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OTB 505 > Final Exam Prep > Flashcards

Final Exam Prep Flashcards

1
Q

What motions are available at the CMC joint of the 1st digit (thumb)?

A

Flexion/Extension
Circumduction
Abduction/Adduction

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2
Q

What motions are available at the CMC joints of the fingers (digits 2-5)?

A

A slight gliding motion

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3
Q

What motions are available at the MCP joint of the thumb?

A

Flexion/extension

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4
Q

What motions are available at the MCP joints of the fingers (digits 2-5)?

A

Flexion/extension and Abduction/Adduction

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5
Q

Which muscles have attachments on the extensor hood?

A
  • Interossei
  • Extensor Digitorum Communis
  • Lumbricals
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6
Q

Which muscle is NOT an extrinsic muscle of the hand?

  • Abductor Pollicis Longus
  • Flexor Pollicis Longus
  • Opponens Pollics
  • Extensor Indicis
A

Opponens Pollics

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7
Q

Which of the following muscles ARE intrinsic muscles of the hand?

A
  • Abductor pollicis brevis
  • Flexor pollicis brevis
  • Flexor digiti minimi
  • Adductor policis
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8
Q

What is the function/action of the palmar interossei?

A

Adduction of the fingers

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9
Q

Which digit is considered the center line of the hand and therefore cannot adduct?

A

Digit 3

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10
Q

On the flexor side of the hand, which muscle inserts on the middle phalanx by splitting into two portions of tendon?

A

Flexor Digitorum Superficialis

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11
Q

If you lost sensation in the tip of your 2nd and 3rd digits, that would indicate damage to the ___________ nerve.

A

Median

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12
Q

If your anterior interosseous nerve is being impinged in the pronator teres due to muscle spasm with medial epicondylitis, you would not be able to perform the precision grip, but you would be able to perform the tripod grasp. This is due to weakness of the ________________, and the ability of an intact _______________ to compensate.

A

FDP, FDS

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13
Q

What is the function of the volar plate at the fingers?

A

Prevent hyperextension

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14
Q

Zone 2 of the flexor tendons is often called “No man’s land” because recovery from injury to the tendons in this area is extremely difficult and very often leads to permanent functional loss. That is due to the significant overlap of which two tendons in this area?

A

FDS & FDP

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15
Q

Which two metacarpals are the most rigidly connected to the distal row of carpal bones?

A

2 & 3

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16
Q

Which two metacarpals are the most mobile and therefore most commonly fractured?

A

4 & 5

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17
Q

The Bunnell-Littler Test looks at intrinsic (Lumbrical) vs extrinsic (EDC) tightness. If testing flexion of the PIP with the MCP held in extension creates more restriction of joint motion than flexion of both together, you decide that the ____________ are tight/short.

A

Lumbricals

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18
Q

There are no tendon insertions onto the proximal phalanx.

A

True

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19
Q

An intrinsic plus position for splinting is advised to prevent contracture at the MCP joints. This is because the collateral ligaments are the most _________ in a position of flexion.

A

Taut/tight

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20
Q

Which bones are more prone to injury in the hand?

A

Phalanges

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21
Q

AXILLARY NERVE INJURY

A

GH fracture or dislocation

Deltoid and Teres Minor

Sensation at lateral
shoulder

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22
Q

MUSCULOCUTANEOUS

NERVE

A

Biceps Brachii

Coracobrachialis

Brachialis

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23
Q

MEDIAN NERVE ENTRAPMENT

A

Median Nerve- FDS, APB, FPB, OP, and 2
Lumbricals

Anterior Interosseous Nerve dives deep – FPL,
FDP, Pronator Quadratus – NO SENSORY

Entrapment Sites: Cubital Fossa (ligament of
struthers), Pronator Teres, Carpal Tunnel

Ape Hand, Pope’s Benediction

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24
Q

ULNAR NERVE ENTRAPMENT

A

Innervates ½ FDP, FCU, ADD policis, hypothenar
eminence, interossei, ½ lumbricals, sensation to ulnar side
of the hand

Entrapment Sites:

Fascial band at medial/posterior elbow

Cubital Tunnel

Guyon’s Canal

Claw hand

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25
Q

RADIAL NERVE PATHOLOGY

A

Innervates Triceps, Brachioradialis, ECRL, ECRB,
sensation of posterior arm, forearm, dorsal-lateral hand

Posterior Interosseous Nerve:

Wrist Extensors, Supinator, Hand Extensors

Entrapment/Pathology Sites:

Radial Groove

Supinator

Radial Tunnel near radial head/arcade of Frohse

Saturday Night Palsy, Wrist drop

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26
Q

Stinger or Burner

A

(C5) – sport’s injury - involves traction or

compression

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27
Q

Erb’s Palsy

A

(C5, C6) – Waiter’s Tip posture

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28
Q

Klumpke’s Palsy

A

(C8, T1)

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29
Q

Horner’s Syndrome

A

(sympathetic fibers C8-T1)

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30
Q

Tendon Healing

A

Early – Inflammatory Phase to early Proliferation

Intermediate – Proliferation Phase

Late – Late Proliferation through Remodeling

Gliding of the tendons is NECESSARY for function

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31
Q

What kind of injury?

Quick stretch rupture or
avulsion

Gradual overstretch – RA

Friction from hardware or
osteophyte

A

Closed tendon injury

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32
Q

What kind of injury?

Laceration

Area of injury does not always
match up skin vs tendon

Dependent on the position of
the hand at the time of injury

A

Open tendon injury

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33
Q

What deformity?
Can be open or closed

Damage to the
Central Slip of the
Dorsal Apparatus

Flexion at the PIP
with Extension at the
DIP

Zone 3

A

Boutonniere deformity

34
Q

What deformity?

Can be open or closed

Damage to the
Terminal Tendon of
the Dorsal Apparatus

Flexion at the DIP with
an inability to extend it

Zone 1

A

Mallet Finger

35
Q

What deformity?

Can occur as a secondary
consequence of Mallet
Finger at the DIP

Can also occur due to volar
plate disruption at the PIP

Flexion at the DIP with
Extension at the PIP

A

Swan Neck

Deformity

36
Q

Jersey Finger or Trigger Finger?

Avulsion of the FDP tendon
insertion from the distal
phalanx

A

Jersey Finger

37
Q

Jersey Finger or Trigger Finger?

Thickened flexor tendon or narrow
flexor sheath

Stenosing Tenosynovitis

A

Trigger Finger

38
Q

Types of Wound Healing

A

Primary Closure/Intention – sutures, adhesives, staples –
wound edges are clean and little to no tissue loss

Secondary Closure/Intention – left open to heal via body’s
processes, scar formation

Tertiary/Delayed Primary Closure – poor vascular supply,
infection, bleeding does not allow for immediate
closure

39
Q

Phases of Wound Healing

A

Hemostasis

Inflammatory

Proliferation

Remodeling or
Maturation

40
Q

Abnormal Scarring

A

Hypertrophic: widened or unsightly scar that does not extend beyond the original boundaries of the wound

Keloid: continue to grow beyond the original injury site.

41
Q

Braden

A

Lower the score = more
risk

Low Risk: 18 – 15

Moderate Risk: 14 – 12

High Risk: 11 or less

42
Q

The brachial plexus is formed via spinal nerves _____ to _____.

43
Q

The 5 terminal branches of the brachial plexus are:

A

Axillary N

Radial N

Median N

Musculocutanous N

Ulnar N

44
Q

The portions of the brachial plexus from proximal to distal are:

A

Roots, Trunks, Divisions, Cords, Terminal Branches

45
Q

The Dorsal Scapular Nerve arises from the:

A

C5 nerve root

46
Q

Which nerve gets fibers directly from the C5 - C7 nerve roots?

A

Long Thoracic Nerve

47
Q

Which terminal branch (peripheral nerve) innervates the Coracobrachialis, Biceps Brachii and Brachialis?

Ulnar Nerve
Musculocutanous Nerve
Brachial Nerve
Median Nerve

A

Musculocutanous Nerve

48
Q

What comes together to form the Posterior Cord?

The Superior Trunks
The Median & Ulnar Nerves
All 3 anterior divisions
All 3 posterior divisions

A

All 3 posterior divisions

49
Q

T/F: The Median Nerve innervates both upper arm and forearm muscles.

50
Q

Which of the terminal branches are the only ones that innervate both the upper and lower arm?

Median N & Ulnar N
Radial N and Musculocutaneous N
Axillary N & Musculocutaneous N
Radial N and Median N

A

Radial N and Musculocutaneous N

51
Q

Which of the following is a high nerve injury to the Radial N that is caused by prolonged compression near the axilla?

Thoracic Outlet Syndrome
Erb’s Palsy
Saturday Night Palsy
Bell’s Palsy

A

Saturday Night Palsy

52
Q

Which of the following refers to a visible position of the hand notable after Median N injury?

Morton’s Hand
Claw Hand
Cubital Tunnel Syndrome
Ape Hand

53
Q

The brachial plexus is formed by the __________ of cervical roots _____________.

A

anterior rami, C5 - T1

54
Q

An isolated injury via entrapment of the posterior interosseous nerve in a muscle spasm of the supinator muscle is a:

mononeuropathy
polyneuropathy
double crush syndrome
central nervous system injury

A

mononeuropathy

55
Q

The classic presentation of a high radial nerve injury is:

Claw Hand
Ape Hand
Wrist drop
Bishop’s Wrist

A

Wrist drop

56
Q

How can one distinguish between pronator syndrome of the median nerve being compressed and anterior interosseous syndrome?

AIN syndrome will have a positive Tinel sign at the wrist

Only pronator syndrome involves entrapment at the pronator teres

They involve different musculature being innervated

Pronator Syndrome will present with sensory symptoms while AIN syndrome will not

A

Pronator Syndrome will present with sensory symptoms while AIN syndrome will not

57
Q

How does claw hand develop?

Significant compression of the median nerve

Significant compression of the ulnar nerve

Laceration of the axillary nerve

The finger flexors overpower the extensors

A

Significant compression of the ulnar nerve

58
Q

Compression of the posterior interosseous nerve will cause:

Loss of thumb flexion
Loss of finger flexion
Loss of thumb extension
Loss of thumb adduction

A

Loss of thumb extension

59
Q

Which of the following is the most significant and damaging nerve injury?

Mild compression
Neuropraxia
Laceration
Axonotmesis

A

Laceration

60
Q

Jersey Finger is the result of:
rupture of the FDS away from its distal attachment

rupture of the distal attachment of the FDP from the bone or bony avulsion

rupture of the central slip

rupture of the terminal tendon insertion

A

rupture of the distal attachment of the FDP from the bone or bony avulsion

61
Q

Which digit does not have cruciate pulleys?

The 5th digit
They all have cruciate pulleys
The thumb
The index finger

62
Q

The flexor tendon sheath provides ___________ to the flexor tendons (check all that apply).

A

synovial fluid to decrease friction

nutrition

enclosure to prevent bowstringing

63
Q

During which phase of healing is the flexor tendon its weakest and most at risk for recurrent rupture?

Maturation
Late fibroblastic/proliferative phase
Remodeling
The inflammatory phase

A

The inflammatory phase

64
Q

In general during tendon repair surgery the surgeon must balance two factors when determining how many sutures to put in. These factors are:

adhesions & infection
strength & elasticity
strength & bulk
elasticity & blood supply

A

strength & bulk

65
Q

What does a dorsal blocking splint prevent?

Extension of the MCPs & flexion of the PIPs & DIPs
Flexion of the MCPs, PIPs, & DIPs
extension of the MCPs, PIPs & DIPs
Flexion of the MCPs & extension of the PIPs/DIPs

A

extension of the MCPs, PIPs & DIPs

66
Q

What are types of tendon gliding exercises?

A

Hook grip
Full fist/Composite flexion
Straight fist

67
Q

What is one method to prevent PIP flexion contracture?

Strapping the IPs into extension overnight
Fully immobilizing the fingers in extension for two weeks
MCP joint mobilization
Quadriga effect

A

Strapping the IPs into extension overnight

68
Q

Zone 2 of the flexor side of the hand is often called “No Man’s Land” due to the high probability of ______________ that limit function.

adhesions
sutures
infection
muscles

69
Q

Why was JP educated to do an HEP that includes passive flexion but not active flexion?

to prevent dehisence of the wound
to reduce the impact of infection
to prevent adhesions but avoid rupture of the newly repaired tendons
to minimize scar formation

A

to prevent adhesions but avoid rupture of the newly repaired tendons

70
Q

entrapment of the anterior interosseous nerve in the forearm. As part of your assessment you ask them to do the following

A

Make the OK sign with their index finger and thumb

71
Q

Your client comes to you for rehab after sustaining a boxer’s fracture (the head of the 5th metacarpal) that has now healed. Due to significant scar tissue in this area, you are concerned about the integrity of which of the following:

The longitudinal arch
The median nerve
The distal transverse arch
The proximal transverse arch

A

The distal transverse arch

72
Q

Hook grip is formed by contraction of the _______________ muscles of the hand:

73
Q

Skier’s thumb is:

a chronic overuse injury to the radial collateral ligament of the MCP

an acute injury to the ulnar collateral ligament at the IP

an acute injury to the ulnar collateral ligament at the MCP

an acute injury to the radial collateral ligament of the MCP

A

an acute injury to the ulnar collateral ligament at the MCP

74
Q

What are the normal phases and order of wound healing?

A

Inflammation, Proliferation, Maturation

75
Q

What is eschar?

A

dry, hard, dead tissue that is firmly adhered to the wound bed and usually dark brown or black

76
Q

What is slough

A

whitish/yellow dead tissue that can cover all or a part of the wound bed

77
Q

What is normal exudate?

A

Clear drainage or fluid seeping from a wound

78
Q

What are the two main objectives of the Inflammatory Phase?

A

Hemostasis (stop the bleeding)

Reduce bacterial load

79
Q

Whats the goal of the Proliferative Phase?

A

Granulation

80
Q

When does scar formation occur?

A

Maturation/Remodeling

OTB 505 (3 decks)

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