Hand & Upper Limb Orthopaedic Topics

Hand, wrist, elbow & shoulder. 180 evidence-informed references covering conditions, classifications, management and high-yield exam notes for FRCS (Tr&Orth), FRACS, EBOT and ABOS preparation.

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Adductor Pollicis AnatomySurgical anatomy of adductor pollicis — transverse and oblique heads, the terminal deep ulnar motor branch, the adductor aponeurosis and Stener lesion, Froment and Jeanne signs, and first web space contracture release.
Adhesive Capsulitis (Frozen Shoulder)Exam-focused guide to adhesive capsulitis (frozen shoulder): what it is, the inflammation-then-fibrosis pathology of the capsule, the three clinical stages, how it is a clinical diagnosis with global loss of passive external rotation, the link with diabetes, the evidence behind injection, physiotherapy, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release, and the practical rules for the exam.
Adult Brachial Plexus InjuryExam-focused guide to adult traumatic brachial plexus injury: applied anatomy of the five-section plexus, preganglionic versus postganglionic injury, the supraclavicular versus infraclavicular patterns, how to examine and image (clinical signs, CT myelography, MRI), why timing of surgery matters, and the reconstructive ladder of neurolysis, nerve graft, nerve transfer and free functioning muscle transfer.
ALPSA LesionsComprehensive guide to Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA), a variant of Bankart lesion characterised by medialized healing.
Anconeus AnatomySurgical anatomy of anconeus: the Kocher and anconeus-based lateral elbow approaches, the anconeus rotation flap for posterior elbow cover and triceps reconstruction, and its role as a dynamic lateral stabiliser in posterolateral rotatory instability.
Animal BitesComprehensive guide to the management of animal bites, focusing on microbiology, antibiotic prophylaxis, and surgical indications.
Anterior Interosseous Nerve AnatomyComprehensive guide to the Anatomy of the Anterior Interosseous Nerve (AIN), including its course, innervation, variants (Martin-Gruber), and clinical syndrome (Kiloh-Nevin).
Anterior Interosseous Nerve SyndromeComprehensive guide to anterior interosseous nerve syndrome including anatomy, clinical presentation, differential diagnosis with Parsonage-Turner syndrome, and management from observation to surgical decompression.
Axillary Nerve AnatomyComprehensive guide to the anatomy, clinical assessment, and management of Axillary Nerve injuries
Blood Supply of the ForearmComprehensive anatomy of the Radial and Ulnar arteries, their branches, anastomoses, and clinical relevance.
Boutonniere DeformityComprehensive guide to Boutonniere Deformity (Central Slip rupture), covering anatomy, Elson's test, and management protocols.
Brachial Plexus AnatomyFellowship-level anatomy of the brachial plexus: roots, trunks, divisions, cords and terminal branches; the branch at each level; Erb's vs Klumpke's palsy; and the supraclavicular/infraclavicular surgical map.
Brachialis AnatomySurgical anatomy of brachialis: its two heads, dual musculocutaneous and radial innervation, its relation to the anterior elbow capsule, and its role in anterior approaches, contracture release and post-traumatic heterotopic ossification.
Brachioradialis AnatomySurgical anatomy of brachioradialis: the paradoxical radial-innervated flexor, its place in the mobile wad and the Henry approach interval, and its use as a tendon transfer to flexor pollicis longus in tetraplegia and high median nerve palsy.
Bristow-Latarjet ProcedureComprehensive guide to the Bristow and Latarjet coracoid transfer procedures for anterior shoulder instability with bone loss, including indications, surgical technique, complications, and outcomes.
CamptodactylyCamptodactyly: the three types and how unequally they are evidenced, why splinting outperforms surgery in the largest series, and how to read two surgical series that reach opposite conclusions about the same operation.
Carpal Boss (Carpometacarpal Boss)Fellowship-level guide to the carpal boss (carpe bossu) - a symptomatic bony prominence on the dorsum of the wrist at the second/third carpometacarpal joints (a localised osteoarthritic osteophyte/exostosis at the base of the index/middle metacarpal and adjacent trapezoid/capitate) - covering its presentation as a fixed, hard dorsal lump distinct from a ganglion, the diagnosis (the 'carpal boss view'/CT), and a non-operative-first management with simple excision of the exostosis for refractory pain (fusion reserved for secondary CMC instability).
Carpal Instability - DISI/VISIComprehensive guide to dorsal and volar intercalated segment instability patterns - classification, diagnosis, and management for orthopaedic exam preparation
Carpal Tunnel SyndromeComprehensive guide to carpal tunnel syndrome, including anatomy, diagnosis, electrodiagnostic criteria, and surgical release techniques
Central Slip InjuriesComprehensive guide to central slip extensor tendon injuries of the finger, including diagnosis, treatment, and boutonniere deformity prevention.
Charcot (Neuropathic) Arthropathy of the ShoulderFellowship-level guide to neuropathic (Charcot) arthropathy of the shoulder: the painless, grossly destructive glenohumeral joint of syringomyelia, its pathophysiology (loss of proprioception/protective sensation), the classic radiographic 'bag of bones' destruction, the crucial differential from tumour and infection, and the largely supportive management with surgery reserved for selected cases.
Charcot (Neuropathic) Joint of the ElbowFellowship-level guide to the Charcot (neuropathic) joint of the elbow - a progressive, destructive arthropathy of an insensate joint - whose classic cause is SYRINGOMYELIA (and other causes of upper-limb sensory loss), presenting with a strikingly swollen, often relatively painless, unstable elbow with marked radiographic destruction/debris - covering the work-up (notably MRI of the cervical spine for a syrinx), the differential from infection and tumour, and the largely supportive management.
Cleft HandComprehensive guide to cleft hand (typical and atypical ectrodactyly) including Manske-Halikis classification, associated syndromes, functional assessment, and surgical reconstruction.
ClinodactylyComprehensive guide to clinodactyly including delta phalanx, bracket epiphysis, associated syndromes, indications for surgery, and corrective osteotomy techniques for Orthopaedic examination.
Complex Metacarpophalangeal Joint DislocationComprehensive guide to irreducible dorsal metacarpophalangeal joint dislocations, including Kaplan lesion, volar plate interposition, pathognomonic signs, and surgical approaches for reduction.
Congenital Clasped ThumbFellowship-level guide to congenital clasped thumb - a progressive flexion and adduction deformity of the thumb (held flexed/adducted into the palm) caused by a deficient or absent extensor mechanism (extensor pollicis brevis/longus), often with first-web narrowing and metacarpophalangeal-joint laxity - covering the supple vs complex (rigid) classification, the syndromic associations, and a management algorithm of early splinting first (effective for flexible types) and surgical reconstruction (tendon transfer, web release, capsular stabilisation) for complex or splint-resistant thumbs.
Coracobrachialis AnatomySurgical anatomy of coracobrachialis: the conjoined tendon, the musculocutaneous nerve piercing the muscle below the coracoid, the safe zone for the anterior shoulder approach, and its relevance to the Latarjet coracoid transfer.
CRPS - Hand (Complex Regional Pain Syndrome)Diagnosis, Budapest Criteria, and multidisciplinary management of CRPS Type I and Type II in the hand.
Crystalline Arthropathy of the HandComprehensive guide to crystalline arthropathies affecting the hand including gout and CPPD, clinical presentation, crystal identification, medical management, and surgical indications for tophaceous gout and chronic arthropathy.
Cubital Tunnel SyndromeComprehensive guide to cubital tunnel syndrome including McGowan grading, Froment's and Wartenberg's signs, and surgical treatment options.
Cutibacterium acnes Shoulder Periprosthetic InfectionComprehensive guide to Cutibacterium acnes periprosthetic joint infection of the shoulder, including diagnosis, microbiology, surgical management, and antibiotic strategies.
De Quervain TenosynovitisComprehensive guide to first dorsal compartment stenosing tenosynovitis
Deep Space Infections - HandComprehensive examination guide to deep space infections of the hand including anatomical spaces, clinical presentations, surgical drainage techniques, and antibiotic management
Deltoid AnatomySurgical anatomy of the deltoid: three heads with distinct actions, the axillary nerve safe zone that scales with arm length rather than sitting at a fixed distance from the acromion, deltoid handling in the deltopectoral and anterosuperior approaches, deltoid tensioning in reverse arthroplasty, and axillary palsy after dislocation.
Deltoid Rupture / AvulsionFellowship-level guide to deltoid muscle rupture/avulsion - an uncommon injury, most often IATROGENIC (notably anterior-deltoid detachment after open or arthroscopic acromioplasty/cuff surgery), occasionally traumatic or secondary to massive rotator cuff failure - covering the resulting deltoid insufficiency (weakness, pain, anterosuperior escape), the diagnosis, and the difficult surgical repair/reconstruction with the key principle that deltoid origin must be protected and meticulously repaired at the time of shoulder surgery.
Digit and Hand ReplantationComprehensive guide to digit and hand replantation - indications and absolute/relative contraindications, warm and cold ischaemia times for digits and the proximal upper limb, the classical sequence of repair (bone, extensor, flexor, artery, nerve, vein), microvascular anastomosis technique, anticoagulation, post-operative monitoring and salvage of the failing replant, Chen and Tamai functional outcome criteria, and the decision-making between replantation and revision amputation
Digital Nerve CompressionComprehensive guide to Digital Nerve Compression syndromes, including Bowler's Thumb, Harpist's Finger, and their management.
DIP Joint ArthritisComprehensive guide to distal interphalangeal joint arthritis - classification, clinical assessment, non-operative and surgical management including arthrodesis and arthroplasty.
Dorsal Interossei of the HandSurgical anatomy of the four dorsal interossei — DAB, bipennate architecture, the deep ulnar motor branch, first dorsal interosseous wasting as the earliest sign of ulnar neuropathy, and the intrinsic contribution to MCP flexion and IP extension.
DRUJ Arthritis (Distal Radioulnar Joint Arthritis)Degenerative or post-traumatic arthritis of the distal radioulnar joint causing ulnar-sided wrist pain and forearm rotation limitation, managed with conservative measures or surgical procedures including DRUJ arthroplasty and salvage procedures
Dupuytren's DiseaseComprehensive guide to Dupuytren's contracture: pathophysiology, classification, surgical indications, treatment options, and recurrence management
Elbow Interposition / Distraction ArthroplastyFellowship-level guide to interposition (and distraction interposition) arthroplasty of the elbow: a joint-preserving, bone-preserving alternative to total elbow arthroplasty for the young, high-demand patient with end-stage (usually post-traumatic) elbow arthritis; the technique (resurfacing the debrided distal humerus with an interposed soft-tissue graft, with or without a hinged distraction external fixator), the central importance of elbow stability, the modest but useful outcomes, and conversion to total elbow arthroplasty.
Epidermal (Epidermoid) Inclusion Cyst of the HandFellowship-level guide to the epidermal inclusion cyst of the hand: a benign keratin-filled cyst that follows traumatic implantation of epidermis, presenting as a firm subcutaneous nodule (or an intraosseous lytic lesion of the distal phalanx) - covering pathogenesis, the differential (ganglion, GCTTS, enchondroma, osteomyelitis), histology, and treatment by complete excision/curettage.
Extensor Pollicis Longus RuptureComprehensive guide to attritional rupture of the extensor pollicis longus tendon at the wrist, including pathogenesis after distal radius fracture and rheumatoid arthritis, diagnosis with the retropulsion (drumming) sign, and EIP-to-EPL tendon transfer reconstruction.
Extensor Tendon InjuriesComprehensive guide to extensor tendon injuries: mallet finger, boutonniere deformity, sagittal band rupture and zone-based management
FelonClosed-space infection of the pulp of the distal phalanx - surgical emergency requiring urgent drainage to prevent osteomyelitis, septic arthritis, and flexor tenosynovitis
Fingertip Injuries & AmputationsComprehensive guide to the management of fingertip injuries, including nail bed repair, local flaps (Atasoy, Moberg, Cross-Finger), and subungual hematomas.
Flexor Carpi Radialis (FCR) TendinitisFellowship-level guide to flexor carpi radialis (FCR) tendinopathy/tendinitis - a volar-radial wrist pain syndrome arising where the FCR runs in its tight fibro-osseous tunnel against the trapezial ridge and scaphoid tuberosity, often associated with trapeziometacarpal (basal thumb) osteoarthritis and seen as a complication of trapeziometacarpal suspension arthroplasty - covering its anatomy, the differential with de Quervain's and scaphotrapezial arthritis, and a non-operative-first management with surgery (tunnel release/debridement) for refractory cases.
Flexor Carpi Radialis AnatomySurgical anatomy of flexor carpi radialis: its own fibro-osseous tunnel over the trapezium, the FCR approach to the volar distal radius and scaphoid, FCR tendinopathy, and its use as a graft in ligament reconstruction and LRTI.
Flexor Carpi Ulnaris AnatomySurgical anatomy of flexor carpi ulnaris: the two heads that roof the cubital tunnel, its status as the only entirely ulnar-innervated wrist flexor, its role as the landmark of Guyon canal, the Green transfer, and calcific tendinitis at the pisiform.
Flexor Digiti Minimi BrevisSurgical anatomy of flexor digiti minimi brevis — hypothenar attachments, its fibrous arch of origin as a compression point for the deep ulnar motor branch, Guyon canal zoning, and donor considerations for the Huber transfer.
Flexor Digitorum Profundus AnatomySurgical anatomy of flexor digitorum profundus: the dual innervation and common ulnar belly that produces the quadriga effect, the lumbrical origin, jersey finger with the Leddy-Packer classification, the Verdan zones and FDP testing.
Flexor Digitorum Superficialis AnatomySurgical anatomy of flexor digitorum superficialis: the independent index belly, the FDS arcade as a median nerve compression point, Camper chiasm, zone II flexor anatomy, and FDS slip harvest for pulley reconstruction and opponensplasty.
Flexor Pollicis Brevis AnatomySurgical anatomy of flexor pollicis brevis: the dual median and ulnar innervation that explains confusing thumb palsy findings, the Riche-Cannieu anastomosis, thenar muscle anatomy for carpal tunnel release safe zones, and the Lanz recurrent motor branch variants.
Flexor Pollicis Longus AnatomySurgical anatomy of flexor pollicis longus: the only flexor of the thumb interphalangeal joint, its anterior interosseous innervation and the OK-sign test, the Linburg-Comstock anomaly, rupture over a prominent volar plate and the rheumatoid Mannerfelt lesion, and reconstruction options.
Flexor Tendon LacerationsComprehensive guide to flexor tendon injury zones, repair techniques and rehabilitation protocols
Flexor Tendon RehabilitationEvidence-based rehabilitation protocols for flexor tendon repairs across all zones, including early active mobilization, passive motion, and place-and-hold techniques
Flexor Tendon Repair TechniquesDetailed guide to flexor tendon repair, focusing on suture techniques (Kessler, Adelaide), strand numbers, and zone-specific management.
Flexor TenosynovitisComprehensive guide to suppurative flexor tenosynovitis: Kanavel signs, sheath anatomy, irrigation technique and prognosis
Flexor-Pronator Mass Strain / TendinopathyFellowship-level guide to flexor-pronator mass injury at the medial elbow - strain, tendinopathy ('golfer's/medial epicondylitis') or, in throwers, partial tearing of the common flexor-pronator origin - covering its role as a dynamic stabiliser against valgus stress (protecting the ulnar collateral ligament), the overlap and crucial distinction from UCL injury and ulnar neuritis in the throwing athlete, the diagnosis, and management from rest/rehabilitation to (rarely) surgery.
Frostbite (Cold Injury)Advanced orthopaedic guide to frostbite of the hand and foot, covering pathophysiology, the freeze-thaw injury, field and hospital rewarming, classification, thrombolysis and iloprost, bone scanning, delayed amputation and rehabilitation.
Gamekeeper's ThumbComprehensive guide to thumb UCL injuries for Orthopaedic examination
Ganglion CystsComprehensive guide to ganglion cyst diagnosis, aspiration, and surgical excision
Glomus Tumour of the HandComprehensive guide to subungual and digital glomus tumours - benign neuromyoarterial hamartomas causing the classic triad of pain, cold sensitivity and pinpoint tenderness, with Love and Hildreth clinical signs, MRI and marginal excision.
HAGL LesionsComprehensive guide to Humeral Avulsion of the Glenohumeral Ligament (HAGL), including the MRI 'J Sign', West Point Classification, and surgical management.
Hand Examination and Clinical LocalisationAn advanced orthopaedic guide to examining the hand and localising pathology from clinical findings, including tendon testing, nerve localisation, sensory testing, deformity analysis, investigations and urgent decision-making.
Herpetic WhitlowFellowship-level guide to herpetic whitlow: a herpes simplex virus infection of the fingertip that mimics a felon or paronychia but must NOT be incised - covering the HSV-1/HSV-2 aetiology and at-risk groups, the grouped-vesicle presentation, the critical differentiation from a bacterial felon, diagnosis, supportive/antiviral management, and complications including autoinoculation and recurrence.
High-Pressure Injection Injury of the HandAdvanced orthopaedic guide to high-pressure injection injury of the hand, including recognition, material risk, imaging, emergency management, operative debridement, complications and rehabilitation.
Human Bites & Fight BitesComprehensive guide to the management of human bites, specifically 'Fight Bites' (Clenched Fist Injuries), outlining the unique microbiology and surgical urgency.
Hypothenar Hammer SyndromeFellowship-level guide to hypothenar hammer syndrome: repetitive blunt trauma to the ulnar artery over the hook of hamate causing thrombosis, aneurysm and digital embolisation - the occupational vascular cause of ulnar-sided digital ischaemia, its workup (Allen's test, angiography, the corkscrew sign) and management.
Inflammatory Arthritis of the ShoulderComprehensive guide to Rheumatoid Arthritis and other inflammatory conditions of the shoulder - pathology, classification, and surgical management
Infraspinatus AnatomySurgical anatomy of the infraspinatus: the posterior arm of the transverse force couple, suprascapular nerve at the spinoglenoid notch, external rotation lag and drop signs, Goutallier and Patte staging, and the infraspinatus-teres minor internervous interval.
Intersection SyndromeComprehensive guide to proximal and distal intersection syndrome of the dorsal wrist - an overuse tenosynovitis distinct from de Quervain disease
Jersey FingerComprehensive guide to Jersey Finger (FDP Avulsion), including Leddy-Packer classification, surgical repair techniques, and rehabilitation.
Kienböck's DiseaseComprehensive guide to Kienböck's disease including staging, pathophysiology, investigation with MRI, and treatment options from immobilization to salvage procedures.
Latarjet ProcedureComprehensive guide to the Latarjet coracoid transfer for recurrent anterior shoulder instability with glenoid bone loss - the triple-blocking effect of Patte, glenoid bone-loss thresholds and the glenoid track, the Instability Severity Index Score (ISIS), deltopectoral approach, operative technique, complications and long-term outcomes
Lateral Elbow Pain: Pattern and DifferentialStructured approach to lateral elbow pain — discriminating tennis elbow from radial tunnel, PLRI, radiocapitellar arthritis, plica and referred cervical pain, with confirmatory tests.
Latissimus Dorsi (and Teres Major) RuptureFellowship-level guide to latissimus dorsi and teres major tendon ruptures - uncommon injuries of the posterior axillary fold seen in throwing/overhead and high-demand athletes (and water-skiers), presenting with acute posterior-axillary pain, bruising and a palpable defect/weakness of extension/adduction/internal rotation - covering the spectrum from strain to complete avulsion, the role of MRI, and the management debate, in which the cohort evidence favours non-operative treatment even for avulsions in professional pitchers, with repair a good option rather than a demand-driven necessity.
Latissimus Dorsi AnatomySurgical anatomy of the latissimus dorsi: thoracodorsal nerve and pedicle anatomy, the spiralling insertion into the floor of the bicipital groove, transfer for irreparable posterosuperior cuff tear, pedicled and free flap use, and its role in the internal rotation contracture of brachial plexus birth palsy.
Levator Scapulae AnatomySurgical anatomy of levator scapulae, its dual C3-C4 and dorsal scapular innervation, its role as a downward rotator of the scapula, and its central place in snapping scapula and superomedial angle resection.
Long Thoracic Nerve AnatomyFellowship-level anatomy of the long thoracic nerve: C5-C7 origin, its long superficial course on serratus anterior, why it is vulnerable, and the medial scapular winging that follows injury.
Lumbrical Muscles of the HandSurgical anatomy of the four lumbricals — the only muscles with both origin and insertion on tendon, dual median and ulnar innervation, lumbrical-plus finger, quadriga, and lumbrical canal infection.
MacrodactylyRare congenital anomaly characterized by localized gigantism of digits, requiring staged surgical management and multidisciplinary care
Madelung DeformityExam-focused guide to Madelung deformity of the wrist: the abnormal distal radial physis and Vickers ligament, the link with Leri-Weill dyschondrosteosis and SHOX gene defects, how the radius deforms in three planes, the classic radiographic measurements, and how treatment is chosen between Vickers ligament release with physiolysis in the growing child and dome osteotomy or salvage in the mature wrist.
Mallet FingerComprehensive guide to the diagnosis and management of Mallet Finger (Tendinous and Bony), including splinting protocols and surgical indications.
Massive Rotator Cuff TearsComprehensive guide to massive rotator cuff tears and treatment options
MCP Joint ArthritisComprehensive guide to MCP joint arthritis including rheumatoid arthritis, post-traumatic arthritis, primary OA, clinical presentation, non-operative management, and surgical options including arthroplasty and arthrodesis for orthopaedic fellowship exam preparation.
Median Nerve AnatomyComprehensive guide to the anatomy, compression syndromes, and clinical pathology of the Median Nerve
Meralgia ParaestheticaCompression neuropathy of the lateral femoral cutaneous nerve causing burning numbness and paraesthesia over the anterolateral thigh
Metacarpal FracturesComprehensive guide to metacarpal fractures for Orthopaedic examination
Midcarpal ArthritisComprehensive examination guide to midcarpal arthritis patterns, diagnostic evaluation, and surgical management including limited wrist fusions and total wrist arthroplasty
Midcarpal InstabilityNon-dissociative carpal instability with abnormal motion between the proximal and distal carpal rows, presenting with a painful catch-up clunk and requiring dynamic clinical and fluoroscopic assessment
Milwaukee Shoulder (BCP Crystal Arthropathy)Comprehensive guide to Milwaukee shoulder syndrome - a rapidly destructive basic calcium phosphate (hydroxyapatite) crystal arthropathy of the shoulder in elderly women, covering crystal biology, alizarin red diagnosis, large bloody non-inflammatory effusions and management for fellowship exam preparation.
Mucous Cysts (Digital Mucoid Cysts)Comprehensive guide to digital mucous cysts including pathophysiology, diagnosis, and surgical excision techniques with osteophyte removal
Musculocutaneous Nerve AnatomyFellowship-level anatomy of the musculocutaneous nerve: lateral cord origin (C5-C7), its course through coracobrachialis, the anterior-arm flexors it supplies, the lateral cutaneous nerve of the forearm, and its role in elbow-flexion nerve transfers.
Nerve Repair PrinciplesComprehensive guide to Peripheral Nerve Repair, including biology, classification, surgical techniques, and rehabilitation.
Nerve TransfersPrinciples and common techniques for Nerve Transfer (Neurotization) in peripheral nerve and brachial plexus surgery.
Neuroma ManagementPathophysiology, diagnosis, and management of painful neuromas, including modern techniques like RPNI and TMR.
OligodactylyPaediatric hand oligodactyly — definition and place within the Oberg-Manske-Tonkin classification, transverse versus longitudinal deficiency, symbrachydactyly, syndromic screening, function-first assessment, toe phalanx and microvascular toe transfer, prosthetics and parental counselling.
Opponens Digiti Minimi AnatomySurgical anatomy of opponens digiti minimi — hypothenar attachments, the deep ulnar motor branch course, Guyon canal zones and the deficits each produces, and its relevance to the Huber transfer and hypothenar hammer syndrome.
Opponens Pollicis AnatomySurgical anatomy of opponens pollicis — the recurrent motor branch of the median nerve and Lanz variants, the mechanics of opposition, opponensplasty selection (Camitz, Huber, Bunnell, EIP) and the Kapandji score.
Osteochondritis Dissecans of the CapitellumComprehensive guide to osteochondritis dissecans (OCD) of the capitellum in adolescent overhead athletes, including differentiation from Panner disease, MRI staging, and management from conservative rest to surgical fixation and cartilage restoration.
Palmar Interossei of the HandSurgical anatomy of the palmar interossei — PAD, unipennate architecture, the Bouvier test, intrinsic-minus versus intrinsic-plus posture, the Finochietto-Bunnell intrinsic tightness test, claw hand and the ulnar paradox.
Palmar LumpPattern and differential for a lump in the palm: discriminators separating Dupuytren nodule, giant cell tumour of tendon sheath, ganglion, ulnar artery aneurysm and epithelioid sarcoma.
Palmaris Brevis AnatomySurgical anatomy of palmaris brevis: the only muscle supplied by the superficial branch of the ulnar nerve, its role as the muscular roof of Guyon canal, palmaris brevis spasm syndrome, and its relevance in hypothenar hammer syndrome and as a turnover flap.
Palmaris Longus AnatomySurgical anatomy of palmaris longus: agenesis prevalence and side, its role as the classic tendon graft donor, its relation to the median nerve at the wrist as the landmark for carpal tunnel incision placement, and the Schaeffer test.
Paronychia (Acute & Chronic)Fellowship-level guide to the commonest hand infection: acute bacterial paronychia versus chronic inflammatory paronychia, the run-around abscess, drainage technique, distinguishing herpetic whitlow and felon, and the chronic-paronychia management ladder.
Parsonage-Turner Syndrome (Neuralgic Amyotrophy)Comprehensive guide to Parsonage-Turner syndrome (neuralgic amyotrophy): the classic painful-onset patchy upper-limb palsy, hourglass fascicular constrictions, MRI denervation, and observation-first management.
Pectoralis Major AnatomySurgical anatomy of the pectoralis major: the clavicular and sternocostal heads, the bilaminar twisted insertion and why the inferior lamina ruptures first, rupture classification and repair, transfer for subscapularis insufficiency and the musculocutaneous nerve, and Poland syndrome.
Pectoralis Major RuptureComprehensive guide to pectoralis major tendon rupture including mechanism, Tietjen classification, clinical assessment, imaging, and surgical management.
Pectoralis Minor AnatomySurgical anatomy of the pectoralis minor: the medial coracoid insertion, its role in scapular protraction and anterior tilt, pectoralis minor tightness in scapular dyskinesis, the retropectoralis minor space and pectoralis minor syndrome, and its release during the Latarjet procedure.
PIP Joint ArthritisComprehensive guide to PIP joint arthritis including anatomy, etiology, clinical assessment, conservative management, silicone arthroplasty, surface replacement, and arthrodesis.
PolydactylyComprehensive guide to polydactyly including preaxial thumb duplication, postaxial types, Wassel classification, and surgical management for Orthopaedic examination.
Posterior Interosseous Nerve AnatomySurgical anatomy of the posterior interosseous nerve: the radial tunnel, the five compression points, finger drop with preserved sensation, and the safe zone for proximal radius exposure.
Posterior Interosseous SyndromeComprehensive guide to Posterior Interosseous Nerve (PIN) compression, including anatomy (Arcade of Frohse), clinical presentation (Finger Drop), and surgical decompression.
Posterior Shoulder Spaces and IntervalsSurgical anatomy of the quadrangular space, triangular space and triangular interval, their contents, quadrilateral space syndrome, and how each is used or endangered in posterior shoulder approaches.
Posterolateral Rotatory Instability of the Elbow (PLRI)Comprehensive guide to posterolateral rotatory instability of the elbow, including LUCL insufficiency, Horii circle injury pattern, clinical tests, imaging, and ligament reconstruction.
Preiser DiseaseComprehensive exam guide to Preiser disease (idiopathic osteonecrosis of the scaphoid): pathophysiology, Herbert-Lanzetta and Kalainov classifications, MRI diagnosis, and stage-based treatment from immobilization to vascularized bone graft and salvage.
Pronator Quadratus AnatomySurgical anatomy of pronator quadratus: its two heads and role as a distal radioulnar joint stabiliser, the terminal anterior interosseous nerve branch, the distal window of the volar Henry approach, and the pronator quadratus repair debate in volar plating of the distal radius.
Pronator SyndromeComprehensive guide to pronator syndrome including differentiation from carpal tunnel syndrome, compression sites, and surgical treatment.
Pronator Teres AnatomySurgical anatomy of pronator teres: two heads with the median nerve passing between them, pronator syndrome versus anterior interosseous nerve syndrome, its use as a tendon transfer to extensor carpi radialis brevis in radial nerve palsy, and its release in the Henry approach.
Proximal Biceps RupturesComprehensive guide to proximal long-head biceps rupture: anatomy, Popeye deformity, associated cuff and pulley disease, imaging, non-operative care, and selected reconstruction
Proximal Row CarpectomyComprehensive guide to proximal row carpectomy (PRC) for SLAC and SNAC wrist arthritis and Kienbock disease - principle of capitate seating into lunate fossa, dorsal surgical approach, indications requiring intact capitate head and lunate fossa cartilage, PIN neurectomy, outcomes versus four-corner fusion, conversion to total wrist fusion, and evidence-based outcomes
Psoriatic Arthritis - HandComprehensive examination guide to psoriatic arthritis affecting the hand and upper extremity, including diagnostic criteria, radiographic patterns, and surgical management strategies
Quadrangular & Triangular SpacesDetailed anatomy of the posterior shoulder spaces, their boundaries, contents, and clinical syndromes.
Quadriga Effect & Lumbrical-Plus FingerFellowship-level guide to two classic flexor-tendon imbalance phenomena that share a common anatomical basis (the flexor digitorum profundus tendons arising from one common muscle belly, with lumbricals originating from the FDP tendons): the QUADRIGA effect - loss of active flexion and grip in the other fingers when one FDP is over-advanced, tethered or amputated - and the LUMBRICAL-PLUS finger - paradoxical IP-joint extension on attempted flexion when an FDP is divided, over-lengthened or grafted too long so its pull is transmitted through the lumbrical to the extensor mechanism.
Radial Nerve AnatomyComprehensive guide to the anatomy, course, branches, and clinical correlations of the Radial Nerve
Radial Tunnel SyndromeComprehensive guide to radial tunnel syndrome including PIN entrapment sites, clinical differentiation from lateral epicondylitis, diagnostic approach, and surgical decompression techniques for orthopaedic exam
Radial-Sided Wrist PainPattern and differential for radial-sided wrist pain: de Quervain's, scaphoid fracture, SLAC/SNAC, CMC arthritis, intersection syndrome and Wartenberg's, with discriminators.
Raynaud's Phenomenon (Hand)Fellowship-level guide to Raynaud's phenomenon of the hand: the triphasic colour change of digital vasospasm, the crucial distinction between primary Raynaud's disease and secondary Raynaud's phenomenon (especially systemic sclerosis), red flags and nailfold capillaroscopy/autoantibody workup, and a stepwise management from cold avoidance through calcium-channel blockers to prostacyclin and surgery for digital ischaemia.
Recurrent & Revision Carpal Tunnel Syndrome (and Endoscopic Release)Fellowship-level guide to persistent, recurrent and revision carpal tunnel syndrome and to endoscopic carpal tunnel release - covering the three failure patterns (persistent = never resolved, often incomplete release; recurrent = relief then return, often perineural scarring; new/iatrogenic = nerve/branch injury), the systematic work-up of the failed release (re-confirm the diagnosis, re-image, electrodiagnostics), and revision options (complete open re-release with external neurolysis, and vascularised flap coverage for scarred nerves), plus the evidence on endoscopic versus open release.
Remplissage ProcedureComprehensive guide to the arthroscopic remplissage procedure for engaging Hill-Sachs lesions in anterior shoulder instability, including glenoid track assessment, surgical technique, combined Bankart repair, outcomes, and stiffness.
Revision Total Elbow ArthroplastyFellowship-level guide to revision total elbow arthroplasty: why primary TEAs fail (aseptic loosening, polyethylene bushing wear, periprosthetic fracture, infection and instability), the central problem of periprosthetic bone loss, the reconstruction options from bushing exchange and re-stemming to impaction grafting and allograft-prosthetic composite, the high complication burden, and the principles of managing the infected TEA.
Rheumatoid Arthritis of the HandComprehensive guide to rheumatoid arthritis affecting the hand - pathophysiology, classification, medical and surgical management including synovectomy, arthroplasty, and arthrodesis
RhomboidsSurgical anatomy of rhomboid minor and major, the dorsal scapular nerve from C5, rhomboid palsy and its subtle winging, and the medial parascapular interval used in the posterior approach to the scapula.
Ring Avulsion InjuryFellowship-level guide to ring avulsion injuries of the finger: the traction-degloving mechanism, the Urbaniak (and Kay) classification, the prognostic importance of an intact PIP joint and FDS, the extended zone of vascular injury requiring vein grafts, and the decision between microvascular revascularisation/replantation and completion amputation.
Sagittal Band InjuriesComprehensive guide to sagittal band injuries of the hand, including diagnosis, surgical repair techniques, and rehabilitation protocols for Orthopaedic exam preparation.
Scalene MusclesSurgical anatomy of the anterior, middle and posterior scalene muscles, the interscalene triangle and its contents, thoracic outlet syndrome and cervical rib, the interscalene block and phrenic nerve palsy, and the supraclavicular approach.
Scaphoid Excision and Four-Corner FusionComprehensive guide to scaphoidectomy and four-corner fusion for SLAC and SNAC wrist arthritis - indications, surgical technique including dorsal approach and fixation options (circular plate, K-wires, screws), preservation of radiolunate motion, outcomes compared with proximal row carpectomy, complications including nonunion and dorsal impingement, and evidence-based results
Serratus AnteriorSurgical anatomy of serratus anterior, the long superficial course of the long thoracic nerve, medial scapular winging and the wall-push test, pectoralis major transfer for chronic palsy, and the serratus flap.
Shoulder (Humeral Head) Resurfacing ArthroplastyFellowship-level guide to humeral head resurfacing arthroplasty: a bone-preserving, stemless cap that resurfaces the humeral head while keeping the metaphysis and shaft, its appeal in younger patients, the technical pitfalls (oversizing/overstuffing and excessive lateral offset that accelerate glenoid wear), the dominant failure mode of glenoid erosion and pain when metal articulates with native glenoid, registry survivorship including pyrocarbon, and the relatively straightforward conversion to a stemmed implant.
SLAC WristComprehensive guide to SLAC wrist - scapholunate advanced collapse including Watson staging, pathophysiology, surgical treatment options, four-corner fusion, and proximal row carpectomy for orthopaedic fellowship examination.
Small Joint Arthroplasty of the HandComprehensive guide to metacarpophalangeal (MCP), proximal interphalangeal (PIP), and carpometacarpal (CMC) joint arthroplasty including silicone Swanson implants, surface replacement, pyrocarbon designs, indications, surgical techniques, and complications
Snapping / Subluxing Extensor Carpi Ulnaris (ECU)Fellowship-level guide to extensor carpi ulnaris (ECU) tendon instability: subluxation/dislocation of the ECU out of its groove on the dorsal ulna when the subsheath tears, causing painful dorsoulnar snapping on supination - covering the anatomy, the provocative supination/ulnar-deviation test, dynamic ultrasound, conservative immobilisation in pronation, and subsheath repair/reconstruction.
Stemless / Short-Stem Shoulder ArthroplastyFellowship-level guide to stemless and short-stem humeral components in anatomic total shoulder arthroplasty: the bone-preserving, metaphyseal-fixation rationale (preserve humeral bone, shorten operative time, avoid diaphyseal stem complications and stress shielding), the requirement for adequate proximal humeral bone quality, the comparable clinical outcomes with fewer radiolucent lines, and the ease of conversion to a stemmed implant at revision.
Sternoclavicular Joint DislocationComprehensive guide to sternoclavicular joint dislocation, including anterior versus posterior types, mediastinal compromise in posterior dislocations, CT diagnosis, closed reduction, and reconstruction risks.
Subcoracoid ImpingementFellowship-level guide to subcoracoid impingement of the shoulder: anterior shoulder pain from narrowing of the coracohumeral interval, with the subscapularis caught between the coracoid tip and the lesser tuberosity; its anatomy and the 'roller-wringer' effect, the coracohumeral distance on MRI, the provocative tests, the genuine controversy over whether it causes subscapularis tears, and the conservative-then-arthroscopic-coracoplasty management.
Subscapularis AnatomyDetailed anatomy of the Subscapularis muscle, its critical role in shoulder stability, innervation, and clinical pathology.
Superficial Radial Nerve AnatomySurgical anatomy of the superficial branch of the radial nerve: emergence between brachioradialis and extensor carpi radialis longus, Wartenberg syndrome, and the nerve most often injured in wrist and thumb base surgery.
Supinator AnatomySurgical anatomy of supinator: the arcade of Frohse and posterior interosseous nerve compression, radial tunnel syndrome versus posterior interosseous nerve palsy, the safe zone for the Thompson approach and proximal radius plating, and supinator motor branch nerve transfer.
Suprascapular Nerve EntrapmentComprehensive guide to suprascapular nerve entrapment at the suprascapular and spinoglenoid notches, including ganglion cyst association, clinical presentation with infraspinatus wasting, EMG diagnosis, and surgical decompression techniques.
Supraspinatus AnatomySurgical anatomy of the supraspinatus: greater tuberosity footprint dimensions, the critical zone, suprascapular nerve constraints, the rotator cable and crescent, and tear patterns with their repair configurations.
Swan Neck DeformityComprehensive guide to Swan Neck Deformity, covering Nalebuff classification, intrinsic tightness testing, and management strategies.
SymphalangismFellowship-level guide to symphalangism - a congenital failure of differentiation of the finger (or toe) joints producing ankylosis/stiffness of the interphalangeal joints, most often the proximal interphalangeal joint - covering its forms (proximal/true vs distal symphalangism, isolated vs syndromic), the genetics and syndromic associations, the characteristic clinical and radiographic features (absent flexion crease, no IP-joint motion), and the largely supportive management given the lack of a true joint to reconstruct.
SyndactylyComprehensive guide to syndactyly including classification, surgical timing, web space reconstruction, and associated syndromes for Orthopaedic examination.
Teres Major AnatomySurgical anatomy of the teres major: the medial lip insertion, the lower subscapular nerve, its role as the floor of the quadrangular and triangular spaces and the roof of the triangular interval, the posterior axillary fold, and the L'Episcopo family of external rotation transfers.
Teres Minor AnatomySurgical anatomy of the teres minor: its axillary nerve supply and pseudoganglion, the inferior facet insertion, its role as the roof of the quadrangular space, hornblower's sign, and why its preservation predicts external rotation after reverse arthroplasty.
TFCC and Ulnar-Sided Wrist PainAdvanced orthopaedic guide to triangular fibrocartilage complex injury and ulnar-sided wrist pain, including anatomy, clinical localisation, imaging, Palmer and arthroscopic classifications, DRUJ stability, operative decision-making and rehabilitation.
The Intrinsic Hand: Intrinsic-Minus (Claw) and Intrinsic-Plus DeformityFellowship-level guide to intrinsic muscle function and the two opposite deformities: intrinsic-MINUS (claw hand - MCP hyperextension + IP flexion from intrinsic paralysis, e.g. ulnar palsy/leprosy) and intrinsic-PLUS (MCP flexion + IP extension from intrinsic tightness/spasticity) - covering the ulnar paradox, the Bouvier and Bunnell tests, and the splinting/tendon-transfer/release management.
The Six Dorsal Extensor Compartments of the WristFellowship-level anatomy reference for the six dorsal wrist extensor compartments beneath the extensor retinaculum: their tendon contents (1 APL/EPB, 2 ECRL/ECRB, 3 EPL, 4 EDC/EIP, 5 EDM, 6 ECU), Lister's tubercle, and the high-yield clinical correlations - de Quervain's (compartment 1), intersection syndrome, EPL rupture at the third-compartment watershed, and the ECU of the sixth compartment.
Thoracic Outlet SyndromeComprehensive guide to Thoracic Outlet Syndrome (TOS), including Neurogenic, Venous, and Arterial types, anatomy of the thoracic outlet, and management strategies.
Thromboangiitis Obliterans (Buerger's Disease)Fellowship-level guide to thromboangiitis obliterans (Buerger's disease) - a non-atherosclerotic, segmental, inflammatory occlusive disease of the small and medium arteries and veins of the extremities, strongly tied to tobacco, presenting in young smokers with distal ischaemia, digital ulceration/gangrene and migratory thrombophlebitis - covering its diagnosis (clinical criteria and the corkscrew-collateral angiogram), the absolute primacy of complete smoking cessation, and the role and limits of revascularisation and amputation in the hand and foot.
Thumb CMC ArthritisComprehensive guide to thumb carpometacarpal arthritis - anatomy, Eaton-Littler classification, grind test, trapeziectomy, LRTI, CMC arthroplasty, and surgical decision-making for orthopaedic exam
Thumb HypoplasiaComprehensive guide to thumb hypoplasia including Blauth classification, associated syndromes, clinical assessment, reconstruction versus pollicization, and surgical management for Orthopaedic examination.
Total Wrist Arthroplasty vs Arthrodesis (Wrist OA Reconstruction)Fellowship-level guide to reconstruction of the arthritic wrist: the decision between total wrist ARTHRODESIS (the durable, reliable fusion - the historical benchmark for high-demand patients and salvage) and total wrist ARTHROPLASTY (motion-preserving, improved with fourth-generation implants but with loosening/instability risks and not for heavy manual labour); indications, the patient factors that drive the choice, outcomes, and the failed-arthroplasty-to-fusion conversion.
Trapezius AnatomySurgical anatomy of the trapezius, the course of the spinal accessory nerve in the posterior triangle, trapezius palsy with lateral scapular winging, and the Eden-Lange and trapezius transfers.
Triceps Brachii AnatomySurgical anatomy of triceps brachii: three heads with separate radial nerve innervation, the radial nerve in the spiral groove, the triceps-splitting, Bryan-Morrey triceps-reflecting and olecranon osteotomy exposures of the distal humerus, and triceps insufficiency after total elbow arthroplasty.
Trigger Finger (Stenosing Tenosynovitis)Comprehensive guide to trigger finger including diagnosis, Green classification, injection technique, and surgical release.
Trigger Thumb (Pediatric)Comprehensive Exam-ready guide to pediatric trigger thumb including Notta's node pathophysiology, observation vs surgical decision-making, A1 pulley release technique, and exam scenarios
Triscaphe Arthritis (STT Arthritis)Degenerative arthritis of the scaphotrapeziotrapezoid joint causing radial-sided wrist pain, managed with activity modification, injections, or surgical options including excision arthroplasty and arthrodesis
Ulnar Club Hand (Ulnar Longitudinal Deficiency)Complete guide to ulnar club hand including classification, surgical management, and functional outcomes in longitudinal upper limb deficiencies
Ulnar Impaction SyndromeComprehensive guide to ulnar impaction syndrome including positive ulnar variance, TFCC tears, ulnar shortening osteotomy, and wafer procedures.
Ulnar Nerve AnatomyComprehensive guide to the anatomy, course, branches, and compression syndromes of the Ulnar Nerve
Ulnar Nerve PalsyComprehensive guide to Cubital Tunnel Syndrome, Guyon's Canal Syndrome, and Ulnar Nerve mechanics.
Ulnar Tunnel Syndrome (Guyon's Canal)Comprehensive guide to ulnar tunnel syndrome including anatomy of Guyon's canal, classification zones, diagnosis, and surgical decompression techniques.
Ulnar-Sided Wrist PainPattern-based differential for ulnar-sided wrist pain: TFCC tear, ulnar impaction, ECU instability, LT injury, DRUJ instability, pisotriquetral arthritis and hook of hamate fracture.
Valgus Extension Overload of the ElbowComprehensive guide to posteromedial olecranon osteophyte impingement in throwing athletes, UCL insufficiency relationship, imaging, and surgical debridement considerations.
Wartenberg's SyndromeComprehensive guide to Wartenberg's Syndrome (Cheiralgia Paresthetica), involving entrapment of the Superficial Radial Nerve, identifying clinical features, and distinguishing it from De Quervain's Tenosynovitis.
Wrist ArthroplastyComprehensive guide to total wrist arthroplasty - indications (RA, OA), implant types (Universal 2, Maestro, ReMotion), surgical technique, complications, and outcomes vs arthrodesis
Wrist Ligament InstabilityAdvanced orthopaedic guide to wrist ligament instability: examination technique, radiographic measurements, staging, arthroscopy, acute repair, chronic reconstruction, lunotriquetral instability and salvage surgery.

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All Hand & Upper Limb topics (180)

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All Hand & Upper Limb topics (180)

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