Wrist (442-459)

Question 1

What arteries contribute to the deep and superficial palmar arches?;

Answer 1

Radial artery and ulnar artery

Question 2

Where does the superficial palmar arch lie in the hand?;

Answer 2

Anterioly to the flexor tendons in the hand and deep to palmar aponeurosis. Gives rise to digital arteries which supply the four fngers

Question 3

When placing an incision for carpal tunnel release, what structures are at risk and how would you avoid injuring them?;

Answer 3

Deep to flexor tendons of hand. Contributes to blood supply to digits and wrist joint.

Question 4

Where do the lumbrical muscles originate and insert?; https://teachmeanatomy.info/encyclopaedia/l/lumbricals-hand/

Answer 4

Orgin- tendon of the flexor digitorum profundus. Inserts- radial aspect of the extensor hood of each digit.

Question 5

Where does the tendon of flexor digitorum superficialis insert?;

Answer 5

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.

Question 6

Where does the tendor of flexor digitorum profundus insert?;

Answer 6

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.

Question 7

What are the pulley system in the hand and where are the pulleys located?; https://teachmeanatomy.info/upper-limb/misc/flexor-system-hand/

Answer 7

A1, A2, A3, A4, A5. To allow gliding of tendons without bow string of tendons (holds the flexor tendons against the phalanges).

Question 8

What pathology is commonly assocaited with the A1 pulley in the fingers?; https://teachmeanatomy.info/upper-limb/misc/flexor-system-hand/

Answer 8

Trigger finger - finger or thumb click or lock when in flexion, preventing return to extension

Question 9

What are the risk factors for Dupuytren’s disease?;

Answer 9

(abnormal thickening of palmar fascia). Modifiable- alcohol, trauma. Non-modifiable- family history, age, ancestry (Scandinavian), seizure disorders

Question 10

What are the management options for Dupuytren’s disease?;

Answer 10

Depends on severity. Conservative- splint & physio. Medical- steroid injection, collangense injection. Surgery- fasciotomy (divide thickened fascia), partial palmar fasiectomy (remove abnormal fascia), amputation

Question 11

Name the boundaries of the anatomical snuff box; https://teachmeanatomy.info/upper-limb/areas/anatomical-snuffbox/

Answer 11

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.

Question 12

Name the contents of the anatomical snuff box;

Answer 12

Radial artery, cephalic vein, superficial branch of radial nerve.

Question 13

What is the blood supply to the scaphoid?;

Answer 13

Deep radial artery

Question 14

Which part of the scaphoid is most likely to fracture?;

Answer 14

Base of scaphoid (proximal)

Question 15

Which part of the scaphoid undergoes avascular necrosis?;

Answer 15

Proximal part

Question 16

How would you manage fractures of the scaphoid?;

Answer 16

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.

Question 17

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.

Answer 17

A) C5/6. B) C6. C) C7. D) C8. E) T1.

Question 18

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

Answer 18

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.