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MSK Week 1 > ICL 4.2: Hand Anatomy & Common Conditions > Flashcards

ICL 4.2: Hand Anatomy & Common Conditions Flashcards

1
Q

what keeps the distal radial-ulnar joint stable?

A

triangular fibro-cartilage complex (TFCC)

it lets everything in the wrist rotate

it’s at the tip of the ulnar styloid so if someone says it hurts there the TFCC is probably torn

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2
Q

which bone moves during pronation?

A

radius

the ulna is stable

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3
Q

what are the characteristics of a normal radial-ulnar joint?

A
  1. ulna and radius are about equal length
  2. radial inclination from the radial styloid to the ulna is about 20 degrees down
  3. volar tilt of the distal surface of the radius is about 10 degrees down
  4. no gaps in the joint
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4
Q

what is a Colles’ fracture?

A

most common fracture

an extra-articular dorsally angulated fracture from a FOOSH that causes the distal radius to get bent backwards

if the radius gets bent backwards, you lose the volar tilt

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5
Q

what’s the pneumonic for the carpal bones?

A

some lovers try positions that they can’t handle

proximal: scaphoid, lunate, triquetrum, pisiform
distal: trapezium, trapezoid, capitate, hamate

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6
Q

how are your carpals connected?

A

there’s a distal and proximal row of carpals that are held together by strong ligaments

this means there’s no significant motion within the rows and they all move together as one unit

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7
Q

what causes a scaphoid fracture? how do you treat?

A

FOOSH

you’ll be tender in the anatomic snuff box

these are unstable and you should be worried because the scaphoid gets it blood supply distal to proximal so the more proximal the fracture, the harder it is to heal

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8
Q

what is carpal instability?

A

the distal row or proximal row of carpals aren’t moving as a unit, they’re moving on their own

a common thing is tearing the scaphoid-lunate ligament

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9
Q

what is SLAC wrist arthritis?

A

this is what happens after a scaphoid-lunate ligament tear

over the years the scaphoid is out there unaligned and you get arthritis after 20 years

to treat you take the scaphoid out to prevent scaphoid from rubbing against the radius

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10
Q

what kind of joint is the carpal metacarpal joint of the thumb? what is a common complication with it?

A

saddle joint

lets your thumb move in any direction!

however, this means that there’s a lot of wear and tear of the thumb CMC joint and usually leads to arthritis –> can take the trapezium out to treat and then a tendon to stabilize the base of the thumb

more common in women

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11
Q

what is a Boxer’s fracture?

A

5th metacarpal-carpal neck fracture (pinky knuckle break)

usually with young, drunk males that get punching injuries

you don’t do much to treat these because there’s so much motion with the pinky

however, deformity in the more radial MC joints need to be fixed

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12
Q

what is the shape of the metacarpal phalangeal joint?

A

cam shaped = wider in volar direction

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13
Q

what is Skier’s thumb?

A

aka Gamekeeper’s thumb

it’s a rupture of the ulnar collateral ligament (UCL) of the thumb in between the thumb and pointer finger

you won’t be able to grip things

often needs to be repaired

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14
Q

what are the different phalanges?

A

3 in each digit; only 2 in the thumb

proximal = P1

middle = P2

distal = P3

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15
Q

what is a PIP joint dislocation?

A

most common joint dislocation; usually dorsally

there’s a rupture of the volar plate

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16
Q

what causes MP arthritis vs. IP arthritis?

A

MP = autoimmune disease (ex. rheumatoid)

IP = osteoarthritis

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17
Q

what are the 4 groups of intrinsic hand muscles?

A
  1. interosseous
  2. lumbricals
  3. thenar
  4. hypothenar
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18
Q

what are the interosseous muscles?

A

they’re between the metacarpals

dorsal ones abduct while palmar adduct

all innervated by ulnar nerve and let you do fine motor skills like typing and playing piano

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19
Q

what are the lumbricals?

A

the only muscle in the body that originates from a tendon and inserts into a tendon –> flexor digitorum profundus to the radial side of the extensor tendon

they help your hand with power grasp

the ones on the ulnar side are called bipenate and come from 2 tendons; so the lumbricals from the ring and pinky finger come from two tendons and this makes sense because most of your grip strength comes from your pinky and ring finger

the lumbricals of the index and long finger are unipenate

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20
Q

what is the ROM for the thenar and hypothenar muscles?

A

abductor, flexor, opponens

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21
Q

what is the extensor digitorum communis?

A

it extends into the MPs of all 4 fingers

it’s 1 muscles with 4 tendon slits

it extends the MP joints but not so much the IP joints

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22
Q

what is the extensor indices proprius?

A

EIP extends the index MP which lets you point your finger

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23
Q

what is the extensor digit minimi?

A

EDM extends the pinky MP joint which is what lets you do the bull horn sign with your hand

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24
Q

which tendons are in the 1st extensor compartment?

A
  1. abductor policus longus
  2. extensor policus brevis

they pull your thumb out;abducts

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25
Q

which tendons are in the 2nd extensor compartment?

A
  1. extensor carpi radialis longus
  2. extensor carpi radialis brevis

pull your wrist up

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26
Q

which tendons are in the 6th extensor compartment?

A

extensor carpi ulnas

27
Q

what is DeQuervain’s tendonitis?

A

1st compartment tendonitis:
1. abductor policus longus

  1. extensor policus brevis
28
Q

what is intersection syndrome?

A

tendonitis of the 2nd compartment where the APL and EPB from 1st compartment cross over the ECRL and ECRB of the second compartment:

  1. extensor carpi radialis longus
  2. extensor carpi radialis brevis
29
Q

how do you diagnose tendonitis?

A
  1. anywhere in the body, the tendon will have point tenderness
  2. if you stretch the tendon it’ll hurt
  3. pain with resistance
30
Q

what is the Finklestein test?

A

stretching tendons –> the examiner grasps the thumb and ulnar deviates the hand sharply. If sharp pain occurs along the distal radius, de Quervain’s tenosynovitis is likely

specifically used for Dequervain’s tendonitis of the 1st extensor compartment

31
Q

what is the extensor mechanism?

A

your long extensor tendon goes right over your MP joint and it extends the MP joint

it does this via the little bands that come off of the extensor tendon called sagittal bands that wrap around the base o the proximal phalanx which lift the finger up –> your extensor tendon doesn’t have any insertion at all on the proximal phalanx

the sagittal bands also keep the extensor tendon on the midline

then the extensor tendon keeps going and divides into 3 slips –> the central slip inserts on the base of the middle phalanx P2 and extends the PIP joint

the lateral two slips run along the edges then come together and insert on P3 and they extend the DIP

32
Q

what is a mallet deformity?

A

avulsion of the extensor tendon from P3

so you lose extension at the DIP joint

ex. when you jam your finger and the tendon rips off P3 so nothing is keeping your DIP straight so your finger droops

the good news is that the tendon doesn’t retract so you can just treat it with splints

33
Q

what is a Boutonniere deformity?

A

avulsion of the central slip of the extensor mechanism from the P2 base

so you get loss of extension at the PIP

PIP joint will flex but the extensor mechanism at the DIP joint is fine so it’ll overflex and the tip of your finger will start to curve up

34
Q

what is a swan neck deformity?

A

hyper-extension at the PIP and flexion of the DIP

could be caused by chronic mallet finger that doesn’t get fixed and eventually causes hyper-extension of PIP

usually because of autoimmune diseases like lupus and rheumatoid arthritis

35
Q

what is your flexor digitorum profundus?

A

starts in the forearm and then it inserts on P3 of digits 2-5 but the long, ring and small fingers usually function together while the index finger is independent

flexes DIP joint of the fingers

involved in power grip

36
Q

what is your flexor digitorum superficialis?

A

inserts on the P2 of digits 2-5 and flexes the PIP joint

it splits into two slips over P1 area and then the flexor digitorum profundus goes through that and that’s called Camper’s chiasm

involves in fine motor skills

37
Q

what are annular pulleys?

A

part of the flexor sheath of the fingers = flexor digitorum superficialis and profundus

annular pulleys 1,3,5 are tendons at the joints of your fingers that let your joints bend

annular pulleys 2 and 4 are functionally important to prevent bowstringing; they hold the tendons next to the bones when you extend your fingers

38
Q

what is the function of the flexor sheath?

A
  1. stabilizes the tendons and allows them to slide
  2. gives the nutrition and makes synovial fluid

tendons = flexor digitorum superficialis and profundus

39
Q

what is jersey finger?

A

flexor digitoum profundus avulsion

common on ring fingers

pt. won’t be able to make a fist

flexor injuries always get fixed with surgery!

40
Q

what are trigger fingers?

A

a tendonitis that happens where the tendon enters the flexor sheath

the tendon gets irritated as it’s going through the sheets and as it’s going through A1 pulley it gets caught and your finger gets caught and stays flexed at PIP

just stretch it out or sometimes you have to cut A1 pulley

41
Q

what is carpal tunnel?

A

transverse carpal ligament is the roof and the carpals are the base of the carpal tunnel where median nerve passes through

median nerve gives you sensation and fine motor and lets you oppose your thumb!!!

causes numbness, night pain, and lots of dropping things

*numbness is ONLY in the fingers, not in the palm

42
Q

what’s inside the carpal tunnel?

A

10 structures:
4 FDP tendons

4 FDS tendons

FPL

median nerve

your FCR tendon is NOT in your carpal tunnel

43
Q

how do you diagnose carpal tunnel?

A
  1. Tinnel’s test
  2. Phalen’s test
  3. Durkin’s test (squeeze the nerve)
44
Q

how do you treat carpal tunnel?

A
  1. splints
  2. stretching
  3. corticosteroid injection
  4. surgical release
45
Q

what are the long term effects of carpal tunnel?

A

hour glass contristriction and then the nerve stops working and then the muscles stop working = thenar muscle wasting

46
Q

what is cubital tunnel syndrome?

A

cubital tunnel aka your funny bone

you’ll get numbest in the ulnar distribution = pinky

you’ll also have pain, waking up at night, loss of motor skills

you diagnose with Tinnel’s test on ulnar nerve in the elbow area

47
Q

how do you treat cubital tunnel syndrome?

A
  1. splint so you don’t bent elbow
  2. avoid pressure on elbow
  3. usually get surgical release to decompress
48
Q

how can the radial nerve get injured? what is Wartenberg syndrome?

A
  1. injury with humeral fracture along surgical neck

2. Wartenberg syndrome = compression of the superficial radial nerve at the wrist (handcuffs)

49
Q

which artery mainly supplies the hand?

A

ulnar nerve (78%)

50
Q

what’s the path of the radial artery through the hand?

A

goes dorsal through the anatomic snuff box, dorsal to thumb metacarpal and forms deep arch

51
Q

what is the path of the ulnar artery through the hand?

A

goes through Guyon’s canal with ulnar nerve then forms the superficial arch of the palm

52
Q

what is ulnar hammer syndrome?

A

clotting of the ulnar artery in Guyon’s canal

you’ll get pain in hypothenar region and numbness in ulnar distribution

you get it from using your hand as a hammer like carpenters

53
Q

what is Raynaud’s disease?

A

vasospasm of the digital arteries

more common women and in the cold

associated with lots of autoimmune diseases

54
Q

what is the function of the palmar fascia?

A

it sticks your skin to your palm!

55
Q

what is Dupuytren’s disease?

A

thickening and contracture o the palmar fascia and you get nodules in the palm

causes flexion usually of the ring finger

more common in white males

56
Q

what kinds of incisions are done during hand surgery?

A

avoid straight longitudinal incisions on flexor surfaces

scars that are straight don’t bend well when you bend your fingers

57
Q

what is cellulitis?

A

superficial soft tissue infection; red, swollen, tender

can treat with IV antibiotics, rest, etc

58
Q

what is Felon infection?

A

subcutaneous abscess of distal pulp space of fingertips

59
Q

what is paronychia?

A

infection around the nail bed

you get it from picking at your nails or biting them

60
Q

what is pyogenic flexor tenosynovitis?

A

infection that goes along the flexor

you have the flexor sheath that surrounds your flexor tendon so it can spread up your forearm

61
Q

what are the 2 parts of the nail bed?

A
  1. germinal matrix = white part = makes nail (nails doesn’t stick to germinal matrix)
  2. serile matrix = pink part = this is what sticks to nail plate
62
Q

what is a ganglion?

A

sac of fluid that comes from your joint

can happen anywhere in the body but wrist is the most common

63
Q

what is bursitis?

A

inflammation of bursa

bursa is a thin fluid filled sac that allows soft tissues to move smoothly over bony prominences; usually very thin

ex. olecran bursitis

treat with rest, avoid direct pressure, ice, drainage

MSK Week 1 (11 decks)

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