Hand and Upper Extremity Surgery
What you must understand
Know the anatomy of the hand - flexor and extensor zones, intrinsic muscles, nerve territories, and vascular supply. Understand common conditions: carpal tunnel syndrome, trigger finger, Dupuytren contracture, de Quervain tenosynovitis, and Kienböck disease. Be fluent in fracture management - distal radius, scaphoid, metacarpal, and phalangeal - and tendon repair principles. Understand nerve injury classification (Seddon: neurapraxia, axonotmesis, neurotmesis) and repair timing.
Traps in questions
- Carpal tunnel syndrome: median nerve, nocturnal symptoms, thenar wasting; Tinel and Phalen tests.
- Scaphoid fractures: tenderness in the anatomic snuffbox; risk of nonunion and AVN of the proximal pole.
- Dupuytren: palmar fascia, ring and small fingers, MCP and PIP contractures; treatment by severity.
- Flexor tendon repair: core suture plus epitendinous repair; early protected mobilization.
- Kienböck disease is avascular necrosis of the lunate - associated with negative ulnar variance.
Worked rule of thumb
For any hand injury, document neurovascular status and test tendons against resistance. A seemingly minor laceration can transect a nerve or tendon - explore when in doubt.
Exam strategy
Questions often test the anatomic zone of injury and the functional consequence - know zones of flexor and extensor tendons.