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med n surg S2 > plastic surgery - hand surgery > Flashcards

plastic surgery - hand surgery Flashcards

1
Q

hand examination

A
  • Accurate diagnosis of hand problems depends on a systematic, careful physical examination
  • assessment of unaffected hand first
  • inspection, palpation, measurement of range of motion, stability assessment, musculotendinous assessment, nerve assessment and vascular assessment should be included in the examination procedure
  • Repeated physical examinations reveal how symptoms change over time, which is important for assessing the effectiveness of the treatment.
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2
Q

assessment of history

A
  • Age
  • Hand dominance
  • Occupation
  • Hobbies
  • Chief complain
  • Previous operation
  • Previousinjuries
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3
Q

inspection assessment

A
  • Discoularation
  • Deformity
  • Muscular atrophy
  • Trophic changes
  • Swelling
  • Skincreases
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4
Q

palpation assessment

A

Useful in identifying
* Abnormal skin temperature
* Areas of tenderness
* Crepitance
* Clicking or snapping sounds
* Effusion
* Masses

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5
Q

De Quervain tenosynovitis (DQTS) tests

A

+ tenderness in soft tissue palpation of 1st extensor compartment (abductor pollicis longus & extensor pollicis brevis)
+ Finkeilsteings test (thumb in palm, move wrist in ulnar position, pain)

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6
Q

intersection syndrome

A
  • similar to DQTS
  • Related to bursal inflammation at the junction of the 1st & 2nd compartments
  • Proximal to De Quarvian, 4-6cm from radiocarpal joint
  • Crepitations or squeaking can be heard with ROM (Squeaker wrist)
  • However 6th compartment tenosynovitis second most common following DQTS
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7
Q

trigger finger / stenosing flexor tenosynovitis

A
  • painful snap / lock
  • palpable nodule (trapped in pulley)
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8
Q

flexor tenosynovitis

A
  • tendon sheath infection
  • due to puncture wound
  • Kanavels cardinal signs
  • 4 signs:
    intense pain on passively extending there finger,
    a flexion position of finger,
    uniform swelling of finger,
    tenderness
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9
Q

range of motion assessment

A
  • Both passive and active ranges of motion should be documented.
  • The contralateral healthy limb and the affected limb should be measured and compared.
  • A limited range of passive motion is associated with joint stiffness and soft tissue contracture
  • The active range of motion is affected by tendon excursion, the posture of the hand and fingers, nerve function and muscular strength.
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10
Q

stability assessment

A
  • The tightness of the ligaments around a joint, morphology of the surface of a joint and musculotendinous balance around a joint are useful indices of joint stability.
  • The stability of ligaments is tested by holding the portions distal and proximal to the joint and gently moving the joint passively to stress the ligaments that stabilize the joint.
  • The opening angle of the affected joint under stress should be assessed using X-rays and compared to the opposite side
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11
Q

musculotendinous assessment

A
  • The integrity of the tendon and the strength of the muscle should be considered when conducting a musculotendinous assessment.
  • Assess posture, motion and power of both intrinsic and extrinsic muscles.
  • MRC power grading scale
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12
Q

flexor zones of hand

A

zone 1- FDA sensation
zone 2- btw FDA sensation & A1 pulley
zone 3- proximal to A1 but distal to carpal tunnel
zone 4- capacitance
zone 5- proximal to carpal tunnel

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13
Q

flexor profundus test

A
  • examine flexor digitorum profundus
  • blocking the pt digits at the distal phalangeal joint & ask pt to flex distal phalanges
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14
Q

flexor sublimes test

A
  • examine flexor digitorum superficialis
  • hold down fingers not being examined & pt to flex finger that is being questioned
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15
Q

flexor pollicis longus (FPL) test

A
  • to test thumb distal phalange
  • same as flexor profundus test to hold at distal phalangeal joint & pt to flex
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16
Q

extensor zones

A

zone 1 - distal interphalangeal joint
zone 2 - btw distal & proximal interphalangeal joint
zone 3 - proximal interphalangeal joint
zone 4 - btw proximal interphalangeal and metacarpal phalangeal joint
zone 5 - metacarpal phalangeal joint
zone 6 - proximal to metacarpal phalangeal joint but distal to wrist joint
zone 7 - wrist joint
zone 8 - proximal to wrist

17
Q

extensor compartment of hand

A
  • 6 compartments (thumb to pinky)
    1st - extensor pollicis brevis & abductor pollicis longus
    2nd - extensor carpi radialis longus & brevis
    3rd - extensor pollicis longus
    4th - extensor indicis & digitorum
    5th - extensor digiti minimi
    6th - extensor carpi ulnaris
18
Q

extensor exam

A
  • pt to place hand on table & extend fingers
19
Q

intrinsic muscles of hand

A
  • thenar
  • hypothenar
  • interosseous & lumbral muscles
20
Q

intrinsic muscle exam

A
  • Thenar muscles are evaluated by asking the patient to place the dorsum of the hand flat on a table and to raise the thumb until it is perpendicular to the palm. The patient is then asked to resist a downward force by the examiner on the thumb.
  • The hypothenar muscles abduct the small finger, moving it away from the other fingers.
  • The interosseous and lumbrical muscles flex the MP joints and extend the PIP and DIP joints of the fingers.
21
Q

nerve assessment of hand

A
  • Evaluation of peripheral nerves should include both motor and sensory function.
  • To evaluate the motor function of the hand, it is necessary to understand the anatomy, biomechanics and peripheral innervation of the muscle.
  • Comprehensive sensibility evaluation includes static and dynamic two-point discrimination testing, Semmes– Weinstein monofilament testing, vibrotactile threshold testing, and cold-heat testing.
22
Q

nerves of hand

A

(thumb to pinky)
- superficial branch of radial n.
- median n.
- ulnar n.

23
Q

tunnel of guyon

A
  • ulnar n. passes through guyon’s tunnel
    & divided into 3 zones
    zone 1 (proximal)- mixed motor & sensory zone
    zone 2 (middle)- motor
    zone 3 (distal)- sensory
24
Q

ulnar n. fallout test

A
  • froment’s test
  • pt to hold piece of paper btw index and thumb (ok hand sign)
  • paper pulled & pt to resist pull
    + if flexion of thumb/distal phalange
    + Jeanne’s sign (hyperextension of thumb at basal carpometacarpal)
25
Q

waternberg sign

A
  • hands placed palm down on table
    + pinky abducted
26
Q

claw deformity

A
27
Q

carpal tunnel

A
28
Q

phallen’s test

A
29
Q

ape hand deformity

A
30
Q

hand of benediction

A
  • median n. injury characteristic
31
Q

radial n. palsy

A
  • wrist drop
32
Q

tinel’s sign

A

nerve regeneration

33
Q

vascular assessment

A
  • There are two types of vascular problems: arterial and venous insufficiency.
  • Vascular problems are assessed according to the color, capillary refill, pressure (turgor) and temperature of the affected part.
  • The Allen’s test is helpful for determining if there is an intact circulatory connection between the radial and ulnar arteries in the hand.
34
Q

allen’s test

A
  • depress/press radial & ulnar arteries ( pt opens and closes fist)
  • normal if blood returns via ulnar artery

med n surg S2 (18 decks)

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