The hand

Question 1

abduction and adduciton of the thumb is iin which plane

Answer 1

sagittal- bringing it forward and back

Question 2

proximal row of carpals from lateral to medial

Answer 2

scaphoid, lunate, triquetrum, pisiform (sesamoid bone w/i tendon of flexor carpi)

Question 3

distal row of carpals from lateral to medial

Answer 3

trapezium, trapezoid, capitate, hamate

Question 4

mnemonic for carpals

Answer 4

Some (scaphoid)
Lovers (lunate)
Try (triquetrum)
Positions (pisiform)
That (trapezium)
They (trapezoid)
Cant (capitate)
Handle (hamate)

Question 5

most common carpal fracture

Answer 5

scaphoid

lunate most commonly dislocated

both usually from FOOSH

Question 6

complications from scaphoid fractures

Answer 6

can disrupt blood supply causing delayed necrosis of bone

Question 7

significance of 1st carpometacarpal joint

Answer 7

one of the most common sites of arthritis

b/w trapezium and base of first metacarpal

Question 8

easy fracture in Boxer’s fracture

Answer 8

commonly in 5th metacarpal neck, most ROM and easily broken

Question 9

which nerve tested by OK sign

Answer 9

anterior interosseus nerve- innervates FPL (thumb) and FDP (index finger)

Question 10

palmar aponeurosis def and septa

Answer 10

continuation of antebrachial fascia

sends a medial septum to 5th metacarpal and lateral septum to 3rd metacarpal and divides hand into compartments

Question 11

5 compartments of hand

Answer 11

hypothenar
thenar
central
adductor
interosseus

limit spread of infection in hand

Question 12

base of palmar aponeurosis becomes…

Answer 12

4 longitudinal fibrous digital sheaths w/i fingers

Question 13

fibrous digital sheaths contain…

Answer 13

superficial and deep flexor tendons and their synovial sheaths

5 annular and 4 cruciform ligaments

Question 14

trigger finger patho

Answer 14

trauma to tendons causes scar tissue, creates nodule on tendon

causes finger to lock into flexion position as nodule catches beneath annular ligament

Question 15

tenosynovitis

Answer 15

inflammation of synovial tendon sheaths

Question 16

fn of synovial tendon sheath

Answer 16

permit tendons to move freely w/ less friction

Question 17

hypothenar compartment muscles

Answer 17

3 intrinsic muscles:
abductor digiti minimi
flexor digiti minimi brevis
opponens digiti minimi

innervated by deep branch of ulnar nerve

located medially in hand

Question 18

thenar compartment

Answer 18

located laterally

3 intrinsic muscles (mainly for opposition of thumb)
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis (main one responsible for thumb opposition)

all innervated by recurrent branch of median nerve except deep head of flexor pollicis brevis

Question 19

muscle of adductor compartment

Answer 19

adductor pollicis- fan shaped w/ two heads (transverse and oblique, contains small sesamoid bone in tendon)

innervated by deep branch of ulnar nerve

Question 20

location/muscles of central compartment

Answer 20

under aponeurosis, contains long flexor tendons and lumbrical muscles

Question 21

lumbrical muscles origin/insertion, innervation

Answer 21

4 intrinsic muscles arising from tendons of FDP

lateral 2 by median nerve, medial 2 by ulnar

insert into extensor expansion (hood ligament) of dorsum of digits 2-5

Question 22

lumbrical function

Answer 22

flex digits at MCP and extend interphlangeal joints at the same time- tightens hood ligament and extends fingers

Question 23

interosseus compartment location

Answer 23

b/w metacarpal bones

Question 24

interosseus muscles

Answer 24

interossei muscles- aid in grip strength

3 palmar from metacarpals 2,4,5 help adduct digits toward axial line

4 dorsal interossei from metacarpals, insert into extensor expansion of digits 2,3,4- abduct digits away from axial line

all innervated by deep branch of ulnar nerve

Question 25

3 extrinsimuscles providing tendons into hand

Answer 25

flexor pollicis longus -1 FDS- 4 FDP- 4 all passing thru carpal tunnel w/ median nerve

Question 26

carpal tunnel syndrome

Answer 26

any condition causing reduction in size of the carpal tunnel, traps median nerve sx in hand distal to median nerve

Question 27

sx of carpal tunnel syndrome

Answer 27

nerve problems w/ lateral 3.5 digits along palmar surface can lose opposiiton of thumb when thenar muscles affected

Question 28

blood supply to hand all from..

Answer 28

ulnar and radial arteries

Question 29

two terminal branches of ulnar artery

Answer 29

superficial palmar arch- gives common and proper palmar digital arteries deep palmar branch both contribute to medial aspect of hand

Question 30

location of distal radial artery

Answer 30

courses dorsally thru anatomical snuff box, enters palm passing deep to first dorsal interosseus muscle

Question 31

2 branches of radial artery

Answer 31

radial indicis and princeps pollicis arteries (index and thumb) lateral aspect of hand

Question 32

anastamosis of radial and ulnar arteries

Answer 32

deep palmar arch, radial artery w/ deep palmar branch of ulnar superficial palmar arch- ulnar artery and superficial branch of radial

Question 33

all intrinsic muslces innervated by which nerve roots

Answer 33

C8 and T1- via deep branch of ulnar and radial

Question 34

describe sesnsory innervation to hand

Answer 34

ulnar- dorsal and palmar of 5th digit, half of 4th radial- dorsal of 1,2,3, half of 4th digit median- palmar of 1,2,3 half of 4th digit and nail beds

Question 35

describe median nerves entry into hand, branches, and key innervations

Answer 35

enters thru carpal tunnel (except palmar branch) gives off recurrent branch innervating thenar muscles innervates 1st and 2nd lumbricals common and proper digital branches for sensation, palmar carpal branch supplies central palm (prior to carpal tunnel, runs over the roof)

Question 36

ulnar nerve entry into hand, branches, key innervations

Answer 36

over flexor retinaculum w/ ulnar artery thru canal of guyon into hand deep branch supplies almost all intrinsic muscles (except 1 and 2 lumbrical) superficial branch gives common and proper digital branches for sensation to digit 5 and half of 4