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Tendon Transfers And Extras CHT Exam
Questions And Answers Latest Update 2024
regain wrist extension (radial) - correct answers PT to ECRB patients with CP to regain wrist extension (different b/c contacted) - correct answers FCU/FCR to EDC or ECRB wrist flexors have less amplitude than extensors therefore this transfer relies on tenodesis to achieve finger extension thumb extension (radial) - correct answers PL to EPL Boye's transfer (radial) - correct answers FDS of MF to EDC (overcomes tenodesis) FCR to APL/EBP FDS of RF to EPL index finger extension (radial) - correct answers MF FDS to EIP small finger extension (radial) - correct answers RF FDS to EDM
thumb opposition (HIGH median) - correct answers EDM or EIP to APB (pisiform/FCU pulley) ADM to APB ECRL to APB thumb opposition (LOW median) - correct answers RF FDS constructed pulley at pisiform to APB at dorsal ulnar aspect of thumb PL to APB thumb IP flexion (median) - correct answers BR, ECU or ECRL (not as good) to FPL BEST CHOISE IS BR index and long flexion (median) - correct answers FDP from RF/SF to FDP IF/MF ECRL to synchronized FDP tendon unit (if flexor side is lost completely such as with compartment syndrome) thumb adduction (ulnar) - correct answers ECRB to AP (with tendon graft) FDS of rF to AP
primary muscle of thumb opposition - correct answers APB L'Episcipo transfer - correct answers lat and teres major are inserted to new posterolateral insertion on humerus to make functional external rotators instead of internal rotators (common for BP injury) how to differentiate high vs. low UNP? - correct answers loss of wrist flexion in ulnar direction low median and ulnar nerve palsy, lose all intrinsic function... what do you want to restore? - correct answers ECRB to adductor tubercle/AP APL to first DAB EIP to APB BR to lateral bands (helps with clawing) tendon excursion goal? how much motion? - correct answers 3-5 mm excursion is needed for best results with FTR 5 mm excursion = .5 radian = 28.7 degrees (MCP joint) referred pain traps - correct answers face/interscapular region
referred pain scalenes - correct answers posterolateral arm/radial 3 digits referred pain supraspinatus - correct answers lateral arm/forearm referred pain infraspinatus - correct answers lateral arm/forearm and radial hand referred pain lats - correct answers posteromedial arm/forearm and ulnar hand referred pain pecs - correct answers anterior shoulder, medial arm, ulnar digits referred pain subscapularis - correct answers posteromedial arm/wrist referred pain serratus - correct answers medial arm/forearm, ulnar hand/digits Martin-Gruber anastomosis - correct answers communicating branch in forearm involving motor fibers of median or AIN to communicate with ulnar nerve trunk (median-innervated intrinsics with no sensory change)
osteogenesis imperfecta - correct answers inherited condition when bone formation is incomplete, leading to fragile, easily broken bones collagen disorder Type I - less collagen Types 2-3 structurally abnormal collagen Osteochondritis Dissecans - correct answers Fragment of cartilage and underlying bone is detached from articular surface, usually at capitellum Arthrogryposis Multiplex Congenita (AMC) - correct answers -non-progressive neuromuscular disorder -multiple congenital contractures at birth -cylinder-like extremities, significant and multiple contractures, dislocation of joints, muscle atrophy -at least 2 or more in multiple body areas Arthrogryposis Multiplex Congenita amyoplasia type - correct answers symmetrical limb involvement, most common, truncal sparing, above average intelligence, midline hemangioma (second most common is distal arthrogryposis)
hypoplastic digits - correct answers when fingers are poorly formed or absent (floating thumb which is attached by merely piece of connective tissue) clinodactyly vs. camptodactyly - correct answers DIP or PIP of SF clindo - coronal plane and laterally flexed campo - sagittale plane and flexed forward syndactyly - correct answers webbed fingers type I congenital deformity - correct answers failure of formation, arrested development transverse deficiencies, phocomelia phocomelia - correct answers limbs underdeveloped and attached closely to trunk, bones missing in upper and lower arm with hand intact Type II congenital deformity - correct answers failure of differentiation/separation thumb-clutched hand, kirner's deformity
Acrosyndactyly - correct answers partial joining of digits with proximal opening, usually due to IU environmental factors. refusing of tips of fingers after once separated in utero Type VII congenital deformity - correct answers generalized skeletal abnormalities madelung's deformity, mafucci's syndrome Madelung deformity - correct answers Shortened distal radius with prominent ulnar head metabolic conditions associated with hypoplasia of radius
- correct answers VACTERL, Fanconi's anemia (slow growth and congenital malformations, bone marrow failure), Thrombocytopenia-absent radius (TAR), Marfan's syndrome (affects connective tissue with varying levels of severity, can include kypohsocoliosis, convex chest well, flat foot) Rothmund-Thomson Syndrome - correct answers Genomic instability, increased cancer incidence, premature aging, facial rash (pokiloderma) with short stature, spares hair, radial ray defects
Aspert's thumb - correct answers short and angulated, first web space is deficient and requires thumb separation for function Retroflexible thumb - correct answers MCP hyperextended and DIP hyper flexed (resembles type III deformity RA) VACTERL (non-random association of birth deficits) - correct answers vertebral anal atresia (narrowing) cardiac defects tracheal anomalies (tracheoesophageal fistula) esophageal atresia (narrowing) rental and radial sided hand/forearm deficiencies (absent radius) limb anomalies (radial hypoplasia, radial club hand, thumb hypoplasia klippel trenaunay syndrome - correct answers port wine stains with excess one growth and soft tissue growth, varicose veins cleft hand deformity - correct answers absence of digits or metacarpals in central portion of hand with normal radius/ulna
1= slight inc. in tone, catch and release or minimal resistance at end of ROM when affected part moved in flex or ext 1+= slight inc. in tone, catch, followed by min. resistance thru remainder (< half) of ROM, parts move easily 2= more marked inc. in tone through most of ROM, but affected parts easily moved 3= considerable inc. in tone, passive mvmt diff. 4= affected parts rigid in flex or ext Obstetric brachial plexus palsy groups - correct answers Group 1 - C5/ Group 2 - C5/6/ Group 3 - C5/6/7/8, flail extremity Group 4 - C5/6/7/8/T1, flail extremity with Horner's syndrome most distal myoelectric prosthetic option - correct answers trans carpal hand or transmetacarpal hand shoulder dysplasia with OBPP - correct answers deformation of GH joint and muscular imbalances so major muscles overpower weaker therefor adducted and IR, lack PROM ER (best predictive value) and can have glenoid retroversion/sublux of humeral head
cookie crusher prosthesis - correct answers one state, two function one muscle; opens with strong contraction, close with light contraction embryonic limb development - correct answers arm buds
- days 28- elongation - days 34- aptosis/separation of rays - days 52 leg a little slower Apert Syndrome Type I - correct answers spade hand, most common thumb is visible separated from index I/M/RF fused with osseous union (complex syndactyly) and form a flat palm thumb radially deviated and clindodactyly present Apert syndrome Type II - correct answers mitten hand, more serious thumb separated from index but not easily seen b/c can be fused revealing only distal phalanx IF->SF syndactylized with osseous unions and form concave palm
Mayfields first stage of PL dislocation - correct answers tearing of SLIL and palmar radioscaphoid ligaments cause SL dislocation (intrinsic and extrinsic ligament tears) Mayfield second stage of PL dislocation - correct answers capital dislocation through disruption in the space of Poirier (lunocapitate dislocation) Mayfield third stage of PL dislocation - correct answers Tq dislocation at Lunotriquetral joint with tearing of UT and LT ligaments Mayfield fourth stage of PL dislocation - correct answers lunate dislocation with disruption of dorsal radoiocarpal ligaments allowing lunate to rate into carpal tunnel (may be associated with scaphoid or capitate fracture and avulsion fractures of radial or ulnar styloids) crucial secondary stabilizers to SLIL - correct answers dorsal: DIC DRC Palmar: STT ligament RSC ligament LRL & SRL
RSL (Lig. of Testut) UC UL these are important when SLIL is torn. if only SLIL is torn will have dynamic instability, if SLIL and extrinsic secondary stabilizers are torn then will have static instability important intrinsic wrist ligaments and strength - correct answers SL (dorsal strength) LT (volar strength) subscapularis referred pain - correct answers posterior delt, scapula, posterior arm/wrist infraspinatus referred pain - correct answers anterior delt, shoulder joint, medial border of scapular, front/lateral arm/forearm superior glenohumeral ligament stabilization - correct answers from labrum to humerus restraint to inferior translation at 0 degrees of abduction and neutral rotation also prevents translation of long head of biceps tendon (biceps pulley)
Triangular space - correct answers circumflex scapular artery TMaj, TMin, Long head triceps at what temp does manual dexterity dysfunction and nerve/circulatory impairment occur? - correct answers <68 degrees F <20 degrees C recommended to keep fingers above 77 degrees F elbow position for keyboard use - correct answers 45- flexion replantation sequence - correct answers boney fixation extensor tendons flexor tendons nerves arteries veins skin can begin ROM 1 week post-op
high MNP identified by... - correct answers lack of pronation nerve repairs protected for.... - correct answers 3 (to 5) weeks thumb responsible for how much hand function? - correct answers 40-50% tendon transfer protocol s/p radial nerve - correct answers LAS elbow at 90 30-full pronation wrist 45 degrees extension MCP joints 0-15 degrees flexion thumb max extension/abduction 4 weeks post- SAS, MCP flexion, AROM 5 weeks post- reeducation muscle used in transfer 7 weeks post- dynamic splinting how long to immobilize s/p tendon transfer? - correct answers 3-4 weeks
