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174 Cards in this Set
- Front
- Back
|
Lumbricals contract when MCP are ____ and IP joints are ____
|
MCP flexed
IP extended |
|
|
what is flexion of the PIP and hyperextension of DIP
|
Boutonniere deformity
|
|
|
Can be caused by injury to the central slip
|
Boutonniere deformity
|
|
|
In a boutonniere deformity the lateral bands sublux doraslly or volarly?
|
Volar
|
|
|
Most important exercise for boutonniere deformity
|
active and passive DIP flexion
Prevent ORL tightness, centralize the lateral bands and advance the central slip |
|
|
When DIP joint flexion is more limited when PIP is passively extended than when flexed, what is tight?
|
ORL (oblique retinacular ligament
|
|
|
How to test for extensor tightness proximal to the wrist
|
Passively hold digits in composite flexion while passively flexing the wrist. If digits are pulled into extension, extrinsic tightness p roximal to the wrist exist.
Note te position of the wrist when ension first detected |
|
|
How to test for extensor tightness distal to the wrist
|
Passively hold the PIP and DIP joints in flexion and passively flex the MCP. If PIP and DIP are pulled into ext than tightness distal to wrist exists
|
|
|
How to test for flexor tightness distal to the wrist
|
Passively hold PIP and DIP in extension and passivley extend the MCP. If the PIP and DIP pull into flexion than tightness exists
|
|
|
How to test for flexor tightness proximal to the wrist
|
Passively maintain full digit extension and passively extended the wrist. If tension pulls the digits into flexion, then extrinsic tightness proximal to the wrist exists.
Note the wrist position |
|
|
How to test for joint capsular tightness
|
If AROM and PROM are the same regardless of the position of the proximal and distal joints, capslar tightness is present
|
|
|
Strongest thumb intrinsic
|
Adductor pollicis (AP)
Stronger than the extrinsic FPL |
|
|
Small and weakest thumb intrinsic
|
Abductor pollicis brevis
|
|
|
Thumb intrinsic that assist with thumb supination, provides thumb MCP stability, assists in extending the thumb IP joint to 0* extension through the extensor mechanism
|
Adductor Pollicis (AP)
|
|
|
If the EPL is impaired or lost, weak IP extension is achieved via insertion of what muscle fibors into the lateral bands?
|
Adductor pollicis (AP)
Together with APB, IP joint extension of the thumb is achieved. |
|
|
DIP joint extension is provided by what structure using a tendoesis effect?
|
Obilique Retinacular Ligament (ORL)
|
|
|
Terminal tendon tenotomoy for treating boutonniere is performed to improved what?
|
Primarily DIP flexion
and secondarily PIP joint extensor deficit may show improvements |
|
|
When can AROM s/p terminal tendon tenotomy be initiated?
|
Immediately
If after surgery ext deficits at the DIP are > 10-15*, may recommend splinting DIP and PIP in full extension for 10 days. DIP joint must be closely monitored for ext lag |
|
|
In swan neck deformity, does the ORL shorten or lengthen?
|
the ORL (Landsmeer's Ligament) lengthens
|
|
|
In swan neck deformity, which directions do the lateral bands displace?
|
Dorsally
|
|
|
What are some causes of swan neck deformity?
|
-Increased forces through extrinsic extensor or intrinsic tendons
-PIP jont instabiity -Loss of FDS tendon -Stretching of the tranverse retinacular ligament -Lax volar plate -release of distal extensor attachment |
|
|
What deformity is summarized with the following imbalances: Transverse retinacular ligaments stretch, triangular ligament fibers shorten, lateral bands sublux dorsally, causing attenuation of the PIP joint volar plate
|
Swan neck deformity
|
|
|
The lumbricals originate from what muscle and insert on the which side of the dorsal apparatus?
|
FDP
Radial side |
|
|
Which is stronger: Lumbricals or Interossei?
|
Interossei
|
|
|
What two muscles flex the MCP and extend the IP?
|
lumbricals and interossei
|
|
|
Conservative treatment for mallet is recommended if less than what % bone is avulsed?
|
1/3
|
|
|
What degree and number of weeks of splinting is recommended for mallet finger?
|
DIP in 0* or hyperextension for 6-8 weeks.
Immobilization is 8 weeks if injury is more than weeks old Additional 2 weeks indicated if pt loses ext quickly once weaned at 6 weeks. |
|
|
Does the ORL extend the DIP?
|
No, it contributes little to to DIP extension
It is considered a retaining ligament that maintains tendon centralizationon the dorsum of the finger |
|
|
The ORL is taut at what degree of DIP flexion?
|
70 degrees
|
|
|
If the ORL is tight, DIP flexion will be limited with PIP flexion or extension?
|
PIP extension
|
|
|
What position is best to stretch the lumbricals?
|
MCP ext or hyperextension and active IP flexion
|
|
|
What structure maintains the central position of the extensor tendon over the MCP joints?
|
Sagittal bands (shroud fibers)
|
|
|
If the sagittal bands attenuate, can a pt extend the MCP from a flexed position?
|
No, however, if placed in MCP to 0* the patient is able to hold the position as the tendon is relocated over the MCP joint
|
|
|
When a pt attempts to make a fist but the IP joints extend rather than flex, this is called what?
|
Paradoxical extension
When the pt attempts to contract the FDP but instead the lumbrical is pulled proximally, thus resulting in IP extension rather than flexion. Can occur if the lumbrical is fibrotic or contracted |
|
|
How is digitial extension achieved?
|
Extrinsic tendons and sagittal bands extend the MCP joint, intrinsic musculature forming oblique fibers extend the PIP joint, lateral bands conjoin to extend the DIP joint
|
|
|
For boutonniere deformity, what is the splint position and exercise recommendation?
|
Uninterrupted PIP Joint ext in 0* for 6 weeks to allow for healing of central slip. DIP joint free with AROM DIP flexion to stretch ORL.
|
|
|
TRUE/FALSE: The radial intrinsics of a patient with RA become tighter than the ulnar intrinsics
|
False
The ulnar intrinsics become contracted because of a variety of dynamic and anatomic factores that occure in the RA hand, which can result in ulnar drift. |
|
|
What muscle arises and inserts into a tendon?
|
Lumbricals
Arise from the FDP and insert into the extensor expansion of the EDC. |
|
|
What is the primary action of the lumbricals?
|
To extend the IP joints and weak flexors of the MCP joint
|
|
|
How can you recognize a boutinniere deformity in the early stages?
|
Hold the PIP jong in full extension and test the amount of DIP joint passive flexion. If the lateral bands have migrated volarly, DIP joint flexion will decrease
|
|
|
What structures form the critical corner?
|
Volar plate, proper collateralligament, accessory collateral ligament where they converge at the base of the Middle phalanx to provide stability to the PIP joint
|
|
|
For the PIP joint:
the Accessory collateral ligament is taut in ______ & the Proper Collateral Ligament is taut in _____ |
Extension
Flexion |
|
|
For the PIP jt, the lateral bands displace ____ in flexion
|
Volarly
|
|
|
What are the three surgical procedures used to retore MCP flexion with intrinsic paralysis due to ulnar nerve palsy?
|
Modified Stiles Bunnell Transfer (FDS 4-tail)
Brand's Intrinsic Transfer (ECRL 4-tail) Zancolli's Lasso Producure (FDS Lasso) |
|
|
Explain Stiles Bunnell Transfer (FDS 4-tail)
|
FDS of Long Finger is split into four equal tails. Each slip is passed throught the Lumbrical Canal of each finger and inserted into the Radial lateral bands of the MF, RF, SF and ulnar lateral band of IF.
|
|
|
Explain Brand's Intrinsic Transfer (ECRL 4-tail)
|
A Free tendon graft (usually plantaris tendon) is sutured to the distal end of the ECRL and divided into 4 slips. Four slips are passed through the interesseous space deep to the deep transverse metacarpal ligament and stitched to the radial lateral bands of MF, RF, SF and unlar lateral band of IF.
|
|
|
Explain the Zancollie's Lasso (FDS Lasso)
|
FDS tendon is divided at the level of P1 of each finger. The proximal stump is pulled back, looped around the A1 pulley and sutured on itself at the level of the MCP.
After surgery, MCPj are maintained at 60-70 of flex, IP in full ext. May be in splint for up to 12 weeks. |
|
|
With ulnar nerve injuries with intrinsic paralysis, what muscles are lost?
|
Hypothenar
Ulnar two lumbricals Interossei Adductor Pollicis muscles |
|
|
What muscles supply balance to the flexor and extensor systems?
What can occur is these muscles are lost? |
Lumbricals and Interossei
Claw Hand |
|
|
Claw hand deformity is an intrinsic plus or minus posture?
|
Minus
|
|
|
Muscle that has a moving site of origin
|
Lumbricals
|
|
|
Inserts all along the body of the first metacarpal and rotates the thumb medially
|
Opponens Pollicis Brevis
|
|
|
Adducts the thumb, IF, RF, SF
|
Palmer/Volar Interossei
|
|
|
Adducts thumb to the palms, fives power for grasping, inserts into the extensor mechanism to assist the IPj of the thumb into 0 deg of ext
|
Adductor Pollicis
|
|
|
Inserts on the medial or lateral aspects of the P1 into the lateral band of the extensor mechanism
|
Interossei
|
|
|
Increases span of grasp and assists with flexion of the SF MCPjt
|
Abductor digiti minimi
|
|
|
Originates from the fascia and transverse carpal ligament and inserts on the P1 and extensor mechanism of the thumb, helps to extend the IPj to 0 deg of ext
|
Abductor pollicis brevis
|
|
|
Wrinkles the skin on the ulnar side of the palm
|
Palmaris brevis
|
|
|
Rotates and draws fifth metacarpal anteriorly
|
Opponens digiti minimi
|
|
|
Assists with thumb adduction and plays a significant role for writing and typing
|
First dorsal interossei
|
|
|
What ligament incirles the PIP jt?
|
Transverse retinacular ligament
Restrains dorsla displacement of the lateral bands. |
|
|
What can occur if the tranverse retinacular ligament is ruptured?
|
Swan neck deformity
|
|
|
What ligament at the PIP holds the lateral bands dorsally?
and loss of this results in the development of what? |
Triangular ligament
Boutonniere deformity |
|
|
What muscle plays in important part in lateral pinch and why?
|
First dorsal interossei because it stabilizes the first CMC t during lateral pinch and power grasp.
Without it, the CMC would radially sublux when loaded |
|
|
Taut at 25 deg of IP flexion
|
Proper collateral ligament
|
|
|
Prevents dorsal bowstringing
|
Sagittal bands
|
|
|
Brodmann Area 44, 45
|
Broca's motor speech area (44, 45)
Nonfluent Aphasia |
|
|
Provides the pulley mechanism for the flexor tendon sheath
|
Transverse carpal ligament
|
|
|
Stabilizes the MCP volar plates
|
Deep transverse metacarpal ligament
|
|
|
Contractures of this ligament prevent MCP flexion
|
MCP collateral ligaments
|
|
|
Prevents dorsal shifting of the lateral bands
|
Tranverse retinacular ligament
|
|
|
Works with the volar plate to stabilize the IP joint fro lateral stresses
|
Accessory collateral ligaments
|
|
|
A sprain to the PIP joing most frequently involves to what ligament?
|
Radial collateral ligament and volar plate
|
|
|
A pseudoboutonniere deformity most commonly occurs in whch finger?
|
Small finger
|
|
|
What is a pseudoboutonniere deformity?
|
Flexion deformity of the PIP joint without DP hyperextension.
|
|
|
Is the FDS injured in a volar dislocation of the PIP joint?
|
No
|
|
|
What are some secondary defects with intrinsic paralysis?
|
Flexion contractures of the PIPjt
Extrinsic flexor tightness Anterior displacemnt of the lateral bands Attenuation of the extensor mechanism |
|
|
How much strength does the intrinsic muscles contribute for power grasp?
|
50%
In a high ulnar injury with loss of 4&5th FDP, up to 60%-80% loss |
|
|
What are some causes of paradoxical extension?
|
Unrepaired profunds tendon distal to the insertion of the superficialis tendon
Heavy adhesions on the profundus tendon distal to the lumbrical insertion An FDF graft that is too long |
|
|
What muscle makes true thumb opposition possible?
|
Opponens pollicis,
without it the thumb is unalbe to rotate or pronate |
|
|
With a median nerve palsy, can the thumb achieve true opposition?
|
No, not without the median innervated Opponens Pollicis.
The FPB can substitue for palmer abduction but this assists with lateral pinch, not opposition |
|
|
T/F
Surgical overcorrection of the paralytic claw hand will turn into an intrinsic plus deformity |
True
|
|
|
What are primary stabilizers of the PIPjt?
|
Proper collateral ligament and accessory collateral ligament
|
|
|
In full PIP extension:
the ACL is ____ the PCL is ____ |
ACL is taut
PCL is slack |
|
|
In full PIP flexion
the ACL is ____ the PCL is ____ |
ACL is slack
PCL is taut |
|
|
What position is recommended for splinting PIP collateral ligament injuries?
|
0-15 deg flexion
|
|
|
What is "saddle syndrome"?
|
Painful adhesions of the interosseous-lumbrical tendons
(will experience pain with the Bunnell Test, passive flexion of the IPjt while the MCPjt is supported in extension) |
|
|
Lumbricals contract when MCP are ____ and IP joints are ____
|
MCP flexed
IP extended |
|
|
what is flexion of the PIP and hyperextension of DIP
|
Boutonniere deformity
|
|
|
Can be caused by injury to the central slip
|
Boutonniere deformity
|
|
|
In a boutonniere deformity the lateral bands sublux doraslly or volarly?
|
Volar
|
|
|
Most important exercise for boutonniere deformity
|
active and passive DIP flexion
Prevent ORL tightness, centralize the lateral bands and advance the central slip |
|
|
When DIP joint flexion is more limited when PIP is passively extended than when flexed, what is tight?
|
ORL (oblique retinacular ligament
|
|
|
How to test for extensor tightness proximal to the wrist
|
Passively hold digits in composite flexion while passively flexing the wrist. If digits are pulled into extension, extrinsic tightness p roximal to the wrist exist.
Note te position of the wrist when ension first detected |
|
|
How to test for extensor tightness distal to the wrist
|
Passively hold the PIP and DIP joints in flexion and passively flex the MCP. If PIP and DIP are pulled into ext than tightness distal to wrist exists
|
|
|
How to test for flexor tightness distal to the wrist
|
Passively hold PIP and DIP in extension and passivley extend the MCP. If the PIP and DIP pull into flexion than tightness exists
|
|
|
How to test for flexor tightness proximal to the wrist
|
Passively maintain full digit extension and passively extended the wrist. If tension pulls the digits into flexion, then extrinsic tightness proximal to the wrist exists.
Note the wrist position |
|
|
How to test for joint capsular tightness
|
If AROM and PROM are the same regardless of the position of the proximal and distal joints, capslar tightness is present
|
|
|
Strongest thumb intrinsic
|
Adductor pollicis (AP)
Stronger than the extrinsic FPL |
|
|
Small and weakest thumb intrinsic
|
Abductor pollicis brevis
|
|
|
Thumb intrinsic that assist with thumb supination, provides thumb MCP stability, assists in extending the thumb IP joint to 0* extension through the extensor mechanism
|
Adductor Pollicis (AP)
|
|
|
If the EPL is impaired or lost, weak IP extension is achieved via insertion of what muscle fibors into the lateral bands?
|
Adductor pollicis (AP)
Together with APB, IP joint extension of the thumb is achieved. |
|
|
DIP joint extension is provided by what structure using a tendoesis effect?
|
Obilique Retinacular Ligament (ORL)
|
|
|
Terminal tendon tenotomoy for treating boutonniere is performed to improved what?
|
Primarily DIP flexion
and secondarily PIP joint extensor deficit may show improvements |
|
|
When can AROM s/p terminal tendon tenotomy be initiated?
|
Immediately
If after surgery ext deficits at the DIP are > 10-15*, may recommend splinting DIP and PIP in full extension for 10 days. DIP joint must be closely monitored for ext lag |
|
|
In swan neck deformity, does the ORL shorten or lengthen?
|
the ORL (Landsmeer's Ligament) lengthens
|
|
|
In swan neck deformity, which directions do the lateral bands displace?
|
Dorsally
|
|
|
What are some causes of swan neck deformity?
|
-Increased forces through extrinsic extensor or intrinsic tendons
-PIP jont instabiity -Loss of FDS tendon -Stretching of the tranverse retinacular ligament -Lax volar plate -release of distal extensor attachment |
|
|
What deformity is summarized with the following imbalances: Transverse retinacular ligaments stretch, triangular ligament fibers shorten, lateral bands sublux dorsally, causing attenuation of the PIP joint volar plate
|
Swan neck deformity
|
|
|
The lumbricals originate from what muscle and insert on the which side of the dorsal apparatus?
|
FDP
Radial side |
|
|
Which is stronger: Lumbricals or Interossei?
|
Interossei
|
|
|
What two muscles flex the MCP and extend the IP?
|
lumbricals and interossei
|
|
|
Conservative treatment for mallet is recommended if less than what % bone is avulsed?
|
1/3
|
|
|
What degree and number of weeks of splinting is recommended for mallet finger?
|
DIP in 0* or hyperextension for 6-8 weeks.
Immobilization is 8 weeks if injury is more than weeks old Additional 2 weeks indicated if pt loses ext quickly once weaned at 6 weeks. |
|
|
Does the ORL extend the DIP?
|
No, it contributes little to to DIP extension
It is considered a retaining ligament that maintains tendon centralizationon the dorsum of the finger |
|
|
The ORL is taut at what degree of DIP flexion?
|
70 degrees
|
|
|
If the ORL is tight, DIP flexion will be limited with PIP flexion or extension?
|
PIP extension
|
|
|
What position is best to stretch the lumbricals?
|
MCP ext or hyperextension and active IP flexion
|
|
|
What structure maintains the central position of the extensor tendon over the MCP joints?
|
Sagittal bands (shroud fibers)
|
|
|
If the sagittal bands attenuate, can a pt extend the MCP from a flexed position?
|
No, however, if placed in MCP to 0* the patient is able to hold the position as the tendon is relocated over the MCP joint
|
|
|
When a pt attempts to make a fist but the IP joints extend rather than flex, this is called what?
|
Paradoxical extension
When the pt attempts to contract the FDP but instead the lumbrical is pulled proximally, thus resulting in IP extension rather than flexion. Can occur if the lumbrical is fibrotic or contracted |
|
|
How is digitial extension achieved?
|
Extrinsic tendons and sagittal bands extend the MCP joint, intrinsic musculature forming oblique fibers extend the PIP joint, lateral bands conjoin to extend the DIP joint
|
|
|
For boutonniere deformity, what is the splint position and exercise recommendation?
|
Uninterrupted PIP Joint ext in 0* for 6 weeks to allow for healing of central slip. DIP joint free with AROM DIP flexion to stretch ORL.
|
|
|
TRUE/FALSE: The radial intrinsics of a patient with RA become tighter than the ulnar intrinsics
|
False
The ulnar intrinsics become contracted because of a variety of dynamic and anatomic factores that occure in the RA hand, which can result in ulnar drift. |
|
|
What muscle arises and inserts into a tendon?
|
Lumbricals
Arise from the FDP and insert into the extensor expansion of the EDC. |
|
|
What is the primary action of the lumbricals?
|
To extend the IP joints and weak flexors of the MCP joint
|
|
|
How can you recognize a boutinniere deformity in the early stages?
|
Hold the PIP jong in full extension and test the amount of DIP joint passive flexion. If the lateral bands have migrated volarly, DIP joint flexion will decrease
|
|
|
What structures form the critical corner?
|
Volar plate, proper collateralligament, accessory collateral ligament where they converge at the base of the Middle phalanx to provide stability to the PIP joint
|
|
|
For the PIP joint:
the Accessory collateral ligament is taut in ______ & the Proper Collateral Ligament is taut in _____ |
Extension
Flexion |
|
|
For the PIP jt, the lateral bands displace ____ in flexion
|
Volarly
|
|
|
What are the three surgical procedures used to retore MCP flexion with intrinsic paralysis due to ulnar nerve palsy?
|
Modified Stiles Bunnell Transfer (FDS 4-tail)
Brand's Intrinsic Transfer (ECRL 4-tail) Zancolli's Lasso Producure (FDS Lasso) |
|
|
Explain Stiles Bunnell Transfer (FDS 4-tail)
|
FDS of Long Finger is split into four equal tails. Each slip is passed throught the Lumbrical Canal of each finger and inserted into the Radial lateral bands of the MF, RF, SF and ulnar lateral band of IF.
|
|
|
Explain Brand's Intrinsic Transfer (ECRL 4-tail)
|
A Free tendon graft (usually plantaris tendon) is sutured to the distal end of the ECRL and divided into 4 slips. Four slips are passed through the interesseous space deep to the deep transverse metacarpal ligament and stitched to the radial lateral bands of MF, RF, SF and unlar lateral band of IF.
|
|
|
Explain the Zancollie's Lasso (FDS Lasso)
|
FDS tendon is divided at the level of P1 of each finger. The proximal stump is pulled back, looped around the A1 pulley and sutured on itself at the level of the MCP.
After surgery, MCPj are maintained at 60-70 of flex, IP in full ext. May be in splint for up to 12 weeks. |
|
|
With ulnar nerve injuries with intrinsic paralysis, what muscles are lost?
|
Hypothenar
Ulnar two lumbricals Interossei Adductor Pollicis muscles |
|
|
What muscles supply balance to the flexor and extensor systems?
What can occur is these muscles are lost? |
Lumbricals and Interossei
Claw Hand |
|
|
Claw hand deformity is an intrinsic plus or minus posture?
|
Minus
|
|
|
Muscle that has a moving site of origin
|
Lumbricals
|
|
|
Inserts all along the body of the first metacarpal and rotates the thumb medially
|
Opponens Pollicis Brevis
|
|
|
Adducts the thumb, IF, RF, SF
|
Palmer/Volar Interossei
|
|
|
Adducts thumb to the palms, fives power for grasping, inserts into the extensor mechanism to assist the IPj of the thumb into 0 deg of ext
|
Adductor Pollicis
|
|
|
Inserts on the medial or lateral aspects of the P1 into the lateral band of the extensor mechanism
|
Interossei
|
|
|
Increases span of grasp and assists with flexion of the SF MCPjt
|
Abductor digiti minimi
|
|
|
Originates from the fascia and transverse carpal ligament and inserts on the P1 and extensor mechanism of the thumb, helps to extend the IPj to 0 deg of ext
|
Abductor pollicis brevis
|
|
|
Wrinkles the skin on the ulnar side of the palm
|
Palmaris brevis
|
|
|
Rotates and draws fifth metacarpal anteriorly
|
Opponens digiti minimi
|
|
|
Assists with thumb adduction and plays a significant role for writing and typing
|
First dorsal interossei
|
|
|
What ligament incirles the PIP jt?
|
Transverse retinacular ligament
Restrains dorsla displacement of the lateral bands. |
|
|
What can occur if the tranverse retinacular ligament is ruptured?
|
Swan neck deformity
|
|
|
What ligament at the PIP holds the lateral bands dorsally?
and loss of this results in the development of what? |
Triangular ligament
Boutonniere deformity |
|
|
What muscle plays in important part in lateral pinch and why?
|
First dorsal interossei because it stabilizes the first CMC t during lateral pinch and power grasp.
Without it, the CMC would radially sublux when loaded |
|
|
Taut at 25 deg of IP flexion
|
Proper collateral ligament
|
|
|
Prevents dorsal bowstringing
|
Sagittal bands
|
|
|
Prevents volar shifting of the lateral bands
|
Triangular ligament
|
|
|
Provides the pulley mechanism for the flexor tendon sheath
|
Transverse carpal ligament
|
|
|
Stabilizes the MCP volar plates
|
Deep transverse metacarpal ligament
|
|
|
Contractures of this ligament prevent MCP flexion
|
MCP collateral ligaments
|
|
|
Prevents dorsal shifting of the lateral bands
|
Tranverse retinacular ligament
|
|
|
Works with the volar plate to stabilize the IP joint fro lateral stresses
|
Accessory collateral ligaments
|
|
|
A sprain to the PIP joing most frequently involves to what ligament?
|
Radial collateral ligament and volar plate
|
|
|
A pseudoboutonniere deformity most commonly occurs in whch finger?
|
Small finger
|
|
|
What is a pseudoboutonniere deformity?
|
Flexion deformity of the PIP joint without DP hyperextension.
|
|
|
Is the FDS injured in a volar dislocation of the PIP joint?
|
No
|
|
|
What are some secondary defects with intrinsic paralysis?
|
Flexion contractures of the PIPjt
Extrinsic flexor tightness Anterior displacemnt of the lateral bands Attenuation of the extensor mechanism |
|
|
How much strength does the intrinsic muscles contribute for power grasp?
|
50%
In a high ulnar injury with loss of 4&5th FDP, up to 60%-80% loss |
|
|
What are some causes of paradoxical extension?
|
Unrepaired profunds tendon distal to the insertion of the superficialis tendon
Heavy adhesions on the profundus tendon distal to the lumbrical insertion An FDF graft that is too long |
|
|
What muscle makes true thumb opposition possible?
|
Opponens pollicis,
without it the thumb is unalbe to rotate or pronate |
|
|
With a median nerve palsy, can the thumb achieve true opposition?
|
No, not without the median innervated Opponens Pollicis.
The FPB can substitue for palmer abduction but this assists with lateral pinch, not opposition |
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T/F
Surgical overcorrection of the paralytic claw hand will turn into an intrinsic plus deformity |
True
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What are primary stabilizers of the PIPjt?
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Proper collateral ligament and accessory collateral ligament
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In full PIP extension:
the ACL is ____ the PCL is ____ |
ACL is taut
PCL is slack |
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In full PIP flexion
the ACL is ____ the PCL is ____ |
ACL is slack
PCL is taut |
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What position is recommended for splinting PIP collateral ligament injuries?
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0-15 deg flexion
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What is "saddle syndrome"?
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Painful adhesions of the interosseous-lumbrical tendons
(will experience pain with the Bunnell Test, passive flexion of the IPjt while the MCPjt is supported in extension) |
