Hand and wrist disorders

Question 1

List two structures that pass through the carpal tunnel

Answer 1

median nerve
flexor pollicis longus
flexor digitorum profundus
flexor digitorum superficialis

Question 2

List two risk factors for carpal tunnel syndrome

Answer 2

hypothyroidism
diabetes
RA
acromegaly

Question 3

Motor innervation of the median nerve in the hand is tested by resistance of…?

Answer 3

thumb abduction

Question 4

The ulna nerve travels between the two heads of

Answer 4

flexor carpi ulnaris

Question 5

What is the management of carpal tunnel syndrome?

Answer 5

splint in dorsiflexion
corticosteroid injection
surgical decompression

Question 6

Which pulley becomes thickened and constricted in trigger finger?

Answer 6

A1
The pulley at the base of each digit where the digit meets the palm is called the A1 pulley.

Question 7

Dupuytren’s disease is caused by thickening and contracture of the…?

Answer 7

palmar fascia

Question 8

Which nerve is the posterior interosseous nerve derived from?

Answer 8

radial nerve

Question 9

Which combination of tendons makes up the De Quervain’s tendons?

Answer 9

Abductor pollicis longus and Extensor pollicis brevis

Question 10

What is the most sensitive method of diagnosing a scaphoid fracture?

Answer 10

MRI

Question 11

Where is the most common site for ganglion in the hand?

Answer 11

finger pulp

Question 12

4 differentials for pain tingling and numbness in fingers of both hands

Answer 12

Carpal tunnel syndrome
ulnar nerve entrapment
peripheral neuropathy
nerve root impingement

Question 13

List three clinical signs of carpal tunnel syndrome

Answer 13

1. Muscle wasting of the thenar eminence
2. Subjective altered sensation in the Median Nerve distribution
3. Weakness of thumb abduction
4. Positive Phalen’s test
5. Positive Tinel’s test

Question 14

Innervation of median nerve?

Answer 14

LOAF
Lumbricals (radial 2), Opponens Pollicis, Abductor Pollicis Brevis, Flexor Pollicis Brevis

Question 15

Which investigation can be done to confirm whether there is nerve compression

Answer 15

nerve conduction studies

Question 16

List three complications of carpal tunnel surgery

Answer 16

infection
accidental injury to nerves, tendons, blood vessels
post-op pain
failure to resolve symptoms
recurrence of symptoms

Question 17

Two risk factors for trigger finger?

Answer 17

> 40
women
diabetes

Question 18

List three risk factors for duputryen’s contracture

Answer 18

family history
male
manual labour
diabetes
smoking
alcohol
age

Question 19

Why is family history a strong risk factor for duputryen’s contracture?

Answer 19

autosomal dominant inheritance

Question 20

Which finger is most commonly affected in duputryen’s contracture

Answer 20

ring finger

Question 21

Name a test for duptryen’s contracture

Answer 21

table top test- if patient cannot place hands flat on table then positive

Question 22

Management for duputryen’s contracture?

Answer 22

needle fasciotomy
palmar fasiectomy
dermofasciectomy

Question 23

Which tendons are involved in de quervain’s?

Answer 23

APL- abductor pollicis longus
EPB- extensor pollicis brevis

Question 24

Test for de quervain’s?

Answer 24

make fist with thumb on inside, then ulnar deviate/adduct wrist = finkelstein’s test