pathology Flashcards
Leddy type 1 jersey finger
FDP tendon retracted to palm, disruption of vascular supply
Leddy type 2 jersey finger
FDP retracts to level of PIP joint
Leddy type 3 jersey finger
large avulsion fracture limits retraction to level of DIP joint
Leddy type 4 jersey finger
osseous fragment and simultaneous avulsion of tendon from fragment, tendon retracts into palm
what tendon can be transferred to repair a chronic EPL rupture?
EIP
when are tendon repairs weakest?
POD 6-12
what is mallet finger?
disruption of the terminal extensor tendon distal to the DIP joint
what is an absolute indication for ORIF or CRPP of a mallet finger?
volar subluxation of distal phalanx
what exam finding is typical in sagittal band rupture
ability to maintain MCP extension after passive extension
what is the first disruption in lunate dislocation?
scapholunate ligament disrupted
what is a Mayfield 1 lunate dislocation?
scapholunate dissociation
what is a Mayfield 2 lunate dislocation?
scapholunate dissociation + lunocapitate disruption
what is a Mayfield 3 lunate dislocation?
scapholunate dissociation + lunocapitate disruption + lunotriquetral disruption
what is a Mayfield 4 lunate dislocation?
scapholunate dissociation + lunocapitate disruption + lunotriquetral disruption + lunate dislocation
which direction does the lunate usually dislocate and what is it associated with?
volar, a/w median nerve compression
what is the best xray view to see a hook of hamate fracture?
carpal tunnel view
what is a milch type 1 fracture?
hook of hamate fracture
what is a milch type 2 fracture?
body of hamate fracture
why should you avoid longitudinal traction during closed reduction of an MCP dislocation?
could pull the volar plate in and make it irreducible
which muscles provide deforming forces in base of thumb fractures?
APL, EPL, adductor pollicis
bennett fracture
intra-articular fracture with a palmar radial fragment
rolando fracture
Y or T shaped complete intra-articular fracture
what structure is damaged in a thumb CMC dislocation?
dorsoradial ligament torn, anterior oblique ligament is intact but peeled off the first metacarpal base
what is a felon?
subcutaneous abscess of the fingertip pulp
what bug is most common in a felon?
staph aureus, gram negative in immunosuppressed, eikenella in diabetics who bite their nails
what are the kanavel signs?
signs of flexor teno
- flexed posturing of involved digit
- TTP over tendon sheath
- marked pain with passive extension
- fusiform swelling of digit
what are primary indications for finger replantation?
thumb at any level, multiple digits, through the palm, wrist level or proximal to the wrist, almost anything in children
what is the blood supply in a medial gastroc flap?
medial sural artery
what is the blood supply in a gracilis flap?
medial femoral circumflex artery
what is the blood supply and nerve at risk in a groin flap?
blood supply = superficial circumflex iliac artery, nerve = lateral femoral cutaneous nerve
what are the potential sites of entrapment in pronator syndrome?
supracondylar process, ligament of struthers, lacertus fibrosus, between ulnar and humeral heads of pronator teres, FDS aponeurotic arch
what nerve is compressed in pronator syndrome?
median
most common sites of entrapment in cubital tunnel syndrome
between 2 heads of FCU/aponeurosis, within Arcade of Struthers, between Osborne’s ligament and MCL
most common cause of ulnar tunnel syndrome
ganglion cyst
what are the possible sites of compression in PIN syndrome?
between brachialis and brachioradialis, Leash of Henry, edge of ECRB, Arcade of Frohse, distal edge of supinator
what is radial tunnel syndrome?
compressive neuropathy of the PIN with only pain, no sensory/motor dysfunction
where is the point of max tenderness in radial tunnel syndrome?
3-5 cm distal to lateral epicondyle
what is wartenberg’s syndrome?
compressive neuropathy of the superficial radial sensory nerve
what can cause intrinsic minus hand?
ulnar or median nerve palsy, charcot-marie-tooth
what is the mechanism of a boutonierre deformity?
rupture of the central slip over the PIP joint
what is the primary lesion in a swan neck deformity?
lax volar plate that allows hyperextension of PIP
what causes the quadrigia effect?
functional shortening of the FDP tendon (FDP of long, middle, and ring finger share a common muscle belly, excursion is equal to shortest tendon)
what causes trigger finger?
entrapment of the flexor tendon at the A1 pulley
what is the inheritance pattern of dupuytrens?
autosomal dominant with variable penetrance
what is the dominant cell type in dupuytrens?
myofibroblasts
what is intersection syndrome and what causes it?
inflammation at crossing points of 1st and 2nd dorsal compartments, repetitive wrist motion
