J Bone Joint Surg Am. 2008 Mar;90 Suppl 2 Pt 1:74-86.
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
While the question implies gout, given the lack of prior history, I would argue that an FNA to confirm tophaceous gout would be appropriate as the next step, as other diseases such as amyloidosis and tumoral calcinosis might present in a similar fashion. With a diagnosis in hand (so to speak), then medical management provided by a rheumatologist would be logical.
Chronic wrist pain in a 50M (C2766)
50 / M - Pain in wrist for more than 1 year. No history of trauma.
What is the likely diagnosis?
I think the URV is unnormal so kinbock disese may be in the mind
we need lateral and scaphoid wrist x-ray, and mri. and have to been sure that no history of trauma. because scapholunat joint and radiocarpal joint doesn't seem good
A 27-year-old man falls on his hand at work. He notices an immediate deformity of his ring finger. Radiographs are provided in Figure A. Which of the following is the most appropriate initial treatment?
Closed reduction, buddy taping, and early motion to prevent stiffness
Closed reduction and full time extension splinting
Open reduction and repair of the central slip of the extensor tendon
Open reduction and repair of the volar plate
Amputation and immediate return to work
Poor question - one would reduce and re-assess the finger in terms of PIPJ stability/tendons. Then decide plan.
Principles of Tendon Transfer
Tendon transfers may reconstruct loss of function through injury, disease or congenital absence. The principles are simple and should be adhered to wherever possible to ensure reliable outcomes for patients.
Excellent presentation. Thank you
Carpal Tunnel Syndrome
IN idiopathic CTS pathology is edema and fibrosis (not inflamation)inflmation may be a cause in rheumatoid arthritis
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
What range of excursion qualifies as "high" vs "low"?
J Plast Surg Hand Surg. 2015 Jun;49(3):160-5. Epub 2014 Oct 7.
J Hand Surg Am. 2015 May;40(5):908-13.e1. Epub 2015 Mar 6.
Clin Orthop Surg. 2012 Mar;4(1):58-65. Epub 2012 Feb 20.
J Pediatr Orthop. 2015 Dec;35(8):838-43.
A 27-year-old male presents with finger pain 2 days after suffering an injury while playing basketball. Physical exam shows swelling of the distal interphalangeal joint with no evidence of open injury. A radiograph is shown in Figure A. Which of the following is the most appropriate treatment at this time?
Extension splinting of DIP joint for 6-8 weeks
Closed reduction and percutaneous pinning
Open reduction and internal fixation
Swan neck deformity correction
Is this not a contradiction between proposed answer and explanation offered
Peripheral Nerves Injury & Repair
This is Question 100 from this years OITE...Following peripheral nerve injury, distal recovery typically occurs first in1. motor function.2. proprioception.3. sympathetic activity.4. temperature.5. pain perception.PREFERRED RESPONSE: 3RECOMMENDED READINGSJackson WM, Diao E. Peripheral nerves: form and function. In: O’Keefe RJ, Jacobs JJ, Chu CR, Einhorn TA, eds. Orthopaedic Basic Science: Foundations of Clinical Practice. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2013: 239-252.Dodds SD. Peripheral nervous system. In: Boyer, MI. ed. AAOS Comprehensive Orthopaedic Review 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 113-126.You guys have above..."return of function - pain is first modality to return" - may want to revisit this issue for testing purposes.
Congenital Dislocation of Radial Head
What is the problem with leaving it there? is there a complication with no surgery?
Bone Joint J. 2015 Nov;97-B(11):1582-7.
J Hand Surg Am. 2012 Jan;37(1):159-64. Epub 2011 Nov 30.