Extensor Forearm and Dorsum Hand

Question 1

De Quervain’s tenosynovitis

Answer 1

Excessive friction of tendons in sheath 1: abductor pollicus longus, extensor pollicis brevis

• Leads to fibrous thickening of sheath and stenosis of osseofibrous tunnel

Question 2

Synovial cyst

Answer 2

Non-tender cystic swelling foudn in association with the synovial sheaths on the dorsum of the hand

• Most commonly found at the distal attachment of extensor carpi radialis brevis muscle

Question 3

Three muscle tendons bound to anatomical snuff box

Answer 3

Anterior borders: tendons of abductor pollicis longus and extensor pollicis brevis

Posterior border: tend of extensor pollicis longus

The scaphoid bone can be palpated deep within the anatomical snuff box and pain felt there indicates a fracture of the scaphoid bone

Question 4

Cutaneous domains of hand by median, ulner, and radial nerves

Answer 4

Question 5

Dermatomes of thumb, index, and pinkey fingers

Answer 5

Thumb = C6

Index = C7

Pinkey = C8

Question 6

Clinical assesment of radial nerve

Answer 6

• Inability to extend wrist and digits (wristdrop)
• Inability to supinate hadn and forearm
• Loss of sensation in the dorsal base of thumb

Question 7

Clinical assesment of ulnar nerve

Answer 7

• Loss of adduction and abduction of fingers
• Loss of flexion of the MCP
• Loss of extension of IP joints of ring and middle fingers
• Sensory loss on palmar and dorsal aspects of half of the ring finger and the pinkey
• Associated with characteristic ulnar claw

Question 8

Allen test

Answer 8

A test for abnormal circulation in the hand

• Have patient make fist and elevate hand for 30 seconds
• Apply pressure over the ulnar and radial arteries to occlude them
• Have patient relax hand while still elevated (should appear blanched)
• Release pressure on ulnar artery
  
  • Positive (good) result is hand returns to normal color
  • Negative result means that ulnar arterial supply to hand is compromise and cannot be safely cannulated

Question 9

How to stop palmar arch bleeding

Answer 9

Must put pressur eon brachial artery near cubital fossa

Question 10

Etiology and symptoms of Raynaud’s

Answer 10

Excessivley reduced blood flow in response to cold or emptional stress

• When bloodflow is returned, skin turns red, then normal, and then often has swelling and painful “pins and needles” sensation

Potentially caused by hyperactivation of sympathetic nervous system causing extreme vasoconstriction of peripheral blood vessels