T2 L9 Intro to surgery of the hand Flashcards
What is the palmar fascia?
Tough layer anchoring skin to skeleton
Extension of forearm fascia
What is the clinical condition associated with the palmar fascia?
Dupuytren’s disease
What is dupuytren’s disease?
Thickening of fascia
Contracture
What are the risk factors for dupuytren’s disease?
Genetics Smoking Alcohol Diabetes Epilepsy
What is the clinical relevance of the flexor tendons?
Traumatic rupture
Trigger fingers
What is trigger fingers?
Catching of tendons at A1 pulley
Degenerate nodule
Thickening of sheath
What are the risk factors for trigger fingers?
Overuse
Degeneration
Change of direction of tendon
What is the treatment of trigger fingers?
Surgery to make A1 pulley hole bigger
How can the nerves be affected?
Median and ulnar nerves Digital nerves to each finger / thumb Dermatomes Injury Compression neuropathies
What is the most common compression neuropathy?
Carpal tunnel
How common is carpal tunnel syndrome?
Affects 5-10% of population at some point in their life
What is carpal tunnel?
Median nerve compression at wrist
The carpal tunnel is an osseous / ligamentous tunnel
What does the carpal tunnel contain?
10 tendons
Median nerves
What are the symptoms of carpal tunnel?
Pins and needles, numbness in a sensory distribution
Worse at night and when using hands
Can be constant
What are the signs of carpal tunnel syndrome?
Thenar wasting
Loss of abduction
Loss of opposition
What is the treatment for carpal tunnel syndrome?
Initially a splint to support the wrist
Steroid injections
Surgery to divide flexor retinaculum and take pressure off
What thenar muscles are affected in carpal tunnel?
Abductor brevis
Opponens
Flexor brevis
Adductor (ulnar)
What is cubital tunnel syndrome?
Ulnar nerve compression at elbow
The fascial compression can occur at 3 sites
What muscles are affected in cubital tunnel syndrome?
Flexor digiti minimi Abductor Opponens Interossei FCU, FDP
What is the treatment of cubital tunnel syndrome?
Surgery to decompress the nerve
What is the innervation of the interosseous muscles?
Ulnar nerve
What are the signs of damage to the ulnar nerve?
Wasted hypothenar web spaces
Paradoxical wasting thenar
Forearm wasting
Clawing of digits
What is the function of the extensor tendons?
Extend MCP joints of all fingers
What is de Quervain’s disease?
Pain around radial styloid
Triggering and pain of thumb extensors
What are the risk factors of de Quervain’s disease?
Degeneration
Overuse
Ciprofloxacin
Anastrazole
What is the treatment of de Quervain’s disease?
Splints
Steroids
Surgery
How many bones are in the hand?
3 phalanges in fingers 2 phalanges in thumb 5 metacarpals 2 sesamoids in thumb 8 carpal bones
What are some bone problems?
Radial fracture
Scaphoid fracture
1st carpometacarpal osteoarthritis
Rheumatoid arthritis
