Learn to interpret NCV
This video except the first 10 mins tells beautifully who want to learn too interpret NCV
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Ligaments of the Fingers
Ignore the last long video it is very elementalThis is better https://m.youtube.com/watch?v=MzO9GFZPfqc
A 64-year-old diabetic female presents with sudden catching and locking of her ring finger when trying to extend it. Attempts at finger extension are painful, and she notes tenderness in her distal palm. A clinical photo is shown in Figure A. Which of the following structures are implicated in the pathogenesis of this condition?
Extensor digitorum tendon
Oblique retinacular ligament
Transverse carpal ligament
Recent studies on cost effectiveness of trigger finger treatment in diabetic patients would advocate for early surgical release rather than steroid injections. Office based needle releases were shown to be most cost effective, however, surgical release was also more cost effective in the diabetic patient population. More importantly, the pathologic lesion is synovitis of the flexor tenosynovium and not an inherent problem with the A1 pulley.
Chronic injury to what anatomic structure can lead to a boutonnière deformity of the finger?
terminal extensor tendon
flexor digitorum profundis tendon insertion
central slip of the extensor tendon
hello. First of all let me state that I am clear that a central slip tear will cause the lateral bands to sublux inferiorly thus changing the vector of force into a pip flexion and dip extension; however, what i am not clear is the fdp rupture option, which to my understanding an fdp rupture with significant tendon retraction can pull on lumbricals (which originate from fdp) and thus cause lumbrical plus deformity = boutonniere deformity. Is this pattern of thinking incorrect? thanks in advance.
A 50-year-old man complains of numbness and tingling along his right small finger. Physical exam is notable for the finding demonstrated in Figure A. Elbow flexion reproduces the numbness and tingling. Physical therapy and splinting have failed to relieve the symptoms. Which of the following is the most appropriate surgical intervention to alleviate the symptoms while minimizing complications?
Simple ulnar nerve decompression at the cubital tunnel
Ulnar nerve decompression at the cubital tunnel with anterior submuscular transposition
Ulnar nerve decompression at the cubital tunnel with anterior subcutaneous transposition
Open carpal tunnel release
Endoscopic carpal tunnel release
why simple decompression. This patient clearly has denervation of the dorsal web muscles. in the review of the information provided it clearly states:indicationswhen nonoperative management failsbefore motor denervation occursRemove picture and give the basic information. Very bad question, and worse answer. Not the first time seeing this in provided questions. very disapointing.
A 50-year-old woman sustains an open both bone forearm fracture seen in Figure A and undergoes the treatment seen in Figure B. During surgery the posterior interosseous nerve was transected and primary repair was attempted. One year following surgery the patient continues to have no posterior interosseous nerve function. Which of the following treatments will best restore function?
Sural nerve grafting to the posterior interosseus nerve
Wrist fusion with transfer of the flexor carpi ulnaris to the finger extensors
Transfer of the flexor carpi radialis to extensor digitorum and the palmaris longus to the extensor pollicis longus
Transfer of the pronator teres to the wrist extensors and the palmaris longus to the finger extensors
Transfer of the flexor carpi ulnaris to the wrist extensors and the palmaris longus to the extensor pollicis longus
There are many options for high radial nerve palsy. This transfer is a modified Jones/Tsuge/Boyd:1. Pronator teres to ECRB2. Flexor carpi radialis to the finger extensors [extensor digitorum communis (EDC)]3. Palmaris longus to extensor pollicis longusIf only PIN involved (i.e. not high radial nerve), then only have to do 1 and 2.
Video showing Elson's test for Boutonniere deformity
Flexor tendons of the fingers within Zone 2 receive their primary nutritional supply from:
Diffusion from the synovial sheath
In your notes, you mention that, "it is the more important source proximal to the MCP joint." Might want to clarify or update that since Zone 2 is for the most part distal to the MCP joint.
A 35-year-old woman reports wrist pain after a fall onto an outstretched hand. On exam, she has focal tenderness over the wrist snuffbox. A radiograph and CT image are shown in Figures A and B. What is the proper treatment of her injury?
Rest, ice, elevation
Removable splint for comfort
Thumb spica cast
Open reduction, internal fixation
Vascularized bone grafting
SNAC (Scaphoid Nonunion Advanced Collapse)
Might be better to have the word "least" in capital letters.
All of the following factors are favorable for digit survival after replantation surgery EXCEPT?
Sharply amputated digit
Crushed amputated digit
Warm ischemia time of 8 hours
Patient age of 10 years
Miller Review 2017: Operative sequence of replantationBone stabilization, usually with shorteningExtensor tendon repairFlexor tendon(s) repairArterial reanastomosisVenous reanastomosisNerve repairSkin approximation (loose)AAOS Review 2017: BoneExtensor Tendons One artery anastomosis to restore circulation Venous Anastomoses Flexor Tendons Secondary Artery Anastomosis Nerve repairs Fasciotomy and skin closure (usually with skin grafting)
You are seeing a 24-year-old male in the emergency room after he was involved in a knife fight. He has severed the common digital nerve to the index finger on his dominant hand, with an 8mm gap between nerve ends. In counseling him about repair, which of the following options is as good as autologous nerve grafting?
Glycolide trimethylene carbonate conduit
Primary end-to-end repair
Polyglycolic acid conduit
According to the last referenced evidence from Dr. Kakar, the correct answer should be polyglycolic acid conduit. Either that or further evidence needs to be presented or the question modified to fit the referenced material.
Non-united Proximal Pole Scaphoid Fracture in a 20M (C2776)
20 / M - Neglected trauma to right wrist 15 months ago.
How would you manage this patient?
Thanks for posting this case, I think this tiny proximal pole piece is avascular, sclerotic and not amenable for fixation. Excision is a good option but u have to check the integrity of scapholunate ligament.This screw should be taken out as soon as possible as it is a mechanical block to any wrist movements.U could have used K wire if headless screws are not available!!
Release of ulnar deep motor branch in Guyon's canal and carpal tunnel release
Demonstrates ulnar nerve being decompressed in the wrist through Guyon's canal and in the hand in addition to carpal tunnel release.
Thank you Susan
primary excision of proximal pole could be more beneficial for less pain and arthritic changes .
Intrinsic Minus Hand (Claw Hand)
I believe the second illustration has the FDP and FDS labeled incorrectly. Thanks,Brandon