Final Exam Prep Flashcards by Latchmi Girdhari

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

Flexion/Extension
Circumduction
Abduction/Adduction

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

A slight gliding motion

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

Flexion/extension

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

Flexion/extension and Abduction/Adduction

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Which muscles have attachments on the extensor hood?

Interossei
Extensor Digitorum Communis
Lumbricals

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Which muscle is NOT an extrinsic muscle of the hand?

Abductor Pollicis Longus
Flexor Pollicis Longus
Opponens Pollics
Extensor Indicis

Opponens Pollics

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

Abductor pollicis brevis
Flexor pollicis brevis
Flexor digiti minimi
Adductor policis

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What is the function/action of the palmar interossei?

Adduction of the fingers

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

Digit 3

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

Flexor Digitorum Superficialis

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

Median

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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.

FDP, FDS

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

Prevent hyperextension

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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?

FDS & FDP

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

2 & 3

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

4 & 5

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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.

Lumbricals

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There are no tendon insertions onto the proximal phalanx.

True

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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.

Taut/tight

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Which bones are more prone to injury in the hand?

Phalanges

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AXILLARY NERVE INJURY

GH fracture or dislocation

Deltoid and Teres Minor

Sensation at lateral
shoulder

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MUSCULOCUTANEOUS

NERVE

Biceps Brachii

Coracobrachialis

Brachialis

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MEDIAN NERVE ENTRAPMENT

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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ULNAR NERVE ENTRAPMENT

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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RADIAL NERVE PATHOLOGY

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

Stinger or Burner

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

Erb’s Palsy

(C5, C6) – Waiter’s Tip posture

Klumpke’s Palsy

(C8, T1)

Horner’s Syndrome

(sympathetic fibers C8-T1)

Tendon Healing

Early – Inflammatory Phase to early Proliferation Intermediate – Proliferation Phase Late – Late Proliferation through Remodeling Gliding of the tendons is NECESSARY for function

What kind of injury? Quick stretch rupture or avulsion Gradual overstretch – RA Friction from hardware or osteophyte

Closed tendon injury

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

Open tendon injury

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

Boutonniere deformity

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

Mallet Finger

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

Swan Neck | Deformity

Jersey Finger or Trigger Finger? Avulsion of the FDP tendon insertion from the distal phalanx

Jersey Finger

Jersey Finger or Trigger Finger? Thickened flexor tendon or narrow flexor sheath Stenosing Tenosynovitis

Trigger Finger

Types of Wound Healing

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

Phases of Wound Healing

Hemostasis Inflammatory Proliferation Remodeling or Maturation

Abnormal Scarring

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.

Braden

Lower the score = more risk Low Risk: 18 – 15 Moderate Risk: 14 – 12 High Risk: 11 or less

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

C5, T1

The 5 terminal branches of the brachial plexus are:

Axillary N Radial N Median N Musculocutanous N Ulnar N

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

Roots, Trunks, Divisions, Cords, Terminal Branches

The Dorsal Scapular Nerve arises from the:

C5 nerve root

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

Long Thoracic Nerve

Which terminal branch (peripheral nerve) innervates the Coracobrachialis, Biceps Brachii and Brachialis? Ulnar Nerve Musculocutanous Nerve Brachial Nerve Median Nerve

Musculocutanous Nerve

What comes together to form the Posterior Cord? The Superior Trunks The Median & Ulnar Nerves All 3 anterior divisions All 3 posterior divisions

All 3 posterior divisions

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

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

Radial N and Musculocutaneous N

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

Saturday Night Palsy

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

Ape Hand

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

anterior rami, C5 - T1

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

mononeuropathy

The classic presentation of a high radial nerve injury is: Claw Hand Ape Hand Wrist drop Bishop's Wrist

Wrist drop

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

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

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

Significant compression of the ulnar nerve

Compression of the posterior interosseous nerve will cause: Loss of thumb flexion Loss of finger flexion Loss of thumb extension Loss of thumb adduction

Loss of thumb extension

Which of the following is the most significant and damaging nerve injury? Mild compression Neuropraxia Laceration Axonotmesis

Laceration

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

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

Which digit does not have cruciate pulleys? The 5th digit They all have cruciate pulleys The thumb The index finger

The thumb

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

synovial fluid to decrease friction nutrition enclosure to prevent bowstringing

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

The inflammatory phase

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

strength & bulk

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

extension of the MCPs, PIPs & DIPs

What are types of tendon gliding exercises?

Hook grip Full fist/Composite flexion Straight fist

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

Strapping the IPs into extension overnight

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

adhesions

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

to prevent adhesions but avoid rupture of the newly repaired tendons

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

Make the OK sign with their index finger and thumb

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

The distal transverse arch

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

extrinsic

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

an acute injury to the ulnar collateral ligament at the MCP

What are the normal phases and order of wound healing?

Inflammation, Proliferation, Maturation

What is eschar?

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

What is slough

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

What is normal exudate?

Clear drainage or fluid seeping from a wound

What are the two main objectives of the Inflammatory Phase?

Hemostasis (stop the bleeding) Reduce bacterial load

Whats the goal of the Proliferative Phase?

Granulation

When does scar formation occur?

Maturation/Remodeling