Miller > hand > Flashcards

hand Flashcards

(95 cards)

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1
Q

what is the central slip

A

terminal EDC tendon, inserts on base of middle phalanx, PIP extension

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2
Q

what is the terminal extensor tendon

A

convergence of lateral bands (contributions from common extensor and intrinsics), inserts on base of distal phalanx

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3
Q

whats the most radial structure in the carpal tunnel

A

FPL tendon

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4
Q

action of intrinsics

A

flex MCP and extend PIP

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5
Q

where do lumbricals originate

A

radial aspect of FDP tendon

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6
Q

where do lumrbicals insert

A

radial lateral bands

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7
Q

lumbrical innervation

A

radial two innervated by median nerve, ulnar two by ulnar nerve

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8
Q

which muscles are innervated by the median nerve

A

pronator teres, FDS, FCR, PL, radial two lumbricals.

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9
Q

what does AIN innervate

A

FPL, index and long FDP (long 50% of the time), PQ

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10
Q

what does the recurrent motor branch of the median nerve innervate

A

APB, opponens pollicis, superficial head of FPB

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11
Q

what does the ulnar nerve innervate

A

FCU, ring/small/long (50% of the time) FDP, ulnar two lumbricals

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12
Q

what does the deep motor branch of the ulnar nerve innervate

A

interossei, ADM, flexor digiti minimi, palmaris brevis, deep head of FPB

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13
Q

what does the radial nerve innervate

A

lateral brachialis, triceps, anconeus, BR, ECRL, ECRB

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14
Q

what does the PIN innervate

A

APL, EPB, EPL, EIP, EDC, EDM, ECU, supinator

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15
Q

scaphoid view xray

A

30 degrees wrist extension, 20 degrees ulnar deviation

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16
Q

most common vascularized bone graft for proximal pole scaphoid AVN

A

1,2 ICSRA (dorsal distal radius) - but not if humpback deformity

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17
Q

what approach do you use for a scaphoid humpback deformity

A

volar

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18
Q

SNAC stage 1

A

radioscaphoid arthritis

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19
Q

SNAC stage 2

A

involvement of scaphocapitate joint

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20
Q

SNAC stage 3

A

involvement of lunocapitate joint

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21
Q

treatment for SNAC stage 1

A

distal pole excision or radial styloidectomy

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22
Q

treatment for SNAC stage 2 or 3

A

PRC (lose some motion and strength), 4 corner fusion, wrist fusion

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23
Q

ligament disrupted in DISI

A

scapholunate (dorsal fibers stronger)

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24
Q

ligament disrupted in VISI

A

lunotriquetral interosseous ligament (volar fibers stronger)

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25
what ligament must be preserved in PRC and why
radioscaphocapitate ligament to prevent ulnar subuxation
26
acceptable angulation for metacarpal neck fractures
index and long fingers <15-20, ring <30-40, small <70
27
acceptable angulation for metacarpal shaft fracture
index and long <10, ring and small <30
28
deforming forces in bennett fracture
APL and thumb extensors displace shaft proximal, dorsal, radial. adductor pollicis supinates and adducts shaft
29
extensor tendon zones
1 - at/distal to DIP, 2 - middle phalanx, 3 - PIP, 4 - proximal phalanx, 5 - MCP, 6 - metacarpal, 7 -wrist, 8 - distal forearm
30
mallet finger
zone 1 extensor tendon injury
31
treatment for acute mallet finger
in first 12 weeks - full-time DIP joint extension splinting x 6 weeks, part time x 4-6 weeks. ORIF if large bony fragment (>50%)
32
what percentage of extensor tendon laceration requires operative repair
>50%
33
boutonierre deformity
zone 3 extensor tendon injury (central slip at PIP). volar subluxation of lateral bands causes DIP hyperextension
34
what percentage of flexor tendon laceration requires operative fixation?
> 60%
35
when is the risk of flexor tendon rupture greatest after repair?
3 weeks, failure occurs at suture knots
36
flexor tendon zones
1 - distal to FDS insertion, 2 - FDS to A1, 3 - palm, 4 - carpal tunnel, 5 - forearm
37
what is the most likely block to reduction for galeazzi
ECU
38
what position do you splint in for galeazzi with reducible DRUJ
supination
39
what deformity can occur with a chronic mallet finger?
swan neck deformity
40
what causes a boutonierre deformity?
central slip disruption/zone 3 extensor tendon injury
41
what structure is most likely to be injured during a pediatric trigger thumb release?
radial digital nerve
42
flap options for volar proximal finger
cross finger flap, axial flag flap
43
flap options for dorsal proximal finger
reverse cross finger flap, axial flag flap
44
flap options for volar thumb
Moberg (<2 cm), FDMA (>2 cm), neurovascular island flap (up to 4 cm)
45
flap options for dorsal thumb
FDMA
46
flap options for first web space
z-plasty with 60 degree flaps, posterior interosseous fasciocutaneous flap
47
most frequent cause of early (within 12 hours) replantation failure
arterial thrombosis from persistent vasospasm
48
most frequent cause of replantation failure after 12 hours
venous congestion or thrombosis
49
treatment for a chemical burn with hydrofluoric acid
calcium gluconate
50
most important predictor of digit survival after replantation
mechanism of injury
51
blood supply for ALT flap
descending branch of lateral femoral circumflex
52
blood supply for gracilis flap
medial femoral circumflex
53
warm ischemia time for replant
<6 hours if proximal to carpus, <12 hours for digit
54
cold ischemia time for replant
<12 hours proximal to carpus, <24 hours for digit
55
infection common with leech treatment
aeromonas hydrophilia
56
EMG changes seen with muscle denervation
fibrillations, positive sharp waves, fasiculations
57
structure at risk with a carpal tunnel incision that's too radial
recurrent motor branch of median nerve
58
endoscopic vs open carpal tunnel release
better short term results with endo, same long term. most common complication = incomplete release
59
when does strength return after open carpal tunnel?
pinch in 6 weeks, grip in 3 months
60
what is pronator syndrome
median nerve compression in forearm
61
sites of compression in pronator and AIN syndrome
supracondylar process, ligament of struthers (between supracondylar process and medial epicondyle), bicipital aponeurosis/lacertus fibrosis, 2 heads of pronator, FDS aponeurotic arch
62
sensory symptoms that differentiate pronator syndrome from carpal tunnel
symptoms in palmar cutaneous branch distribution
63
borders of cubital tunnel
floor - MCL and elbow capsule, walls - olecranon and medial epicondyle, roof - FCU fascia and arcuate ligament of Osborne
64
sites of compression in cubital tunnel syndrome
acrade of struthers (fascial thickening at hiatus of medial IM septum 8cm prox to med epicondyle), medial head of triceps, medial IM septum, Osborne ligament, anconeus epitrochlearis, between 2 heads of FCU, aponeurosis at proximal edge of FDS
65
most common cause of ulnar tunnel syndrome
ganglion cyst
66
borders of Guyons canal
floor - transverse carpal ligament. roof - volar carpal ligament, radial - hook of hamate, ulnar - pisiform and abductor digiti minimi
67
sites of compression in PIN syndrome
fascial bands at radial head, recurrent leash of Henry, edge of ECRB, Arcade of Frohse (most common, proximal supinator), distal supinator
68
what is radial tunnel syndrome
lateral elbow/radial forearm pain with no motor or sensory symptoms
69
where is the superficial sensory branch of radial nerve compressed in Wartenberg syndrome
between BR and ECRL with forearm pronation
70
what is disrupted in neurapraxia
myelin sheath only
71
early tendon transfer for wrist flexion contracture in CP
FCU to ECRL/ECRB
72
what nerve is at risk with the approach to the cubital tunnel
medial antebrachial cutaneous
73
vascularized bone graft for Stage i-IIIa keinbocks
4+5 ECA
74
how does collagen change in dupuytrens
increase in ratio of type III to type I
75
most common malignant soft tissue tumor in the hand
epithelioid or synovial sarcoma
76
where does the princips pollicis artery originate?
radial artery or deep palmar arch
77
most common malignancy of the hand
squamous cell carcinoma
78
two structures not involved in dupuytrens
cleland ligaments, transverse palmar ligament
79
empiric antibiotic treatment for dog and cat bites
ampicillin/sulbactam and amoxicillin/clavulanate
80
signals that control proximal to distal limb development
AER, fibroblast growth factor
81
signals that control radial to ulnar growth
ZPA, sonic hedgehog protein
82
signals that control dorsal to volar growth
wingless type pathway (wnt), LMX-1 protein
83
what structure is at risk in pediatric trigger thumb release
thumb radial digital nerve
84
inheritance of syndactyly
autosomal dominant, reduced penetrance, variable expression
85
inheritance of postaxial polydactyly (small finger duplication)
10x more common in blacks, autosomal dominant
86
cause of madelung's deformity
disruption of volar ulnar physis of distal radius, tethered by Vicker's ligament
87
genetics of madelung's
x-linked dominant mutation in SHOX gene (Leri-Weill dyschondrosteosis)
88
how much can a z-plasty lengthen at an angle of 30, 45, and 60 degrees
30 - 25%, 45 - 50%, 60 - 75%
89
amount of extensor lag seen for each mm of phalangeal shortening
12 degrees
90
are dorsal or volar intercarpal ligaments stronger?
dorsal
91
order of tendons in first extensor compartment
EPB is ulnar to APL , APL frequently has multiple slips
92
progression of arthritis in SLAC wrist
radial styloid, radioscaphoid, lunocapitate, radiolunate
93
order of ligament failure in perilunate instability
scapholunate, capitolunate, lunotriquetral, dorsal radiocarpal
94
what is vicker's ligament and where does it run
causes madelung deformity, tethers volar ulnar corner of distal radius to lunate
95
what position is the DRUJ most stable in
supination
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