SR 69 - Hand Surgery Flashcards by Ryan Bird

Bones of the hand?

Phalanges
Metacarpal bones
Carpal bones

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What is the tip of the finger joint?

Distal InterPhalangeal joint (DIP)

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What is the middle finger joint?

Proximal InterPhalangeal joint (PIP)

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What is the knuckle joint?

Metacarpal Phalangeal joint (MP)

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What are the intrinsic hand muscles?

Lumbricals

Interosseous muscles

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What is adduction and abduction of the fingers?

ADDuction is to the midline

ABDuction is away from the midline

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What are the trauma zones of the hand?

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

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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What is the ulnar nerve distribution?

Half of ring finger and medial

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What is the radial nerve distribution?

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

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What is the median nerve distribution?

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

Tips of fingers on the back

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How can radial nerve motor function be tested?

Wrist and MCP extension

- Abduction and extension of thumbs

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How can the ulnar nerve motor function be tested?

Spread fingers apart against resistance

- Check ability to cross index and middle fingers

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How can the median nerve function be tested?

Touch the thumb to the pinky (distal median nerve)

- Squeeze examier’s finger (proximal median nerve)

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How can the flexor digitorum profundus apparatus be tested?

Check isolated flexion of the finger DIP joint

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How can the flexor digitrum superficialis apparatus be tested?

Check isolated flexion of the figer at the MP joint

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Where do the digital arteries run?

On medial and lateral sides of the digit

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What hand lacerations should be left unsutured?

Human and animal bites

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

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

What is a felon?

Infection of the tip of the finger pad

Treat with incision and drainage

What is a paronychia?

Infection of the side of the finger nail

Treat by incision and drainage

What is tenosynovitis?

Tendon sheath infection

What are Kanavel’s signs?

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

Most common bacteria in tenosynovitis and paronychia?

Staph aureus

How do you treat bites (human and animal)?

Debridement and irrigation Administration of antibiotics Leave wound open

Unique bacteria in human bites?

Eikenella corrodens

Unique bateria in dog and cat bites?

Pasteurella multicoida

What is the most common hand/wrist tumor?

Ganglion cyst

What is an extremely painful type of subungual tumor?

Glomus tumor | subungual - under the nail

What is a 'boxer's fracture'?

Fracture of the fourth or fifth metacarpal

What is a 'drop finger' injury?

Laceration of the extensor tendon over the MP injury

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

Mallet finger

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

Boutonniere deformity

What fracture causes pain in the 'anatomic snuffbox'?

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

What is the 'safe position' of hand splinting?

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

What is Dupuytren's contracture?

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

What is Gamekeeper's thumb?

Injury to the ulnar collateral ligament of the thumb

How should a subungal hematoma be treated?

Release pressure by burning a hole in the nail

What is carpal tunnel syndrome?

Compression of the median nerve in the carpal tunnel

What is the most common cause of carpal tunnel syndrome?

Synovitis

What are less common causes of carpal tunnel syndrome?

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

Symptoms of carpal tunnel syndrome?

Pain and numbness in the median nerve distribution

What are the signs of carpal tunnel syndrome?

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)

What is the workup for CTS?

EMG | Nerve conduction study

What is the initial treatment for CTS?

Nonoperative - rest, wrist splint, NSAIDs

What are indications for surgery with CTS?

Refractory symptoms, theanr atrophy, thenar weakness

What is the surgical treatment for CTS?

Release transverse carpal ligament