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Plastics > Examination of the Hand > Flashcards

Examination of the Hand Flashcards

1
Q

What is the palmar surface of the hand aka?

A

Volar

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2
Q

What is the back surface of the hand also known as?

A

Dorsal surface

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3
Q

Where are the flexor tendon located?

A

Volar surface of hand

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4
Q

Where are the extensor tendons located?

A

Dorsal surface of hand

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5
Q

What is the thenar eminence?

A

Soft tissue bulk on the volar surface proximal to the thumb

It contains the intrinsic muscles of the thumb

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6
Q

What is the hypothenar eminence?

A

Soft tissue bulk on volar surface of hand proximal to pinky

Contains intrinsic muscles of the pinky

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7
Q

What are the bones of the hands?

A

Carpals (8 bones of wrist)
Metacarpals (1 to 5)
Phalanges (3 per finger, 2 for thumb)

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8
Q

What joints exist between the carpal and metacarpal bones?

A

Carpo-metacarpal joints

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9
Q

What joints exist between the metacarpal and phalangeal bones?

A

Metacarpo-phalangeal joints

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10
Q

What joints exist between the phalangeal bones?

A

Interphalangeal point (proximal and distal)

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11
Q

What forms the carpal tunnel?

A

Carpal arch of the carpal bones

Flexor retinaculum forms roof

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12
Q

What passes through the carpal tunnel?

A

Median nerve

9 flexor tendons of the digits

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13
Q

What muscles make up the thenar eminence? State their function

A

Opponens pollicis - opposition of thumb
Abductor pollicis brevis - abduction of thumb
Flexor pollicis brevis - flexion of thumb

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14
Q

What muscles make up the hypothenar eminence? State their function

A

Opponens digiti minimi - opposition of little finger
Abductor digiti minimi - abduction of little finger
Flexor digiti minimi - flexion of little finger

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15
Q

What muscles exist between metacarpal bones?

A

Interosseous muscles (dorsal and volar)

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16
Q

How many dorsal interossei are there? What is their role?

A

4

Abduction of fingers

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17
Q

How many volar dorsal interossei are there? What are their role?

A

3

Adduction of fingers

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18
Q

Where are the lumbrical muscles found?

A

FDP tendons

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19
Q

What is the role of the lumbrical muscles?

A

Flexion of MCP

Extension of PIP and DIP

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20
Q

What is the action of palmaris brevis?

A

Helps improve grip

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21
Q

What is the action of adductor pollicis?

A

Adduction of thumb

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22
Q

What are the extrinsic muscles of the hand?

A 
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
Flexor carpi radialis
Flexor carpi ulnaris
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23
Q

Where does the tendon of the FDS insert and what is its role?

A

Inserts on middle phalange so allows flexion of PIP

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24
Q

Where does the tendon of the FDP insert and what is its role?

A

Inserts on distal phalanges so allows flexion of DIP

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25
Q

Where does the tendon of the flexor pollicis longus insert and what is its role?

A

On distal phalanx of thumb, so allows flexion of thumb

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26
Q

What is the role of flexor capri radialis?

A

Abduction of hand

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27
Q

What is the role of flexor capri ulnaris?

A

Adduction of the hand

28
Q

What muscles are found in the 1st extensor compartment and what are their roles?

A

Abductor pollicis longus (abduction of thumb)

Extensor pollicis brevis (extension of proximal phalanx of thumb)

29
Q

What muscles are found in the 2nd extensor compartment and what are their roles?

A

Extensor carpi radialis longus and brevis (extension + abduction of wrist)

30
Q

What muscle is found in the 3rd extensor compartment and what is its r role?

A

Extensor pollicis longus (extends distal phalanx of thumb)

31
Q

What muscles are found in the 4th extensor compartment and what are their roles?

A 
Extensor digitorum (extends digits expect thumb and extends wrist)
Extensor indicis proprius (extends index finger)
32
Q

What muscles are found in the 5th extensor compartment and what are their roles?

A

Extensor digiti minimi (extension of little finger)

33
Q

What muscle is found in the 6th extensor compartment and what is its role?

A

Extensor carpi ulnaris (extension + adduction of wrist)

34
Q

What are the extensor hoods?

A

Formed by the tendons of the ED and EPL

An important site of attachment for many intrinsic muscles

35
Q

What tendon forms the palmar apnoeurosis?

A

Palmaris longus tendon

36
Q

What is the anatomical snuffbox?

A

Triangular depression on posterolateral side of wrist

37
Q

What forms the borders of the anatomical snuffbox?

A

Lat - abductor pollicis longus + extensor pollicis brevis

Med - extensor pollicis longus

Floor - scaphoid + trapezium

38
Q

What are the contents of the anatomical snuffbox?

A

Extensor carpi radialis longus and brevis
Radial artery
Radial nerve
Cephalic vein

39
Q

What is the blood supply to the hand?

A

Ulnar + radial arteries which form the superficial and deep palmar arches

40
Q

Where does the ulnar artery supply?

A

Side of index finger, middle, ring and little finger

41
Q

What are the branches of the ulnar artery?

A

Deep palmar branch (anastomoses with deep palmar arch formed by radial artery)
Palmar digital artery (supplies ulnar side of little finger)

3 common palmar digital arteries (branch into proper palmar digital arteries to supply radial side of little finger, ring and middle finger and ulnar side of index finger)

42
Q

Where does the radial artery supply?

A

Radial side of index finger, thumb

43
Q

What four branches does the radial artery become?

A

Princeps pollicis artery and radialis indicis artery

Dorsal carpal + dorsal metacarpal branches supply dorsal aspect of hand

44
Q

What artery supplies the dorsal interossei?

A

Radial

45
Q

What is the venous drainage of the hand?

A

Interconnected networks of deep and superficial veins

46
Q

From what side of the hand does the cephalic vein arise?

A

Radial

47
Q

From what side of the hand does the basilic vein arise?

A

Ulnar

48
Q

What is the distribution of the radial nerve?

A

Dorsal surface from thumb to middle finger

49
Q

What is the distribution of the median nerve?

A

Thumb, index, middle and half of ring finger

50
Q

What is the distribution of the ulnar nerve?

A

Little finger and half of ring finger

Motor supply to all intrinsic muscles expect thenar muscles and lateral 2 lumbricals

51
Q

Why is it essential to treat swelling of the hand?

A

If left untreated it will encourage a fibroblastic change causing moving parts of the hand to adhere –> loss of function

52
Q

How can we minimise swelling of the hand?

A

Keeping it elevated

53
Q

What are the purposes of splinting?

A

Protect injured structures
Prevent joint contracture
Prevent development of strong substitution patterns
Maximise functional use of hand

54
Q

Should you tell the patient to avoid moving the hand when its in a splint?

A

No encourage controlled active mobilisation (i.e. movement within the splint as this helps with rehab)

55
Q

What are the different ways of immobilising the hand?

A

Hand cast
Buddy splint - for finger injuries (tape fingers together)
FDP and FDS splint - when flexors of fingers injured
FPL splint
FCR and FCU splint
ED splint
etc.

56
Q

How should you manage a burnt hand?

A

Put in clear bag, elevate to reduce swelling, move fingers + wrist to prevent adhesions/contractions
Pain relief
Excision of dead tissue, appropriate surgery

57
Q

How should you manage a hand infection?

A 
Elevation
Rest
Antibiotics (swab wound first) 
Incision + drainage if pus present
Tetanus prophylaxis for open wounds
58
Q

What is paronychia?

A

Infection of skin fold that sits over the finger nail

59
Q

What tends to cause paronychia?

A

Nail biting or aggressive manicure

60
Q

How does paronychia present?

A

Painful, swollen, red nail fold

61
Q

Who does chronic paronychia tend to occur in?

A

Those who constantly have wet hands, e.g. bartenders, usually a fungal infection

62
Q

What is felon?

A

Infection of distal pad of finger usually caused by puncture of finger tip by thorn or splinter

63
Q

What is tenosynovitis?

A

Infection of flexor tendon sheath

64
Q

What are the 4 signs of tenosynovitis?

A

Partially flexed posture of finger
Pain with passive finger extension over the palmar side of finger
Pain to touch over palmar side of finger
Circumferential swelling around entire finger

65
Q

What is the commonest organism from a human bite to cause infection in the hand?

A

Eikenella corrodens

Plastics (6 decks)

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