Surgery of the hand

Question 1

What are the features of palmar fascia and which disease is it associated with?

Answer 1

Tough layer anchoring skin to skeleton
Extension of forearm fascia
Tightened by palmaris longus (apes)
Dupuytren’s disease

Question 2

What is dupuytren’s disease and what are its causes?

Answer 2

Thickening of fascia, contracture

Genetic, smoking, alcohol, diabetes/epilepsy

Question 3

Which conditions are associated with flexor tendons?

Answer 3

Traumatic rupture, trigger fingers

Question 4

What is trigger fingers and what are its causes?

Answer 4

Catching of tendons at A1 pulley, degenerate nodule,
thickening of sheath.
Overuse, degeneration, change of direction of tendon

Question 5

What can nerve problems be caused by?

Answer 5

Injury, compression neuropathies

Question 6

What is carpal tunnel syndrome and which structures are involved?

Answer 6

Median nerve compression at wrist, osseous/ligamentous tunnel.
Tendons, nerves.
Nerve function. 3 of thenar muscles + sensory symptoms in radial half of hand.

Question 7

Which structures are associated with thenar muscles?

Answer 7

Abductor brevis, opponens, flexor brevis, adductor (ulnar).

Fine control, species advantage.

Question 8

What are the signs of carpal tunnel syndrome?

Answer 8

Thenar wasting, loss of abduction + opposition

Question 9

What is cubital tunnel syndrome and which structures are involved?

Answer 9

Ulnar nerve compression at elbow, fascial compression at 3 sites.
Nerve only.
Nerve function. forearm + hand muscles, sensory symptoms ulna half of hand.

Question 10

What is the interosseus muscle and which structures is it associated with?

Answer 10

Palmar/dorsal, insertion to proximal phalanx, adduction/abduction.
Insertion to extensor hood
Interphalangeal extension, ulnar nerve

Question 11

What are the ulnar nerve signs?

Answer 11

Wasted hypothenar web spaces, paradoxical wasting thenar, forearm wasting, clawing of digits.

Question 12

What is the action of the extensor tendons?

Answer 12

Extend MCP joints of fingers
Thumb tendons, wrist tendons, retinaculum
12 in all, some multi-stranded

Question 13

What are the symptoms and treatment of de Quervain’s disease?

Answer 13

Triggering + pain of thumb extensors.
Degeneration, overuse.
Ciprofloxacin, anastrazole.

Question 14

What are the causes of ruptures?

Answer 14

Lacerations, fracture, synovitis, arthritis.

No triggering

Question 15

What are the features of the digital extensor hood?

Answer 15

Long extensors, interossei, lumbrical.
Finely balanced
Complex multibundle flat tendon

Question 16

Outline the osteology of the hand?

Answer 16

3 phalanges in fingers
2 phalanges in thumb
5 metacarpals
2 sesamoids in thumb
8 carpal bones

Question 17

What are the common bone problems?

Answer 17

Radial fracture, scaphoid fracture.

1st CMC osteoarthritis, rheumatoid arthritis.