Hand

Question 1

Identify structures except:
-15, 17-21, 26-28.16 + 25 red

Where do the lumricals attach?

Answer 1

Lumbricals attachments

Question 2

Identify Ulnar artery, radial artery, superficial palmar arch,superficial palmar branch of radial artery?

Answer 2

Question 3

How is the superficial palmar arch formed?

Answer 3

-Mainly by arch of superficial division of ulnar artery and is completed by the superficial palmar branch of radial artery

Question 4

Answer 4

Question 5

posterior view. Identify listers tubercle?

Answer 5

Question 6

Anterior view. Identify styloid process of radius?

Answer 6

Question 7

Answer 7

Question 8

Answer 8

Question 9

What is the blood supply to the scaphoid bone?

Answer 9

-Retrograde blood supply from dorsal carpal branch of radial artery. Fracture of distal or middle portion can leave proximal part at risk of AVN

Question 10

Describe clinical applicationof listers tubercle

Answer 10

Tubercle on dorsal radius. ‘Lighthouse of the wrist’. EPL tendon runs around it-serves as a pulley for EPL (wraps around medial side and takes 45 degree turn)

Question 11

What are the attachments of the flexor retinaculum?

Answer 11

Proximal
–> pisiform
–> tubercle of scaphoid

Distal
–> hook of hamate
–> trapezium

Question 12

What are the structures passing through the carpal tunnel?

Answer 12

-4 tendons of FDS
-4 tendons FDP
-1 tendon FPL
-Median nerve

-FCRL passes through flexor retinaculum

Question 13

Answer 13

Question 14

Thumb movements: which muscles do flexion at mcp/ipj and what is their innervation?

Answer 14

-FPL: median (anterior interosseous)
-FPB: median (recurrent branch)

Question 15

Extension at MCP/IPJ thumb

Answer 15

-EPL
-EPB

Radial (PIN)

Question 16

Abduction (palmar)

Answer 16

APL: radial (PIN)
APB: Median (recurrent branch

Question 17

Adduction

Answer 17

Adductor pollicis: ulnar (deep branch)

Question 18

Opposition

Answer 18

Opponens pollicis
Flexor pollicis brevis
Abductor pollicis brevis

Innervation
–> median nerve recurrent branch

Question 19

How to test FDP?

Answer 19

By fixing PIP

Question 20

How to test FDS?

Answer 20

Adjacent digits must be held in extension in order to eliminate FDP motion in adjacent fingers, which otherwise might give the impression of FDS motion in examined finger

Question 21

Where do the tendons of FDS and FDP insert?

Answer 21

FDS: split tendon on both sides of middle phalanx

FDP: passes through split tendon of FDS to be inserted into the terminal phalanx

Question 22

Which tendon is attached to the pisiform?

Answer 22

Flexor carpi ulnaris

Question 23

What makes extensor tendons attached to the phalanges?

Answer 23

Extensor expansion

Question 24

Where does extensor digitorum insert?

Answer 24

-Extensor expansion of middle and distal phalanges of 2nd, 3rd, 4th and 5th fingers

Question 25

What is the function of the intertendinous connections?

Answer 25

-Create space between extensor tendons -Redistribute force between tendons -Coordinate extension of fingers -Stabilise MCPJ

Question 26

Identify the two tendons inserting into the index finger dorsally?

Answer 26

-Extensor indicis (medial) -Extensor digitorum (lateral)

Question 27

What is the origin/insertion/action/nerve supply of first dorsal interosseous Identify 1st dorsal interosseous, extensor indicis, radius, ulna, extensor digitorum tendons, intertendinous connections, abductor digiti minimi

Answer 27

O: 1st metacarpal I: lateral side of extensor expansion of index finger Action: abduction of index finger Nerve supply: deep branch ulnar nerve

Question 28

When you are doing power grip of hand, what is the role of the radial nerve?

Answer 28

-Supplies wrist extensors which give mechanical advantage to power grip by synergistic activity which causes more efficient flexion of the digitis

Question 29

Why is hand grip more powerful in extension than in flexion?

Answer 29

-Flexor muscles in extension are in a state of greater tension than in flexion, so contraction in this position is more powerful

Question 30

What are the borders of the anatomical snuff box?

Answer 30

Boundaries Posterior border (medial): EPL tendon Anterior border (lateral): EPB tendon, APL tendon Proximal border: styloid process of radius Distal border: apex of snuffbox Floor: trapezium and scaphoid Contents: radial artery, superficial branch radial nerve, cephalic vein

Question 31

Where does EPL insert?

Answer 31

Dorsum of base of terminal phalanx of thumb

Question 32

Insertion of EPB?

Answer 32

Dorsum of base of proximal phalanx of thumb

Question 33

Surface markings: show me anatomical snuff box on your hand

Answer 33

Question 34

What is the median nerve sensory distribution in the hand?

Answer 34

-Lateral 2/3rd of palm of the hand -Lateral (radial) 3.5 digits on the palmar side -Dorsum of the tips of index/middle/thumb

Question 35

Answer 35

Question 36

Posterior hand/distal forearm innervation

Answer 36

Ulnar: medial 1.5 digits Median: Tips of lateral 3.5 fingers Radial: Lateral posterior dorsum of hand

Question 37

What is the median motor distribution in hand?

Answer 37

Lateral two lumbricals Opponens pollicis Abductor pollicis brevis FPB

Question 38

What is the clinical picture of a median nerve injury at the elbow?

Answer 38

-Hyperextended thumb (paralysis FPB) -Adducted thumb (paralysis of abductor pollicis brevis) -Flat thenar eminence -Loss of sensation from: lateral 2/3rd of palm of hand, lateral 3.5 digits (palmar and distal dorsal aspect)

Question 39

Clinical picture of ulnar nerve injury at the wrist?

Answer 39

--> clawing of 4th and 5th digits (paralysis of medial lumbricals and interossei) --> Loss of sensation of the medial 1/3rd of the palmar and dorsal aspects of hands and fingers

Question 40

Cause of ulnar paradox?

Answer 40

-In proximal ulnar nerve injuries, there will be paralysis of the medial 1/2 of fdp which will decrease the flexion of the IP joints

Question 41

Sensory distribution of axillary/musculocutaneous/radial/ulnar/median nerve in the arm

Answer 41

Question 42

Answer 42