Module 11

Question 1

Which of the following is considered a function of the hand? Select all that apply.
-grasp and manipulation of objects
-expression through gestures
-sexual functions
-orienting objects in space

Answer 1

-grasp and manipulation of objects
-expression through gestures
-sexual functions

Explanation:
The hand allows for grasping and manipulating objects, expression through gestures, touch functions and sexual functions. Orienting objects in space requires intermediate and proximal segment motion.

Question 2

True or False: The ability of the hand to conform to the characteristics of object surfaces is called accommodation.

Answer 2

True

Question 3

True or False: Drinking from a water bottle requires use of a precision grasp while holding a pen to write requires use of a power grasp.

Answer 3

False

Question 4

Which of the following structures forms the roof of the carpal tunnel?
Transverse carpal ligament
Extensor retinaculum
The palmar carpal ligament
Palmar Aponeurosis

Answer 4

Transverse carpal ligament

Question 5

True or False: The tendons of FPL, FDS and FDP are contained in flexor tendon sheaths that consist of both a synovial layer and fibrous layer.

Answer 5

True

Question 6

True or False: An infection in the tendon sheath of the thumb often presents with redness and swelling at the wrist because of the continuity of the ulnar bursa.

Answer 6

False

Explanation:
This statement is false: the digital synovial tendon of the little finger is a direct continuation of the common flexor synovial tendon sheath (ulnar bursa). It is the radial bursa that continues as the synovial sheath of the thumb and because of this continuation an infection of the tendon sheath of the thumb often presents at the wrist.

Question 7

True or False: This function of the fibrous layer of the flexor tendon sheaths is to prevent bowstringing of the tendons as they cross multiple joints.

Answer 7

True

Explanation:
This statement is true: the arrangement of cruciate and annular ligaments of the fibrous sheath form a series of pulleys that hold the flexor tendons close to the bone; they prevent bowstringing of the tendons and facilitate appropriate movement of the tendons across the multiple joints.

Question 8

Which of the following structures of the extensor expansion is important for producing PIP extension?
Central band
Lateral band
Terminal tendon

Answer 8

Central Band

Explanation:
The central band is formed by the ED tendon inserting into the base of the middle phalanx - its function is extension of the PIP joint. The lateral bands (2) formed by the tendons of the short muscles of the hand will pass over the lateral aspects of the PIP joints and join the slips of the ED tendon over the middle phalanx; finally all of the tendons converge to insert on the base of the distal phalanx. This is called terminal tendon, which produces extension of the DIP joint.

Question 9

Which of the following muscles is considered a muscle of the thenar muscle? Select all that apply.
Opponens pollicis
Opponens digiti minimi
Lumbricals
Flexor pollicis brevis
Adductor pollicis

Answer 9

Opponens pollicis
Flexor pollicis brevis
Adductor pollicis

Explanation:
All of the muscles with the name pollicis (latin meaning of thumb) are thenar muscles; digiti minim= little digit and all of the hypothenar muscles will have digit minim in the name; all other muscles (i.e. lumbricals and interossei) are considered short muscles of the hand.

Question 10

Which of the following muscles originates from both the trapezium and scaphoid? Select all that apply.
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Adductor pollicis

Answer 10

Abductor pollicis brevis
Flexor pollicis brevis

Explanation:
The flexor pollicis brevis and the abductor pollicis have origin points from both the trapezium and scaphoid. The opponens pollicis originates from the trapezium; the adductor pollicis from the trapezoid, capitate, and the 2nd and 3rd metacarpal bones.

Question 11

Which of the following muscles inserts on the 1st metacarpal bone?
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis

Answer 11

Opponens pollicis

Explanation:
The opponens pollicis inserts onto the 1st metacarpal bone; all the others insert onto the proximal phalanx of the thumb.

Question 12

Which of the following muscles originates from the pisiform?
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis

Answer 12

Abductor digiti minimi

Explanation:
The abductor digiti minimi originates from the pisiform; the others originate from the hook of the hamate.

Question 13

Which of the following muscles inserts on the 5th metacarpal bone?
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi

Answer 13

Opponens digiti minimi

Explanation:
The opponens digiti minimi inserts on the 5th metacarpal bone; the others insert onto the proximal phalanx of the 5th digit.

Question 14

Which of the following muscles insert on the extensor expansion? Select all that apply.
Lumbricals
Dorsal Interossei
Palmar Interossei
Flexor Pollicis brevis

Answer 14

Lumbricals
Dorsal Interossei
Palmar Interossei

Explanation:
All of the short muscles of the hand (lumbricals and interossei) insert on the extensor expansion

Question 15

Which structures travel through the carpal tunnel? Select all that apply.
Tendons of flexor digitorium superficialis
Tendons of flexor digitorium profundus
Tendon of flexor carpi radialis
Tendon of flexor pollicis longus
Median nerve
Ulnar nerve

Answer 15

Tendons of flexor digitorium superficialis
Tendons of flexor digitorium profundus
Tendon of flexor pollicis longus
Median nerve

Question 16

Which of the following carpal bones forms the medial (ulnar) boundary of the ulnar canal?
Pisiform and pisohamate ligament
Hook of hamate
Palmar carpal ligament
Transverse carpal ligament

Answer 16

Pisiform and pisohamate ligament
Explanation:
The pisiform and the pisohamate ligament form the medial (ulnar) boundary of the ulnar canal; the hook of the hamate forms the lateral (radial) boundary; the palmar carpal ligament forms the roof and the transverse carpal ligament forms the floor.

Question 17

Which of the following structures pass through the ulnar canal? Select all that apply.
Ulnar nerve
Median nerve
Radial artery
Ulnar artery

Answer 17

Ulnar nerve
Ulnar artery

Explanation:
The ulnar nerve and artery travel through the ulnar canal; the median nerve travels through the carpal and the radial artery travels along the floor of the anatomical snuff box.

Question 18

Which structures are contained in the central compartment of the hand? Select all that apply.
Tendons of flexor digitorium superficialis and profundus
Radial nerve
Superficial and deep palmar arterial arches
Digital branches of the median and ulnar nerves
Tendon of flexor pollicis longus

Answer 18

Tendons of flexor digitorium superficialis and profundus
Superficial and deep palmar arterial arches
Digital branches of the median and ulnar nerves

Question 19

Which branch of the median nerve arises prior to the median nerve entering the carpal tunnel?
Recurrent branch
Digital branches
Palmar cutaneous branch

Answer 19

Palmar cutaneous branch

Question 20

Which muscles are supplied by the recurrent branch of the median nerve? Select all that apply.
Opponens pollicis
Abductor pollicis brevis
Dorsal Interossei
Adductor Pollicis
1st and 2nd lumbricals

Answer 20

Opponens pollicis
Abductor pollicis brevis

Explanation:
The recurrent branch of the median nerves will innervate: opponens pollicis, abductor pollicis and the superficial head of the flexor pollicis brevis; the deep head of the flexor pollicis brevis and the adductor pollicis are supplied by the deep branch of the ulnar nerve; the first two lumbricals are supplied by the digital muscular branches of the median nerve.

Question 21

True or False: Upon passing through the ulnar canal, the ulnar nerve divides into a superficial branch and a deep sensory branch.

Answer 21

False

Question 22

Which of the following muscles is innervated by the deep branch of the ulnar nerve? Select all that apply.
Opponens digiti minimi
Abductor digiti minimi
Dorsal Interossei
3rd and 4th lumbricals
Adductor pollicis

Answer 22

Opponens digiti minimi
Abductor digiti minimi
Dorsal Interossei
3rd and 4th lumbricals
Adductor pollicis

(all of the above)

Explanation:
The deep branch of the ulnar nerve supplies all of the intrinsic muscles of the hand (including all of the ones listed above) with the exception of the opponens pollicis, abductor pollicis; superficial head of the flexor pollicis brevis (all innervated by the recurrent branch of the median nerve) and the first two lumbricals (innervated by the digital motor branches of the median nerve).

Question 23

Your patient had an injury to the ulnar nerve. Where do you anticipate your patient will have sensory loss?
Central palm and the majority of the thenar eminence
Palmar and dorsal surfaces of the 4th and 5th digits
Lateral 2/3rds of the dorsum of the hand

Answer 23

Palmar and dorsal surfaces of the 4th and 5th digits

Explanation:
Damage to the ulnar nerve would result in a loss of sensation over the hypothenar eminence, and the palmar and dorsal surfaces of 1/2 of ring finger and pink; loss of sensation of the central palm and the majority of the thenar eminence would be seen with a median nerve injury; and loss of sensation over the lateral 2/3rds of the dorsum of the hand would be associated with a radial nerve injury.

Question 24

True or False: An anastomosis between the deep palmar branch of the ulnar artery and the radial artery form the deep palmer arterial arch.

Answer 24

True

Explanation:
This statement is true: the ulnar artery enters Guyon’s Canal (lateral to the nerve) and then it gives off the deep palmar branch which forms an anastomosis with the radial artery forming the deep palmar arch.