Hand

Question 1

most common injury for the skeletal parts of the hand

Answer 1

fracture

Question 2

treatment for displaced fractures

Answer 2

open reduction and internal fixation

Question 3

test for finger alignment

Answer 3

• normal: all fingers except thumb point towards scaphoid

- not observed = fingers cross on top of each other

Question 4

what is boxer’s fracture

Answer 4

• force is borne by smallest portion of 5th metacarpal (fracture of neck)

Question 5

what is gamekeeper’s or skier’s thumb

Answer 5

• avulsion fracture of attachment of ulnar collateral ligament of the thumb
• caused by hyperextension and valgus force on the interphalangeal joint of thumb

Question 6

the strongest ligament at the proximal interphalangeal joint

Answer 6

volar plate

Question 7

injury to volar plate

Answer 7

rupture of volar plate -> dorsal subluxation of proximal interphalangeal joint

• reduction of subluxation requires application of traction and volar pressure on middle phalanx
• splint for 2-3 wks

Question 8

counterpart of volar plate on dorsal side

Answer 8

extensor hood

Question 9

what is boutonniere deformity

Answer 9

the rupture of the extensor hood on the proximal interphalangeal joint

Question 10

what is mallet finger injury

Answer 10

rupture at distal interphalangeal joint

Question 11

management of extensor hood injuries

Answer 11

• traction and dorsal pressure across joint

- immobilization (splint)

Question 12

flexor zones

Answer 12

1: over distal interphalangeal joint
2: over proximal interphalangeal join and metacarpophalangeal joint
3: over palm
4: over wrist
5: over forearm

Question 13

what are pulleys

Answer 13

4 annular pulleys
3 cruciate pulleys

• keep tendon close to bone
• allow more efficient transmission of flexion

Question 14

most important flexor pulleys

Answer 14

a2 and a4

Question 15

what is a bowstring

Answer 15

• rupture of a2 or a4 = less efficient finger flexion

- bowstring effect: tendons move away from bone

Question 16

test for intact flexor tendons

Answer 16

• passively extend wrist = fingers will flex
• passively flex wrist = fingers will extend
• (+) finding = tenodesis effect

Question 17

radial nerve provides sensation to __

Answer 17

• dorsum of thumb, index, and radial side of long finger up to proximal interphalangeal joint

Question 18

test for radial nerve

Answer 18

• pinch dorsal side of first web space

Question 19

what is median nerve

Answer 19

• sensation to volar side of hand

- from thumb to radial side of ring finger

Question 20

what is ulnar nerve

Answer 20

• sensation to the small finger and ulnar side of the ring finger on both volar and dorsal sides

Question 21

carpal tunnel syndrome is caused by __

Answer 21

compression of median nerve

Question 22

symptoms of carpal tunnel

Answer 22

numbness and pain on thumb, index finger, long finger, and radial side of ring finger

Question 23

ten structures that pass through carpal tunnel

Answer 23

• 4 flexor digitorum superficialis tendons
• 4 flexor digitorum profundus tendons
• flexor pollicis longus
• median nerve

Question 24

test for median nerve

Answer 24

phalen’s test and tinel’s test

Question 25

differentials for carpal tunnel

Answer 25

c6-c7 radiculopathy and polyneuropathy in dm

Question 26

diagnosis for carpal tunnel

Answer 26

- emg-ncv - msk uts - check thenar muscles for atrophy (chronic compression)

Question 27

treatment for carpal tunnel

Answer 27

- conservative treatment: splint - pharma: corticosteroid injections - tendon gliding exercises - median nerve mobilization exercises - surgery

Question 28

de quervain's tenosynovitis affects __

Answer 28

extensor pollicis brevis and abductor pollicis longus = pain in area of first dorsal compartment of wrist

Question 29

what is finkelstein's test

Answer 29

- provocative test to reproduce symptoms of de quervain's tenosynovitis

Question 30

treatment for de quervain

Answer 30

- anti-inflammatory drugs - thumb spica splint - corticosteroid injection - surgery (incise retinaculum)

Question 31

what is trigger finger

Answer 31

- overuse of flexor tendon = microtrauma - produce nodules - affect a1 pulley

Question 32

treatment for trigger finger

Answer 32

- corticosteroids - rehab exercises - surgery (incise a1 pulley)