5 Written Questions

1. inserted between 2 others- in layers
   they refer to proximal row as intercalcated b/t radioulnar jt and distal carpal row
2. 
   spans from PCL to volar plate, taut in extension up to 15 flexion
3. an extensor tendon crossing the wrist
   2nd comp most common- fibrosis at insertions
   conservative: wrist splint & avoid pain x 4-6 weeks
   surgical: neutral wrist splint 1-2 weeks then @1-2 wks AROM/PROM, 6 weeks strength
4. Ballottement test
5. Double V shape, thick strong, intracapuslar
   stabilize against hyperexten. & ulnar carpus translation- strongest

5 Matching Questions

1. ECU tenosynovitis: conservative vs surgery
2. trigger finger: post op mgmt
3. MPJ dislocation: conservative txmt protocol
4. VISI: volar intercalcated segmental instability
5. trigger finger: mgmt

1. a LT ligament disruption causing scaphoid to flex pulling lunate with it while unopposed triquetrum extends
   SL angle <30 degrees
2. b neutral wrist splint x 4-6 weeks
   LAS 4-6 weeks, then initiate wrist AROM, 8 weeks initiate supination and pronation
3. c week 1- static PIP ext splint, PROM, scar/wound, desensitization, w/strenous tasks splint in hand based MP or finger based PIP ext
4. d 2 choices: hand based MP extension OR PIP only extended 3-6 weeks- with THUMB, include IP in ext.
5. e DBS extension block at 30-40 MP flexion x 3-4 weeks
   week 1- MPJ AROM in splint
   week 3- MPJ PROM flexion only
   4 weeks AROM OOS
   week 6- prog. strength
   dont sacrifice mobility for stability of joint!

5 Multiple Choice Questions

1. instability within extrinsic ligaments- abnormal motion of entire proximal carpal row at radiocarpal or midcarpal joints(most common)
   aka midcarpal instability
   1. CIND: carpal instability non-dissociative
   2. PALMAR Carpal ligaments include:
   3. Carpal ligaments: dorsal
   4. Carpal ligaments: palmar
2. hand based gutter splint MP @ 30-50
   @ 3-4 weeks change to buddy straps w/AROM
   1. SLAC wrist surgical interventions: 5 for DISI
   2. MP joint collateral differences from PIPJ:
   3. MPJ sprain: conservative txmt for incomplete collateral ligament tear or minor avulsions
   4. DISI: dorsal intercalcated segmental instability
3. debridement or ligament repair or dorsal capsulodesis by reinforcing SL ligament to decrease palmar flexion and dorsal subluxation of scaphoid or ligament reconstruction or partial fusions (SL, STT or SC)
   1. Volar dislocation of PIPJ: surgical txmt
   2. RCL ligament injury splint position:
   3. Surgical intervention options for DISI: SL insufficiency
   4. Contraindication for DISI/VISi treatment:
4. actively and passively unstable, complete disruption of ligament- avulsion fracture or dislocation
   1. Grade I ligament injury:
   2. Lunotriquetral ligament: injury
   3. Grade III ligament injury:
   4. DORSAL Carpal ligaments include:
5. radioscaphoid, radiolunate, radiotriquetral , dorsal intercarpal, trapezium trapeziod, trapezoid capitate, capitate hamate
   1. DORSAL Carpal ligaments include:
   2. Lunotriquetral ligament: injury
   3. Dorsal dislocation of PIPJ:
   4. Carpal ligaments: palmar

5 True/False Questions

1. Sagittal band: complications → extensor lag, radial SB injuries of SF can lead to abduction deformity

   True        False

2. Thumb dorsal dislocation: complex (surgery) → open reduction w/FPL tendon sheath excision & collateral repair-
   dorsal block thumb spica MP @ 30 x 2 weeks
   2 weeks- blocked extension exercises
   6-8 weeks gentle PROM

   True        False

3. 4 corner fusion immoblization time: → immobilized 6-7 weeks

   True        False

4. MPJ sprain: indications for surgery → extensor lag, lack of full flexion, MP immobilized at 30-50 to prevent ligament tightness, gentle intrinsic stretching

   True        False

5. Contraindication for DISI/VISi treatment: → passive forceful flexion which overstretches the ligaments, which increases instability

   True        False