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Questions Flashcards

1
Q

Where is the initial portal for wrist arthrosocpy?

A

typically the 3,4 portal which is 1 cm distal to lister’s tubercle

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2
Q

Bunnell Test: passive PIP flexion ____ when MCP are taken from flexion to extension because ____

A
  • decreased/lost
  • this tightens the intrinsics
  • **the opposite would be true with extrinsic tightness
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3
Q

what are the transfers for EPL and EDC for PIN palsy?

A

-palmaris longus and FCR

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4
Q

Thenar flaps are best for ___ patients with ____ _____ defects on the ____ and ____ fingers

A
  • younger
  • volar oblique
  • index and long
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5
Q

what is a kite flap and what is it good for?

A

1st dorsal metacarpal artery flap and for dorsal thumb defects with exposed extensor tendons

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6
Q

what is the warm and cold ischemia time for replanted digits?

A

better outcomes with < 12 hrs warm and 24 hrs cold ishcemia

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7
Q

name the components of the tfcc

A

ucl, meniscal homologue, articular disc, volar and dorsal radioulnar ligaments, and ECU tendon sheath

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8
Q

what is the pathology behind wartenberg’s sign?

A

accessory slip of extensor digiti minimi is innervated by the radial nerve that attaches to abductor digiti minimi which causes the finger to abduct

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9
Q

explain the difference between intrinsic plus and minus

A
  • intrinsic plus: PIP and DIP extension and MCP flexion

- intrinsic minus: extrinsics are more powerful so you get MCP hyperextension and flexion at the PIP/DIP

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10
Q

intrinsic minus is aka ___ hand and seen with what conditions?

A
  • claw hand
  • not splinting in intrinsic plus, median or ulnar nerve deficiencies, volkmann contracture, crush hand, compartment syndrome
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11
Q

what is the quadregia effect?

A

overtensioning of the FDP tendons with repair can cause the adjacent flexor tendons to be overtensioned and they will not be able to get to full flexion

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12
Q

what is lumbrical plus?

A

DIP amputation, FDP disruption distal to the origin of the lumbrical, or undertensioning of the FDP graft can cause overtensioning from the sag to the lumbrical thus causing extension of PIP/DIP
***remember that lumbricals flex the MCP and extend at the DIP/PIP joints

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13
Q

name the 3 types of nerve injury

A
  1. neuropraxia
  2. axonotmesis: axon disruption
  3. neurotmesis: complete disruption of nerve
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14
Q

what is the most common position (pronation/supination and wrist flexion/extension) that leads to TFCC injury?

A

-forearm pronation and wrist extension; think about when athletes fall how they most commonly brace themselves; don’t overthink this

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15
Q

after operative treatment of a central slip injury, how are the immobilized? what joint motion is encouraged?

A
  • PIP in full extension with DIP free

- DIP motion but flexion in particular

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16
Q

is there any functional outcome benefit of form PT versus patient guided PT at home s/p ORIF distal radius?

A

no

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17
Q

how might you immobilize a zone 6 extensor tendon laceration repair?

A

yoke splint that holds the finger repair in hyperextension but allows for MCP/PIP/DIP motion; this is helpful for motion and decreasing adhesions but doesn’t immobilize as well and risks poor patient compliance

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18
Q

go through the deformities with 1st CMC arthritis

A

CMC: adduction and flexion
MCP: hyperextension and abduction
IP: hyperflexion

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19
Q

what is the difference between corticosteroid injection and PT for tennis elbow/lateral epicondylitis?

A
  • corticosteroids have worse outcomes compared to PT; remember its not traditional inflammation but rather angiofibroplasia; PRP is more reasonable
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20
Q

what is an important secondary stabilizer with scapholunate ligament injury that helps prevent DISI deformity with SL injury?

A

dorsal intercarpal ligaments

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21
Q

when is a wafer procedure indicated?

A

It is the removal of 2-4 mm of distal ulna with ulnocarpal impingement, positive ulnar variance, and continued pain from TFCC injury

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22
Q

Replant guidelines: fix the ___ first; ___ before ___, use ___ grafts copiously, warm ischemia has ___ time for replant vs cold

A
  • bone
  • arteries
  • veins
  • vein
  • shorter
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23
Q

congenital radioulnar synostosis is caused by failure of ____ during the 7th week of gestation

A

segmentation

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24
Q

what is the optimal time for repair of transected nerve in GSW for example humeral shaft fracture?

A

-1-3 weeks as this allows the zone of injury to declare itself

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25
Q

what is the cutoff for repair of partial FDP lacerations?

A

60%

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26
Q

radial nerve palsy transfers: what is the most consistent one performed? what is used for EPL if present? what is used for EDC?

A
  • pronator teres to ECRB
  • palmaris longus
  • FCR most commonly but also can use FCU or FDS
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27
Q

how is post axial polydactylyl inherited?

A

autosomal dominant

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28
Q

what are the steps to releases for a PIP flexion contracture?

A
  1. checkrein ligament
  2. accessory collaterals and volar plate
  3. proper collaterals
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29
Q

cross finger and reverse cross finger flaps: which is used for volar and which is more commonly used for dorsal?

A
  • volar with cross finger flap and dorsal with reverse cross finger flaps
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30
Q

Replantation: when does arterial or venous thrombosis occur after replant? what treatment is used for venous and not arterial and what is the mechanism? what are some things you can do?

A
  • <12 hrs is usually arterial, > 12 hours is venous
  • leeches as they excrete hirudin which is 100 times more potent than heparin
  • release constrictive bandages, place in dependent position, consider heparin, stellate ganglion block
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31
Q

what is the blood supply to the lateral arm flap?

A

posterior radial collateral branches off of the profunda brachii

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32
Q

do you resect notta’s nodule with pediatric trigger thumb?

A
  • no
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33
Q

viewing from a 3/4 portal for wrist arthroscopy, what is the order of the volar extrinsic wrist ligaments?

A

radioscaphocapitate, long radiolunate, short radiolunate

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34
Q

Rupture of tendons with distal radius fractures: volar plating to distal? scaphoid nonunion/spurring? hook of hamate nonunion? screw length with volar plating?

A
  • FPL
  • radial flexor tendons
  • small finger flexor tendons
  • EPL
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35
Q

where is the incision made for SL ligament repairs? what side of the ligament is stronger, volar or dorsal? with acute repair, what do you also usually do?

A
  • dorsally
  • dorsal
  • k wire fixation for 3-4 weeks
36
Q

what is the cutoff for warm and cold ischemia for replantation?

A
  • cold: 24 hrs; warm: 12 hrs
37
Q

what is the problematic proximal phalanx fracture that is hard to treatment non-operatively?

A
  • proximal metaphyseal
38
Q

1st MCP skier’s thumb: text proper in ___ and accessory in ____, what is a stenar lesion?

A
  • 30 deg flexion
  • 0 deg flexion
  • UCL torn off the proximal phalanx and stuck behind the adductor aponeurosis
39
Q

what causes a mirror hand deformity? apical ectodermal ridge causes ___ growth while the ZPA causes ___ growth

A
  • abnormal duplication of the zone of polarizing activity
  • longitudinal
  • anterior to posterior and radial to ulnar
40
Q

at zone 2 for flexor tendons, where does the blood supply come from?

A
  • synovial sheath
41
Q

which is faster, digit by digit or structure by structure for replants?

A
  • structure by structure
42
Q

what approach, volar vs dorsal should be used for humpback deformity scaphoid nonunion? what is the gold standard for graft? if using a distal radius pedicle, would you go dorsal or volar?

A
  • volar
  • vascularized MFC
  • dorsal because thats where the artery is
43
Q

does wrist extension or flexion increase the force through the scaphoid facet and how is this easy to remember?

A
  • flexion; just think about the mechanism of fall on outstretched wrist for SL injury
44
Q

what is the triad for presentation of glomus tumor? they are benign ___

A
  • fingertip pain, cold insensitivity, and tenderness with mass
  • ** raynaud’s doesn’t have a mass***
  • hamartomas
45
Q

what is the worst material for high pressure injection injection injuries?

A
  • oil > grease/chlorofluorocarbon substances > water/latex
46
Q

what are the 5 sites of compression of PIN syndrome? what is the most common?

A
  • leash of henry (radial recurrent), arcade of froshe (supinator fibrous edge), fibrous bands superficial to the radiocapitellar joint, distal edge of the supinator
  • arcade of froshe
47
Q

purulent flexor tenosynovitis that involves the thumb, distal forearm, and small finger spread’s through what space?

A
  • fascial space called parona’s space in between PQ and FDP
48
Q

what cells make myelin and what does myelin do to conduction velocity?

A
  • schwann cell

- increased

49
Q

what structures are injured with axonotmesis? what is left intact?

A
  • axon and myelin are discontinuous
  • usually the endo, peri, and epineurium but there are varying levels depending on the classification where the endo and peri can be affected
50
Q

Peripheral Nerve Repair: Direct repair for ___ tension; conduits (bovine/porcine) are good for ___ defects with ___ nerves; allograft and autograft are good for what size defects?

A
  • no
  • < 2-3 cm
  • sensory; usually digital nerves
  • <5 cm for allograft and > 5 cm for autograft
51
Q

what age patient does better with nerve repairs, old or young? who does better with lacerations proximal or distal?

A
  • young

- distal

52
Q

NCS: decreasing the myelination would ___ velocity and ___ latency, axonal loss would ___ amplitude

A
  • decrease
  • increase (takes more time)
  • decrease
53
Q

CTS: what is the threshold for monofilament test that would be positive for CTS dx? what is the most sensitive physical exam test? what is the cutoff for latency for motor and sensory? what position are night splints? status post CTR you get pinch by ___ and grip by ___ weeks

A
  • 2.83 mm
  • Durkan’s compression test
  • > 4.5/3.5
  • neutral as flexion or extension at the wrist increases the pressure
  • 6
  • 12
54
Q

what is parsonage turner syndrome? what is a common nerve that is affected?

A
  • viral illness that preceded by shoulder pain

- AIN

55
Q

ulnar tunnel syndrome: what are the 3 zones of guyon’s canal?

A
  • mixed; motor; sensory
56
Q

Radial nerve/PIN: FREAS sites of compression? what is the difference with radial tunnel vs PIN? what is commonly mis-dx with radial tunnel?

A
  • fascial band at RC joint; recurrent leash of henry; ECRB leading edge; arcade of frosche (proximal edge of supinator); distal edge of supinator
  • radial tunnel doesn’t have any sensory or motor deficits
  • lateral epicondylitis
57
Q

what is wartenberg syndrome?

A

-compression of SRN under the BR and ECRL

58
Q

Brachial plexus: what type of injury is Horner’s syndrome and what is the triad?

A
  • preganglionic; ptosis, miosis, anhidrosis
59
Q

Radial nerve transfers: wrist extension? finger extension? thumb extension?

A
  • PT to ECRB
  • FCR to EDC
  • PL to EPL
60
Q

Fingertip Injuries: > 50% ___ intolerance, volar oblique in a thumb? LF and MF with volar olique and what age? all other volar oblique?

A
  • cold (most common complication)
  • moberg
  • thenar flap; just kids
  • cross finger flap
61
Q

Fingertip injuries: what type oblique would V-Y be good for?

A
  • dorsal oblique
62
Q

Fingertip injuries: what type oblique would V-Y be good for?

A
  • dorsal oblique
63
Q

Lumbrical plus finger: originates on ___ tendon, if lacerated and retracts then gets paradoxial ___ when they flex their fingers

A
  • FDP

- extension

64
Q

what are 2 early reasons for failure with skin grafts? Z-plasty: increasing length with 60, 45, and 30 degrees?

A
  • shear and hematoma that prevents it from taking

- 75%, 50%, 25%

65
Q

Digital brachial index: < ___ is abnormal

A
  • 0.7
66
Q

what is the cutoff DBI with hypothenar hammer syndrome between ligation vs reconstruction?

A
  • 0.7
67
Q

Replantation: warm and cold ischemia for digits? wrist and proximal?

A
  • 12/24 (longer because there isn’t muscle like proximal to the wrist
  • 6/12
68
Q

Replantation failure: first 12 hrs? after 12 hrs? after 1 week? what is the most common secondary procedure?

A
  • arterial
  • venous
  • infection
  • tenolysis
69
Q

why can you extend DIP after fowler tenotomy (release of extensor tendon over middle phalanx for swan neck deformity) but not mallet finger?

A
  • dorsal capsule and landsmeer ligament are still intact (ORL)
70
Q

intrinsic minus and plus hand

A
  • minus: MCP hyperextension and IP flexion

- plus: MCP flexion and IP extension

71
Q

epitendinous suture for flexor tendon injuries increases the strength by ___ and prevents ___ ___

A
  • 10-50%

- gap formation

72
Q

what is the space that thenar to hypothenar purulent flexor tenosynovitis can spread and give you a horseshoe abscess?

A
  • parona’s space
73
Q

felon is an infection of the ___ ___ while a paronychia is an infection of the ___ ___

A
  • distal pulp

- nail fold

74
Q

what organism with human bites?

A
  • eikenella
75
Q

what is the tendon at risk with non-op treatment of distal radius fracture? what is the transfer for treatment? what is the berst predictor for loss of reduction with CR of DR fractures? is there any evidence to support PQ repair? what is the flexor tendon that is at risk with placing the plate too distal with volar plating DR fractures?

A
  • EPL
  • EIP transfer
  • Age (> 60-65)
  • no
  • FPL
76
Q

with SL injury the lunate follows the triquetrum and goes ___, with LT injury the lunate follows the scaphoid and goes ___

A
  • dorsal (DISI)
  • volar (VISI)
  • **remember the scaphoid wants to flex and the triquetrum wants to extend
77
Q

what are 2 clinical complications of hook of hamate fx left untreated?

A
  1. nonunion

2. flexor tendon rupture

78
Q

1st CMC joint dislocation most commonly goes ___ from disruption of ____ ligament

A
  • dorsal

- dorsoradial

79
Q

where do 80% of the ucl at the 1st MCP occur? what about for the rcl of the 1st MCP?

A
  • distally from the PP

- proximally from the MC more common

80
Q

2 mm of MC shortening results in ___ deg extensor lag, how many extensor lag with 1 mm shortening of terminal tendon with mallet finger injury?

A
  • 7

- 25

81
Q

index to small, what are the degrees of PIP fusion?

A
  • 40, 45, 50, 55
82
Q

how would you unload the lunate with keinbocks?

A
  • shorten the radius in situations that are ulnar negative and have increased shear forces; you could also do a capitate shortening if there was no negative ulnar variance
83
Q

Duputryn’s disease: what cell? what type of collagen? what ligament is not involved? bands become ___ when they become pathologic, spiral cord moves the bundle ___ and ___, that cord gives contracture at MCP joint? which cord gives contracture of the DIP joint?

A
  • myofibroblast
  • greater type III collagen
  • Cleland’s ligament
  • cords
  • volar and midline
  • pretendinous cord
  • retrovascular cord
84
Q

what extrinsic ligament of the wrist is the primary stabilizer after PRC?

A

radioscaphocapitate

85
Q

what is the cell involved with dupuytren’s disease? what type of collagen becomes more prominent? what ligament is not involved?

A
  • myofibroblast
  • type III
  • cleland’s ligament (cleland’s is the ceiling)
86
Q

what is the order or replant?

A

bone - tendon - artery - veins and make sure you go structure by structure and not digit by digit

87
Q

Peripheral nerve injury: what is the first lost and the last to come back? show the entire order

A
  • motor

- motor - proprioception - light touch - sensory - temperature - sympathetic

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