Hand - Neurovascular

Question 1

What are the four branches of the deep branch of the radial artery before it becomes the deep palmar arch?

Answer 1

1) Dorsal carpal branch
2) Dorsal scaphoid branch
3) Princeps pollicis
4) Radialis indicis

Question 2

What muscle does the superficial branch of the radial artery course volarly over or through?

Answer 2

Abductor pollicis brevis (APB)

Question 3

In the hand, which arteries form the anatamosis between the superficial palmar arch & the deep palmar arch?

Answer 3

Palmar metacarpal arteries of the deep arch & the common digital arteries of the superficial arch

Question 4

What are the two branches of the superficial branch of the radial artery?

Answer 4

1) Palmar carpal branch

2) Palmar scaphoid branch

Question 5

Where does the Superficial Branch of the Radial Nerve (SBRN) emerge in the forearm?

Answer 5

Between the brachioradialis & extensor carpi radialis longus (ECRL) , 9cm proximal to the radial styloid

Question 6

What are the borders of the carpal tunnel?

Answer 6

• Radial = Scaphoid tubercle & trapezium
• Ulnar = Hook of the Hamate & Pisiform
• Roof = TCL
• Floor = Proximal carpal row

Question 7

Where is the median nerve typically positioned in the carpal tunnel?

Answer 7

1) Radial 60%
2) Central 22%
3) Volar-radial 18%

Question 8

What are the three common branching patterns of the Recurrent Branch of the Median Nerve (RBMN)?

Answer 8

1) 50% after the carpal tunnel
2) 30% under the TCL
3) 20 % through the TCL

Question 9

What muscles are supplied by the RBMN?

Answer 9

1) Flexor Pollicis Brevis
2) Abductor Pollicis Brevis
3) Opponens Pollicis
4) Radial x2 lumbrcials

Question 10

What does the palmar cutaneous branch of the ulnar nerve innervate?

Answer 10

1) Ulnar palmar skin of the hand

2) Palmaris brevis muscle

Question 11

What are the borders of Guyon’s Canal?

Answer 11

Ulnar = Pisiform, Pisohamate ligament, abductor digiti minimi muscle belly 
Radial = Hook of the Hamate 
Roof = Palmar Carpal Ligament 
Floor = Transverse Carpal Ligament

Question 12

What muscles are innervated by the deep motor branch of the ulnar nerve?

Answer 12

1) Adductor pollicis
2) Deep head of the FBP
3) Dorsal/palmar interossesi
4) Lumbricals III & IV
5) Hypothenar muscles
- Abductor digiti minimi
- Flexor digiti minimi brevis
- Opponens digiti minimi

Question 13

What are the three zones of ulnar nerve compression at Guyon’s Canal?

Answer 13

Zone 1 = Proximal to bifurcation
Zone 2= Deep motor branch
Zone 3 = Superficial sensory branch

Question 14

What are the most common causes of a Zone I ulnar nerve lesion?

Answer 14

1) Ganglia

2) Hook of the Hamate fx

Question 15

What are the most common causes of a Zone II ulnar nerve lesion?

Answer 15

1) Ganglia from the triquetrohamate joint

2) Hamate fx

Question 16

What is the most common cause of a Zone III ulnar nerve lesion?

Answer 16

Ulnar arterial thrombosis

Question 17

What are the 13 signs and tests for an ulnar nerve palsy?

Answer 17

1) Froment sign
2) Jeanne sign
3) Duchenne’s sign
4) Masse’s sign
5) Wartenburg’s sign
6) Egawa sign
7) Andre-Thomas sign
8) Pollock sign
9) Bouvier maneuver
10) Earle-Viasou sign
11) Mumenthaler’s sign
12) Bunnell’s sig
13) Other
- Confrontational testing
- Index finger abduction