Wrist and Hand Flashcards
1
Q
Name the soft tissue palpation for wrist and hand
A
Ulnar artery Radial artery Palmaris Longus Tendon Carpal Tunnel Region Thenar Eminence Hypothenar eminence Palmar Aponeurosis Tissues Surrounding proximal interphalangeal joints Tissues surrounding distal interphalangeal joints Distal tufts of fingers
2
Q
Wrist ROM
A
Flexion 80
Extension 70
Ulnar Deviation 30
Radial Deviation 20
3
Q
ROM Hand
A
Finger abd Finger add Thumb flexion Thumb Extension Finger Flexion Finger Extension Finger Opposition
4
Q
The thumb is involved with what percent of hand function?
A
40-50%
5
Q
What is the strongest finger?
A
The middle
6
Q
What type of joint is the Distal Radio-Ulnar joint?
A
A double pivot joint that unites the distal radius and ulan and articular disc TFCC
7
Q
T or F
The radial styloid process is approx one-half inch shorter than the ulnar styloid process
A
False
8
Q
This type of fracture results in posterior angulation of the distal radius fragment
A
Colle’s Fracture
9
Q
What is an aka for Colle’s Fracture
A
Dinner Fork Fracture
10
Q
This is an extension fracture of the radius…
A
Colle’s Fracture
11
Q
T or F
Smith’s Fracture is an extension fracture of the radius
A
False
Flexion fracture of the radius
12
Q
Smith’s Fracture aka
A
Garden Spade Deformity
13
Q
Is there posterior or anterior angulation with a Garden Spade Deformity
A
Anterior
14
Q
What does TFCC stand for?
A
Triangular Fibrocartilage Complex
15
Q
The TFCC lies in-between what structures of the wrist?
A
Between the medial proximal row and distal ulan within the medial aspect of the wrist.
16
Q
All of the following are primary functions of the TFCC except:
- Improve Joint Congruency
- Increase ROM
- Cushion against compressive forces
- Transmit axial load from the hand to the forearm
A
- Increase ROM was not mentioned as a primary function of this complex
17
Q
There are ___ Carpal bones and ____ metacarpals
A
8
5
18
Q
The proximal row of carpal bones from lateral to medial are…
A
Scaphoid (navicular)
Lunate
Triquetrum
Pisiform
19
Q
Name the distal row of carpal bones
A
Trapezium
Trapezoid
Capitate
Hamate
20
Q
What is the most common fractured bone of the wrist?
A
Navicular
21
Q
T or F
Navicular is the largest bone carpal bone
A
True
aka for Navicular = Scaphoid
22
Q
What feature of the wrist allows us to make a fist? Think structure and articulations
A
The triangular shaped gap between the distal radial head and Triquetrium
23
Q
T or F
Hamate is the largest in the distal row of carpals
A
False
Capitate
24
Q
Name the second most fractured and the most commonly sublimated carpal
A
Lunate
25
What tendon covers the lunate, capitate and base of the 3rd metacarpal?
Extensor Carpi radialis tendon which inserts into the base of the 3rd metacarpal.
26
In what direction does the arch of the hand fall?
Posterior -> Anterior
27
T or F
The proximal row of carpals is convex laterally and concave medially
True
28
What is meant by a compound articulation
Each row of carpal joints has both a concave and convex segment
29
Stability of the CMC joint is provided by what ligaments?
The palmar and dorsal Carpometacarpal and intermetacarpal ligaments
30
The metacarpals articulate with the respective proximal phalanges in what type of joint? Multi axial, uniaxial or biaxial?
Biaxial joints
31
The MCP joints allow for what type of movements?
Flexion-extension
| Medial-Lateral Deviation with a slight degree of axial rotation
32
What joints in the body are consider to be "Sellar"
1st Carpometacarpal Joint
| Calcaneal and Cuboid joint
33
Describe a Bennett's Fracture
Fracture through the base of the first metacarpal neck with dorsal and radial displacement of the shaft. Bone goes Posterior and Lateral
34
T or F
Bar room fracture consists of a posterior displacement of the head of the 4th or 5th metacarpal neck.
False
Anterior displacement
35
How does a Boxer's Fracture compare to a Bar Room
Boxer = 2nd or 3rd finger
| Bar Room = 4th or 5th
36
What are Heberden's Nodes?
Fount on one or more fingers
Distal joints are enlarged by hard nodules on either side of the dorsal midline
Condition in women usually hereditary
37
T or F
Heberden's Nodes are painful and motion is unlimited
False
Painless
38
How does Bouchard's Nodes differ from Heberden's?
Involves the PIP
39
Does RA usually present unilaterally or bilaterally?
Bilaterally
40
When a patient comes in suffering from Bouchard's nodes as a good DC what should we check?
For an increase in ADI
41
MOI for Swan Neck Deformity
RA
42
Describe how someone's finger would look with a Swan Neck deformity
PIP joint deforms into hyperextension and the DIP joint is flexed
43
What is a Boutonniere Deformity?
The central slip of the Extensor Digitorum Communis tendon is avulsed from the insertion in to the base of the middle phalanx, the PIP is flexed and the DIP is extended.
44
T or F
The extrinsic palmar ligaments provide the majority of rotational restraints, binding the proximal row into a unit of rotational stability
False
This is describing the intrinsic ligaments
Extrinsic = wrist stability
45
What are the medial and lateral collateral ligaments of the fingers named?
```
LCL = Cleland's
MCL = Grayson's
```
46
This dense connective tissue bracelet encases the forearm and maintains the relationship of the tendons that cross the wrist.
Antebrachial Fascia
47
What prevents the tendons of the wrist area from "bow-stringing" when the tendons turn a corner at the wrist?
Extensor Retinaculum
48
The extensor retinaculum compartments contains the tendons of what muscles from medial to lateral?
Abductor pollicis longus and extensor pollicis brevis
Extensor Carpi Radialis Longus and Brevis
Extensor pollicis longus
Extensor digitorum indicis
Extensor digiti minimi
Extensor carpi ulnaris
49
Proximally where does the retinaculum attach?
| Distally?
```
Prox = To the tubercle of the scaphoid and the pisiform
Dist = hook of the hamate and the tubercle of Trapezium
```
50
Avulsion of the Flexor Digitorum Profundus tendon is known as?
Jersey Finger
51
MOI for Jersey Finger
The finger gets caught in an object and actively flexed DIP joint is suddenly and forcibly extended resolution gin a rupture
52
What makes up the floor of the Carpal Tunnel
The palmar radiocarpal ligament + palmar ligament complex
53
T or F
The roof of the Carpal Tunnel is made of the Extensor Retinaculum (Transverse Carpal Ligament)
False
Flexor Retinaculum babyyyy
54
What is the name of the tunnel that serves as a passage way for the ulnar nerve and artery into the hand?
Tunnel of Guyon
55
Name the structures that form the Roof of the Tunnel of Guyon
The palmar (solar) carpal ligament, palmaris brevis muscle and the palmar aponeurosis
56
Tunnel of Guyon is located between what two carpal bones?
The hook of the hamate and the pisiform
57
T or F
Cyclist hand is irritation to the median nerve
false
Ulnar
58
Describe Dupuytren's Contracture
This is a fibrotic condition of the palmar aponeurosis that results in nodule formation or scarring of the aponeurosis, and which may ultimately cause finger flexion contractures
59
Are you able to palpate nodules with Dupuytren's Contracture?
There is evidence of a small painless nodule that can be palpated in the palmar aponeurosis near the base of the digit.
60
The extensor hood is formed from a combination of the tendons and insertion from what muscles?
Extensor Digitorum
Extensor Indicis
Extensor Digiti minimi
61
What is the name given when the terminal phalanx of the finger is permanently flexed at the distal joint and it cannot be voluntarily extended
Mallet Finger
62
T or F
| Mallet Finger is caused by a rupture of the flexor tendon that inserts on the terminal phalanx
False
| Extensor tendon
63
The hills/mounds/peaks on the palm of the hands are formed from what?
Neuromuscular bundles that supply the fingers and lumbricals.
64
The valleys on the palm are made from what?
The paths of the flexor tendons at the point where they cross the joints.
65
Surgical No Man's Land is located where on the hand?
The distal palmar crease approximately at the knuckles of the MCP's
66
When flexion of the finger feels normal; but re-extension is accompanied by a painful snap that the patient sometimes refers to the dorsum of the hand is known as?
Trigger Finger
67
Name the Anterior Compartment Superficial muslces
Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris
68
Name the Intermediate Muscle of the Anterior Compartment
Flexor Digitorum Superficialis
69
How many deep muscles or the Anterior Compartment are there? Name them
3
Flexor pollicis longus
Flexor digitorum profundus
Pronator Quadratus
70
Name the Superficial muscles of the posterior compartment
Ext Carpi Radialis Longus
Ext Carpi Radialis Brevis
Ext Digitorum & Ext digiti minimi
Ext Carpi Ulnaris
71
Deep muscles of the Posterior Compartment
Abd Pollicis Longus
Abd Pollicis Brevis
Ext Pollicis Longus
Extensor Indicis
72
What soft tissue structures lie on the floor of the Anatomical Snuff Box
The deep branch of the radial artery and the tendinous insertion of the ECRL
73
What tendons form the Anatomical Snuff Box
APL
| EPB and the ulnar border formed by the EPL
74
What bone forms the floor of the snuff box?
Scaphoid
75
Do males or females suffer from De Quervain's Disease?
8:1 Female
76
Ulnar Collateral Ligament Avulsion of the MCP joint is known as?
Skier's Thumb aka Gamekeeper's Thumb
77
Name the short muscles of the thumb (4)
Abd pollicis brevis
Flex pollicis brevis
Opponins pollicis
Add pollicis
78
Name the short muscles of the 5th digit
Abd digiti minimi
Flex digiti minimi
Opponens digiti minimi
79
Functions of the Lumbricales
Function to perform the motion of the IP joint extension with the MCP joint held in extension and can assist in MCP flexion.
80
Name the Functional Arches of the Hand
Transverse Arch
Metacarpal Arch
Longitudinal Arch
Oblique Arch
81
What arch of the hand is formed by the 3rd and 5th digit pans lengthwise
Longitudinal Arch
82
Avascular Necrosis of Lunate aka?
Keinboch's Disease
83
Is Keinboch's more common in men or women?
Males 20-40yrs
84
What structure limits supination?
the interosseous membrane, and the bony impaction between the ulnar notch of the radius and the ulnar styloid process.
85
T or F
During wrist flexion most of the motion occurs in the mid carpal joint
True
60% or 40 degrees versus 40% or 30 degrees at the radoiocarpal joint.
86
Where does the majority of wrist extension occur?
Radiocarpal joint 66.5%
87
T or F
Thumb flexion and extension occur in the sagittal plane that is perpendicular to the frontal plane of finger flexion and extension
False
| Occurs in the frontal plane
88
Name the power grips
Fist Grip
Cylindrical Grip
Ball Grip
Hook Grip
89
What joints are mainly involved with precision or prehension grips
MCP
90
What is Felon?
- Inflammation of the terminal finger pad is confined by tough fascia attached to the periosteum
- tenderness is intense
- swelling of the fingertips
91
Paronychia aka?
Hangnail
92
What is a functional range of motion for the hand?
Is the range in which the hand can perform most of its grip and other functional activities
