HAND / WRIST

Question 1

Common sites of compression of the ulnar nerve

Answer 1

Between 2 head of FCU

Arcade of Struthers

Between Osborne’s Ligament & MCL

Medial head of triceps

Medial intermuscular septum

Medial Epicondyle

Fascial bands within FCU

Anconeus Epitrochlearis (anomalous muscle)

Proximal edge of FDS aponeurosis

Question 3

Which ligament is most important for CMC stability?

Answer 3

DORSO-RADIAL ligament

Question 4

Zones of Guyon’s Canal (motor vs sensory)

Answer 4

Zone 1 = mixed

Zone 2 = motor

Zone 3 = sensory

–LEW’s mnemonic: “alphabetical! MIxed, MOtor, SENsory”

Question 5

Contents of the 3rd DORSAL compartment of the hand

Answer 5

3 - EPL

Question 6

What is the average distance between the top of the humeral head and the insertion of the pec tendon on the humerus?

Answer 6

5.6 cm

Question 7

What is Wartenberg Sign?

Answer 7

persistent small finger ABDuction and EXTENSION during attempted adduction

– due to weak 3rd palmar interossei and SF lumbrical (ulnar neuropathy)

Question 8

Contents of the 6th DORSAL compartment of the hand

Answer 8

6 - ECU

Question 9

Common sites of radial nerve compression

Answer 9

Fibrous bands of radiocapitellar joint

Recurrent leash of henry (radial recurrent vessels)

Medial ECRB

Arcade of Froshe

Supinator (distal edge)

– LEW’s mnemonic: FREAS

Question 10

What is the minimum ranges for elbow ROM needed to accomplish ADLs?

Answer 10

30 to 130 degrees

– Lew’s mnemonic: “100 degrees for 100% of function”

Question 11

Which component of the nail bed is responsible for 90% of nail growth?

Answer 11

GERMINAL matrix

Question 12

What secondary role does Vinculum Brevis Profundus?

Answer 12

VBP provides blood supply to FDP tendon distal to the A5 pulley

Question 13

What is FROMENT SIGN?

Answer 13

compensatory thumb IP flexion by FPL (AIN) during pinch

– due to loss of MCP flexion by adductor pollicis (ulnar neuropathy)

Question 14

Which is the most common finger and most common deviation with sagittal band disruption?

Answer 14

LONG finger most common, deviates ULNARLY most common (due to radial sagittal band disruption)

– associated with RA and pugilists “aka KYLE injuries”

Question 15

Contents of the 2nd DORSAL compartment of the hand

Answer 15

2 - ECRB + ECRL

Question 16

Contents of the 4th DORSAL compartment of the hand

Answer 16

4 - EDC + EIP

Question 17

What is JEANNE SIGN?

Answer 17

compensatory thumb MCP hyperextension and thumb adduction by EPL with pinch

– due to loss of IP extension and thumb adduction

(ulnar neuropathy)

Question 18

What are the contraindications to performing a Proximal Row Carpectomy (PRC) for SLAC wrist?

Answer 18

• incompetent radio-scapho-capitate ligament (necessary to prevent ulnar subluxation)
• capito-lunate arthritis (Stage III)

Question 19

Contents of the 1st DORSAL compartment of the hand

Answer 19

1 - APL + EPB

Question 20

Describe the course of the ulnar nerve as it enters the cubital tunnel.

Answer 20

Pierces intramuscular septum at Arcade of STRUTHERS (8cm prox to medial epicondyle)

>> passes from anterior to posterior compartment of the arm as it enters cubital tunnel

Question 21

What is Wartenburg’s Syndrome?

Answer 21

compressive neuropathy of the superficial sensory radial nerve (SRN)

AKA “cheiralgia paresthetica” – sensory manifestation only

– scissoring action of brachioradialis & ECRL tendons during forearm pronation

Question 22

What are you testing with Resisted Long Finger extension?

Answer 22

Tests ECRB for lateral epicondylitis

Question 23

What comprises the “floor” of the cubital tunnel?

Answer 23

Posterior & Transverse ligaments of MCL + elbow joint capsule

Question 24

Contents of the 5th DORSAL compartment of the hand

Answer 24

5 - EDM

Question 25

What is MASSE sign?

Answer 25

Flattening of the palmar arch and loss of ulnar hand elevation

– due to weak opponens digiti quinti + decreased SF MCP flexion

Question 26

What comprises the “roof” of the cubital tunnel?

Answer 26

FCU Fascia + Osborne’s ligament