoma
inhaled - pentorex, gas and air

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8
Q

what is a biers block

A

tourniquet and IV local anaesthetic
is prefered to haematoma block

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9
Q

how are stable displaced fractures of the wrist managed

A

manipulation: exaggerate deformity, realign bone, splint fracture and XR post reduction

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10
Q

what is measured to assess if a wrist fracture is stable

A

radial inclination
radial shortening
volar tilt

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11
Q

what is radial inclincation

A

around 23 degress

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12
Q

what is radial height

A

around 12 mm

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13
Q

what is volar tilt

A

between 2 -20 degrees

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14
Q

what are the operative timings for intra/extra-articular fractures

A

intra-articular - 72 hours
extra-articular - 1 week

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15
Q

when is conservative management appropriate for wrist fractures

A

radiologically stable, extra-articular
first line for over 65

involved closed reduction and immbolisation

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16
Q

what are operative options for wrist #

A

closed reduction and percutaneous pinning can be used for colles
DRAFTF trails show no difference between K wires and plates and are quicker and less expensive

17
Q

when would you use ORIF for a wrist fracture

A

severe angulation
intra-articular #
insability

18
Q

when can they restore function post wrist operation

A

light use within 2 week
more vigorous activity 6 weeks

19
Q

which nerve is affected in cubital tunnel syndrome and what are its nerve roots

A

ulnar nerve
C8 and T1

20
Q

what is the route of the ulnar nerve

A

ulnar nerve descends in a plane between the axillary artery (lateral) and the axillary vein (medial).
It proceeds down the medial aspect of the arm with the brachial artery located lateral.

At the mid-point of the arm it enters the posterior compartment of the arm.
through the ulnar tunnel (small space between the medial epicondyle and olecranon).

In the forearm, the ulnar nerve pierces the two heads of the flexor carpi ulnaris, and travels deep to the muscle, alongside the ulna

21
Q

what does the muscular branch of the ulnar nerve supply

A

flexor capri ulnaris
flexor digitorum profundus (ulnar part)

22
Q

what does the superficial branch of the ulnar nerve supply

A

palmaris brevis

23
Q

what does the deep branch of the ulnar nerve supply

A

hypothenar muscles
adductor pollicis
interossei muscles

24
Q

what can cause cubital tunnel syndrome

A

compression of the ulnar nerve at the medial malleolus by:
normal motions
fractures
arthritis

25
Q

what’s the presentation of cubital tunnel syndrome

A

muscular atrophy of the first dorsal web space
ulnar distribution paraesthesia (5th and half of 4th digit and palm)
elbow pain radiating to the forearm

26
Q

what are the signs of cubital tunnel syndrome

A

froments test
- difficulty holding paper between finger and thumb

ulnar claw
- paralysis of 4th and 5th lumbrical
hyperextension of MCP and IPJs

27
Q

what investigations can be done for cubital tunnel syndrome

A

XR
nerve conduction studies

28
Q

what is there for conservative treatment of cubital tunnel syndrome

A

activity modification
NSAIDs and steriods aren’t benefiscial

29
Q

what surgical options are there to treat cubital tunnel syndrome

A

ulnar nerve decompression
with or without anterior transposition or medial epicondylectomy

30
Q

which nerve is affected in carpal tunnel syndrome and what are its nerve roots

A

median nerve
all 5 roots; C5 C6 C7 C8 T1

31
Q

what sensory does the median nerve provide

A

digital cutaneous branch - tips of fingers
palmar cutaneous branch - palm, is spared in CTS

32
Q

which muscles does the median nerve supply

A

all flexors except the ulnar ones

by the recurrent branch in the hand:
thenar muscles and radial lumbrical

33
Q

what are risk factors/ causes for carpal tunnel

A

MEDIAN TRAP

m - myxoedema
e - oedema premenstrually
d - diabetes
i - idiopathic
a - acromegaly
n - neoplasm

t - trauma
r - RA
a - amyloidosis
p - pregnancy

34
Q

what are sign/symptoms of carpal tunnel syndrome

A

paraesthesia of the digital cutaneous area
positive phalens and tinnels test
hand of benediction
ape hand deformity

35
Q

what is the management of carpal tunnel syndrome

A

lifestyle - physio
surgery - carpal tunnel release

36
Q

what are some risk factors of dupuytrens contractions

A

FHx
smoking
alcohol
diabetes
epilepsy - anticonvulsant drugs

37
Q

management of Dupuytren’s

A

collagenase injection
fasciotomy - division of the cord
fasciectomy - removal of the cord
dermofasciectomy - removal of the cord, skin and subcut fat, then skin graft

38
Q

what is cubital fossa syndrome

A

compression of the ulnar nerve at the medial malleolus

3: surgery (32 decks)

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