Week 3 Hand surgery

Question 1

Describe intraarticular and extraarticular hand fractures.

Answer 1

• in an extraarticular fracture-if the fingers are aligned when flexed, no surgery is needed, however if there is rotation, need to be fixed
• intraarticular: e.g.
• Bennett’s fracture: at the base of the 1st Metacarpal, tension from the abductor pollicis longus rotates thumb into supine position

Question 2

What is considered no man’s land of the flexor tendons of the hand?

Answer 2

Zone 2, the flexor tendon sheath. Lacerations to this area are difficult to treat because there are two tendons going through a “tunnel” of the tendon sheath. High possibility of scar formation.

Question 3

What are the classic signs of tendon sheath infection? Four Signs of “Kanavel”

Answer 3

i. Diffuse swelling of the finger
ii. Tenderness along the flexor sheath
iii. Finger held in a slight flexed position
iv. Excruciating pain with passive extension of the finger

Question 4

What is Wartenberg’s syndrome? Wartenberg’s sign?

Answer 4

• Wartenberg’s sign: little finger remains abducted when patient is asked to abduct then adduct fingers. Due to injury of ulnar nerve
• -wartenberg’s syndrome is due to entrapment of the superficial radial nerve. Numbness and tingling of posterior aspect of thumb.

Question 5

What is Allen’s test?

Answer 5

• Prior to doing a radial arterial line, need to test integrity of collateral circulation
  1. By occluding the radial and ulnar arteries, and then releasing one side, the fingers should all regain circulation.
  2. After one attempt, the test should be repeated releasing the other artery, and checking circulation.
  3. A positive result is when some digits do not regain circulation with release of the flow.

Question 6

What are the signs of carpal tunnel?

Answer 6

a. Tinels: tapping on the nerve recreates the sensation
b. Phalens: flexing the wrist reproduces the numbness
c. Durkin’s Compression: Pressure over the carpal tunnel reproduces the symptoms (most sensitive test)