Hand and Wrist

Question 1

what does the antebrachial (deep) fascia of the anterior forearm thicken distally to

Answer 1

palmar carpal ligament at the wrist

then flexor retinaculum (transverse carpal ligament)

Question 2

where does the flexor retinaculum attach

Answer 2

to scaphoid/trapezoid laterally

pisiform and hamate medially

Question 3

what does the flexor retinanculum prevent during flexion

Answer 3

bowstringing of the tendons

Question 4

what tendon fuses with and strengthens the flexor retinaculum

Answer 4

palmaris longus

Question 5

what is the carpal tunnel composed of

Answer 5

carpal bones and flexer retinaculum

Question 6

what is the contents of the carpal tunnel

Answer 6

the long tendons of the forearm flexor muscles and the median nerve

Question 7

carpal tunnel syndrome

Answer 7

result of compression of the median nerve due to swelling in the tunnel

palmar cutaneous branch of the median nerve is given off before the tunnel to travel superficially to reach the skin of the palm, therefore spared in carpal tunnel syndrome so sensation of centre palm is unaffected

Question 8

what do the radial and ulnar arteries form in the hand

Answer 8

the superficial palmar branch of the radius and the ulna form the superficial palmar arch

the deep branch of the radial and ulnar artery form the deep palmar arch

Question 9

dupuytren’s contracture

Answer 9

thickening and shortening of the palmar fascia - flexed finger deformities of, in particuar, ring and little fingers

Question 10

what is the innervation of the dorsal aspect of the hand

Answer 10

Question 11

what is the innervation of the palmar aspect of the hand

Answer 11

Question 12

ring block technique

Answer 12

used to anaesthetise a finger

local anaesthetic deposited in a ring around the base of the finger to anaesthetise all 4 proper digital nerves

Question 13

what must not be used to anaesthetise the proper digital arteries

Answer 13

adrenaline

they are end arteries

Question 14

fibrous digital sheaths

Answer 14

continuous with digital bands of the palmar aponeurosis

the sheaths attach to both sides of the phalanges and form a secure tunnel through which the FDS, FDP and FPL (int and deep) tendons and their synovial sheaths travel distally

Question 15

anatomical snuff box

• pain

Answer 15

tenderness in the floor of it following trauma is suggestive of a scaphoid fracture

Question 16

what are your lumbricals supplied by

Answer 16

lateral - median nerve

medial - ulnar nerve

Question 17

what are your interossei innervated by

Answer 17

ulnar nerve

Question 18

what is the action of the lumbricals

Answer 18

attach to FDP tendon

flex MCP (anterior aspect) and extend PIP (posterior aspect)

Question 19

action of the interossei

Answer 19

palmar - adduct digits

dorsal - abduct digits

Question 20

adductor pollicus innervation

Answer 20

ulnar nerve

Question 21

what test is used for the adductor pollicus

Answer 21

Froment’s test

Question 22

what is the action of the interossei

Answer 22

anterior and posterior for abduction/adduction of the fingers

Question 23

what is the action of the lumbricals

Answer 23

flex MCP/extend PIP

Question 24

name the intrinsic muscles of the hand

Answer 24

interossei

lumbricals

palmaris brevis

thenar and hypothenar eminence

Question 25

Answer 25

palmaris brevis

Question 26

at which position of the wrist is there optimal power grip

Answer 26

extended

Question 27

how does lymph drain from the hand

Answer 27

via cubital and axillary lymph nodes

Question 28

where do the cephalic and basilic veins originate

Answer 28

superficial veins

dorsal venous network of the hand

Question 29

how are the cephalic and basilic veins connected at the elbow

Answer 29

median cubital vein

Question 30

vena comitantes

Answer 30

usually paired veins that lie either side of an artery - pulsations of the artery aid venous return

eg brachial veins and artery