Wrist (442-459) Flashcards
What arteries contribute to the deep and superficial palmar arches?;
Radial artery and ulnar artery
Where does the superficial palmar arch lie in the hand?;
Anterioly to the flexor tendons in the hand and deep to palmar aponeurosis. Gives rise to digital arteries which supply the four fngers
When placing an incision for carpal tunnel release, what structures are at risk and how would you avoid injuring them?;
Deep to flexor tendons of hand. Contributes to blood supply to digits and wrist joint.
Where do the lumbrical muscles originate and insert?; https://teachmeanatomy.info/encyclopaedia/l/lumbricals-hand/
Orgin- tendon of the flexor digitorum profundus. Inserts- radial aspect of the extensor hood of each digit.
Where does the tendon of flexor digitorum superficialis insert?;
Origin- medial epicondyle of humerus & the radius. Spilts into four tendon at wrist and travels through carpal tunnel. Inserts- base of the middle phalanx of the four digits (more proximal than FDP). Flexes proximal IP joint.
Where does the tendor of flexor digitorum profundus insert?;
Orgin- ulna. Spilts into four tendons at wrist and travels through carpal tunnel. Inserts- to base of the distal phalanx of each digit (more distal than FDS). Flexes distal IP joint.
What are the pulley system in the hand and where are the pulleys located?; https://teachmeanatomy.info/upper-limb/misc/flexor-system-hand/
A1, A2, A3, A4, A5. To allow gliding of tendons without bow string of tendons (holds the flexor tendons against the phalanges).
What pathology is commonly assocaited with the A1 pulley in the fingers?; https://teachmeanatomy.info/upper-limb/misc/flexor-system-hand/
Trigger finger - finger or thumb click or lock when in flexion, preventing return to extension
What are the risk factors for Dupuytren’s disease?;
(abnormal thickening of palmar fascia). Modifiable- alcohol, trauma. Non-modifiable- family history, age, ancestry (Scandinavian), seizure disorders
What are the management options for Dupuytren’s disease?;
Depends on severity. Conservative- splint & physio. Medical- steroid injection, collangense injection. Surgery- fasciotomy (divide thickened fascia), partial palmar fasiectomy (remove abnormal fascia), amputation
Name the boundaries of the anatomical snuff box; https://teachmeanatomy.info/upper-limb/areas/anatomical-snuffbox/
Ulnar (medial border)- extensor pollicis longus (EPL) tendon. Radial (lateral) border- extensor pollicis brevis (EPB) tendon and abductor pollicis longus (APL) tendon. Floor- scaphoid and trapezium. Roof- skin.
Name the contents of the anatomical snuff box;
Radial artery, cephalic vein, superficial branch of radial nerve.
What is the blood supply to the scaphoid?;
Deep radial artery
Which part of the scaphoid is most likely to fracture?;
Base of scaphoid (proximal)
Which part of the scaphoid undergoes avascular necrosis?;
Proximal part
How would you manage fractures of the scaphoid?;
6 weeks scaphoid cast if fracture confirmed on x-ray. If suspision of scaphoid fracture but not confirmed- put in splint and re-image in 2 weeks +/- MRI. If fracture confirmed pt needs scaphoid cast. If no tenderness and no fracture then can discharge.
State the nerve root(s) responsible fot the following actions- A) Elbow flexion. B) Wrist extension. C) Elbow extension. D) Middle finger flexion. E) Little finger abduction.
A) C5/6. B) C6. C) C7. D) C8. E) T1.
Name three radiological features you would expect in an X-ray of a patient presenting with features of osteoarthitits and rheumatoid arthritis; ADD XR PIC
Common features- joint space narrowing. Differences- OA bone cyst, OA oestophytes and subchondral sclerosis, OA Heberden (bony swelling at DIP) and Bouchard nodes (at PIP). RA sublaxation of joint, RA swan neck deformity + ulnar deviation, RA periarticular osteoporosis.
