Clinical Anatomy of the Wrist & Hand

Question 1

Wrist Joint

Answer 1

Synovial joint between the distal end
of the radius and ulna with the carpal
bones • Radius articulate with scaphoid and
lunate
• Radioulnar disc articulate with lunate
and triquetrum

Question 2

Wrist Joint

-movement

Answer 2

Flexion and extension • Abduction (lateral deviation) and

adduction (medial deviation)

Question 3

Intercarpal joints

Answer 3

Synovial joints shared a single capsule • Limited movements, but contributes to
the positioning of the hand in flexion,
extension, abduction and flexion

Question 4

Bones of the wrist-Proximal Row – lateral to medial

Answer 4

1. Scaphoid
2. Lunate
3. Triquetrum
4. Pisiform (pea shaped)

Question 5

Bones of the wrist-Distal Row - lateral to medial

Answer 5

5. Trapezium
6. Trapezoid
7. Capitate: articulate
8. Hamate
   • hook on palmar surface*

Question 6

1
st carpometacarpal (CMC) joint
between trapezium and base of
thumb

Answer 6

addle joint which permits
flexion, extension, abduction,
adduction and opposition of thumb

Question 7

2
nd to 5th carpometacarpal
(CMC)joints

Answer 7

only permits limited

gliding movements

Question 8

Metacarpophalangeal (MCP) joints

Answer 8

permits flexion, extension,

abduction and adduction of digits

Question 9

Interphalangeal (IP) joints

Answer 9

permits flexion and extension

Question 10

Anatomical Snuff Box

Answer 10

A triangular depression formed on

the posterolateral side of the wrist

Question 11

Anatomical Snuff Box-Lateral borde

Answer 11

• abductor pollicis longus

* extensor pollicis brevis.

Question 12

Anatomical Snuff Box-Medial border:

Answer 12

extensor pollicis longus.

Question 13

Anatomical Snuff Box-• Roof:

Answer 13

Superficial branch of the radial nerve

• cephalic vein.

Question 14

Anatomical Snuff Box- Floor:

Answer 14

Scaphoid and trapezium,
• Distal ends of the tendons of ECRL &
ECRB.

Question 15

Anatomical Snuff Box-Contents

Answer 15

radial artery.

Question 16

Clinical Correlate- pain in the “anatomical snuffbox-Where is the fracture?

Answer 16

Scaphoid fracture

Question 17

What can be the clinical consequences of

delaying treatment of the scaphoid fracture?

Answer 17

Nonunion, avascular necrosis of proximal

portion

Question 18

Clinical Correlate – Boxers

Fracture

Answer 18

Impaction fracture of the neck
fifth metacarpal (sometimes
can involve the fourth
metacarpal)
• Usually comminuted
• Usually because of a direct
blow with a clenched fist
against a solid surface.

Question 19

Colle’s:

Answer 19

fracture of the
distal radius with posterior
displacement of the distal
fragment

Question 20

Smith’s

Answer 20

fracture of the
distal radius with anterior
displacement of the distal
fragment

Question 21

Scaphoid fracture:

Answer 21

usually
around the neck. May lead
to avascular necrosis of
the proximal fragmen

Question 22

Carpal Tunnel

Answer 22

The carpal tunnel is
formed anteriorly at the
wrist
• Floor: Deep arch formed
by the carpal bones
• Roof: Flexor retinaculum
• Contents: The tendons of
FDS, FDP, FPL, and the
median nerve

Question 23

Guyon’s Canal

Answer 23

• Roof: palmar carpal
ligament
• Floor: flexor
retinaculum and
hypothenar muscles
• Contents: ulnar nerve
artery and vein

Question 24

Compartments of the hand-Midpalmar (central)

Answer 24

Contains long flexor
tendons, lumbricals,
palmar arches

Question 25

Compartments of the hand-Thenar eminence

Answer 25

Contains FPL tendon and three thumb muscles Recurrent median nerve

Question 26

Compartments of the hand-Hypothenar eminence

Answer 26

Contains three little finger muscles Deep motor branch of the ulnar nerve

Question 27

Compartments of the hand-Four interosseous spaces

Answer 27

Palmar and dorsal interosseous muscles Deep motor division of the ulnar nerve

Question 28

Clinical Correlate: Dupuytren’s Contracture

Answer 28

``` •Flexion contracture of the hand •Thickening and contraction of the palmar aponeurosis •Nodule formation •Unable to extend fingers ```

Question 29

Clinical Correlate: Dupuytren’s Contracture-Treatment

Answer 29

``` •Needle aponeurotomy is a minimally invasive technique where the cords are weakened through the insertion and manipulation of a small needle. Once weakened, the offending cords may be snapped by simply pulling the finger(s) straight ```

Question 30

Clinical Correlate: Dupuytren’s Contracture-Surgery

Answer 30

cutting out thickened and contracted bands in palmar aponeurosis

Question 31

Fibrous digital tendon sheaths

Answer 31

``` -dense connective tissue surrounding tendons of FDP, FDS & FPL muscles -Hold tendons to the phalanges and prevent bowing ```

Question 32

Synovial sheaths

Answer 32

Within the fibrous sheath the tendon has a synovial sheath directly surrounding it

Question 33

Radial Bursa

Answer 33

Synovial sheath surrounding the tendon of FPL continuing through to carpal tunnel

Question 34

lnar bursa – common | flexor sheath

Answer 34

``` Synovial sheath surrounding the tendons of FDP & FDS of 5th digit continuing through the midpalmar space and into the carpal tunnel ```

Question 35

Clinical Correlate: Trigger finger (Stenosing Tenosynovitis)

Answer 35

``` •Fibrosis and tightening of the fibrous digital sheath of the flexor tendons at the level of the metacarpophalangeal (MCP) joint •Inflammation and nodule formation of the flexor tendons. •Triggering of the affected finger is due to tendons requiring excessive force to fully extend or flex ```

Question 36

Extensor hood

Answer 36

``` Tendons of extensor digitorum and extensor pollicis longus expand over the proximal phalanx, makes a “hood” which then divides into a central band and 2 lateral bands ```

Question 37

Extensor hood -Serves as an attachment for

Answer 37

• Lumbricals • Dorsal interossei • Palmar interossei • Due to attachment, these muscles also extend at the interphalangeal joint

Question 38

Dorsal interosseous

Answer 38

Abduction of digits • Extension of digits • Deep branch of the ulnar nerve

Question 39

Palmar interosseous

Answer 39

• Adduction • Extension of digits • Deep branch of the ulnar nerve

Question 40

Adductor policis

Answer 40

• Adducts the thumb • Deep branch of the ulnar nerve

Question 41

Blood supply of the hand

Answer 41

-Superficial palmar arch Mainly from ulnar artery -Deep palmar arch Mainly from radial artery

Question 42

Lumbricals

Answer 42

``` • 1 st-2nd palmar digital branches of median nerve • 3rd-4th Deep branch of ulnar nerve • Flex metacarpophalangeal (MCP) joints and extend interphalangeal joints of digits 2-5 ```

Question 43

Thenar Group

Answer 43

``` Recurrent branch of the median nerve 1. Flexor policis brevis 2. Abductor policis brevis 3. Opponens pollicis ```

Question 44

Hypothenar Group

Answer 44

``` Deep branch of the ulnar nerve 1. Flexor digiti minimi 2. Abductor digiti minimi 3. Opponens digiti minimi ```

Question 45

Clinical Correlate: Allen Test

Answer 45

- Erythema – normal test | - Pallor – beware!

Question 46

Venous drainage of | hand-Superficial veins:

Answer 46

``` On the dorsum of the hand, the dorsal venous network coalesces on the medial side of the wrist to form the basilic vein and on the lateral side of the wrist to form the cephalic vein ```

Question 47

Venous drainage of | hand- Deep veins:

Answer 47

``` • Superficial and deep venous palmar arches accompany arterial palmar arches in the hand • Drain into the paired radial and ulnar veins ```

Question 48

Lymphatic drainage of | Upper Limb

Answer 48

``` • Follows the same path of the venous drainage of the upper limb • All lymphatics drain to the axillary nodes -• All lymph then pass from apical to subclavian trunk to lymphatic/thoracic duc ```

Question 49

Lymphatic drainage of Upper Limb-Superficial drainage: veins within the skin and superficial fascia

Answer 49

``` -Medial hand, forearm and arm • Lymphatic fluid will go to lateral (humeral) axillary nodes, then to central axillary nodes, then finally to apical axillary nodes -Lateral hand, forearm and arm • Lymphatic fluid will go directly to the apical axillary nodes ```

Question 50

Lymphatic drainage of Upper Limb-Deep drainage: veins within the compartments

Answer 50

• Lymphatic fluid from the compartments of hand, forearm and arm will go to lateral (humeral) nodes, then to central then finally to apical