The Wrist and Hand Lecture Powerpoint

Question 1

Recall the bones of the wrist

Answer 1

Distal ulna and radius and 8 carpal bones scaphoid (navicular) lunate triquetrum, pistiform, hamate capitate, trapezoid, tapezium (so long to pinky, here comes the thumb)

Question 2

3 muscles for wrist extension

Answer 2

Extensor carpi radialis longis, brevis, and ulnaris

Question 3

2 muscles for wrist flexion

Answer 3

Flexor carpi radialis, flexor carpi ulnaris

Question 4

Abduction and adduction of fingers is performed by…

Answer 4

….dorsal and palmar interossei muscles

Question 5

Atrophy of thenar muscles indicates ___ nerve compression, hypothenar muscle atrophy indicates ___

Answer 5

median, ulnar

Question 6

Smith’s fracture

Answer 6

Fracture of distal radius with ventral displacement of hand, reverse of colles fracture

Question 7

1st carpal metacarpal arthritis (CMC joint)

Answer 7

Also known as trapeziometacarpal arthritis, can be treated with NSAIDS or surgical removal

Question 8

Where does dequervain’s tenosynovitis occur?

Answer 8

Over the extensor and abductor tendons of the thumb as they cross the radial styloid

Question 9

What 2 tendons form the anatomical snuff box?

Answer 9

Exensor pollocis longus and extensor pollocis brevis/abductor pollocis longus

Question 10

Sensation of hand nerve supply

Answer 10

Median does thenar surface, palmar side and part of dorsal side digits 1-3 and part of 4, ulnar does remaining palmar side and part of dorsum of hand as well as part of digit 4 and 5, radial nerve just does part of dorsum of hand and dorsum of thumb on half the hand

Question 11

Finkelstein’s test

Answer 11

Grip thumb in wrist and then undergo ulnar deviation to test for dequarvian tenosynovitis

Question 12

Thumb abduction test

Answer 12

Test if thumb is weak to resisted abduction indicative of isolated median nerve damage (carpal tunnel)

Question 13

Scaphoid (navicular) fracture needs a ___ for fear of avascular necrosis or nonunion

Answer 13

referral to orthopedics

Question 14

Kienbocks disease

Answer 14

Avascular necrosis of lunate bone of unknown etiology (perhaps disease state, perhaps fracture, etc), bone fragments can cause excruciating pain, after bone degenerates other carpal bones migrate within hand causing crippling, surgical options can result in loss of function via bone removal or fusing but helps alleviate pain

Question 15

Trigger finger and management

Answer 15

Painless nodule in flexor tendon in palm near metacarpal head, too big to enter tendon sheath during extension of fingers from flexed position, has auditory pop when extended with effort, can be treated with steroid injections or surgery

Question 16

Gamekeepers/skier’s thumb

Answer 16

Injury to ulnar collateral ligament of the thumb resulting from hyperabduction of MCP joint, either torn or avulsed at insertion to the proximal phalynx of the thumb, can be due to fall or skiing injury