A 44-year-old male factory worker presents with a 7-month history of pain and paresthesias involving the palmar aspect of the left thumb, index finger, long finger, and the radial half of the ring finger. He reports that this often occurs at night when trying to go to sleep. He has a history of anemia and obstructive sleep apnea. Percussion over the volar wrist crease produces electric sensation distally in the hand and wrist flexion with the elbow in extension produces thumb paresthesias within 18 seconds. Figure A demonstrates a radiograph of the left hand. A sensory nerve conduction velocity test shows a distal sensory latency of 5.7 ms. Which of the following is the most appropriate next step in management?
Phonophoresis and 6-week course of Vitamin B6 (pyridoxine)
Open carpal tunnel release
1-month course of nonsteroidal anti-inflammatory drugs [NSAIDs] and physical therapy
1-month course of bumetanide, smoking cessation, and physical therapy
May I suggest the new AAOS Guidelines on Carpal Tunnel Syndrome be introduced and the question updated?
Which of the following peripheral nerve structures functions to cushion the nerve against external pressure?
I have read several basic sciences textbooks that describe the epineurium as providing tensile strength whilst the perineurium provides the compressive strength. Given that the epineurium is collagen based this makes sense that it would support the tensile strength. The perineurium limits the spread of oedema and therefore it would make sense that this provides the compressive strength. Any thoughts? Advance
Video showing Elson's test for Boutonniere deformity
Great video indeed, thanks
Video showing Trigger finger.
Under FTSG a "con" for this type of graft is "revascularization takes 2 to 3 days". I think this is an error and refers to STSG. May need editing
At 61 yo and preparing for my 3rd recertification exam(finished 1984), I can only say this question SUCKS!! The stem does not say he ONLY has night time symptoms. There is no one on the planet that would only treat this patient with night splints, additionally, the patient would look at you like you were crazy. NSAIDs, PT and splints, +/- and injection or 2, then surgery. Are y'all (southern) trying to find out what we know, or how well we can read question writer's minds. HELP
A 45-year-old man presents with a three-month history of unilateral symptoms in his right wrist and hand. He first noticed a palpable nodule over the volar aspect of his wrist about three months ago. The nodule would become painful after weekends of heavy drinking at which time he noticed tingling sensation in his index and middle fingers. He notes that ibuprofen has helped improve the pain in the past. On clinical examination, he has a palpable, painless, solid nodule over the volar aspect of his wrist. He has no motor or sensory deficits and negative carpal tunnel provocative tests. An axial CT and MRI image are provided in figures A and B. What would be the most appropriate next step in the management of his symptoms?
Fine needle aspiration
Referral to rheumatologist
The mass is not going to resorb, so ultimately it will need to be excised. Ive had gout for 30 years and seldom does drinking alone cause a flare---a little presumptuous to assume this is a gouty tophus.
Base of Thumb Fractures
May I suggest the inclusion of this excellent short video to explain the difference between the fracture types and the deforming forces. It made everything clear to me.https://www.youtube.com/watch?v=NdcSNRS7PRU
A 34-year-old man sustains a finger flexor tendon laceration and undergoes operative repair. Which of the following statements best describes the tendon motion rehabilitation protocol as depicted in Figures A where the splint holds the wrist at 45 degrees of flexion?
Low force and low excursion
Moderate force and potentially high tendon excursion
Low force and high tendon excursion
High force and high tendon excursion
High force and low tendon excursion
Should replace this picture for the question. One cannot see the wrist position and therefore cannot answer the question.
Peripheral Nerves Injury & Repair
ignore my comment, mistaken!
Think there is error in talking about axontmesis and neurotmesis. It is disruption of Epineurium which distinguishes the two, NOT endoneurium as stated on your page.
DIP and PIP Joint Arthritis
The numbers regarding PIP & DIP fusion tend to be confusing- the degrees differ even within the same chapter of Green 7th ed.
Basilar Thumb Arthritis
Typo: "excision of proximal third of trapezioid excision of proximal third of trapezioidindicationsindications"Also, during the last few years a suture button technique has been around, shouldn't be mentioned already?
Median (FCR/FDS) to Radial (PIN/ECRB) Nerve Transfer with Pronator Teres to ECRB Tendon Transfer
Demonstrates Median (FCR/FDS) to Radial (PIN/ECRB) Nerve Transfer with Pronator Teres to ECRB Tendon Transfer for radial nerve palsy and resulting loss of wrist extension.
Excellent dissection skills.
Agree with Dr Anonymous - wrist looks like it is in extension with MCPJs at 90 = POSI.
Can Med Assoc J. 1963 Sep 07;89:508-12.
Local steroid injection is always successive in management of dequervan in my practice
Chin Med J. 1954 Mar-Apr;72(2):146-52.
De Quervain's Tenosynovitis
Phil,It looks like historically the term TENOVAGINITIS was used, or it was an error. But I have not seen the term used since 1963.Thus proper term is De Quervain's tenosynovitis.DE QUERVAIN'S DISEASE: STENOSING TENOVAGINITIS AT THE RADIAL STYLOID PROCESS.YOUNGHUSBAND OZ, BLACK JDCan Med Assoc J. 1963 Sep 7. 89. :508-12PMID: 14042803 (Link to Abstract)Stenosing tendovaginitis at the radial styloid process (De Quervain's disease).KUO PF, SUN CM, LING LLChin Med J. 1954 Mar-Apr. 72. (2). :146-52PMID: 13172801 (Link to Abstract)
Radial Tunnel Syndrome
Surgical success noted once as 50-90% (and named "disappointing"), then as 70-90% in the last paragraph. Ain't clear at all. Thank you.