Free Orthopedics Review | Dr Hutaif General Orthopedics -...

In comparing the clinical efficacy of intra-articular sodium hyaluronate injections vs triamcinolone injections for the treatment of hallux rigidus, which factor showed significantly better improvement in the sodium hyaluronate group:

Which anatomical feature does not predispose patients to peroneal tendon dislocation:

A 39-year-old man has a forced dorsiflexion injury while skiing. Radiographs taken in the emergency department show a small avulsion flake off the lateral surface of the fibula distally on the mortise view. This patient most likely has:

Which of the following is not considered to be a risk factor for peroneal tendon tears:

The thoracic outlet syndrome is characterized by:

A typical presentation of thoracic outlet syndrome is likely to include:

Primary treatment of thoracic outlet syndrome should include:

The term acrosyndactyly describes digits that are:

In normal development, the differentiation of the interdigital web space is influenced by which of the following factors:

Syndactyly may be isolated, it may be bilateral, or it may occur as part of a broader genetic syndrome. Which of the following syndromes are commonly associated with syndactyly:

Surgical separation of syndactylized fingers produces two separate digits with an increase in total surface area. How are the gaps in coverage left by eliminating the common side between the two fingers best addressed:

The of the brachial plexus emerge between the anterior middle scalane muscles:

Dupuytren contracture is a progressive disease involving:

Which of the following statements is true:

Initial treatment for De Quervain disease involves:

The ulnar nerve arises from:

Which of the following statements is true:

The treatment of stenosing tenosynovitis should include all of the following except:

Swan-neck deformity can be caused by which of the following:

Which of the following identifies the clinical finding of inadvertent hyperextension of the thumb metaphalangeal joint during attempted thumb-index finger pinch?

The Bunnell procedure to provide index finger abduction in ulnar nerve palsies refers to:

Ganglions most commonly arise from the:

Pain from a dorsal carpal ganglion is caused by:

Optimal treatment for a symptomatic ganglion is:

The following pair of tendons is affected in De Quervain disease:

Poor or incomplete resolution of symptoms following first dorsal compartment release for De Quervain disease would most likely occur as a result of:

When performing a tendon transfer to restore thumb index finger lateral pinch in an ulnar nerve palsy, which tendon, when transferred to the 1st dorsal interosseous provides the greatest power?

In the diagnosis of a boutonniere deformity, a patient will not present with:

In the diagnosis of a boutonniere deformity, a patient may present with:

Horner syndrome includes all of the following except:

Axonotmesis involves injury to which of the following structure:

All of the following may be seen with preganglionic lesion EXC EPT:

Weakness of which of the following muscles is not seen with root avulsion:

In obstetric brachial plexus injury, return of which of the following muscle by 3 months is considered an indicator of plexus recovery:

A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder x-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram.
C linical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to âswingâ his elbow into flexion.
The diagnosis of the boyâs condition is:

A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder x-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram.
C linical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to âswingâ his elbow into flexion.
What is the level of lesion:

A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder x-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram.
C linical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to âswingâ his elbow into flexion.
What is the least helpful test in further management of this patient:

A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder x-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram.
C linical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to âswingâ his elbow into flexion.
The plan of management in this boy 5 months after injury with no clinical improvement should be:

A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder x-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram.
C linical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to âswingâ his elbow into flexion.
What will be the most important indication for an early exploration in this case:

A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder x-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram.
C linical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to âswingâ his elbow into flexion.
The most important function that needs to be restored in this boy is:

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9½ lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the natal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the
fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age.
You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MC P) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The x-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner Syndrome and the grasp reflex is absent.
The diagnosis of this boyâs condition is:

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9½ lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the natal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the
fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age.
You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MC P) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The x-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner Syndrome and the grasp reflex is absent.
The level of the lesion in this boyâs case is:

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9½ lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the natal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the
fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age.
You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MC P) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The x-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner Syndrome and the grasp reflex is absent.
Appropriate surgical management in this case should be: