Medical Malpractice Insurance for orthopaedic surgeons

Upper Extremity

– Discussion:     – upper extremities are involved in as many as two-thirds of pts who have peripheral neuropathy, but the involvement tends to be milder & to become clinically symptomatic at later age than does involvement of the lower extremities;     – intrinsic-minus hands develop with decreased stability

Ulnocarpal Impaction / Impingement Syndrome

– See: RU joint – Discussion:     – refers to impingement of the ulnar head against the carpi which can lead to TFCC tears and lunotriquetral ligament attrition;     – lunotriquetral ligament attrition may occur from compression and translation shear as the lunate becomes impinged against the ulnar head;     – causes:   … Read more

Ulnocarpal Impingement Syndrome

– Discussion:     – impingement of distal ulna on carpi which may arise from positive ulnar variance or non union of distal ulnar frx;     – positive ulnar varience leads to loading of the ulnocarpal joint and resultant LT disruption, lunate chondral lesion, and TFCC tears;     – diff dx: (ulnar sided … Read more

Ulnar Translocation

– Discussion:     – most frequent radiocarpal instability;     – the lunate is translocated ulnarly, and therefore is not supported by the radius;     – ulnar translationn is also commonly seen in disease such as RA or in Madelung’s deformity;             – in RA, may occur along … Read more

Ulnar Variance

– Discussion:     – mean ulnar variance is 0.9 mm (range: 4.2 to 2.3 mm);     – functional anatomy:            – w/ neutral variance, 80% of load is born by radius and 20% by ulna;            – 2.5 mm increase in ulnar varience will increase … Read more

Ulnar Bursae

– Anatomy:     – ulnar bursae includes little finger tendon sheath which begins at terminal phalanx & extends proximally half way up the palm;           – occassionally the distal unexpanded part of little finger tendon sheath does not communicate w/ ulnar bursae;     – in the palm, the ulnar … Read more

Tuberous Sclerosis

– Discussion:     – is classically characterized by a clinical triad of epileptic seizures, mental retardation and skin lesions which have been considered          hamartomas of the skin and brain;     – adenoma sebaceum is the most familiar cutaneous stigma;     – high percentage of pts (66%) have radiographic findings … Read more

Trigger Finger: Non Operative Treatment

– DIP Joint Immobilization:     – immoblization of the DIP joint is extremely useful in preventing triggering in all of the fingers including the thumb;     – DIP immobilization (leaving the PIP free), has minimal functional limitations and most patients can work without restrictions;     – technique: consider applying two layers of … Read more

Trigger Finger / Tenosynovitis

– See: – Phalangeal Injury – Congenital Trigger Thumb – Rheumatoid Trigger Finger – Discussion: – results from localized tenosynovitis of superficial and deep flexor tendons adjacent to A1 pulley at a metacarpal head; – inflammation causes nodular enlargement of tedon distal to pulley; – occurs most often in middle or ring fingers (occassionally in … Read more