====== Hand Review Course 20007 ======

===== Anatomy of hand (Lluch) =====

  - Ulnar styloid: distal continuation of olecranon
  - ECU: extensor or ulnar deviation dependent on wrist position

Finger ROM arc different with or without intrinsic function

The hand is not a specialized instrument (Lluch)

Functions of the hand: non-prehensile (precision or force - capable of both simultaneously) or prehensile

==== Wrist anatomy (Stanley) ====

  - Tq most important bone; Tq is the engine, Scaphoid is the caboose

==== Diagnostic Imaging (Tsou) ====

  - 25 1mm sections for wrist (3 Tesla MRI)

==== Ligament Reconstruction in the wrist (Tay SC) ====

=== SLD  ===

  - Tenodesis
  - Capsulodesis
  - Bone-tissue-bone: Remote (Navicular-cuneiform, iliac crest), Local
  - IC fusion

=== SLD Tenodesis ===

  - Modified Brunelli with its various modifications
  - 3 ligament reconstruction (Garcias-Elias, Stanley JHSA 06)
  - Modified Brunelli (Talwalker 2006)

=== Moran (JHSA 2006): compared capsulodesis and tenodesis ===

  - decreased ROM
  - no change in ROM
  - capsulodesis: better pain relief
  - tenodesis: better SL angle

=== Treatment algorith for SLD: Garcias-Elias & Stanley (2006) ===

==== Balancing the hand (Lluch) ====

  - radial inclincation of finger is consequence of ulnar drift not cause
  - Ulnar subluxation is the most important cause of ulnar drift

== Correction of ulnar drift in RA ==

  - release ADQM
  - plicate Radial saggital band
  - cross intrinsic transfer: biomechanically sound but not useful

== Swan Neck Deformity ==

  - according to Lluch is secondary to flexor tendon synovitis
  - plus PIPJ volar plate elongation
  - plus imbalance between flexors and extensor

==== Arthroplasty/Fusion (Stanley) ====

  - In post-traumatic OA: soft tissues may be bigger problem than joint itself