Delayed Treatment of Flexor Tendons Staged Tendon Reconstruction

Flexor Digitorum Superficialis Tendon

Schneider History and Clinical Presentation An 18-year-old student lacerated both flexor tendons in zone 2 of his right dominant index finger on broken glass. His primary treatment was by direct repair of both flexor tendons 3 days postinjury, and he was started on a mobilization program in a hand therapy unit. Unfortunately, this did not result in functional pull-through of his flexor tendons. He then underwent flexor tenolysis in an attempt to salvage function, a procedure that...

Triscaphe Degenerative Arthritis

A 62-year-old right hand dominant woman who works as a polisher presented with right wrist pain progressively worsening over the last 6 months. She noted significant and progressive difficulty with strength and holding onto small objects. She denied any trauma and noted no specific previous treatment. The patient had specific localized tenderness and swelling of the scaphoid-trapezium-trapezoid STT triscaphe joint. This area is located by following the index meta-carpal proximally until a...

Scapholunate Advanced Collapse

Scaphoid Non Union Advanced Collapse

Siegel History and Clinical Presentation A 54-year-old right hand dominant man who works as a museum director presented with a 3-year history of gradually increasing pain, swelling, and loss of mobility in his right wrist. He also noted the recent onset of nocturnal paresthesias in the sensory distribution of the median nerve. There was no history of trauma, although he had played professional basketball for 12 years. A wrist splint, nonsteroidal antiinflammatory...

Tfcc Compression Test

Ulnar Snuffbox Test

Lunotriquetral LT instability results from a disruption of the dorsal and palmar LT interosseous complex. A spectrum of pathology is possible, proportional to the magnitude and acuity of ligamentous disruption. Degenerative membrane perforation may be asymptomatic. Partial tears of the LT membrane may produce dynamic instability, and complete ligament dissociation may produce a static VISI pattern. Lunotriquetral instability most commonly follows a specific injury. Hyperextension at the wrist...

Complex Regional Pain Syndrome Type 1 Reflex Sympathetic Dystrophy

Agin History and Clinical Presentation A 50-year-old woman was undergoing magnetic resonance imaging MRI with contrast. Intravenous access was started in her right antecubital fossa. As the infusion of gadolinium was started, the patient reported a burning pain in her arm from the antecubital fossa to her fingers. Her forearm and hand swelled. As the swelling increased, she reported numbness and cyanosis. Over the next few days the swelling resolved. Slowly sensation returned to her...

Eponychial Marsupialization

Eponychial Marsupialization

Paronychia is the most commonly seen infection of the hand Warm soaks and antibiotics effective if there is no drainage or fluctuance Eponychial marsupialization for chronic paronychia also remove nail if signs of involvement Herpetic whitlow Acute paronychia Chronic paronychia This patient's presentation is typical of acute paronychia, an infection of the soft tissue folds surrounding the fingernail. The clinical presentation initially consists of localized tenderness of the paronychial...

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome Stages

Do not use this technique in recurrent carpal tunnel syndrome for a repeat procedure when an open procedure was done previously. Never exert force in passing instruments across the ligament without good visualization to avoid cutting the median nerve. A positive Tinel's sign is present directly over the palmar cutaneous branch of the median nerve, which the patient says simulates her numbness and tingling to the thenar eminence. In addition to this, she has an area of numbness of 3 X 2 cm...

Chemotherapy Extravasation

Chemotherapy Extravasation

Intravenous infusion pumps can be particularly dangerous because they can inadvertently force fluid into an extravascu-lar space, producing a compartment syndrome. Pediatric patients can be especially at risk for pump-related problems since the automatic shut off pressure of the pump may be gauged for adult physiology. A specific protocol for administration of doxorubicin hydrochloride Adriamycin should be followed. Preventable problems have been identified as producing extravasation events,...

Brachydactyly Cosmetic Surgery

Polish Syndrome Hand Size

Avoid surgery on mild brachy-dactyly. Avoid distraction osteogenesis at the phalangeal level in brachydactyly. Radiographs of the chest and shoulder were normal. Several views of the hands revealed mild webbing of the second and third web spaces and shortened digits on the right hand, primarily at the middle phalangeal level Fig. 78-2 . Brachydactyly associated with Poland's syndrome Clinodactyly Figure 78 1. A 5-year-old child with small right hand and mild syndactyly of the second and third...

Wrist Drop Radial Nerve Connective Tissue Disease

Brachial Biceps Lipoma

Beware of cervical radicu-lopathy presenting as posterior interosseous syndrome. No sensory symptoms in posterior interosseous syndrome. Beware tendon rupture in rheumatoid patients presenting as posterior interosseous nerve syndrome. Treatment is entirely different. Revisions usually secondary to incomplete release of nerve through supinator. Compression of posterior interosseous nerve has been reported at distal edge of supinator. The right forearm measured 2 cm larger than the left in...