Proximal phalanx fracture in a 20M (C2737)
20 / M - 20 year old male presents with finger pain after a fall on outstretched hand. Closed injury. XRays are shown.
Is the current position of the fracture acceptable?
Skeletal Radiol. 2015 Dec;44(12):1709-25. Epub 2015 Jul 30.
A 20-year-old man has pain, swelling, and popping over his index metacarpophalangeal joint after striking a wall 3 days ago. Radiographs are normal, but physical exam reveals a palpable defect over the dorsum of the joint with clenching of the fist, and this defect is resolved with extension of the metacarpophalangeal joint. What is the next most appropriate step in treatment?
Trigger finger steroid injection
Extension splinting of the metacarpophalangeal joint
Extensor hood reconstruction
Metacarpophalangeal joint arthrodesis
if green's says acute is till 3 weeks then please correct the info in the topic, now it says extension splint for 4-6 weeks indicationsacute injuries (within one week) which is wrong. thx
Extensor Tendon Injuries
There was a test question regarding the Elson test on the 2016 OITE. You may want to add some further explanation. With the Elson test which evaluates for a central slip injury the DIP joint remains supple because the central slip is intact and the lateral bands are not recruited. With disruption of the central slip, the PIP joint can still be extended, but it is done so by recruiting the lateral bands, which cause the DIP joint to be stiff and even hyperextended. This represents a positive test, disruption of the central slip. Also I think it would be of benefit to have an anatomy section that describes the extensor mechanisms for the finger. Perhaps I just can't find it.
Acute radial tunnel syndrome in a 50F (C2735)
50 / F - A 50 year old female patient presents with insidious onset of pain over the lateral aspect of her left elbow and forearm, which has started radiating down to the left hand.
Her symptoms started 10 days ago. The pain was initially aggravated with activity and relieved with rest. More recently, the pain has persisted even at rest and is increased with activity involving extension of the wrist and elbow as well as shoulder abduction.
She is currently unable to lift a small amount of weight secondary to pain. There was no gross weakness of wrist or finger extension.
What is the likely diagnosis?
Sagittal Band Rupture (traumatic extensor tendon dislocation)
Dear Colleagues, I would be grateful if someone can elaborate more on extensor tendon subluxation with ulnar SB rupture
In biomechanics: it mentions that full section of ulnar SD does not result in tendon subluxation
In the MRI section, the text mentions that subluxation of extensor tendon in radial direction due ulnar SB defect
Can someone explain please?
In Rx section above: casting duration can be up to 5 months! Does anyone know if that is evidence based?
Would anyone agree with me that they would Not want to put the patient in cast that long if they are surgical candidates
Surely, If casting is going to be that long then the pros of surgery would outweight the cons in a patirnt fir for surgery
J Am Acad Orthop Surg. 2007 May;15(5):308-20.
Which of the following patients with Dupuytren's contracture would benefit the most from dermatofasciectomy and full-thickness skin grafting opposed to traditional fasciectomy?
70-year-old sedentary male with small finger involvement isolated to the MCP joint
50-year-old male systems analyst with ring and small finger involvement limited to the MCP joints
65-year-old female golfer with ring and small finger involvement including MCP and PIP joints
40-year-old female stenographer with middle, ring, and small finger involvement including MCP and PIP joints with 50 and 55 degree contractures of ring and small finger MCP joints, respectively
None of the above as no difference in outcome has been demonstrated between the two procedures
Armstrong et al JBJS 2000 - dermofasciectomy <10% recurrence rate
A 28-year-old NFL running back complains of continued hand pain three days following an injury sustained while being tackled. He was splinted on the field. He has tenderness over the long finger metacarpal head, with subluxation of the extensor tendon into the intermetacarpal area during active metacarpophalangeal joint flexion. A representative MRI is shown in Figure A. What is the next best step in management of this patient?
Continued splinting in flexion
Continued splinting in extension
Open repair of the disrupted junctura tendinae
Open repair of the disrupted sagittal band
The answer of 'surgery' is dubious.The evidence to support surgery is at best weak, plus to assume that the patient would want to have surgery as opposed to non operative treatment is quite an assumption. It may be near the end of season, before a long gap in sporting action, the context is not made clear in the question.Plus at the end of the day this comes down to the patient's decision after an informed discussion. Not all athletes will opt for surgery and the chance of a slightly faster recovery given that there are some risks attached.
J Hand Surg Am. 1982 Jul;7(4):404-6.
A 72-year-old female complains of progressive weakness with grasp and key pinch in her left hand. Physical exam of the hand is significant for decreased sensation on the volar aspect of the fourth and fifth digits. Dorsal sensation throughout the hand is normal. A clinical photo displaying bilateral key pinch is shown in Figure A. What is the most likely cause of compression?
Accessory head of the FPL
Flexor carpi ulnaris
Ganglion within Guyon's canal
Froment's paper sign and Jeanne's sign-- unusual etiology.Drury W, Stern PJJ Hand Surg Am. 1982 Jul. pii: S0363-5023(82)80154-8. 7. (4). :404-6PMID: 6288794 (Link to Abstract)Froment's paper sign and Jeanne's sign-- unusual etiology.Drury W, Stern PJJ Hand Surg Am. 1982 Jul. pii: S0363-5023(82)80154-8. 7. (4). :404-6PMID: 6288794 (Link to Abstract)
Similar to Froment’s sign, Jeanne’s sign is also seen in response to pinch forces. Instead of isolated thumb IP flexion as seen in Froment's sign, the IP flexion is accompanied by MP joint hyperextension (Jeanne's sign).https://handlab.com/resources/clinical-pearl-25-froments-sign/
I think this is Jeanne sign !!
Bilateral Madelung Deformity of the Wrist (C2514)
26 / F - History of injury to left wrist 06 months back while playing handball. Had mild pain following injury but did not went for medical help.
Has mild pain left wrist on excessive activities, load lifting and on extreme of forearm movements.
Right hand dominant female.
How would you treat this patient?
The involved wrist needs to be examined for carpal dislocations, SL and other ligament patency,
PIP Fracture Dislocation (C2475)
70 / F - 10 days old injury left middle finger, treated with finger splint
Would you get a CT scan to determine proper treatment?
Too little information and attention to associated conditions. High chance of painful stiff PIP joint or ankylosis with any treatment in a 70-year-old patient 10 days after trauma. The patient should be informed about the necessity of arduous postoperative rehabilitation to regain the PIP joint function. If otherwise healthy patient is confident of being able to actively contribute to long rehabilitation, to the treatments listed above I would add the following. Momentous distraction and external fixation (or just pinning with crossed 2 KW) to have the PIP joint space open for 2-3 weeks. Then removal of implants and rehabilitation. Frequent active motion is of paramount importance. Removal of loose bone fragment/s may be necessary as a secondary procedure.
A 42-year-old male sustains the injury seen in Figure A. Which of the following is true regarding management of this injury?
Replantation at this level has a worse functional outcome when compared to above the elbow amputations
The veins should be reconstructed prior to the arteries
Bony stabilization should occur at the end of the procedure
Vein grafting should not be used at this level of amputation
A warm ischemia time of 8 hours is a relative contraindication to replantation
Intrinsic Minus Hand (Claw Hand)
it will be really useful, if you could describe the procedures in more detail. thank you
Intrinsic Plus Hand
@subbukanu balaravindran.. bunnells test makes sense. just imagine if intrinsics are tight. so the position of the hand will be as MCP flexed and IP extended (the regular actions of Lumbricals and interossei), passive flexion of fingers will be possible to a larger extent. Now once you extend the MCPJ, you are actually going opposite to the actions of intrinsics, this will stretch the intrinsics more (as they are already tight) and will decrease the amount of flexion of PIPJ (because they usually cause PIPJ extension).