MSK Bones of the Hand and Carpal Tunnel

Question 1

Give the names of the distal carpals in the lateral to medial direction (4)

Answer 1

• Trapesium
• Trapezoid
• Capitate
• Hamate
• THAT THEY CAN’T HANDLE*

Question 2

In what direction does the numbering of the metacarpals run?

Answer 2

Lateral to medial I.e. Thumb = 1, pinky = 5

Question 3

Give the three areas of phalanges

Answer 3

• Proximal
• Middle
• Distal

Question 4

What is a Bennet’s fracture?

Answer 4

Fracture of the first metacarpal base due to hyperabduction of the thumb

Question 5

What is a Boxer’s fracture?

Answer 5

Fracture of the fifth metacarpal neck, usually due to hitting a hard object

Question 6

Give the names of the proximal carpals in the lateral to medial direction (4)

Answer 6

• Scaphoid
• Lunate
• Triquetrum
• Pisiform
• SCARED LOVERS TRY POSITIONS*

Question 7

What is the anatomical snuffbox/radial fossa?

Answer 7

A triangular depression found on the lateral aspect of the dorsum of the hand

Question 8

What are the borders of the anatomical snuffbox? (5)

Answer 8

• Ulnar/medial border = Tendon of the extensor pollicis longus
• Radial/lateral border = Tendons of the abductor pollicis longus and extensor pollicis brevis
• Proximal border = Styloid process of the radius
• Floor = Scaphoid and trapezium
• Roof = Skin

Question 9

What does the anatomical snuffbox contain?

Answer 9

• Radial artery
• Radial nerve
• Cephalic vein

Question 10

How is the anatomical snuffbox clinically relevant?

Answer 10

• Can palpate radial artery
• Localised pain in the AS is most likely a scaphoid fracture. This fracture can rupture the proximal area of the scaphoid’s blood supply which can lead to avascular necrosis and future arthritis

Question 11

What is the anatomical snuffbox/radial fossa?

Answer 11

A triangular depression found on the lateral aspect of the dorsum of the hand

Question 12

What are the borders of the anatomical snuffbox? (5)

Answer 12

• Ulnar/medial border = Tendon of the extensor pollicis longus
• Radial/lateral border = Tendons of the abductor pollicis longus and extensor pollicis brevis
• Proximal border = Styloid process of the radius
• Floor = Scaphoid and trapezium
• Roof = Skin

Question 13

What does the anatomical snuffbox contain?

Answer 13

• Radial artery
• Radial nerve
• Cephalic vein

Question 14

How is the anatomical snuffbox clinically relevant?

Answer 14

• Can palpate radial artery
• Localised pain in the AS is most likely a scaphoid fracture. This fracture can rupture the proximal area of the scaphoid’s blood supply which can lead to avascular necrosis and future arthritis

Question 15

What forms the carpal tunnel?

Answer 15

• Laterally = Scaphoid and Trapezium tubercules
• Medially = Hook of Hamate and Pisiform
  (Carpal Arch = deep)
• Flexor Retinaculum
  (Originates on lateral side and inserts on medial side of carpal arch = superficial)

Question 16

What does the carpal tunnel contain? (4)

Answer 16

• Tendon of flexor pollicis longus
• Median nerve
• Flexor digitorum superficialis tendons (4)
• Flexor digitorum profundus tendons (4)

Question 17

What is carpal tunnel syndrome? How does it present?

Answer 17

• Compression of the median nerve

- ‘Pins and needles’ sensation in digits 2 - half of 4 and weakness of thenar muscles

Question 18

What is the cause of carpal tunnel syndrome?

Answer 18

Unknown cause but could be due to arthritic changes in carpal bones/thickening of tendons