Wrist And Hand

Front 1

a. What are the risk factors for carpal tunnel syndrome?

Back 1

i. Diabetes
ii. Pregnancy
iii. Smoking
iv. Repetitive motion

Front 2

b. What are the symptoms of carpal tunnel syndrome?

Back 2

i. Numbness and tingling of radial 3.5 digits
ii. Aching/wasting in thenar region
iii. Worse at night
iv. Dropping objects, can’t open jars

Front 3

c. What nerve innervates the fingertips?

Back 3

i. Proper palmar digital branches of median nerve

Front 4

d. What should you look for in a PE of carpal tunnel syndrome?

Back 4

i. Thenar atrophy
ii. Phalen maneuver
iii. Tinel’s sign

Front 5

e. How do you dx carpal tunnel syndrome?

Back 5

i. Clinical dx from signs and symptoms
ii. Confirmed with EMG-NCV tests

Front 6

f. How do you non-operatively tx carpal tunnel syndrome?

Back 6

i. Activity modification
ii. Night splinting
iii. Steroid injection
iv. NSAID/vitamin B6

Front 7

g. When is surgical intervention indicated in carpal tunnel syndrome?

Back 7

i. When non-responsive to non-operative management for 3 months
ii. Patients show thenar weakness, atrophy, or NCV showing denervation

Front 8

h. What are the outcomes of endoscopic vs. open procedures to treat carpal tunnel syndrome?

Back 8

i. Endoscopic shows earlier return to work

Front 9

i. How well does tx of carpal tunnel syndrome work?

Back 9

i. Up to 25% have persistent symptoms

Front 10

j. What is cubital tunnel syndrome?

Back 10

i. Ulnar nerve entrapment at cubital tunnel

Front 11

k. What is radial tunnel syndrome?

Back 11

i. Entrapment of posterior interosseous nerve

Front 12

l. What is pronator syndrome?

Back 12

i. Median nerve entrapment in proximal forearm

Front 13

m. What is double crush phenomenon?

Back 13

i. Noncomitant cervical nerve root impingement

Front 14

a. What is Dupuytren’s contracture?

Back 14

i. Nodular thickening and contraction of the palmar fascia
ii. Nodules found near distal palmar crease

Front 15

b. With what is Dupuytren’s contracture related?

Back 15

i. Epilepsy
ii. DM
iii. Pulmonary disease
iv. Alcoholism
v. Smoking
vi. Vibrational repetitive trauma

Front 16

c. What fingers are most commonly involved in Dupuytren’s contracture?

Back 16

i. Ring finger
ii. Small finger, middle finger, thumb, index finger

Front 17

d. What is the common presentation of Dupuytren’s contracture?

Back 17

i. Difficulty with grasping objects, gloves, and putting hand in pocket

Front 18

e. How do you tx Dupuytren’s contracture?

Back 18

i. Splints may slow progression, but will not cure
ii. Percutaneous aponeurotomy
iii. **Collagenase injections

Front 19

f. What is the surgery for Dupuytren’s contracture?

Back 19

i. Excision of cords
ii. Release joint contractures
iii. Complex skin closures

Front 20

g. How far are the joints flexed in a repair of Dupuytren’s contracture?

Back 20

i. 30 degrees at MP joint
ii. 10 degrees at PIP joint

Front 21

a. What causes trigger finger?

Back 21

i. Locking of digit caused by thickening of A1 pulley

Front 22

b. What fingers are most often involved in trigger finger?

Back 22

i. Long and ring
ii. Pediatrics-- thumb

Front 23

c. What are the MCC of trigger finger?

Back 23

i. Idiopathic
ii. Rhematoid arthritis
iii. DM

Front 24

d. How do you tx trigger finger?

Back 24

i. Rest
ii. NSAIDs
iii. Injection of SHEATH
iv. Possible surgical release of A1 pulley

Front 25

a. What is DeQuervain’s tenosynovitis?

Back 25

i. Swelling or stenosis of the tendon sheath surrounding the APL and EPB

Front 26

b. In what dorsal compartments are the APL and EPB?

Back 26

i. 1st dorsal compartment

Front 27

c. What are the symptoms of DeQuervain’s tenosynovitis?

Back 27

i. Locking and pain within radial aspect of the wrist
ii. Tenderness to palpation at 1st dorsal compartment on radial side of wrist
iii. Positive Finkelstein test

Front 28

d. How do you perform the Finkelstein test?

Back 28

i. Flexion of thumb into palm and ulnar deviation of the wrist

Front 29

e. How do you tx DeQuervain’s tenosynovitis?

Back 29

i. Thumb spica splint and NSAIDs for 2 weeks
ii. Steroid injection
iii. Surgical release of 1st dorsal compartment

Front 30

f. What is the rule of injections for DeQuervain’s tenosynovitis?

Back 30

i. No more than three

Front 31

a. What causes Jersey finger?

Back 31

i. Trauma
ii. Rhematoid arthritis

Front 32

b. What finger is most often involved in Jersey finger?

Back 32

i. Ring finger

Front 33

c. What zone is injured in Jersey finger? What muscle?

Back 33

i. Zone 1
ii. FDP

Front 34

d. Where is zone 1 in the hand?

Back 34

i. Distal to sublimis

Front 35

e. Where is zone 2 in the hand?

Back 35

f. Where is zone 3 in the hand?

Front 36

g. Where is zone 4 in the hand?

Back 36

i. Carpal tunnel

Front 37

h. Where is zone 5 in the hand?

Back 37

i. Proximal to carpal tunnel

Front 38

i. What muscles insert onto the finger? On what phalanges?

Back 38

i. FDP onto distal phalanx
ii. FDS onto middle phalanx

Front 39

j. How do you test for Jersey finger?

Back 39

i. Test for active flexion and strength
ii. Test DIP and PIP joints independently

Front 40

k. How do you tx Jersey finger?

Back 40

i. Surgical repair within one week of injury

Front 41

a. What is mallet finger?

Back 41

i. Rupture, laceration, or avulsion of the insertion of the extensor tendon at the base of the distal phalanx

Front 42

b. What are the symptoms of mallet finger?

Back 42

i. Inability to fully straighten DIP

Front 43

c. How do you tx mallet finger?

Back 43

i. CONTINUOUS splinting of DIP
ii. 6 weeks full time followed by 2 weeks at night
iii. Keep finger extended while cleaning finger

Front 44

d. How do you reduce mallet finger?

Back 44

i. Axial traction
ii. Test stability and tendons
iii. Buddy tape to adjacent finger

Front 45

a. What is the tx for a fracture of both forearm bones?

Back 45

i. ORIF

Front 46

b. What is a Galeazzi fracture?

Back 46

i. Radial fracture with dislocation of the distal radioulnar joint

Front 47

c. What is a Monteggia fracture?

Back 47

i. Ulnar fracture with dislocation of the proximal radiocapitellar joint

Front 48

a. What causes a scaphoid fracture?

Back 48

i. Fall on outstretched hand

Front 49

b. What are some complications associated with scaphoid fracture?

Back 49

i. High incidence AVN and nonunion

Front 50

c. What are the symptoms of a scaphoid fracture?

Back 50

i. Tenderness and swelling in the anatomic snuffbox

Front 51

d. What will initial x-rays show on a scaphoid fracture?

Back 51

i. Normal

Front 52

e. How do you tx a scaphoid fracture (even a suspected one)?

Back 52

i. Arm cast with thumb spica
ii. Surgical tx preferred

Front 53

f. How long can a scaphoid fracture take to heal?

Back 53

i. 3-6 months

Front 54

a. What causes a boxer’s fracture?

Back 54

i. Direct impact to the metacarpal head

Front 55

b. What type of angulation is present in a boxer’s fracture?

Back 55

i. Distal end of broken metacarpal has volar angulation

Front 56

c. What degree of angulation is acceptable in a boxer’s fracture?

Back 56

i. 10-15 degrees angulation acceptable with reduction

Front 57

d. What degree of angulation is acceptable in a boxer’s fracture of the 5th metacarpal? What happens if the angulation is greater?

Back 57

i. Up to 70 degrees acceptable
ii. Surgery is angulation is greater

Front 58

a. What type of angulation is present in a fracture of the phalanges?

Back 58

i. Dorsal angulation present due to intrinsics

Front 59

b. How do you tx a stable fracture of the phalanges?

Back 59

i. Closed reduction
ii. Splinting

Front 60

c. How do you tx an unstable fracture of the phalanges?

Back 60

i. Closed reduction with percutaneous pinning or ORIF

Front 61

d. What angulation or malrotation is acceptable in a fracture of the phalanges?

Back 61

i. ABSOLUTELY NONE

Front 62

e. What is a Tuft fracture?

Back 62

i. Crush fracture of the distal phalanx

Front 63

f. How do you tx a Tuft fracture?

Back 63

i. Drain sublingual hematoma through hole made with heated paper clip
ii. Apply U-shaped splint with tape to protect finger