Hand

Question 1

• continuation from antebrachial fascia

- blends with palmar carpal ligament and palmaris longus tendon

Answer 1

palmar aponeurosis

Question 2

• composed of annular and cruciform parts

- holds flexor tendons to phalanx during flexion

Answer 2

fibrous digital sheath

Question 3

lies deep to palmar aponeurosis and palmaris longus, part of the palmar fascia

Answer 3

flexor retinaculum (transverse carpal ligament)

Question 4

dense connective tissue band that bridges between trapezium and pisiform plus hook of hamate, forms roof of carpal tunnel

Answer 4

flexor retinaculum (transverse carpal ligament)

Question 5

• progressive shortening, thickening, and fibrosis of palmar fascia and aponeurosis
• affects 4th and 5th fingers, pulled into partial flexion
• commonly bilateral, male, over 50
• treat: collagenase injections, surgical excision of fibrotic parts

Answer 5

Dupuytren’s Contracture of palmar fascia

Question 6

superficial (no compartment), wrinkles hypothenar skin, aids in palmar gripping

Answer 6

palmaris brevis

Question 7

function of the three thenar muscles?

Answer 7

opposition of the thumb

Question 8

• abducts carpometacarpal join of thumb, assists with early opposition
• thenar muscle

Answer 8

abductor pollicis brevis

Question 9

• medial to abductor pollicis brevis
• flexes thumb
• innervated by median nerve
• thenar muscle

Answer 9

flexor pollicis brevis

Question 10

• lies deep to abductor pollicis brevis
• opposes thumb (requires flexion and medial rotation of 1st metacarpal bone)
• thenar muscle

Answer 10

opponens pollicis

Question 11

• most ulnar, located under palmaris brevis
• abducts 5th digit
• hypothenar muscle

Answer 11

abductor digiti minimi

Question 12

• lateral to abductor digiti minimi
• flexes 5th digit
• hypothenar muscle

Answer 12

flexor digiti minimi

Question 13

• deepest hypothenar muscle

- opposition of 5th metacarpal (requires flexion and lateral rotation)

Answer 13

opponens digiti minimi

Question 14

• flex metacarpophalangeal joint, extend interphalangeal joints
• digits 1&2 by median nerve, 3&4 by ulnar nerve
• L or Z movement
• originate from tendon of flexor digitorum profundus

Answer 14

lumbricals

Question 15

adducts thumb, innervated by ulnar nerve

Answer 15

adductor pollicis

Question 16

abducts digits, ulnar nerve

Answer 16

dorsal interossei

Question 17

adducts digits, ulnar nerve

Answer 17

palmar interossei

Question 18

muscle bellies in the forearm, only tendons enter hand, important synovial sheaths

Answer 18

extrinsic muscles of the hand

Question 19

split and attach to base of middle phalanx

Answer 19

FDS tendons

Question 20

don’t split, attach to bade of distal phalanx

Answer 20

FDP tendons

Question 21

• cause: injury such as puncture of palm by rusty nail
• swelling digits, painful movement
• infxn can spread to palm, carpal tunnel, forearm
• if digital synovial sheath ruptures can spread into midpalmar space

Answer 21

tenosynovitis (infection of synovial sheath)

Question 22

• excessive friction of tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
• fibrous thickening of synovial sheath
• pain in wrist, radiates to forearm and thumb
• test: hold thumb inside 4 fingers and adduct (ulnar deviate) wrist join

Answer 22

De Quervain’s Tenovaginitis Stenosans

Question 23

• repetitive forceful use of fingers causes thickening of fibrous digital sheath
• FDS and FDP tendons may enlarge, can’t extend finger
• passive extension produces snapping sound

Answer 23

Digital Tenovaginitis Stenosans (Trigger finger)

Question 24

enters hand in Guyon’s canal (anterior to flexor retinaculum), b/w pisiform and hook of hamate

Answer 24

ulnar artery

Question 25

-main termination of ulnar artery, branches out common palmar digital arteries

Answer 25

superficial palmar arch

Question 26

-main termination of radial artery, through anatomical snuffbox
-branches out palmar metacarpal arteries
-

Answer 26

deep palmar arch

Question 27

• passageway deep to flexor retinaculum (transverse carpal ligament)
• b/w tubercles of scaphoid & trapezium and pisiform and hook of hamate
• 9 tendons (4 FDS, 4 FDP, 1 FPL)
• median nerve passes through

Answer 27

Carpal Tunnel

Question 28

• supplies 3 thenar muscles, 1st and 2nd lumbricals

- innervates skin on lateral palm, side of digits 1,2,3, lateral half of digit 4, distal half of dorsum of these fingers

Answer 28

median nerve

Question 29

enters palm region superficial to carpal tunnel, not affected by carpal tunnel syndrome

Answer 29

palmar branch of median nerve

Question 30

• lesions of tendons or synovial sheaths (inflammation, infection, fluid retention, excessive exercise)
• sensation changes in median nerve supply area, thenar muscle weakness
• Dx: median nerve related symptoms, reduce by pressing on wrist for 30 seconds

Answer 30

carpal tunnel syndrome

Question 31

superficial to flexor retinaculum and palmar aponeurosis, supplies skin on medial side of palm

Answer 31

palmar cutaneous branch of ulnar nerve

Question 32

supplies medial one and a half digits on anterior surface

Answer 32

superficial branch of ulnar nerve

Question 33

supplies hypothenar muscles, medial two lumbricals, adductor pollicis, all the interossei

Answer 33

deep branch of ulnar nerve

Question 34

supplies medial half of dorsum of hand, 5th digit, half of 4th digit

Answer 34

dorsal branch of ulnar nerve

Question 35

• cause: gunshots, stab wounds, fracture of distal humerus, olecranon, head of radius
• clawhand, deviates to radial side when flex the wrist

Answer 35

ulnar nerve injury

Question 36

innervates skin of lateral 2/3 of dorsum of hand, dorsum of thumb, lateral one and a half digits on proximal part

Answer 36

radial nerve