Alphonsus Chong's Personal Wiki

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