EBOT

Mano degenerativa. Enfermedad de

Dupuytren
• Q1
A 64-year-old diabetic female presents with sudden
catching and locking of her ring finger when trying to
extend it. Attempts at finger extension are painful,
and she notes tenderness in her distal palm. A clinical
photo is shown in Figure A. Which of the following
structures are implicated in the pathogenesis of this
condition? QID: 1050
1. Extensor digitorum tendon
2. Grayson’s ligament
3. Oblique retinacular ligament
4. A1 pulley
A 64-year-old diabetic female presents with sudden
catching and locking of her ring finger when trying to
extend it. Attempts at finger extension are painful,
and she notes tenderness in her distal palm. A clinical
photo is shown in Figure A. Which of the following
structures are implicated in the pathogenesis of this
condition? QID: 1050
1. Extensor digitorum tendon
2. Grayson’s ligament
3. Oblique retinacular ligament
4. A1 pulley
• Q2
A 45-year-old patient presents with recurrence of
radial sided wrist pain after undergoing a first dorsal
compartment release about 3 months ago. The
surgery was completed by one of your partners;
operative reports indicate that the sheath was incised
on the dorsal edge. On physical exam she is found to
have normal appearing skin, a negative Tinel’s sign,
and a positive Finklestein test. What is the most likely
cause of the recurrence of her symptoms? QID: 4613
1. Complex regional pain syndrome
2. Failure to decompress the EPB sub-sheath
3. Development of neuroma
4. Failure to decompress the APB sub-sheath
A 45-year-old patient presents with recurrence of
radial sided wrist pain after undergoing a first dorsal
compartment release about 3 months ago. The
surgery was completed by one of your partners;
operative reports indicate that the sheath was incised
on the dorsal edge. On physical exam she is found to
have normal appearing skin, a negative Tinel’s sign,
and a positive Finklestein test. What is the most likely
cause of the recurrence of her symptoms? QID: 4613
1. Complex regional pain syndrome
2. Failure to decompress the EPB sub-sheath
3. Development of neuroma
4. Failure to decompress the APB sub-sheath
Tinel +
• Q3
 A 56-year-old right hand dominant male
presents to your office complaining of right
thumb pain worsened with pincer grip and
using his mobile phone. He is a writer, and is
having difficulty holding his pen.
Radiographs from this visit are shown in
Figure A. Compared with trapeziectomy
alone, which of the following treatment
options is likely to result in superior pain
relief
1. and improvementwith
Trapeziectomy of key-pinch
interpositional palmaris longus
strength? QID: 753
arthroplasty
2. Trapeziectomy, interpositional arthroplasty, and palmar
oblique ligament reconstruction using flexor carpi radialis
autograft
3. Partial trapeziectomy with capsular interpositional
arthroplasty
4. None of the above
 A 56-year-old right hand dominant male
presents to your office complaining of right
thumb pain worsened with pincer grip and
using his mobile phone. He is a writer, and is
having difficulty holding his pen.
Radiographs from this visit are shown in
Figure A. Compared with trapeziectomy
alone, which of the following treatment
options is likely to result in superior pain
relief
1. and improvementwith
Trapeziectomy of key-pinch
interpositional palmaris longus
strength? QID: 753
arthroplasty
2. Trapeziectomy, interpositional arthroplasty, and palmar
oblique ligament reconstruction using flexor carpi radialis
autograft
3. Partial trapeziectomy with capsular interpositional
arthroplasty
4. None of the above
Definitive surgical management of basal joint arthritis commonly involves excision of the
diseased trapezium with concomitant interpositional arthroplasty at the carpometacarpal joint
in an effort to mantain the height of the metacarpal. This is commonly done with flexor carpi
radialis (FCR) or palmaris longus (PL) autograft. Recent studies have called into question the
need for interpositional arthroplasty, suggesting that excision of the trapezium alone can provide
non-inferior results.
• Q4
A 68-year-old female office assistant reports left thumb pain that
has progressively worsened over the past 2 years. She is left hand
dominant and reports difficulty with opening jars and holding a
coffee cup. On examination of the left hand she has a positive
thumb carpometacarpal grind test and has a fixed deformity at the
thumb metacarpalphalangeal joint. Figure A demonstrates the left
hand grasping an object and Figure B shows a radiograph of the left
thumb. What is the most appropriate next step in treatment? QID:
3669
1. Carpometacarpal joint fusion and metacarpophalangeal joint
volar capsulodesis.
2. Carpometacarpal joint resection arthroplasty and
metacarpophalangeal joint volar capsulodesis.
3. Carpometacarpal joint resection arthroplasty and
metacarpophalangeal joint fusion.
4. Carpometacarpal joint resection arthroplasty and temporary
A 68-year-old female office assistant reports left thumb pain that
has progressively worsened over the past 2 years. She is left hand
dominant and reports difficulty with opening jars and holding a
coffee cup. On examination of the left hand she has a positive
thumb carpometacarpal grind test and has a fixed deformity at the
thumb metacarpalphalangeal joint. Figure A demonstrates the left
hand grasping an object and Figure B shows a radiograph of the left
thumb. What is the most appropriate next step in treatment? QID:
3669
1. Carpometacarpal joint fusion and metacarpophalangeal joint
volar capsulodesis.
2. Carpometacarpal joint resection arthroplasty and
metacarpophalangeal joint volar capsulodesis.
3. Carpometacarpal joint resection arthroplasty and
metacarpophalangeal joint fusion.
4. Carpometacarpal joint resection arthroplasty and temporary
• Q5
 A 32-year-old carpenter complains of progressively worsening
wrist pain for the last 2 months. He denies any recent history
of trauma to the wrist or hand. An MRI is obtained and a
representative image is provided in Figure A. Which of the
following surgical interventions is thought to be effective for
this condition by inciting a local vascular healing response?
QID: 3149
1. Ulnar shortening osteotomy
2. Distal radius core
decompression
3. Proximal row carpectomy
4. Scapholunate ligament
reconstruction
 A 32-year-old carpenter complains of progressively worsening
wrist pain for the last 2 months. He denies any recent history
of trauma to the wrist or hand. An MRI is obtained and a
representative image is provided in Figure A. Which of the
following surgical interventions is thought to be effective for
this condition by inciting a local vascular healing response?
QID: 3149
1. Ulnar shortening osteotomy
2. Distal radius core
decompression
3. Proximal row carpectomy
4. Scapholunate ligament
reconstruction
• Q6
A 40-year-old right-handed professional football player
reports persistent right wrist pain after falling during a game
5 days ago. A radiograph is shown in Figure A. Management
should consist of.
QID: 8740
1. Inmobilization in a long
thumb spica cast
2. Arthroscopic repair and
percutaneus pinning
3. Open repair and
percutaneus pinning
4. Dorsal capsulodesis
A 40-year-old right-handed professional football player
reports persistent right wrist pain after falling during a game
5 days ago. A radiograph is shown in Figure A. Management
should consist of.
QID: 8740
1. Inmobilization in a long
thumb spica cast
2. Arthroscopic repair and
percutaneus pinning
3. Open repair and
percutaneus pinning
4. Dorsal capsulodesis
• Q7
A 65-year-old man fell and injured his
right wrist. Radiographs taken in the
emergency room are seen in Figure A. He
was treated as a sprain and no further
follow-up was planned. He sustained 2
minor falls over the next 6 years and his
wrist pain recurred. Recent radiographs
are seen in Figure B. Surgical treatment
that will best address his symptoms and
preserve wrist motion consists of. QID:
4523
1. Scaphotrapezialtrapezoidal (STT)
fusion
2. Complete wirst arthrodesis
3. Proximal row carpectomy
4. Four corner fusion with
scaphoidectomy
A 65-year-old man fell and injured his
right wrist. Radiographs taken in the
emergency room are seen in Figure A. He
was treated as a sprain and no further
follow-up was planned. He sustained 2
minor falls over the next 6 years and his
wrist pain recurred. Recent radiographs
are seen in Figure B. Surgical treatment
that will best address his symptoms and
preserve wrist motion consists of. QID:
4523
1. Scaphotrapezialtrapezoidal (STT)
fusion
2. Complete wirst arthrodesis
3. Proximal row carpectomy
4. Four corner fusion with
scaphoidectomy
• Q8
 A 50-year-old patient presents with stiffness in her hand. A clinical
photo is shown in Figure A. During surgical exposure, the
neurovascular bundle is identified and dissected. What is the clinically
most important pathologic structure to identify and what is its
location relative to the neurovascular bundle in the digit? QID: 4605

1. Spiral cord which is central and

superficial to the neurovascular
bundle
2. Central cord which is midline and
superficial to the neurovascular
bundle.
3. Spiral cord which is lateral and
deep to the neurovascular bundle
4. Central cord which is lateral and
deep to the neurovascular bundle.
 A 50-year-old patient presents with stiffness in her hand. A clinical
photo is shown in Figure A. During surgical exposure, the
neurovascular bundle is identified and dissected. What is the clinically
most important pathologic structure to identify and what is its
location relative to the neurovascular bundle in the digit? QID: 4605

1. Spiral cord which is central and

superficial to the neurovascular
bundle
2. Central cord which is midline and
superficial to the neurovascular
bundle.
3. Spiral cord which is lateral and
deep to the neurovascular bundle
4. Central cord which is lateral and
deep to the neurovascular bundle.
Neurovascular bunldle

Spiral cord
• Q9
All of the following have been implicated in the
pathogenesis of Duputryen's contracture
EXCEPT? QID: 1238
1. Transforming growth factor-beta (TGF-beta)
2. Myofibroblast
3. Platelet-derived growth factor (PDGF)
4. CBFA-1
All of the following have been implicated in the
pathogenesis of Duputryen's contracture
EXCEPT? QID: 1238
1. Transforming growth factor-beta (TGF-beta)
2. Myofibroblast
3. Platelet-derived growth factor (PDGF)
4. CBFA-1
• Q10
Which of the following patients with Dupuytren's
contracture would benefit the most from
dermatofasciectomy and full-thickness skin grafting
opposed to traditional fasciectomy? QID: 3204
• 1. 50 year old male systems analyst with ring and small
finger involvement limited to the MCP joints
• 2. 65 year old female golfer with ring and small finger
involvement including MCP and PIP joints.
• 3. 40 year old female stenographer with middle, ring,
and small finger involvement including MCP and PIP
joints with 50 and 55 degree contractures of ring and
small finger MCP joints, respectively
• 4. None of the above, as no difference in outcome has
been demonstrated between the two procedures.
Which of the following patients with Dupuytren's
contracture would benefit the most from
dermatofasciectomy and full-thickness skin grafting
opposed to traditional fasciectomy? QID: 3204
• 1. 50 year old male systems analyst with ring and small
finger involvement limited to the MCP joints
• 2. 65 year old female golfer with ring and small finger
involvement including MCP and PIP joints.
• 3. 40 year old female stenographer with middle, ring,
and small finger involvement including MCP and PIP
joints with 50 and 55 degree contractures of ring and
small finger MCP joints, respectively
• 4. None of the above, as no difference in outcome has
been demonstrated between the two procedures.
Dermatofasciectomy and full-thickness grafting has not demonstrated superior
finger range of motion, recurrence rate, or patient satisfaction in comparison
with traditional fasciectomy.

The main reference from Ullah et al conducted a prospective randomized study

of 84 Dupuytren's cases treated with fasciectomy alone or dermatofasciectomy
with full-thickness skin grafting. The question was whether the overlying skin
needed to be excised. No difference in clinical outcome or recurrence rate was
discovered.

Roy et al reviewed 79 cases of advanced Dupuytren's treated with radical

fasciectomy (but preservation of the overlying skin) and then adding full-
thickness skin grafting to the open areas once the fingers were extended. They
found their results of fasciectomy to be similar to those published for
dermofasciectomy.