Session 4 Lecture Notes

Question 1

In the joints of the hand - what do the following stand for:
CMCJ
MCPJ
PIPJ
DIPJ

Answer 1

CMCJ - carpometacarpal joint
MCPJ - metacarpalphalangeal joint (your knuckles)
PIPJ - proximal interphalangeal joint
DIPJ - distal interphalangeal joint

Question 2

What do the radial and ulnar artery branch into in the hand?

Answer 2

The deep palmar arch

The superficial palmar arch

Question 3

The superficial palmar arch lies superficial to which long flexor tendons?

Answer 3

Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus

Question 4

Why do you perform an Allens test before taking arterial blood gas?

Answer 4

Because not everyone has ulnar artery supply to the hand

This could put the person at risk to their blood circulation to the hand

Question 5

What section of the nail has growing potential? If this is kept intact the nail will regrow

Answer 5

The germinal matrix of the nail bed

Question 6

What 4 bones make up the corners of the carpal tunnel?

Answer 6

1. scaphoid
2. pisiform
3. trapezium
4. hamate

Question 7

What ligament protects the median nerve as it travels through the carpal tunnel?

Answer 7

The flexor retinaculum

Question 8

The muscles in the hand innervated by what nerve = the mneumonic LOAF?
What does LOAF stand for?

Answer 8

The intrinsic muscles of the hand that are innervated by the median nerve 
LOAF:
Lumbricals 1&2
Opponens pollicis 
Abductor pollicis brevis 
Flexor pollicis brevis

Question 9

Which fingers are innervated by the median nerve and which the ulnar nerve?

Answer 9

Median = first 3 1/2 fingers (thumb, index, middle and half ring finger)
Ulnar = one and 1/2 fingers (little finger and half ring finger)

Question 10

What is the only movement of the thumb which is innervated by the ulnar nerve?

Answer 10

ADduction

ADductor transverse and ADductor oblique

Question 11

What area of the hand = sensation of the radial nerve?

Answer 11

The back of the first three digits (thumb, index and middle finger)

Question 12

At rest why are our fingers usually bent?

Answer 12

Because the tone of the muscles in the flexors is stronger than the extensors
The strength we have in our fingers for gripping is much greater than strength to push away

Question 13

What lies in between the scaphoid and lunate?

Answer 13

The scaphoid lunate ligament

Question 14

Why might you get pain around the scaphoid area even if there is no fracture?

Answer 14

You could have damaged the scaphoid lunate ligament that holds these 2 carpal bones together

Question 15

What is tenosynivitis?

Answer 15

Swelling of tendons

Question 16

What is De Quernan’s tendosynivitis?

Answer 16

Swelling of the APL and EPB muscle tendons entering the thumb
Abductor pollicis longus
Extensor pollicis brevis

Question 17

How do you test for De Quernan’s tendosynivitis?

Briefly explain

Answer 17

Finkelstein’s test
Patient clenches their fist with the thumb inside and you ulnar deviate at the wrist
Pain in APL and EPB = confirms diagnosis

Question 18

What is the difference between a Colles fracture and a Smiths fracture?

Answer 18

Colles fracture = wrist moves outwards
Smiths fracture = wrist
moves inwards