MCQs-Hand 7
that arrives 10 days out with mild median nerve symptoms is not an indication for operation. The main indication for an operation is SHORTENING.

– again: to test for an acute Boutenniere injury: look for ACTIVE PIP joint extension with the MCP joint FLEXED.

– quadriga and lumbrical plus are sort of opposite anatomic problems. Both can occur aft amputations of the fingers. In quadriga, the tension of the FDP is too tight (if it is sutured over the stump or attached to the extensor hood to drap over the tip of the amputation) so that when that finger is flexed, it reaches its maximal flexion before the others. Because FDP is a common muscle belly, the rest cannot flex any further. The treatment is to release the FDP. On the other hand, the lumbrical plus deformity can occur when the middle phalanx is amputated and the FDP is releatively LONG – the pull of FDP is then more through the lumbrical, thereby EXTENDING the PIP joint when the patient tries to flex it. The treatment is release of the lumbrical tendon.

– the last to return after radial nerve injury is debatable, but probably EPL. The first to recover is ECU.

– in front of the elbow, the most medial structure is the MEDIAN nerve, the most lateral structure is the biceps tendon (heading down to the radial tuberosity). Therefore, the artery is in between.

– when talking about compressive lesions of the median nerve, the nerve is compressed by ligament of Struthers, pronator teres, lacertus fibrosis, and the arch of FDS. The vascular leash (recurrent radial artery – leash of Henry) compresses the radial nerve and not the median nerve.

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