Forearm, Wrist, hand

Question 1

Forearm bones: Radius and Ulna

Answer 1

Question 2

Forearm Joints

Radioulnar

Radiocarpal

Answer 2

• Proximal and distal radioulnar joints = synovial joint
  
  • Pronate (cross)
  • Supinate

Question 3

Forearm Joints

Radioulnar

Radiocarpal

Answer 3

• Radiocarpal joint
  
  • Flex/extend
  • Abduct/adduct
  • Circumduct

Question 4

Anterior Forearm Muscles

Superficial muscles

Pronator teres

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

Intermediate muscles

Flexor digitorum superficialis

Deep muscles

Pronator quadratus

Flexor digitorum profundus

Flexor pollicus longus

Answer 4

Question 5

Anterior Forearm Muscles

Superficial muscles

Pronator teres

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

Intermediate muscles

Flexor digitorum superficialis

Deep muscles

Pronator quadratus

Flexor digitorum profundus

Flexor pollicus longus

Answer 5

Question 6

Anterior Forearm Muscles

Superficial muscles

Pronator teres

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

Intermediate muscles

Flexor digitorum superficialis

Deep muscles

Pronator quadratus

Flexor digitorum profundus

Flexor pollicus longus

Answer 6

Question 7

Anterior Forearm Muscles

Superficial muscles

Pronator teres

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

Intermediate muscles

Flexor digitorum superficialis

Deep muscles

Pronator quadratus

Flexor digitorum profundus

Flexor pollicus longus

Answer 7

Question 8

Anterior Forearm Muscles

Superficial muscles

Pronator teres

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

Intermediate muscles

Flexor digitorum superficialis

Deep muscles

Pronator quadratus

Flexor digitorum profundus

Flexor pollicus longus

Answer 8

Question 9

Anterior Forearm Nerve

Answer 9

• Median* > anterior interosseus
• Ulnar
  
  • Flexor carpi ulnaris
  • Ulnar half of flexor digit. Profundus

Question 10

Anterior Forearm Blood Supply

Answer 10

• Radial artery
• Ulnar artery
• Interosseous artery

Question 11

Posterior Forearm Muscles

Superficial

Brachioradialis

Extensor radialis longus

Extensor carpi radialis brevis

Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

Deep

Supinator

Abductor pollicis longus

Extensor pollicis brevis

Extensor pollicis longus

Extensor indicis

Answer 11

Question 12

Posterior Forearm Muscles

Superficial

Brachioradialis

Extensor radialis longus

Extensor carpi radialis brevis

Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

Deep

Supinator

Abductor pollicis longus

Extensor pollicis brevis

Extensor pollicis longus

Extensor indicis

Answer 12

Question 13

Posterior Forearm Muscles

Superficial

Brachioradialis

Extensor radialis longus

Extensor carpi radialis brevis

Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

Deep

Supinator

Abductor pollicis longus

Extensor pollicis brevis

Extensor pollicis longus

Extensor indicis

Answer 13

Question 14

Posterior Forearm Muscles

Superficial

Brachioradialis

Extensor radialis longus

Extensor carpi radialis brevis

Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

Deep

Supinator

Abductor pollicis longus

Extensor pollicis brevis

Extensor pollicis longus

Extensor indicis

Answer 14

Question 15

Posterior Forearm Muscles

Superficial

Brachioradialis

Extensor radialis longus

Extensor carpi radialis brevis

Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

Deep

Supinator

Abductor pollicis longus

Extensor pollicis brevis

Extensor pollicis longus

Extensor indicis

Answer 15

Question 16

Posterior Forearm Nerve

Answer 16

• Radial nerve
  
  • Bracioradialis
  • Extensor carpi radialis longus
• Deep radial nerve
  
  • Remaining muscles
• Posterior interosseous nerve?

Question 17

Posterior Forearm Blood Supply

Answer 17

• Posterior interosseous arteries
• Allen’s test

Question 18

Distal Forearm

Answer 18

Distal forearm anterior

• Radial artery
• Ulnar artery
• Median nerve > laterally palmaris longus tendon

Distal forearm posterior

• Extensor retinaculum / posterior annular ligaments
  
  • Holds digit extensor tendons in place

Question 19

Wrist/Hand Nerves and Bones

Answer 19

Wrist/hand nerve

• Ulnar nerve > deep ulnar nerve > primary motor nerve to instrinsic hand muscles
• Median nerves > primary sensory nerve to palmar hand

Wrist/hand bones

• Carpal bones (8)
  
  • Scaphoid – distal radius
  • Lunate – distal radius
  • Triquetrum
  • Pisiform – tendon of flexor carpi ulnaris
  • Trapezium – thumb metacarpal
  • Trapezoid
  • Capitate
  • Hamate – ulnar nerve and artery pass lateral
• Metacarpal (5)
• Phalanges (14)

Question 20

Wrist/Hand Joints

Intercarpal Joint

Metacarpophalangeal Joint

Carpometacarpal Joint (Thumb)

Interphalangeal

Answer 20

Question 21

Wrist/Hand Joints

Intercarpal Joint

Metacarpophalangeal Joint

Carpometacarpal Joint (Thumb)

Interphalangeal

Answer 21

• Flex/extend
• Abduct/adduct
• Circumduct

Question 22

Wrist/Hand Joints

Intercarpal Joint

Metacarpophalangeal Joint

Carpometacarpal Joint (Thumb)

Interphalangeal

Answer 22

• Thumb carpometacarpal Joint
  
  • Flex/extend
  • Abduct/adduct
  • Oppose/repose

Question 23

Wrist/Hand Joints

Intercarpal Joint

Metacarpophalangeal Joint

Carpometacarpal Joint (Thumb)

Interphalangeal

Answer 23

• Interphalangeal
  
  • Proximal (PIP)
  • Distal (DIP)

Question 24

Wrist/Hand Fascia

Answer 24

• Palmar aponeurosis
  
  • Facilitates grip
• Flexor retinaculum (anterior)
  
  • Roof of carpal tunnel
    
    • 9 tendons
    • Median nerve
      
      • Inflammation/Compression > Carpal Tunnel Syndrome
        
        • Tx: flexor retinaculum incision
• Extensor Retinaculum (posterior)

Question 25

Hand muscles (18)

Thenar

Hypothenar

Digits

Answer 25

• Thenar (3) + 1 adductor
  
  • Flexor pollicis brevis
  • Abductor pollicis brevis
  • Opponens pollicis
• Hypothenar (3)
  
  • Flexor digitorum minima
  • Abductor digitorum minimi
  • Opponens digitorum minini
• Digits
  
  • Lumbercles (4)
  • Interossei (7)

Question 26

Hand muscles (18)

Thenar

Hypothenar

Digits

Answer 26

• Thenar (3) + 1 adductor
  
  • Flexor pollicis brevis
  • Abductor pollicis brevis
  • Opponens pollicis
• Hypothenar (3)
  
  • Flexor digitorum minima
  • Abductor digitorum minimi
  • Opponens digitorum minini
• Digits
  
  • Lumbercles (4)
  • Interossei (7)

Question 27

Hand muscles (18)

Thenar

Hypothenar

Digits (lumbricals)

Answer 27

• Thenar (3) + 1 adductor
  
  • Flexor pollicis brevis
  • Abductor pollicis brevis
  • Opponens pollicis
• Hypothenar (3)
  
  • Flexor digitorum minima
  • Abductor digitorum minimi
  • Opponens digitorum minini
• Digits
  
  • Lumbercles (4)
  • Interossei (7)

Question 28

Hand muscles (18)

Thenar

Hypothenar

Digits (interossei)

Answer 28

• Thenar (3) + 1 adductor
  
  • Flexor pollicis brevis
  • Abductor pollicis brevis
  • Opponens pollicis
• Hypothenar (3)
  
  • Flexor digitorum minima
  • Abductor digitorum minimi
  • Opponens digitorum minini
• Digits
  
  • Lumbercles (4)
  • Interossei (7)

Question 29

Hand Innervation

Motor C8/T1

Sensory C6, C7, C8

Answer 29

• Motor C8/T1
  
  • Median nerve
    
    • 2 lumbricals
    • Thenar muscles
  • Deep ulnar*
    
    • Adductor pollicis
    • Ulnar 2 lumbricals
    • Hypothenar muscles
    • Interossei
• Sensory C6, C7, C8
  
  • Median*
    
    • Radial 3.5 digits
  • Ulnar
    
    • Ulnar 1.5 digits

Question 30

Hand Blood Supply

Answer 30

• Radial artery
  
  • Deep palmar arch
• Ulnar artery
  
  • Superficial palmar arch

Question 31

Colle’s Fracture

Answer 31

• FOOSH
• Proximal radial deviation > dinner fork deformity

Question 32

Scaphoid Fracture

Answer 32

• FOOSH
• Proximal scaphoid > necrosis