Week 5 SDL Workbook: the Hand

Question 1

What are Heberden’s and Bouchard’s nodes? Which joints are they associated with?

Answer 1

• Heberden node = a bony swelling of the distal interphalangeal finger joint
• Bouchard node = a bony swelling of the proximal interphalangeal joint
• Signs of osteoarthritis

Question 2

What is the name of the triangular shaped fascia beneath the palm and what is its function?

Answer 2

Palmar fascia - protects the flexor tendons, lumbricals and neurovascular structures

Question 3

How does the adductor pollicis differ from the 3 thenar eminence muscles?

Answer 3

• it is not located in the thenar eminence

- it is not innervated by the same nerve as the thenar eminence muscles

Question 4

What are the lumbrical muscles important for?

Answer 4

fine, prevision movements of our fingers

Question 5

Which acryonym reminds us of the action of the palmar and dorsal interossei?

Answer 5

“PAD-DAB”
Palmar = adduction of the fingers (bringing them in)
Dorsal = abduction of the fingers (seperating them)

Question 6

Which finger has no palmar interosseous muscle?

Answer 6

the middle (third) digit

Question 7

Which muscle adducts the little finger?

Answer 7

the third palmar interosseous - there is no adductor in the hypothenar eminence

Question 8

how can the middle finger move independantly to either side?

Answer 8

it has 2 dorsal interossei attached to it

Question 9

Why is the extensor expansion an important structure?

Answer 9

• helps anchor the long extensor tendons

- is the insertion point for the interossei and lumbrical muscles

Question 10

Which two veins form from the dorsal venous network?

Answer 10

cephalic and basilic veins

Question 11

Which vein runs through the anatomical snuffbox?

Answer 11

cephalic vein

Question 12

which arteries supply blood to the hand?

Answer 12

radial and ulnar

Question 13

what is the modified allen’s test?

Answer 13

a simple test that allows a clinician to assess the adequacy of the blood flow within the ulnar artery before the radial artery is accessed for procedures

Question 14

Why do we have anastomoses between the ulnar and radial arteries?

Answer 14

to ensure that if one of the arteries is compromised, the hand will still be perfusing providing the other artery is patient

Question 15

Explain which parts of the skin of the hand the median nerve innervates

Answer 15

• the middle and lateral palm
• the palmer surface of the lateral 3.5 digits
• the dorsum of the lateral 3.5 digits to DIPJ of the fingers and IPJ of the thumb

Question 16

Explain which parts of the skin of the hand the ulnar nerve innervates

Answer 16

• the ASB
• the dorsum of the lateral hand and lateral 3 digits as far as the DIPJs of the 2nd and 3rd digits and the IPJ of the thumb

Question 17

Explain which parts of the skin of the hand the radial nerve innervates

Answer 17

• the medial palm and dorsum of the hand
• the palmar surface medial 1.5 digits
• the dorsum medial 2 digits excluding lateral ½ of tip of the 4th digit, distal to DIPJ

Question 18

Even if you don’t see a scaphoid fracture on X-ray, why do you treat a patient as though they do?

Answer 18

risk of the proximal fragment of the scaphoid being under perfused which causes avascular necrosis - this can cause arthritis