Ravi Board/OITE Prep > Hand > Flashcards

Hand Flashcards

(89 cards)

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1
Q

tx of traumatic sagittal band injury

A

leads to extensor tendon subluxation; in pro athelte -open repair; in others extension splinting if acute (< 4-6weeks)

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2
Q

PIN innervation

A

EDC, EDM, ECU, EPB, EPL, EIP, APL and SOMEtimes ECRB

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3
Q

kids with radial defects need what other work up

A

Echo, Renal US, CBC - looking for VATER or VACTERL or fanconis anemia

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4
Q

surgery for DIP joint fracture

A

if > 30% of joint surface

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5
Q

which frx to use dorsal extension block

A

PIP fracture dislocation with < 40% joint surfac; if JUST dislocation - splint

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6
Q

peds thumb trigger finger- what age

A

typically by age 2; non op after age 3 does not work

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7
Q

what is lumbrical plus

A

FDP rupture and retraction leads to paradoxixal IP joint extension when trying to flex

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8
Q

segmental nerve injuries use which graft

A

collagen conduit

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9
Q

annular pulley order

A

A1,3,5, over the joints. C1,2,4

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10
Q

size limits of volar island flap

A

2.5 to 3.5 cm defect on volar aspect

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11
Q

pip joint fractures - does anatomic reduction matter

A

no

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12
Q

pre vs post axial poly dactyly

A

pre is thumb side duplication; post is small finger side

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13
Q

which polydactyly in whites needs a work up

A

POST (pinky side) axial

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14
Q

thrombosis after digit replantation

A

venous/congestion is typically WITHIN 12 hours ; arterial is after 12 hours

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15
Q

cubital tunnel syndrome structures

A

MCL and Osbournes ligament - ulnar nerve

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16
Q

endo vs epi vs perineurium

A

endo is around the axon; peri covers nerve fasicles and has high tensile strength; protects from edema; epi is supportive sheath around peripheral nerves that cushion against external pressure - loose mesh of collagen

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17
Q

tx of stage 3 SLAC

A

4 corner fusion

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18
Q

grayson and clelands lig with Dupuytrens

A

only Graysons is involved

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19
Q

tx of hemmorrhagic blister

A

drainage with skin left intact - do NOT debride or if intact; leave alone in dry dressings

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20
Q

stages of Kienbocks

A

Lichtman 1. normal xr, needs MRI; 2. sclerosis; 3. sclerosis + collpase; 4. adjacent degeneratio

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21
Q

flap for dorsal thumb defects

A

Kite flap from 1st dorsal metacarpal artery

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22
Q

tx of DRUJ OA in laborer

A

ulnar hemiresection + TFCC recon in heavy laboroer

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23
Q

darrach procedure

A

resection of distal ulna head (only for elderly/low demand)

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24
Q

after nerve injury, which part does wallerian

A

distal segment does wallerian degen (phagocytes eat the nerve)

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25
Blauth IIIA and IIIB
presence of cmc joint stability in Blauth IIIA. The CMC joint must stable for grasp and pinch.
26
arterial blood supply to a medial gastroc flap
sural artery.
27
Wafer procedure
ulnar prominence with impingment and TFCC tear
28
basis for claw hand
weak intrinsics; strong extrinsics - called intrinsic minus
29
causes of intrinsic minus
Volkmann's contractre; leprosy; HMSN, ulnar or median nerve palsy; compartment syndrome/crush injury
30
recurrence with DIP cyst aspiration
up to 40 %
31
contraindiciation to moberg flap
if its > 1.5cm- otherwise it would increase stiffness
32
CMC and MCP arthritis
resection arthroplasty of CMC with MCP fusion - when MCP is > 40 deg
33
MCP hyperextension
0-10 is non-op; 10-20 deg is perc pinning; 20-40 capsulodesis
34
zone 1 jersey finger tx
surgery
35
when should you replant at zone 2
only with thumb
36
when to repair ring avulsion injuries`
ONLY if no bone, tendon or nerve injury - vascular is ok
37
hand amputation tx
if zone 3 or proximal you should replant
38
structures needing release in peds trigger
A1; A2 or A3 sometimes; FDS slips (notta nodule)
39
what is associated with thumb hypoplasia
radial aplasia; thrombocytopenia, renal CNS CV abnormalities
40
structure at risk b/w palmaris longus and FCR
cutaneous branch of median nerve
41
extension vs neutral splinting for CTS
extension is more functional but can worsen symptoms; neutral is best for night time - least pressure
42
cause of madelung
impaired growth of volar/ulnar phsysis of Distal radius due to either bony lesion or vicker'sligament
43
lethal condition a/w radial club hand
Fanconi's anemia - auto recessive; get CBC, c-some analysis - typically noted at 6-9 years;
44
z plasty lengthening amounts
30 deg, 45 deg and 60 deg gives 25-50-75% respectively
45
tx of macrodactylyl
fuse physis when finger reaches length of same sex parent
46
max amount of distance for FDP repair
must be < 1cm; if longer consider staged or grafting with palmaris; silicone rod for collapses sheath
47
deep vs superficial palmar arch
deep is more proximal and radial artery; superificial is supplied by ulnar artery and is distal
48
grip at pinch strengthe after CTS release
typicall by 3 months its at 100% or higher
49
Bunnell's test
increased PIP flexion when you go from MCP extension to MCP flexion - indicates intrinsic tightness
50
central slip injury causes
boutonniere
51
replantation order
bone; extensor tendons; flexor tendons; artery; then vein or nerve; last skin
52
ischemia time
12 hrs for cold , 6 for warm
53
main complication of distal phalanx orif
symptomatic hardware requiring removal
54
order of SLAC wrist degen changes
Radioscahpoid, capitolunate, lunate is last to go if at all
55
function of proper and accessory collateral lig in thumb
both restrain against radial deviation - PCL is for flexion; ACL is extension
56
1st dorsal compartment contents
APB, EPL
57
complication with correct syndactyly
Web creep, the most common complication of this procedure, is the distal migration of the web commissure seen in surgically corrected syndactyly patients.
58
what is often torn in volar PIP dislocation
Central slip
59
most common dorsal ganglion in hand
via wrist in SL ligament
60
spiral cord in Dupuytrens
spiral cord will be lateral and deep to the NV bundle
61
composition of spiral cord in Dupuytrens
pretendinous band, spiral band, grayson ligament, and latearl digitial sheath
62
spiral cord's effect on NV bundle
displaces it centrally and superficially
63
central cord in Dupuytrens
extension of pretendinous band - causes PIP contracture
64
best finger rehab protocols are
low force, high excursion
65
wassel thumb classification (1-6)
1 -bifid distal phalanx, 2. dupilicat distal phalanx, 3. duplicate distal phalanx with forked middle phalanx; 4. double phalanxes, 5. doubles with bifid metacarpal; 6. double digit all the way to Metacarpal; 7. triphalanx
66
what does NOT run in the carpal tunnel
FCR
67
risk factors for amniontic band syndrome
low birth weight and premature < 37 weeks
68
meisser corpuscle
rapid adapting sensory receptor - sensitive to touch
69
merkel's skin receptor
slow adapting - detect (sustained) pressure, texture, low Hz vibration and eval by 2 point discriminiation
70
Pacinian corpuscles
respond to high Hz vibration and rapid indentations of the skin
71
Ruffini corpuscles
slow adpating for skin stretch
72
tx of hypothenar hand syndrome
there are 2 components, thrombosis and aneurysm; if thrombosis > 2 weeks conservative; < 2 weeks fibrinolysis; if aneurysm then excision and repair or vein graft
73
sx of madelungs
ulnocarpal impaction; reduced forearm rotation; median nerve compression
74
bilateral madelung seen with
Leri Weil (SHOX gene) sex dominant mutation
75
dorsal wrist compartment 4 contents
PIN and EDC
76
thumb flaps
if volar and < 2cm - Moberg; if > 2cm then FDMA flap
77
cross finger flap indiciations
volar based injuries to non-thumb digits
78
thenar flap for
volar based injuries to index and middle
79
low vs high median n compression
in low mostly thumb opposition is lost; in high thumb opposition, IP flexion and middle finger flexion have to be addressed
80
beurgers and smoking cessation
leads to decreased disease progression and decreased amputation
81
which nerves recover best
radial, musculocutaneous; and femoral
82
Froments sign
using FPL (AIN) to compensate for thumb opposition due to ulnar nerve deficit
83
Kienbock stage 3 vs 4 tx
stage 3 - STT fusion w or w/o lunate excision or PRC: stage 4 is always PRC
84
lumbrical plus
loss of FDP function (either severed or too long) can lead to paradoxial PIP EXTENSION with attempted flexion
85
Apert syndrome
fgfr2- facial dysmorphia and complex syndactyly
86
nat hx of peds trigger thumb
60% resolve without tx; of those that done; the flexion improves a lot
87
which polydactyly is more common in African Americans
post-axial (pinky side)
88
tx of pediatric collapsed thumb
serial splinting
89
cuase of peds collapsed thumb
absence of EPB and or EPL
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