T2 L9 Intro to surgery of the hand

Question 1

What is the palmar fascia?

Answer 1

Tough layer anchoring skin to skeleton

Extension of forearm fascia

Question 2

What is the clinical condition associated with the palmar fascia?

Answer 2

Dupuytren’s disease

Question 3

What is dupuytren’s disease?

Answer 3

Thickening of fascia

Contracture

Question 4

What are the risk factors for dupuytren’s disease?

Answer 4

Genetics
Smoking
Alcohol
Diabetes
Epilepsy

Question 5

What is the clinical relevance of the flexor tendons?

Answer 5

Traumatic rupture

Trigger fingers

Question 6

What is trigger fingers?

Answer 6

Catching of tendons at A1 pulley
Degenerate nodule
Thickening of sheath

Question 7

What are the risk factors for trigger fingers?

Answer 7

Overuse
Degeneration
Change of direction of tendon

Question 8

What is the treatment of trigger fingers?

Answer 8

Surgery to make A1 pulley hole bigger

Question 9

How can the nerves be affected?

Answer 9

Median and ulnar nerves
Digital nerves to each finger / thumb
Dermatomes
Injury 
Compression neuropathies

Question 10

What is the most common compression neuropathy?

Answer 10

Carpal tunnel

Question 11

How common is carpal tunnel syndrome?

Answer 11

Affects 5-10% of population at some point in their life

Question 12

What is carpal tunnel?

Answer 12

Median nerve compression at wrist

The carpal tunnel is an osseous / ligamentous tunnel

Question 13

What does the carpal tunnel contain?

Answer 13

10 tendons

Median nerves

Question 14

What are the symptoms of carpal tunnel?

Answer 14

Pins and needles, numbness in a sensory distribution
Worse at night and when using hands
Can be constant

Question 15

What are the signs of carpal tunnel syndrome?

Answer 15

Thenar wasting
Loss of abduction
Loss of opposition

Question 16

What is the treatment for carpal tunnel syndrome?

Answer 16

Initially a splint to support the wrist
Steroid injections
Surgery to divide flexor retinaculum and take pressure off

Question 17

What thenar muscles are affected in carpal tunnel?

Answer 17

Abductor brevis
Opponens
Flexor brevis
Adductor (ulnar)

Question 18

What is cubital tunnel syndrome?

Answer 18

Ulnar nerve compression at elbow

The fascial compression can occur at 3 sites

Question 19

What muscles are affected in cubital tunnel syndrome?

Answer 19

Flexor digiti minimi
Abductor
Opponens
Interossei 
FCU, FDP

Question 20

What is the treatment of cubital tunnel syndrome?

Answer 20

Surgery to decompress the nerve

Question 21

What is the innervation of the interosseous muscles?

Answer 21

Ulnar nerve

Question 22

What are the signs of damage to the ulnar nerve?

Answer 22

Wasted hypothenar web spaces
Paradoxical wasting thenar
Forearm wasting
Clawing of digits

Question 23

What is the function of the extensor tendons?

Answer 23

Extend MCP joints of all fingers

Question 24

What is de Quervain’s disease?

Answer 24

Pain around radial styloid

Triggering and pain of thumb extensors

Question 25

What are the risk factors of de Quervain’s disease?

Answer 25

Degeneration
Overuse
Ciprofloxacin
Anastrazole

Question 26

What is the treatment of de Quervain’s disease?

Answer 26

Splints
Steroids
Surgery

Question 27

How many bones are in the hand?

Answer 27

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

Question 28

What are some bone problems?

Answer 28

Radial fracture
Scaphoid fracture
1st carpometacarpal osteoarthritis
Rheumatoid arthritis