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Surgical Recall > SR 69 - Hand Surgery > Flashcards

SR 69 - Hand Surgery Flashcards

1
Q

Bones of the hand?

A

Phalanges
Metacarpal bones
Carpal bones

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2
Q

What is the tip of the finger joint?

A

Distal InterPhalangeal joint (DIP)

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3
Q

What is the middle finger joint?

A

Proximal InterPhalangeal joint (PIP)

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4
Q

What is the knuckle joint?

A

Metacarpal Phalangeal joint (MP)

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5
Q

What are the intrinsic hand muscles?

A

Lumbricals

Interosseous muscles

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6
Q

What is adduction and abduction of the fingers?

A

ADDuction is to the midline

ABDuction is away from the midline

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7
Q

What are the trauma zones of the hand?

A 
Zone 1 - beyond PIP
Zone 2 - MP to PIP
Zone 3 - Thumb crease to MP
Zone 4 - Lower half of the palm
Zone 5 - Palmer crease and proximal
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8
Q

Where is ‘no man’s land’? Significance?

A

Zone 2 - distal palmer crease to just beyond the PIP joint

Flexor tendon injuries here have a poor prognosis - expert is needed to repair

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9
Q

What is the ulnar nerve distribution?

A

Half of ring finger and medial

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10
Q

What is the radial nerve distribution?

A

Back of hand, half of ring finger and lateral, NOT including tips of fingers
Lateral part of thumb

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11
Q

What is the median nerve distribution?

A

Palmer side of hand, half of ring finger and lateral.

Tips of fingers on the back

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12
Q

How can radial nerve motor function be tested?

A
  • Wrist and MCP extension

- Abduction and extension of thumbs

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13
Q

How can the ulnar nerve motor function be tested?

A
  • Spread fingers apart against resistance

- Check ability to cross index and middle fingers

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14
Q

How can the median nerve function be tested?

A
  • Touch the thumb to the pinky (distal median nerve)

- Squeeze examier’s finger (proximal median nerve)

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15
Q

How can the flexor digitorum profundus apparatus be tested?

A

Check isolated flexion of the finger DIP joint

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16
Q

How can the flexor digitrum superficialis apparatus be tested?

A

Check isolated flexion of the figer at the MP joint

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17
Q

Where do the digital arteries run?

A

On medial and lateral sides of the digit

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18
Q

What hand lacerations should be left unsutured?

A

Human and animal bites

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19
Q

Should a clamp ever be used to stop a laceration bleeder on the hand?

A

NO
Use pressure then tourniquet for a definitive repair if bleeding does not cease
Nerves run with blood vessels

20
Q

What is a felon?

A

Infection of the tip of the finger pad

Treat with incision and drainage

21
Q

What is a paronychia?

A

Infection of the side of the finger nail

Treat by incision and drainage

22
Q

What is tenosynovitis?

A

Tendon sheath infection

23
Q

What are Kanavel’s signs?

A

Signs of tenosynovitis

  • Affected finger held in flexion
  • Pain over volar aspect of affected tendon on palpation
  • Swelling of affected finger (fusiform)
  • Pain on passive extension
24
Q

Most common bacteria in tenosynovitis and paronychia?

A

Staph aureus

25
Q

How do you treat bites (human and animal)?

A

Debridement and irrigation
Administration of antibiotics
Leave wound open

26
Q

Unique bacteria in human bites?

A

Eikenella corrodens

27
Q

Unique bateria in dog and cat bites?

A

Pasteurella multicoida

28
Q

What is the most common hand/wrist tumor?

A

Ganglion cyst

29
Q

What is an extremely painful type of subungual tumor?

A

Glomus tumor

subungual - under the nail

30
Q

What is a ‘boxer’s fracture’?

A

Fracture of the fourth or fifth metacarpal

31
Q

What is a ‘drop finger’ injury?

A

Laceration of the extensor tendon over the MP injury

32
Q

What is the classic deformity resulting from laceration of the extensor tendon over the DIP joint?

A

Mallet finger

33
Q

What is the classic deformity resulting from laceration of the extensor tendon over the PIP joint?

A

Boutonniere deformity

34
Q

What fracture causes pain in the ‘anatomic snuffbox’?

A

Schapoid fracture
Visible 2 weeks later on Xray (NOT initially)
Can cause avascular necrosis
Place in cast if clinically suspected

35
Q

What is the ‘safe position’ of hand splinting?

A

In a C-shape, with hand slightly extended and fingers/thumb slightly flexed

36
Q

What is Dupuytren’s contracture?

A

Fibrosis of palmar fascia, causing contracture of an inability to extend digits

37
Q

What is Gamekeeper’s thumb?

A

Injury to the ulnar collateral ligament of the thumb

38
Q

How should a subungal hematoma be treated?

A

Release pressure by burning a hole in the nail

39
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve in the carpal tunnel

40
Q

What is the most common cause of carpal tunnel syndrome?

A

Synovitis

41
Q

What are less common causes of carpal tunnel syndrome?

A 
Median artery (persistent)
Edema of pregnancy
Diabetes
Idiopathic
Acromegaly
Neoplasm (i.e. ganlioneuroma)
Thyroid (myxedema)
Rheumatoid arthritis
Amyloid
Pneumatic drill usage
SLE

MEDIAN TRAPS

42
Q

Symptoms of carpal tunnel syndrome?

A

Pain and numbness in the median nerve distribution

43
Q

What are the signs of carpal tunnel syndrome?

A

Tinel’s sign (percussion over median nerve)
Phalen’s test (flexion of wrist)
Thenar atrophy
Wartenberg’s sign (hand resting on a surface - pinky finger rests in abduction compared to the other 4 digits)

44
Q

What is the workup for CTS?

A

EMG

Nerve conduction study

45
Q

What is the initial treatment for CTS?

A

Nonoperative - rest, wrist splint, NSAIDs

46
Q

What are indications for surgery with CTS?

A

Refractory symptoms, theanr atrophy, thenar weakness

47
Q

What is the surgical treatment for CTS?

A

Release transverse carpal ligament

Surgical Recall (32 decks)

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