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MRCSalah anatomy > Hand > Flashcards

Hand Flashcards

1
Q

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

Where do the lumricals attach?

A

Lumbricals attachments

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2
Q

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

A
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3
Q

How is the superficial palmar arch formed?

A

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

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4
Q
A
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5
Q

posterior view. Identify listers tubercle?

A
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6
Q

Anterior view. Identify styloid process of radius?

A
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7
Q
A
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8
Q
A
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9
Q

What is the blood supply to the scaphoid bone?

A

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

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10
Q

Describe clinical applicationof listers tubercle

A

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)

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11
Q

What are the attachments of the flexor retinaculum?

A

Proximal
–> pisiform
–> tubercle of scaphoid

Distal
–> hook of hamate
–> trapezium

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12
Q

What are the structures passing through the carpal tunnel?

A

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

-FCRL passes through flexor retinaculum

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13
Q
A
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14
Q

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

A

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

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15
Q

Extension at MCP/IPJ thumb

A

-EPL
-EPB

Radial (PIN)

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16
Q

Abduction (palmar)

A

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

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17
Q

Adduction

A

Adductor pollicis: ulnar (deep branch)

18
Q

Opposition

A

Opponens pollicis
Flexor pollicis brevis
Abductor pollicis brevis

Innervation
–> median nerve recurrent branch

19
Q

How to test FDP?

A

By fixing PIP

20
Q

How to test FDS?

A

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

21
Q

Where do the tendons of FDS and FDP insert?

A

FDS: split tendon on both sides of middle phalanx

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

22
Q

Which tendon is attached to the pisiform?

A

Flexor carpi ulnaris

23
Q

What makes extensor tendons attached to the phalanges?

A

Extensor expansion

24
Q

Where does extensor digitorum insert?

A

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

25
Q

What is the function of the intertendinous connections?

A

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

26
Q

Identify the two tendons inserting into the index finger dorsally?

A

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

27
Q

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

A

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

28
Q

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

A

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

29
Q

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

A

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

30
Q

What are the borders of the anatomical snuff box?

A

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

31
Q

Where does EPL insert?

A

Dorsum of base of terminal phalanx of thumb

32
Q

Insertion of EPB?

A

Dorsum of base of proximal phalanx of thumb

33
Q

Surface markings: show me anatomical snuff box on your hand

A
34
Q

What is the median nerve sensory distribution in the hand?

A

-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

35
Q
A
36
Q

Posterior hand/distal forearm innervation

A

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

37
Q

What is the median motor distribution in hand?

A

Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
FPB

38
Q

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

A

-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)

39
Q

Clinical picture of ulnar nerve injury at the wrist?

A

–> 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

40
Q

Cause of ulnar paradox?

A

-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

41
Q

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

A
42
Q
A

MRCSalah anatomy (15 decks)

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