The Hand

Question 1

ID of carpal bones

Answer 1

So Long to Pinky (scaphoid, lunate, triquetral, pisiform)
Here Comes the Thumb (hamate, capitate, trapezoid, trapezium)

Question 2

Movement of the digits

Answer 2

Abduction, adduction, extension, flexion

Question 3

Thumb is also known as

Answer 3

First digit

Question 4

What is the deep fascia of the hand?

Answer 4

Palmar aponeurosis

Question 5

Thenar muscle group

Answer 5

Flexor pollicis brevis, abductor pollicis brevis, opponens pollicis

Question 6

Hypothenar group muscles

Answer 6

Flexor digiti minimi, abductor digiti minimi, opponens digiti minimi

Question 7

Adductor pollicis function

Answer 7

Innervated by ulnar nerve, NOT A THENAR MUSCLE

Question 8

Lumbricals

Answer 8

Originate from tendons of FDP, insert into dorsal expansion
Innervation of 1&2 - median nerve
Innervation of 3&4 - ulnar nerve

Question 9

1&2 median nerve lumbrical innervation also known as…

Answer 9

Anterior interosseous nerve

Question 10

Dorsal interossei (DABS)

Answer 10

Abduct fingers at the MP joint “DAB” away from the 3rd digit
Innervated by ulnar nerve

Question 11

Palmar interossei (PADS)

Answer 11

Function: adduct the fingers at MP joints “PAD” towards the 3rd digit
Innervated: ulnar nerve

Question 12

Superficial arteries of the hand

Answer 12

Ulnar artery contributor, joins superficial palmar branch of radial artery, common palmar digital arteries, proper palmar digital arteries

Question 13

What is the superficial arteries of the hand referred to?

Answer 13

Superficial palmar arch

Question 14

Deep palmar arch is mainly from…

Answer 14

Radial artery

Question 15

Deep branch of the ulnar nerve supplies most muscles in the hand…

Answer 15

Hypothenar muscles, medial two lumbricals, adductor pollicis, all interossei muscles

Question 16

Superficial branch of ulnar nerve is…

Answer 16

Mainly sensory to the medial hand

Question 17

Guyon’s tunnel injury

Answer 17

• Spares the palmar cutaneous branch (supplies skin over the hypothenar eminence) and the dorsal cutaneous br (supplies skin over the dorsum of 5th digit)
• Lesions to the nerve more proximally in the tunnel will involve all branches, sparing only FDP, FCU and the dorsal cutaneous branch
• Lesions more distally in the tunnel may spare the superficial sensory branch and innervation to hypothenar muscles

Question 18

Deficits to ulnar nerve at WRIST

Answer 18

• Wrist flexion is not affected (FCU intact)
• Wasting of hypothenar eminence and interosseous spaces
• severe clawing of digits 4 & 5 because of unbalanced action of FDP
• Froment’s sign
• Sensory loss on palmar aspect of 4th and 5th digits (spares the dorsal cutaneous br)

Question 19

Clawing of digits mechanism

Answer 19

The interosseii and lumbricals function together to flex the MP joints, extend the IP joints AND counterbalance the strong flexors/extensors of the digits (FDS, FDP & ED). The palmar and dorsal interoseii also work together in adduction/abduction of digits.
When the interosseii and lumbrical acting on a digit are paralyzed, the digit “claws” from unopposed and unbalanced action of forearm muscles (namely extensor digitorum and flexor digitorum superficialis/profundus).
The “clawing” position is opposite the action of the interosseii/lumbricals: therefore, a clawed digit is hyperextended at the MP joint and flexed at the PIP and DIP joints

Question 20

If ulnar nerve injury occurs, the… lumbricals will be clawed

Answer 20

Medial

Question 21

Avascular necrosis of scaphoid bone

Answer 21

non-union of proximal and distal fragments after transverse fracture along
the middle 1/3 (“waist” of the scaphoid); the distal portion includes the nutrient artery entrance site – “waist”
fracture can damage this artery and leave the proximal fragment without a blood supply = avascular necrosis

Question 22

Allen test

Answer 22

tests the integrity of communication between the ulnar and radial arteries in the hand; pt will make a tight fist and the radial and ulnar arteries are compressed at the wrist with your fingers, the pt opens the hand (it should appear pale); the ulnar compression is removed → if the circulation is intact, normal color will return in a few seconds, if the hand remains pale it indicates that ulnar circulation to the hand is insufficient

Question 23

Mononeuropathy

Answer 23

refers to nerve signs/symptoms restricted to the cutaneous and muscular
distribution of a single nerve (e.g. median mononeuropathy) compare to radiculopathy

Question 24

Polyneuropathy

Answer 24

refers to nerve signs/symptoms within multiple nerve territories
• diabetes often causes a symmetric, distal polyneuropathy characterized by “stocking and glove” sensory loss

Question 25

Injury to both the ulnar and median nerves at wrist leads to clawing of…

Answer 25

Digits 2-5

Question 26

What is not possible with both ulnar and median nerve injury

Answer 26

Opposition

Question 27

Dupuytren’s Contracture

Answer 27

pathological thickening and shortening of the longitudinal bundles of the palmar aponeurosis; draws fingers (usually digits 4 & 5) into palm to such a degree that they become useless. Can mimic an ulnar claw since it commonly affects digits 4 & 5

Question 28

Boxer’s fracture

Answer 28

fracture of 5th metacarpal

Question 29

FOOSH stands for…

Answer 29

Fall of outstretched hand

Question 30

FOOSH in youth

Answer 30

Displacement of distal radial epiphysis

Question 31

FOOSH in adolescent

Answer 31

Clavicular fracture

Question 32

FOOSH in elderly

Answer 32

Colle’s fracture

Question 33

Most commonly fractured carpal bone

Answer 33

Scaphoid

Question 34

Most commonly dislocated carpal bone

Answer 34

Lunate

Question 35

Nerve to thenar compartment

Answer 35

Recurrent branch of median nerve

Question 36

Innervation of adductor pollicis

Answer 36

Ulnar (deep branch)

Question 37

Innervation of all interosseous muscles

Answer 37

Ulnar (deep branch)