Lecture 14- Wrist and Hand

Question 0

Scaphoid (“boat”) – ….. ….. ………
• Lunate (“moon”)
• Triquetrum (“3 cornered”)
• Pisiform (“pea”)

Answer 0

most commonly fractured

Question 1

3 groups of bones: 
 • Carpals, n=....
 • Metacarpals, n=...
 • Phalanges, n=...
 • Cartilaginous at birth. 
• Ossified by .....-years-of-age

Answer 1

8
5
14
12

Question 2

Trapezium (“Table”)
• Trapezoid (resembles trapezium)
• Capitate (“Head”)
• Hamate (“…. …..”)

Answer 2

Little hook

Question 3

Condyloid radiocarpal joint
• Condyloid joint = oval articular surface of one
bone fits into complementary ……… in
another.

Answer 3

concavity

Question 4

Wrist (Radiocarpal) joint
• Synovial (condyloid) joint between the distal end
of the radius and the articular disc overlying the
distal end of the ulna, and the …….,…….. And ……..

Answer 4

scaphoid, lunate

triquetrum.

Question 5

Wrist (Radiocarpal) joint
Anterior & posterior ligaments strengthen the
……. ……

Answer 5

joint capsule

Question 6

Wrist (Radiocarpal) joint

Movements?

Answer 6

Movements: flexion, extension, abduction,

adduction and circumduction.

Question 7

Which has a greater range of motion?
Abduction ( radial deviation) or adduction (ulnar deviation)
WHY?

Answer 7

Abduction, ulnar styloid gets in the way

Question 8

Palmar ………. and palmar …….. ligaments reinforce the wrist joint capsule.

Answer 8

radiocarpal

ulnocarpal

Question 9

Dorsal ……… and radial and ulnar ……… ligaments

reinforce the wrist joint.

Answer 9

radiocarpal

collateral

Question 10

What is the function of the deep transverse metacarpal ligament?

Answer 10

Bounds heads of metacarpals

Question 11

Phalangeal ligaments

What is their function?

Answer 11

Strapping tendons to bone

Question 12

What is the function of the extensor retinaculum?

Answer 12

Strapping down tendons

Question 13

What is the function of the synovial sheaths?

Answer 13

Helps ligaments move independently

Question 14

Flexor Retinaculum
Thickening of deep fascia that holds …… …… …… in
position at the wrist.

Answer 14

long flexor tendons

Question 15

Flexor Retinaculum

Proximal border = ……. …….. …… crease on anterior wrist.

Answer 15

distal transverse skin

Question 16

Flexor Retinaculum

Distal border = attached to ……… ………

Answer 16

palmar aponeurosis

Question 17

Flexor Retinaculum

Medial attachment = ……. bone and ……. Of …….

Answer 17

pisiform

hook of hamate

Question 18

Flexor retinaculum

Lateral attachment = tubercle of …….. and ………. bones.

Answer 18

scaphoid

trapezium

Question 19

Carpal Tunnel

Created by position of …….. bones and …….. ………

Answer 19

carpal

flexor retinaculum

Question 20

Carpal Tunnel
• 4 tendons of flexor ………. ………
• 4 tendons of flexor ………. ………
• Tendon of flexor ……… ……….
•……… nerve

Answer 20

digitorum profundus
digitorum superficialis
pollicis longus
Median

Question 21

Carpal Tunnel Syndrome
• Entrapment syndrome.
• Pressure on ……. nerve.

Answer 21

Median

Question 22

Carpal tunnel syndrome
Aetiology: overuse, swelling of tendons and tendon …….. (e.g.
rheumatoid arthritis) and cysts arising from …….. joints.

Answer 22

sheaths

carpal

Question 23

Carpal tunnel syndrome
Symptoms: pain and …… And …… in distribution of median nerve.
• Treatment: surgery, ……….. injections.

Answer 23

pins and needles

corticosteroid

Question 24

Palmar aponeurosis | Gives firm attachment to overlying ...... to improve ...... and protect underlying ........

Answer 24

skin grip tendons

Question 25

Intrinsic hand muscles • Entirely within hand (on ....... side) • Execute ......... ..........

Answer 25

palmar | precision movements

Question 26

``` Intrinsic hand muscles • Palmaris brevis • Interossei (dorsal or palmar) (n=7 or 8) • Lumbrical muscles (n=4) • Adductor pollicis • Thenar: ball of ....... • Hypothenar: ball of ...... ```

Answer 26

Thumb | Pinky

Question 27

Phalangeal muscles • Palmar ......... • Dorsal ........ • Lumbricals

Answer 27

interossei | Interossei

Question 28

Interossei muscles All innervated by deep branch of ...... nerve (.....,....)

Answer 28

ulnar C8, T1

Question 29

Palmar muscles:....... fingers toward middle finger PAD

Answer 29

adduct

Question 30

Dorsal: ...... fingers from middle DAB

Answer 30

Abduct

Question 31

Adductor pollicis Adducts .......; Pollicis = Latin for ......

Answer 31

thumb | Thumb

Question 32

Thenar muscles • ........ pollicis brevis • .......... pollicis brevis • .......... pollicis

Answer 32

Abductor Flexor Opponens

Question 33

Thenar muscles Chiefly responsible for

Answer 33

opposition of the thumb

Question 34

Abductor pollicis brevis (abducts thumb, moves anterior in AP plane) • Adductor pollicis (adducts thumb) • Extensor pollicis longus • Flexor pollicis brevis (flexes thumb at CM and MCP joints) • Flexor pollicis longus • Opponens pollicis (moves thumb to touch tip of little finger)

Answer 34

.

Question 35

Hypothenar muscles | What three muscles?

Answer 35

* Abductor digiti minimi * Flexor digiti minimi brevis * Opponens digiti minimi

Question 36

Arteries of the palm Ulnar artery => ....... ....... arch Radial artery => ....... ...... arch Anastomoses between the two

Answer 36

superficial palmar | deep palmar

Question 37

Superficial palmar arch Ulnar artery anterior to flexor retinaculum ->Superficial palmar arch (deep to palmar aponeurosis) Anastomoses with radial artery -> 4 digital arteries

Answer 37

.

Question 38

Deep palmar arch Direct continuation of the ....... artery. Joins with deep branch of ...... artery. Sends branches ........ to anastomosis around wrist joint and inferiorly to join digital branches of ....... ....... ......

Answer 38

radial ulnar superiorly superficial palmar arch.

Question 39

Arteries of the palm Thumb and lateral side of index finger mainly supplied by ...... artery Medial side of index finger, middle, ring and little finger mainly supplied by ...... artery

Answer 39

radial | ulnar

Question 40

Venous network | Dorsal venous network drain back into ...... and ...... veins

Answer 40

basilic | cephalic

Question 41

Dermatomes C6 = ...... C7 = ....... ... ....... ...... C8 = ..... ..... ...... ......

Answer 41

Thumb index & middle finger ring & little finger

Question 42

Median nerve palsy Median nerve lesion result in ? Ring and little fingers still flexed because ?

Answer 42

inability to flex thumb, index and middle finger at MCP joint. ulnar nerve is intact.

Question 43

Ulnar nerve palsy “Claw hand” ....... ...... lesion results in inability to ....... ....... ....... of ring and little finger. Patients can’t make a ........ ....... Also can’t extend interphalangeal joints to straighten fingers.

Answer 43

Ulnar nerve flex the DIP joint complete fist.

Question 44

Radial nerve palsy “Wrist drop” Radial nerve lesion results in ........ ......... ..... in forearm. Because ........ ........ ....... no longer opposed, ....... ........

Answer 44

denervation of extensor muscles forearm flexor muscles Wrist drops