Lecture 3: Wrist and Hands

Question 1

Carpal bones (8)

Answer 1

scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate

Question 2

Metacarpals

Answer 2

I-V
thumb-I
little fingers -V

Question 3

Phalanges

Answer 3

1. proximal
2. middle
3. distal

II-V
*thumb, I, lacks middle

Question 4

Median nerve

Answer 4

runs anterolaterally and innvervates the muscles responsible for flexion of the wrist and fingers (digits 1-3, and radial aspect of the 4th)

Question 5

Radial nerve

Answer 5

extends posteriorly to the ulna and radius. Solve nerve involved in the muscles responsible for extension of the forearm, wrist, and fingers

Question 6

Ulnar

Answer 6

positioned more anteromedially , running between flexor digitorum superficialis and flexor digitorum profundus, inlovled in flexion of the wrist and fingers- also responsible for spanning fingers

Question 7

Wrist joint /radiocarpal joint

Answer 7

condyloid synovial joint of the distal upper limb that connects and serves as a transition point between the forearm and hand

joint itself is formed through the articulations between the distal radius (no ulna) and the scaphoid, lunate, triquetrum

Question 8

Ligaments (4)

Answer 8

maintain stability of the wrist joint

1. palmar radiocarpal
2. dorsal radiocarpal
3. ulnar collateral ligaments
4. radial collateral ligaments

Question 9

Wirst ROM: Flexors (5)

Answer 9

flexor carpi radialis, flexor capri ulnaris, flexor digitorum superficialis, flexor digitorum profundis, and to a lesser extent flexor pollicus longus and palmaris longus

Question 10

Wrist ROM: Extension (5)

Answer 10

extensor capri radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum and to a lesser extent extensor indicis

Question 11

Wrist ROM: abduction (4)

Answer 11

abductor policis longus, flexor carpi radialis, extensor carpi radialis longus, and extensor carpi radialis brevis

Question 12

Wrist ROM: Adducton (2)

Answer 12

flexor capi ulnaris, extensor carpi ulnaris

Question 13

Snuffbox

Answer 13

1. medially- tendon of extensor pollicis longus muscle
2. laterally-tendons of the abductor pollicis longus and extensor pollicis brevis muscles
   * flood of snuffbox contains the radial artery (pulse can be detected) and terminal end of superficial radial nerve, which passes subcutaneously over the region

Question 14

Scaphoid Fracture

symptoms
testing/imaging
tx

Answer 14

carpal bone fracture typically occurs from fall onto outstretched arm with the wrist in dorsiflexion

*suspect in any patient with wrist pain after fall

• pt. typically complains of pain localized to snuffboc
• can also present with volar prominence pain (base of thenar eminence) or distal lister’s tubercle
• plain XR may not show fx at first, r/c repeat in 7-10 days
• tx: short arm or long arm thumb spica

Question 15

FOOSH

Answer 15

fall on outstretched hand

Question 16

colle’s fracture

Answer 16

most common FOOSH

fracture of distal radius

clinical condition produces dinner fork deformity

place the arm in a well-molded sugar tong, reverse tong, or doulbe sugar tong splint (NOT circumferential cast) with the arm in neutral position

Question 17

Carpal Tunnel and carpal tunnel syndrome

Answer 17

carpal tunnel is a narrow passageway in the wrist, about an inch wide

carpal tunnel protects the median nerve and flexor tendons that bend the fingers and thumb

median nerve-compression in the carpal tunnel is the most common compression neuropathy, is often linked to occupational repetitve movements related to wrist flexion and extension, holding the wrist in an awk position or strong gripping of objects

long-term compression often leads to thenar atrophy and weakness of the thumb and index fingers, reflecting the loss of innervation to the muscles distal to the median nerve damage