20230714 Hand teaching

A 8-month-old male presents with the hand deformity seen in Figure 1. Examination reveals restrictions in passive extension and abduction of the thumb. His mother tells you that her other two children had similar deformities that required operative management. What would you offer as the first-line treatment option for this child's deformity?

• Observation

• Serial splinting of thumb

• Thumb-index finger web space reconstruction

• Thenar muscle tendon transfer

• First metacarpophalangeal joint arthrodesis

All of the tendons can be used as donor for a case of clasped thumb tendon transfer except?

• EIP

• FCR

• ADM

• PL

• FDS

Which condition is not associated with clasped thumb?

• X-linked MASA syndrome

• Arthrogryphosis

• Digitotalar dysmorphisms

• Pierre Robin syndrome

• Freeman-Sheldon syndrome

In which stage of trigger thumb where triggering is observed when interphalangeal joint is extended passively?

• 1

• 2

• 3

• 4

• 5

A 6-year-old child has a fixed flexion deformity of the interphalangeal (IP) joint of the right thumb. The thumb is morphologically normal, with a nontender palpable nodule at the base of the metacarpophalangeal joint. Clinical photographs are shown in Figure 2. Based on these findings, what is the treatment of choice?

• Complete release of the proximal annular pulley of the flexor sheath

• Removal of the nodule in the flexor pollicis longus

• Fractional lengthening of the flexor pollicis longus tendon at the musculotendinous junction

• Steroid injection into the palpable nodule

• No treatment because this condition normally spontaneously resolves