Upper limb 3 - Wrist and Hand

Question 1

How many radioulnar joints do we have?

Answer 1

2

Question 2

What movements occur at the radioulnar joints?

Answer 2

pronation and supination

Question 3

What bones articulate at the radoiocarpal joint?

Answer 3

distal radius with scaphoid, lunate and triquetrum

Question 4

What type of synovial joint is the radiocarpal joint?

Answer 4

condyloid synovial joint

Question 5

what are the 2 planes of movement at the radiocarpal joint?

Answer 5

flexion-extension and adduction-abduction

Question 6

What are the points of attachment of the medial collateral ligament of the wrist?

Answer 6

Ulnar styloid process - triquetrum

Question 7

What are the points of attachment of the lateral collateral ligament of the wrist?

Answer 7

Radial styloid - scaphoid

Question 8

What could result in avascular necrosis in the hand?

Answer 8

A FOOSH that fractures the scaphoid

Question 9

Where would you feel tenderness as a result of a scaphoid fracture?

Answer 9

Tenderness in the anatomical snuffbox

Question 10

What is Bennett’s fracture?

Answer 10

A fracture of the base of the first metacarpal bone which extends into the carpometacarpal joint

Question 11

What is Colle’s fracture?

Answer 11

Dorsal displacement of distal radius

Question 12

What is Smith’s fracture?

Answer 12

Ventral displacement of distal radius

Question 13

What are the borders of the anatomical snuffbox?

Answer 13

Medial border - Abductor pollicis longus & Extensor pollicis brevis
Lateral border - Extensor pollicis longus

Question 14

What structures are found in the anatomical snuffbox?

Answer 14

Radial artery
Radial nerve
Cephalic vein

Question 15

What is the function of the palmar aponeurosis?

Answer 15

A tough fibrous layer limiting movement of the palmar skin (allows grip)

Question 16

What is Dupuytren’s contracture?

Answer 16

Progressive condition that causes shortening and thickening of the palmar fascia. Aponeurotic thickening causes passive flexion.

Question 17

What is the function of the intrinsic hand muscles?

Answer 17

Bring about precise control of digit movement

Question 18

What do both the thenar eminence and hypothenar eminence contain?

Answer 18

• A flexor muscle
• An abductor muscle
• An opposer muscle

Question 19

What is the golden rule of hand muscle innervation?

Answer 19

Everything is C8 & T1 supplied​
​
Everything is ulnar nerve supplied except:​
​ - Thenar muscles​
​ - Lumbricals (1& 2) which go to digits 2 & 3​

Question 20

What would muscle wasting of the thenar eminence suggest?

Answer 20

Median nerve damage

Question 21

What is the function of the lumbricals?

Answer 21

Flex the MCP joints and extend the PIP & DIP joints

Question 22

What do the palmar interossei muscles do?

Answer 22

Adduct the digits

Question 23

What do the dorsal interossei muscles do?

Answer 23

Abduct the digits

Question 24

What is Froment sign?

Answer 24

A loss of functioning of adductor pollicis ​

(e.g. in Ulnar nerve lesion) leads to excess thumb flexion whilst pinching (pinching normally requires thumb adduction)​

Question 25

What travels through the carpal tunnel?

Answer 25

• 4x Flexor digitorum superficialis
• 4x Flexor digitorum profundus
• Flexor pollicis longus
• Median nerve

Question 26

Where does the flexor retinaculum of the carpal tunnel attach to?

Answer 26

Pisiform, hook of hamate, scaphoid tubercle and trapezium tubercle

Question 27

What is the surface anatomy marking of the entrance to the carpal tunnel?

Answer 27

Carpal tunnel passes ~2cm distal to the distal wrist crease

Question 28

Where does the palmar (cutaneous) branch of the median nerve travel?

Answer 28

Runs superficial to the carpal tunnel

Question 29

Where is Guyon’s canal?

Answer 29

More superficial than carpal tunnel, runs just lateral to pisiform

Question 30

Give some examples of things that can cause carpal tunnel syndrome

Answer 30

Ganglion cyst, giant cell tumour, neuroma, lipoma, soft tissue thickening, fluid retention