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MSK > Week 9 > Flashcards

Week 9 Flashcards

1
Q

Why is the brachioradialis considered a paradoxical muscle?

A

Because it is on the posterior forearm but acts to flex the elbow. Main flexor in mid-prone (neutral) position, only assists flexion in supinated position

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2
Q

Where does the brachioradialis originate and insert?

A

Lateral supracondylar ridge of humerus into distal radius (think about the name it’s logical!)

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3
Q

All the muscles of this compartment with the prefix ‘-extensor’ originate from the common extensor origin at the lateral epicondyle. The extensor carpi radialis longus is the odd one out, where does this originate and insert?

A

Origin - lateral supracondylar ridge of humerus

Insertion - dorsal surface of the base of the second metacarpal

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4
Q

The extensor carpi radialis longus and brevis have the same actions, what are they?

A

To extend and abduct the wrist

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5
Q

Where does the extensor carpi radialis brevis insert?

A

The base of the third metacarpal bone

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6
Q

The extensor carpi radialis longus and brevis are innervated by different branches of the same nerve, explain

A

Longus because it originates before the cubital fossa is supplied by the radial nerve whereas the brevis is supplied by the deep branch of the radial nerve

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7
Q

Which nerve innervates the extensor digitorum, the extensor digiti minimi and the extensor carpi ulnaris?

A

The posterior interosseous branch of the radial nerve

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8
Q

What is the action of the extensor digitorum?

A

Extend the four fingers at the metacarpophalangeal and interphalangeal joints

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9
Q

The extensor digiti minimi and extensor digitorum insert onto the ‘extensor hood’ of their corresponding fingers. Whilst the extensor digitorum only acts to flex the four fingers, what actions does the minimi have?

A

Extends the little finger and assists flexion in the wrist

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10
Q

The extensor carpi ulnaris (like it’s brother) has two heads, the ulnar head originates from the olecranon. Where does it insert and what are it’s actions?

A

Base of fifth metacarpal

Adducts and extends the wrist

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11
Q

The anconeus originates on the lateral epicondyle at the common extensor origin and inserts onto the olecranon. What are it’s actions?

A

Weak extensor of the elbow, stabilises the elbow joint and prevents pinching of the joint capsule within the olecranon fossa during pronation by abducting the ulna

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12
Q

There are seven muscles of the posterior superficial compartment, ignoring the anconeus talk through them merially to laterally

A

Extensor carpi ulnaris, extensor digiti minimi, extensor digitorum, extensor carpi radialis brevis, extensor carpi radialis longus, brachioradialis

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13
Q

With the exception of the supinator, where do the muscles in the deep compartment of the forearm act?

A

On the thumb and index finger

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14
Q

The supinator is most active in the absence of resistance to supination, with resistance the biceps brachii mainly acts. In terms of nerve supply the supinator is the odd one out of the compartment, which nerve supplies it?

A

The deep branch of the radial nerve

Note the rest of the compartment is innervated by the posterior interosseous branch of the radial nerve

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15
Q

The deep muscles of the posterior forearm go in what order from lateral to medial epicondyle

A

Supinator, abductor pollicus longus, extensor pollicus longus, extensor pollicus brevis, extensor indicis

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16
Q

Where does the abductor pollicus longus insert?

A

The radial side of the base of the first metacarpal

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17
Q

what is the action of the extensor pollicis longus?

A

Extends all of the joints of the thumb (3)

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18
Q

What do the fibrous bands linking the tendons of the extendor digitorum do (caled juncturae tendinum)?

A

Prevent full extension of middle or ring fingers whilst other fingers are flexed

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19
Q

The radial nerve exits the axilla inferiorly, then enters the radial (spiral) grove of the humerus along with the profunda brachii artery and travels between the lateral and medial heads of the triceps brachii. Terminates in fossa to give off the superficial branch (sensory) and deep branch (muscular) What area of the arm does it supply sensation to?

A

Posterior arm, lower lateral arm, posterior forearm, you know the bits of the hand. NOTE - the deep branch of the radial nerve is called the posterior interosseous nerve after passing into the posterior forearm

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20
Q

What is the wrist joint comprised of?

A

The distal radius, triangular fibrocartilage complex, the scaphoid and the lunate (NOT THE ULNA)

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21
Q

What movements occur at the wrist joint?

A

Flexion/extension, abduction,adduction circumduction (mixture of all 4)

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22
Q

Give the major muscles causing wrist flexion, extension, abduction and adduction

A

Flexion - Flexor carpi radialis, flexor carpi ulnaris
Extension - Extensor carpi radialis longus, Extensor carpi radialis brevis, extensor carpi ulnaris
Abduction - extensor carpi radialis longus, extensor carpi radialis brevis, flexor carpi radialis
Adduction - flexor carpi ulnaris, extensor carpi ulnaris

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23
Q

Wrist according to hiltons law is innervated by what nerves?

A

radial, ulnar and median

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24
Q

Learn the bones of the hand, using mnemonic Some Lover Try Position That They Cannot Handle, and think trapezium Under the thumb

A

T

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25
Q

The hook of hamate forms the medial border of what?

A

The carpal tunnel through (and the lateral border of the ulnar canal)

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26
Q

Which hand bone has a high rate of malunion because of its retrograde blood supply by the radial artery?

A

Scaphoid

27
Q

What movements can occur at the thumb?

A

Flexion/extension, palmar abduction, radial adduction, opposition/retropulsion

28
Q

Intrinsic muscles of the hand originate and insert within the hand, extrinsic muscles insert in the hand but originate in the forearm. How can the actions of the interossei be remembered?

A

PAD and DAB (4 on the door)
Palmar adduct - there are three
Dorsal abduct - there are four

29
Q

The actions of the lumbricals can be remembered by making and L with your fingers, using this what are the actions of the lumbricals?

A

flexion at MCPJ joints and extension at the IPJ

30
Q

The muscles of the thenar and hypothenar eminences can be remembered by OAF

A

Thenar - opponens pollicis, abductor pollicis brevis, flexor pollicis brevis (and adductor pollicis)
Hypothenar - opponens digiti minimi, abductor digiti minimi, flexor digit minimi

31
Q

What nerve supplies the thenar muscles?

A

Median nerve exept the deep head of flexor pollicis brevis which is supplied by the ulnar nerve

32
Q

What nerve supplies the hypothenar muscles?

A

the ulnar nerve

33
Q

What is the function of the lumbricals?

A

To link the FDP tendon on the palmar surface to the extensor digitorum tendon on the dorsum. They flex the MCP joints and extend the OP joints (L shape)

34
Q

Describe the innervation of the lumbricals

A

index and middle fingers are median nerve and are unipennate
little finger and ring finger are ulnar nerve are ulnar nerve and bipennate
(named 1 to four starting with index finger)

35
Q

Describe the innervation of the interossei

A

All are ulnar nerve

36
Q

Which finger doesn’t have palmar interossei?

A

Middle finer

37
Q

At what point does the FDS divide into two slips only to recombine at the middle phalanxes?

A

proximal phalanxes

38
Q

Give the borders of the carpal tunnel

A

Floor - carpal bones
ceiling - flexor retinaculum
lateral - scaphoid and trapezium
medial - hook of hamate and pisiform

39
Q

Guyon’s canal (ulnar canal) is superficial to the flexor retinaculum, it can be palpated just lateral to the pisiform bone. What passes through here?

A

Ulnar nerve and artery

40
Q

Give the borders of the anatomical snuff box

A

Lateral border - tendons of the abductor pollicis longus (most lateral) abd extensor pollicis brevis
Medial border - tendon of extensor pollicis longus
Proximal border - styloid process of radius
Floor - scaphoid and trapezium
Roof - skin

41
Q

What are the contents of the anatomical snuff box?

A

Radial artery/superficial branch of the radial nerve/cephalic vein

42
Q

The arterial supply of the hand consists of the superficial and deep palmar arches, which artery contributes most to each although both are contributed to by ulnar and radial

A

Deep - radial

Superficial - ulnar

43
Q

The intrinsic muscles of the hand are all supplied by the ulnar nerve except which ones that can be remembered by LOAF

A

Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

44
Q

Testing the peripheral nerve territories is done by the following:
1)Dorsum of first interweb space
2)palmar surface of the tip of the index finger
3)ulnar border of the hand
Which nerve are we testing for in each?

A

1) radial
2) median
3) ulnar nerve (NOTE THIS IS HOW ITS SPELT)

45
Q

Scaphoid fractures normally occur from falling onto an outstretched hand, where would a patient typically complain of pain in such a fracture?

A

Pain in the anatomical snuff box which is exacerbated on wrist mocement

46
Q

The scaphoid bone has a retrograde blood supply meaning that fractures have a high risk of avascular necrosis and malunion. What can this lead to?

A

Osteoarthrtitis

47
Q

Explain what a Colles’ fracture is

A

an extra-articular fracture in the distal radius with dorsal angulation and impaction

48
Q

What is the mechanism of a Colles’ fracture?

A

Falling onto an outstretched hand which is pronated and in dorsiflexion

Common in osteoporotic patients such as post-menopausal women or young children

49
Q

What are some complications of Colles’ fractures?

A

Malunion resulting in pronated ‘dinner fork’ deformity
median nerve palsy
osteoarthritis
tear of the extensor pollicis longus tendon

50
Q

Smith fractures can be thought of as the opposite to Colles’ fracture. Describe the fracture

A

Fracture of the distal radius with palmar angulation

Malunion results in ‘garden spade’ deformity

51
Q

RA mainly affects the MCPJ and PIPJ of the hands and feet, and the cervical spine. Give some potential symptoms of RA of the hand

A

Pain and swelling at PIPJ’s and MCPJ’s/redness at the joints/stiffness in the morning or after periods of inactivity/carpall tunnel syndrome/fatigue and flu like symptoms/rheumatic nodules

52
Q

The two specific hand deformities we need to know about are the swan neck deformity and the boutinniere deformity, explain each

A

Swan neck - PIPJ hyperextends and the MCPJ and DIPJ are flexed
Boutinniere - MCPJ and DIPJ are hyperextended and PIPJ is flexed

53
Q

Psoriasis is a skin condition that causes red, flaky patches of skin covered with silvery scales. They commonly occur on the elbow, knees, scalp and lower back. A minority will develop arthritis, describe some presentations

A

Arthitis at the DIPJ
Nail lesions
swollen digits

54
Q

Osteoarthritis commonlt affects the DIPJ’s, swelling here and eventual osteophyte formation are called Heberden’s nodes, if it occurs at the PIPJ’s what are they called?

A

Bouchard’s nodes

55
Q

Give some common symptoms of carpal tunnel syndrome

A

Weakness and atrophy (wasting) of the thenar muscles, flexion and adduction will be spared but abduction will be weak. Manual dexterity diminished and parasthesia the median nerve sensory distribution of the hand

56
Q

A patient presents with parasthesia in the ring and little fingers, progressing to weakness of the intrinsic muscles of the hands. What is this called?

A

Guyon’s canal syndrome

57
Q

What is Dupuytren’s contracture?

A

A localised thickening and contracture of the palmar aponeurosis leading to a flexion deformity of the adjacent fingers

58
Q

Dupuytren’s contracture is mainly inherited but can occur sporadically give some conditions that increase the risk of getting this

A

Type 1 diabetes/epilepsy medication/smoking/heart disease/HIV/trauma to the hand or fingers

59
Q

Injury to the radial nerve in the radial froove of the humerus often occurs with a mid-shaft humeral fracrure. Describe the presentation

A

The wrist and fingers ill be flexed due to paralysis of the brachioradialis and extensor muscles.

Sensory loss will only be in the hand as the posterior cutaneous nerve of the forearm branches off from the radial nerve before the radial groove

Extension won’t be compromisd because the triceps are supplied by the radial nerve before entering the radial groove

60
Q

Injury to the median nerve can often happen in a supracondylar fracture of the humerus, describe the presentation

A

The forearm will be supinated and wrist flexion will be weak. Hand of Benediction is the classical sign which is where the patient tries to make a fist but only the little and ring fingers flex to make it because the are supplied by the ulnar nerve (supplying that half of the FDP)

Sensory innervation will be lost in the median nerve territoy of the hand

61
Q

Injury to the median nerve at the wrist gives what presentation?

A

Paralysis of LOAF giving the ‘Ape hand deformity’ - wasting of the thenar muscles

62
Q

Damage too the ulnar nerve at the writ results in ulnar claw. Describe this

A

thumb and lateral two fingers will be hyperextended and the little and ring fingers will be flexed due to unopposed flexion. Parasthesia across the sensory distribution of the ulnar nerve in the hand.

63
Q

Explain how a swan neck deformity comes about in RA

A

Tissues on the palmaer aspect of the PIPJ become lax due to synovitis -> imbalance in the muscles on the dorsal and palmar surfaces -> results in hyperextension

64
Q

Why can superficial lacerations at the wrist result in loss of sesnation in the plam of the hand and not in the digits?

A

Because it cuold severe just the palmar cutaneous branch of the median nerve and not the median nerve itself

MSK (11 decks)

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