The Purple Book - Ch. 1 Clinical Anatomy Flashcards
(82 cards)
1
Q
Signs of this condition is a significant reduction of finger flexion force in the digits adjacent to the ring finger as well well as flexor contracture of the ring finger
A
Quadrigia Phenomenon
2
Q
When advancing the FDP for a tendon repair, what is the length of advancement that may lead to Quadrigia phenomenon?
A
1 cm
3
Q
What structures pass through Guyon’s Canal?
A
The ulnar nerve and the ulnar artery
4
Q
This phenomenon results when the patient attempts to contract the FDP but instead the lumbrical is pulled proximally resulting in PIPD and DIPJ extension rather than flexion.
A
lumbrical-plus phenomenon
5
Q
_____________is an indicator of ulnar nerve and interosseus muscle paralysis which means the patient is ale to flex the middle finger but not radially or ulnarly deviate the middle finger.
A
Egawa’s sign
6
Q
________is an anatomic interconnection of the FPL and the FDP of the index finger.
A
Linburg’s sign.
7
Q
What structures form the anatomical snuffbox?
A
The scaphoid, EPL, APL, and EPB
8
Q
Which muscles contribute to the functional motion for reaching overhead?
A
The serratus anterior and the upper trapezius.
9
Q
Where does the serratus anterior insert?
A
The lateral inferior angle of the scapula
10
Q
Where does the upper trapezius insert?
A
The acromion process.
11
Q
Name the structures that are contained in the carpal tunnel.
A
The median nerve, flexor Pollicis longus (FPL), and the FDP (x4) and FPS (x4).
12
Q
What structures make up the ulnar border of the carpal tunnel?
A
The hamate, triquetrum, and the pisiform.
13
Q
What structures make up he radial border of the carpal tunnel?
A
The scaphoid, trapezium, and the fascia over the flexor carpi radialis (FCR)
14
Q
What structures make up the floor of the carpal tunnel?
A
The concave carpal arch.
15
Q
What structure make up the roof of the carpal tunnel?
A
The flexor retinaculum, the deep forearm fascia and the distal APL euros is of the thenar and hypothenar eminences.
16
Q
An interosseous ligament complex links the scaphoid and the lunate. This complex is made up of:
A
A dorsal and volar ligament about portion and a central membranous portion.
17
Q
Of the interosseos ligament complex of the scaphoid and lunate, which aspect is considered the strongest?
A
The dorsal portion is considered the strongest and most vital for normal scapholunate kinematics during wrist motion.
18
Q
Which of the following structures is implicated in the development of PIPJ flexion contraction? A. Check-rein ligaments B. Collateral ligaments of the PIP joint C. The Volar Plate D. All of the Above
A
All of the above
19
Q
Which extensor tendons are in the first dorsal compartment?
A
Abductor Pollicus Longus and the Extensor Pollicis Brevis
20
Q
Which extensor tendons are in the second dorsal compartment?
A
Extensor Carpi Radialis Brevis and Extensor Carpi Radialis Longus
21
Q
Which extensor tendons are in the third dorsal compartment?
A
Extensor Pollicis Longus
22
Q
Which extensor tendons are in the fourth dorsal compartment?
A
Extensor digitorum and Extensor Indicis Proprius
23
Q
Which extensor tendons are in the fifth dorsal compartment?
A
Extensor digits minimi
24
Q
Which extensor tendons are in the sixth dorsal compartment?
A
Extensor carpi ulnaris
25
Which muscle is the most efficient extensor of the wrist?
The extensor radialis brevis
26
Lateral epicondylitis is a common disorder causing pain with grasp and loss of lifting ability among individuals afflicted with the problem. Which muscle is the primary problem?
Extensor carpi radialis brevis
27
Which structure is commonly involved in trigger finger?
Flexor digitorm superficialis
28
Which combination of carpal bones serves as the attachment sites of the transverse carpal ligament?
Hamate, pisiform, trapezoid, and scaphoid
29
An acute compartment syndrome requires”
Immediate fasciotomy of all compartments involved
30
A patient presents with a GSW to the forearm through the cubical tunnel lacerating the ulnar nerve. The clinical exam reveals that the patient has no FDP function to the small and ring finger; however, the intrinsic muscles are intact and functioning perfectly. What phenomena can explain this clinical finding?
Martin-Gruber anastomosis
31
This muscle is a strong finger abductor that inserts into the base of the of the proximal phalanx of the finger.
First dorsal interosseous
32
This muscle is innervated by the median nerve and originates from the transverse carpal ligament.
Abductor Pollicis brevis
33
This muscle is innervated by the ulnar nerve and inserted into the ulnar side of the proximal phalanx of the thumb and the extensor expansion of the thumb.
Adductor pollicis
34
This muscle inserts into the base of the third metacarpal.
Extensor Carpi Radialis Brevis
35
This muscle is innervated by the posterior interosseous nerve and inserts into the base of the fifth MCP
Extensor carpi ulnaris
36
This muscle originates from the lateral epicondyle of the humerus and the adjacent portion of the ulna and inserts into the upper third of the radius.
Supinator
37
This muscle is innervated by the posterior interosseous nerve and inserts into the first distal phalanx
Extensor pollicis longus
38
This muscle originates from the length of the second metacarpal and abducts the index finger
First volar interosseous.
39
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The elbow’s main stabilizer to valgus strain is which of the following:
A. Medial epicondyle
B. Medial collateral ligament
C. Lateral epicondyle
D. Lateral collateral ligament
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B. Medial collateral ligament
40
With paralysis of the interosseous muscles, the long finger extensors are unopposed. They hyperextend the MCP joints during finger extension. However, stabilization and prevention of hyperextension of the MCP during extension to the PIP and DIP joints, thus resulting in extension. Which test was just described.
Bouvier. The Bouvier test is used to determine whether the PIP joint capsule and extensor mechanism are working normally.
41
There are 5 annular pulleys and 3 crucial pulleys in each digit. What are the critical pulleys required to maintain relatively normal tendon gliding
A2 and A4
42
Accurately describe the Triangular Fibrocartilage Complex (TFCC).
The TFCC consists of a meniscal homologue which includes the ECU sub sheath, the ulnar collateral ligament, and the volar and dorsal DRUJ ligaments
43
What is the major arterial supply to the forearm and hand?
The brachial artery
44
A patient is referred for orthotic positioning of the hand following micro vascular reconstruction. To protect the vascular component of the repair, how long should the patient wear the orthosis/
7 - 14 days
45
Cleland’s and Grayson’s ligaments perform what functions?
Stabilize the digital skin preventing rotary movement of the skin around the fingers.
46
The vascular structure of the hand consists of :
The superficial palmar arch, the deep palmar arch and the common palmar arteries.
47
Name the innervation of the Palmaris Brevis:
Superficial branch of the ulnar nerve
48
Name the innervation of the Pronator Quadratus
Anterior Interosseous nerve
49
Name the innervation of the Abductor Pollicis Brevis
Median nerve
50
Name the innervation of the Adductor Pollicis
Deep branch of ulnar nerve
51
Name the innervation of the extensor indicis proprius
Posterior Interosseous Nerve
52
Name the innervation of the Brachioradialis.
Radial nerve
53
What is the only muscle that arises from and inserts into tendon?
Lumbricals
54
This muscle is often called the “workhorse” of the hand.
Lumbricals
55
A patient is referred with a dx of Kienbock’s disease. The script reads:Stage 4 Kienbock’s disease; evaluate and treat. The patient is 4 week post-op and comes to therapy one day following cast removal. The referring surgeon is in surgery and no other information is available at this moment. What surgical procedure is most likely to have been performed?
A proximal row carpectomy
56
Which of the following anatomic structures is not a proximal compression site of the median nerve?
A. The ligament of Struthers
B. The bicipital aponeurosis
C. The arcade of Struthers
D. The arch of the flexor digitorum superficialis.
The arcade of Struthers. The arcade of Struthers is a proximal compression site of the ulnar nerve and is not involved in median nerve pathology
57
What is another term for the anatomic structure bicipital aponeurosis?
Lacertus Fibrosis
58
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When the digits move from a position of full extension to flexion rotational movements occur causing the digits to converge. Which of the following structures is the convergence point?
A. Hook of hamate
B. Scaphoid tubercle
C. Base of the first metacarpal
D. Tubercle of the trapezium
```
B. Scaphoid tubercle
59
Which combination of passive structures is critical for maintaining glenohumeral stability during movement fo the shoulder?
The labrum, superior and inferior glenohumeral ligaments, and the joint capsule.
60
Vascularity of the scaphoid is oriented in a central-distal to proximal direction. Due to this vascular structure, what is common following scaphoid fracture?
Non-union
61
The function of this muscle is to Increase the span of grasp and assist with flexion of the fifth MCP joint.
Abductor digits minimi
62
The function of this muscle is to rotate and draw the 5th MCP anteriorly
Opponents digits minimi
63
The function of this muscle is to adduct the thumb to the palm, gives power for grasping, and inserts into the extensor mechanism to assist the IP joint of the thumb into 0 degrees of extension
Adductor pollicis
64
The function of this muscle is to insert on the medial or lateral aspects of the proximal phalanx into the lateral band of the extensor mechanism
Interossei
65
The muscle has a moving site of origin
Lumbricals
66
This muscle originates from the trapezium and transverse carpal ligament and inserts on the proximal phalanx and extensor mechanism of the thumb; helps to extend the IP joint to 0 degrees of extension
Abductor Pollicis Brevis
67
This muscle inserts all along the body of the first metacarpal and rotates the thumb medially
Opponents Pollicis
68
This muscle assists with thumb addiction and plays a significant role in writing and typing.
First dorsal interossei
69
This muscle adducts the thumb, index, ring, and small fingers
Volar interossei
70
This muscle wrinkles the skin on the ulnar side of the palm
Palmaris Brevis
71
Metacarpophalangeal collateral ligaments 2-5 have a unique biomechanical action. Which answer effectively describe this action?
A. With the MCPJ extended the collateral ligaments are loose and with flexion they tighten.
B. With the MCPJ extended the collateral ligaments are tight and with flexion they loosen.
C. Constraint function is not affected by the position of the proximal phalanx and the ligaments are tight throughout MCP movement.
D. Constraint function is not affected by the position of the proximal phalanx and the ligaments are loos throughout the MCP movement
With the MCPJ extended the collateral ligaments are loose and with flexion they tighten.
72
True or False: Ulnar deviation deformity fo the MCPJ in the rheumatoid hand occurs due to the contracture of the ulnar intrinsic muscles.
False. The deformity is secondary, not the initial cause.
73
What two muscles create the medial and lateral borders of the cubical fossa.
A. Biceps medially ad brachioradialis laterally
B. Brachioradialis laterally and pronator teres medially
C. Pronator teres laterally and brachioradialis medially
D. Flexor carpi ulnaris medially and biceps ulnarly
B. Brachioradialis laterally and pronator teres medially.
74
The quadrangle space contains which nerve and artery combination?
A. Musculocutaneous nerve and posterior circumflex artery.
B. Musculocutaneous nerve and anterior circumflex artery.
C. Axillary nerve and posterior circumflex artery
D. Axillary nerve and anterior circumflex artery.
Axillary nerve and posterior circumflex artery
75
What artery passes through the anatomic snuffbox?
Radial artery
76
The superficial venous system of the upper limb at elbow combines to form an “M” pattern in the volar forearm. The veins in this pattern are:
A. Median cubical vein, basilic vein, and lateral cutaneous vein.
B. Basilic vein, cephalic vein, and median cubital vein.
C. Cephalic vein, lateral cutaneous vein, and basilic vein.
D. Axillary vein, basilic vein and the cephalic vein.
B. Basilic vein, cephalic vein, and median cubital vein.
77
A patient has sustained a Brachial plexus injury and presents with a los of elbow flexion as the major functional impairment. After further investigation, it is determined the patient has a non-operable C5, C6 avulsion. The patient presents with a loss of thumb function, elbow flexion, and an internally rotated shoulder. Hand function remains relatively well preserved. The surgeon has decided that restoration of elbow flexion is the first reconstructive goal. Which of the following muscles could be used in this situation to restore elbow flexion?
A. Teres Minor. B. Flexor-pronator muscle group
C. Pectoralis minor. D. Coracobrachialis
B. Flexor Pronator muscle group.
In selecting a muscle to use, the surgeon will always look first at innervated muscle tendon units that cross the joint where function is being restored. In this case, the only listed muscle tendon unit that crosses the elbow is the flexor-pronator group for elbow flexion.
78
A patient presents with recovering function of the intrinsic muscles of the hand after a low ulnar nerve repair. Which listed exercises is the most appropriate for this patient?
A. Pinching putty into a cone with the interphalangeal joints held in extension
B. Hyperextension of the MCPJs against rubber band traction
C. Joint blocking
D. Grip strengthening by using a hand help with mild resistance.
A. Pinching putty into a cone with IP joints held in extension
79
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A therapist is treating a patient after a hand replantation from transmetacarpal amputation. What dysfunction often develops that can be prevented?
A. Intrinsic-plus posture
B. Boutonnière deformity
C. Intrinsic-minus posture
D. Extensor retinaculum lengthening
```
C. Intrinsic-minus posture
80
Which of the following statements best describe the “space of Poitier”?
A. A gap between the scaphoid and lunate bones.
B. Weakness from an absence of ligamentous support of the lunate/capitate articulation.
C. An area of avascularity in the scaphoid
D. T-shaped ligaments over the hamate and triquetrum
B. Weakness from an absence of ligamentous support of the lunate/capitate articulation.
81
A new shoulder patient presents with a positive external rotation lag sign. This sign is positive due to:
A. Tears of the infraspinatus and the subscapularus
B. Tears of the superior labrum and the supraspinatus
C. Tears of the supraspinatus and the infraspinatus
D. Tears of the suscapularis and the supraspinatus
C. Tears of the supraspinatus and the infraspinatus
82
True of False: The adductor pollicis is the strongest of the intrinsic muscles.
True
