S2_L4: Wrist and Hand Flashcards by Mind Med

What movements can the radiocarpal joint perform?

flex, extend, abduct (radial deviate) and adduct (ulnar deviate)

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FILL IN THE BLANKS.

If the muscle is inserted medially, it will (1)_____
If the muscle is inserted laterally, it will (2)_____

adduct
abduct

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What type of joint is the 1st CMC?

saddle joint

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The 2nd-5th CMC joints are what type of joints?

synovial plane joints

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Name 4 tests to confirm CTS syndrome.

Flick’s test
Tinel’s test
Prayer’s test
Phalen’s test

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The following is a predisposing factor for CTS, EXCEPT:

A. pregnancy
B. diabetes
C. arthritis
D. fracture
E. none

E. none

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What injury involves a fracture to the 5th metacarpal, usually caused by punching?

Boxers’ fracture

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The bones that make up the palm of the hand are called the

metacarpals

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The bones in the fingers are called

phalanges

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The eight bones that make up the wrist are the

carpals

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TRUE OR FALSE: The third metacarpal has no palmar interosseous

True

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The _____ muscle acts as the palmar interosseous of the thumb

adductor pollicis

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Normally there are only 3 palmar interossei. If so, which interossei faces medially and laterally?

1st - medial
2nd & 3rd - lateral

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What is the dermatomal level of T1?

medial aspect of arm

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What is the dermatomal level of C7

middle finger

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What is the dermatomal level of C5

lateral aspect of the arm

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What is the myotome level of C6?

elbow flex, wrist extend

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What is the myotome level of C8?

fingers flexion, thumb extension

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The deep tendon reflex of C5-C6 is for what muscle?

biceps brachii

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Case: Pt. who complains of pain on his neck, radiates to the arm up to the thumb. Upon physical exam, there is sensory deficit on the thumb, difficulty and weakness in elbow flexion and wrist extension and absence of brachioradialis reflex. What root is affected?

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SCENARIO: Pt. had an accident and fell. Upon examination, there is sensory loss at middle finger, absence of triceps reflex, and he cannot extend elbow nor flex the wrist What root is affected?

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A sliding door deformity means?

There is lateral winging of the scapula

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The wrist is also called?

carpus

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The following is true about the radiocarpal joint, EXCEPT:

A. Articulation between the distal end of the radius and
the articular disc above and the scaphoid and lunate
B. It is an ellipsoid joint/condyloid
C. Have anterior and posterior ligaments that strengthen the capsule
D. Innervated by the anterior interosseous nerve and deep branch of radial nerve
E. None

A. Articulation between the distal end of the radius and
the articular disc above and the scaphoid and lunate

NOTE: It also articulated with the triquetral bone

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What movement happens in the intercarpal joints?

gliding

The following is true about the flexor retinaculum, EXCEPT: A. Is a thickening of deep fascia B. Holds/supports the long flexor tendons in position at the wrist C. Converts the convex anterior surface of the hand into the carpal tunnel D. Attach medially to the pisiform & hamate E. Attach laterally to the scaphoid and trapezium bones

C. Converts the convex anterior surface of the hand into the carpal tunnel NOTE: The anterior surface is concave.

The flexor digitorum profundus is said to be dually innervated. Which nerves supply this muscle?

ulnar and anterior interosseous nerve

Ill fitted crutches may cause impingement in what nerve?

Radial Nerve

The 1st metacarpal articulates with what carpal bone?

trapezium

TRUE OR FALSE: The 3rd metacarpal only articulated with the capitate among the carpal bones.

True

MCP joints are what type of joints?

Synovial condyloid joints

What are the actions allowed in MCP joints?

flex and extend; abduct and adduct

TRUE OR FALSE: Collateral ligaments are cord-like bands present on each side of the joints, The collateral ligaments are lax when the joint is in flexion and tight when the joint is in extension. A. Both statements are true. B. Both statement are false. C. Only the 1st statement is true D. Only the 2nd statement is true

C. Only the 1st statement is true

TRUE OR FALSE: The palmar ligaments are strong and contain some fibrocartilage and are firmly attached to the phalanx but less so to the metacarpal bone. The palmar ligaments of the second, third, fourth, and fifth joints are united by the deep transverse metacarpal ligaments, which hold the heads of the metacarpal bones together. A. Both statements are true. B. Both statement are false. C. Only the 1st statement is true D. Only the 2nd statement is true

A. Both statements are true.

The dorsal interossei helps in what movement?

abduction

The (1)______ and (2)_____ are strong bands of deep fascia that hold the long flexor and extensor tendons in position at the wrist.

1. flexor retinacula 2. extensor retinacula

TRUE OR FALSE: The attachment to the trapezoid consists of superficial and deep parts and forms a synovial lined tunnel for passage of the tendon of the flexor carpi radialis.

False. It is the attachment of the trapezium.

The extensor retinaculum is is attached medially to the (1)_____ & (2)_____ and laterally to the (3)_____.

1. pisiform 2. hamate 3. radius

The following structures pass SUPERFICIAL to flexor retinaculum, EXCEPT: A. ulnar nerve B. palmaris longus tendon C. palmar cutaneous branch of median nerve D. flexor carpi ulnaris tendon E. flexor carpi radialis tendon

E. flexor carpi radialis tendon

The following structures pass BENEATH the flexor retinaculum, EXCEPT: A. flexor pollicis longus tendon B. median nerve C. palmar cutaneous branch of ulnar nerve D. flexor digitorum superficialis E. flexor digitorum profundus

C. palmar cutaneous branch of ulnar nerve

The following structures pass SUPERFICIAL to extensor retinaculum, EXCEPT: A. abductor pollicis longus B. basilic vein C. cephalic vein D. dorsal cutaneous branch of ulnar nerve E. superficial branch of radial nerve

A. abductor pollicis longus

The following structures pass BENEATH the to extensor retinaculum, EXCEPT: A. extensor carpi ulnaris tendon B. extensor indicis C. extensor pollicis longus tendon D. extensor digiti minimi tendon E. none

E. none

What are the 3 nerves that supply the hand/ wrist?

1. MEDIAN NERVE 2. RADIAL NERVE 3. ULNAR NERVE

Enumerate the contents of the carpal tunnel.

1. flexor digitorum superficialis (4) 2. flexor digitorum profundus(4) 3. flexor pollicis longus 4. median nerve

This test is also called the reverse prayer's test and is done with the dorsal area of the hand put together.

phalen’s test

The (1)_____ test is done by tapping on the (2)_____ nerve to test for carpal tunnel syndrome.

1. Tinel's 2. median

TRUE OR FALSE: In CTS, one of the s/sx is an observable "swollen hand"

True

This structure arise from tendon of flexor digitorum profundus in the palm and insert into the lateral side of the corresponding extensor expansion

Lumbricals

What nerve innervates the interossei?

ulnar nerve

The word "thenar" refers to the area of the?

Thumb

This is the triangular skin depression on lateral side of wrist

Anatomical Snuffbox

Which annular ligaments are critical to prevent bowstringing?

A2 and A4

TRUE OR FALSE: The anatomical snuffbox contains the scaphoid.

True

Which annular ligament pulley most commonly involved in trigger finger?

These pulleys function to prevent sheath collapse and expansion during digital motion.

Cruciate pulleys

Zone II of the flexor tendons of the hand is known as the?

“No Man’s Land” or “No Man’s Zone”

Zone IV of the flexor tendons of the hand is under what ligament?

carpal ligament

The following is true about Zone II of the flexor tendons of the hand, EXCEPT: A. extends from the middle of the middle phalanx to distal palmar crease. B. consists of the profundus tendon only C. surrounded by a number of pulleys D. NONE

B. consists of the profundus tendon only NOTE: This is for Zone I. For Zone II, it contains both flexor tendon superficialis and flexor tendon profundus.

This zone of the hand is also called lumbrical zone.

Zone III

The finger extensor system has (1)_____ zones, and that of the thumb has (2)_____ zones.

1. nine 2. seven

What root is being tested if sensory assessment is done on the medial arm?

Determine the myotome level responsible for the following actions. 1. Shoulder elevation 2. Neck flexion 3. Shoulder abduction A. C1-C2 B. C3 C. C4 D. C5 E. C6

1. C 2. A 3. D

Determine the myotome level responsible for the following actions. 1. Thumb extensor 2. Adduction of hand 3. Finger flexors A. T1 B. C3 C. C7 D. C8 E. C6

1. D 2. A 3. D

Determine the myotome level responsible for the following actions. 1. Elbow extension 2. Neck side flexion 3. Wrist extension A. T1 B. C3 C. C7 D. C8 E. C6

1. C 2. B 3. E

The triceps tendon reflex involves what nerve roots?

C6,7 & 8

When the Brachioradialis tendon reflex is elicited, what should be the expected movement?

supination of the radioulnar joints

The following is true about Erb-Duchenne Palsy, EXCEPT: A. Limb becomes medially rotated, supinated, extended, and abducted B. Also known as “waiter’s tip” deformity C. Affects Suprascapular nerve, nerve to subclavius, musculocutaneous nerve, axillary nerve D. Causes tearing or traction of the C5-6 roots E. Results from excessive displacement of the head to the opposite side and depression of shoulder on same side

A. Limb becomes medially rotated, supinated, extended, and abducted NOTE: It is pronated and adducted

The following is true about Klumpke's Palsy, EXCEPT: A. Usually affects C8 T1 B. Also known as “claw arm” deformity C. Affected nerves are ulnar and median nerve especially of the small hand D. Usually due to traction injuries caused by excessive abduction of arm E. None

B. Also known as “claw arm” deformity NOTE: It is the "claw hand" deformity

This sign becomes positive when a pt shows an inability to adduct thumb because the adductor pollicis is paralyzed, so patient contracts flexor pollicls longus.

Froment’s sign

This condition often has a MOI of a drunkard sleeping with hand at the back of chair

Saturday night palsy or honeymoon palsy

If a pt is dx with the radial nerve palsy, what is the most observable deformity?

wrist drop

The anatomical snuffbox is medially bounded by?

extensor pollicis longus tendon

How many dorsal compartments are present in the hand?

Determine which muscle is present in the dorsal compartment. 1. extensor pollicis longus 2. extensor digiti minimi 3. extensor carpi ulnaris A. First compartment B. Second compartment C. Third compartment D. Fourth compartment E. Fifth compartment F. Sixth compartment

1. C 2. E 3. F

Determine which muscle is present in the dorsal compartment. 1. abductor pollicis longus 2. extensor pollicis brevis 3. extensor indicis proprius A. First compartment B. Second compartment C. Third compartment D. Fourth compartment E. Fifth compartment F. Sixth compartment

1. A 2. A 3. D

Determine which muscle is present in the dorsal compartment. 1. extensor carpi radialis longus 2. extensor carpi radialis brevis 3. extensor digitorum A. First compartment B. Second compartment C. Third compartment D. Fourth compartment E. Fifth compartment F. Sixth compartment

1. B 2. B 3. D

TRUE OR FALSE: The Flexor Retinacula is attached medially to the pisiform & hamate and laterally to the scaphoid and trapezium bones. A. Both statements are true. B. Both statement are false. C. Only the 1st statement is true D. Only the 2nd statement is true

A. Both statements are true.

This condition affects the base of first metacarpal (thumb), d/t sudden hyperextension and pull on the thumb

Bennette’s fracture