Wrist Anatomy and Pathology

Question 1

What carpal bones makes up the radiocarpal joint?

Answer 1

Radius + Scaphoid and Lunate

Question 2

What carpal bones makes up the ulnocarpal joint?

Answer 2

Ulna + Lunate and Triquetrium

Question 3

What is the attachment site for Lister’s Tubercle?

Answer 3

Dorsal radial tubercle

Question 4

What “processes” are landmarks for compartment 1 and compartment 6 of the wrist?

Answer 4

1 - Radial styloid

6- Ulnar styloid

Question 5

What carpal bone is embedded in a tendon and is not involved in wrist movement?

Answer 5

Pisiform

Question 6

What tendons are in compartment 1?

Answer 6

APL & EPB

Question 7

What tendons are in compartment 2?

Answer 7

ECRL & ECRB

Question 8

What tendons are in compartment 3?

Answer 8

EPL

Question 9

What tendons are in compartment 4?

Answer 9

ED (digitorum) is more superficial & EI (indices) is more deep

Question 10

What tendons are in compartment 5?

Answer 10

EDM (digiti minimi)

Question 11

What tendons are in compartment 6?

Answer 11

ECU

Question 12

What two compartments are connected to the thumb?

Answer 12

1 and 3 - hint: they both have “pollicis” in their names

Question 13

What compartments lie on the radius and what ones lie on the ulna?

Answer 13

Radius - 1-4

Ulna - 5-6

Question 14

Tendons from which compartment (s) are affected in De Quervain’s tenosynovitis?

Answer 14

1 - thumb side

Question 15

What tendons form the lateral aspect of the “snuff box” ?

Answer 15

Compartment 1 - APL & EPB

Question 16

What tendon(s) form the medial aspect of the “snuff box” ?

Answer 16

Compartment 3 - EPL

Question 17

What tendon commonly ruptures in patients w/ rheumatoid arthritis due to it’s sharp radial deviation around Lister’s tubercle?

Answer 17

EPL

Question 18

The crossing of what tendons creates “intersection syndrome”? (hint: theres 2)

Answer 18

EPL (compartment 3) over the ECRL and ECRB
AND APL & EPB (compartment 1) over ECRL and ECRB

Question 19

What two compartments are most
commonly affected by tenosynovitis of the wrist?

Answer 19

5 and 6

Question 20

What nerve is affected in carpal tunnel?

Answer 20

Median nerve at the wrist - landmarks = pisiform and scaphoid bones

Question 21

What nerve is affected in Guyon tunnel/cyclists finger?

Answer 21

Ulnar nerve at the wrist - beside ulnar artery and pisiform bone

Question 22

The flexor retinaculum of the wrist forms the roof. What bones does it attach to on the radial aspect and what bones does it attach to on the ulnar side?

Answer 22

Radial side = scaphoid and trapezium

Ulnar side = pisiform and hamate

Question 23

Cyclists finger is also known as ?

Answer 23

Guyon tunnel - site for ulnar nerve compression in long distance cyclists

Question 24

What landmarks do we see on ultrasound in Guyon tunnel?

Answer 24

Ulnar artery, pisiform (proximally) and hamate (distally)

Question 25

How to decipher between joint effusion vs synovial hypertrophy/synovitis?

Answer 25

Joint effusions will be anechoic to hypoechoic, will be compressible, won't light up with colour, may contain swirling of echoes Synovial hypertrophy may be hypoechoic, will have colour flow internally, and will NOT compress with transducer pressure

Question 26

Synovitis of the dorsal wrist will have what kind of appearance on ultrasound?

Answer 26

Hypoechoic marbles that light up - slide 8

Question 27

On ultrasound, you see hypoechoic round "marble" looking pathology that has colour flow on the dorsal wrist, what is the most likely diagnosis?

Answer 27

Synovitis

Question 28

What pathology should you look for if you suspect bony erosions?

Answer 28

Synovitis

Question 29

What pathology of the wrist leads to pain, numbness and weakness in the associated area of the hand?

Answer 29

Nerve pinching/compression

Question 30

What pathology is the most common entrapment syndrome of the upper limb?

Answer 30

Carpal tunnel syndrome - compression of median nerve

Question 31

What is the most common CAUSE of carpal tunnel syndrome specifically? a) Ganglion cysts b) Solid masses c) Tenosynovitis of flexor tendons d) Tenosynovitis of extensor tendons

Answer 31

C - tenosynovitis of flexor tendons

Question 32

SF of carpal tunnel?

Answer 32

1. Thickened median nerve by 3x - hypoechoic 2. Loss of "honeycomb" nerve appearance

Question 33

Measuring carpal tunnel includes length from pisiform to scaphoid and then directly superior to the retinaculum. What is the abnormal measurement to the retinaculum?

Answer 33

>4mm

Question 34

What are the carpal tunnel measurements? Normal Boderline Abnormal

Answer 34

Normal <9mm Borderline 9-12mm Abnormal >12mm

Question 35

T or F? A bifid median nerve increases the likelihood of carpal tunnel syndrome?

Answer 35

TRUE

Question 36

Patient presents with parasthesia of the last 2 digits (ring finger and pinky). What is the most likely diagnosis?

Answer 36

Guyon tunnel - compression of the ULNAR nerve AKA "cyclists finger"

Question 37

What is the most common cause of Guyon Tunnel AKA cyclists finger?

Answer 37

Trauma - falling

Question 38

What pathology involves the immune system attacking the tendon sheaths in the wrist & causing inflammation of synovial lining of tendons?

Answer 38

Rheumatoid tenosynovitis

Question 39

What is the main SF of rheumatoid tenosynovitis?

Answer 39

"Pannus" = hypoechoic with fluid in sheath - has colour flow

Question 40

What tendon in what compartment is most commonly affected by rheumatoid tenosynovitis?

Answer 40

Extensor carpi ulnaris - compartment 6

Question 41

What pathology includes large amounts of fluid around the tendons causing symptoms similar to gout?

Answer 41

Tenosynovitis

Question 42

What is the most common tendinopathy of the wrist?

Answer 42

De Quervains Tenosynovitis - affects compartment 1 tendons of the wrist

Question 43

What is another name for De Quervains Tenosynovitis?

Answer 43

Stenosing tenosynovitis

Question 44

What is the most common tendon of the wrist to tear?

Answer 44

Flexor digitorum profundis

Question 45

What are the most commonly affected EXTENSOR tendons in terms of tears?

Answer 45

EPL - compartment 3 - bends around listers tubercle EDM - compartment 5 - bends around ulnar styloid

Question 46

What extensor tendon is the most prone to subluxation?

Answer 46

Extensor carpi ulnaris = compartment 6

Question 47

"Boxer knuckle" is AKA?

Answer 47

Extensor tendon subluxation

Question 48

What is Gamekeeper's or skier's thumb?

Answer 48

Injury to the ulnar collateral ligament (UCL)- on the medial aspect of the dorsal thumb

Question 49

Stener lesion is when the ligament is retracted proximally, this lesion is seen in what pathology?

Answer 49

Gamekeeper's or skier's thumb

Question 50

Skier's thumb is due to what action? a) Acute hyperabduction b) Chronic hyperabduction c) Acute hypoabduction d) Chronic hypoabduction

Answer 50

Acute HYPER-abduction

Question 51

Stenosis tenosynovitis of the A1 pulley is also known as?

Answer 51

Trigger Finger

Question 52

What is the most common expansible lesion of the wrist?

Answer 52

Ganglia

Question 53

Dorsal ganglia most commonly arises from what ligament?

Answer 53

Scapho-lunate

Question 54

T or F? Palmar ganglia is ALWAYS found on the ulnar aspect of the wrist?

Answer 54

FALSE - always found on the RADIAL side

Question 55

Palmar ganglia often arises from what joint?

Answer 55

Radioscaphoid

Question 56

What type of ganglion causes pain due to compression on the radial nerve?

Answer 56

Dorsal occult ganglion

Question 57

What is the 2nd most common mass of the wrist/ hand?

Answer 57

Giant cell tumor of tendon sheath (GCTTS)

Question 58

Where is extensor indices in relation to extensor digitorum in the dorsal wrist? A) Medial B) Lateral C) Superficial D) Deep

Answer 58

D) deep

Question 59

Where is the hook of hamate in relation to the ulnar nerve? A) Anterior B) Posterior C) Medial D) Lateral

Answer 59

Posterior

Question 60

What are the three wrist recesses?

Answer 60

1. Radio-carpal joint 2. Mid-carpal joint 3. Distal radio-ulnar joint