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Ortho Dx > Wrist and Hand > Flashcards

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
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2
Q

Wrist ROM

A

Flexion 80
Extension 70
Ulnar Deviation 30
Radial Deviation 20

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3
Q

ROM Hand

A 
Finger abd
Finger add
Thumb flexion 
Thumb Extension 
Finger Flexion 
Finger Extension 
Finger Opposition
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4
Q

The thumb is involved with what percent of hand function?

A

40-50%

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5
Q

What is the strongest finger?

A

The middle

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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

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7
Q

T or F

The radial styloid process is approx one-half inch shorter than the ulnar styloid process

A

False

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8
Q

This type of fracture results in posterior angulation of the distal radius fragment

A

Colle’s Fracture

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9
Q

What is an aka for Colle’s Fracture

A

Dinner Fork Fracture

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10
Q

This is an extension fracture of the radius…

A

Colle’s Fracture

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11
Q

T or F

Smith’s Fracture is an extension fracture of the radius

A

False

Flexion fracture of the radius

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12
Q

Smith’s Fracture aka

A

Garden Spade Deformity

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13
Q

Is there posterior or anterior angulation with a Garden Spade Deformity

A

Anterior

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14
Q

What does TFCC stand for?

A

Triangular Fibrocartilage Complex

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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.

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16
Q

All of the following are primary functions of the TFCC except:

  1. Improve Joint Congruency
  2. Increase ROM
  3. Cushion against compressive forces
  4. Transmit axial load from the hand to the forearm
A
  1. Increase ROM was not mentioned as a primary function of this complex
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17
Q

There are ___ Carpal bones and ____ metacarpals

A

8

5

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18
Q

The proximal row of carpal bones from lateral to medial are…

A

Scaphoid (navicular)
Lunate
Triquetrum
Pisiform

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19
Q

Name the distal row of carpal bones

A

Trapezium
Trapezoid
Capitate
Hamate

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20
Q

What is the most common fractured bone of the wrist?

A

Navicular

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21
Q

T or F

Navicular is the largest bone carpal bone

A

True

aka for Navicular = Scaphoid

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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

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23
Q

T or F

Hamate is the largest in the distal row of carpals

A

False

Capitate

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24
Q

Name the second most fractured and the most commonly sublimated carpal

A

Lunate

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25
Q

What tendon covers the lunate, capitate and base of the 3rd metacarpal?

A

Extensor Carpi radialis tendon which inserts into the base of the 3rd metacarpal.

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26
Q

In what direction does the arch of the hand fall?

A

Posterior -> Anterior

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27
Q

T or F

The proximal row of carpals is convex laterally and concave medially

A

True

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28
Q

What is meant by a compound articulation

A

Each row of carpal joints has both a concave and convex segment

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29
Q

Stability of the CMC joint is provided by what ligaments?

A

The palmar and dorsal Carpometacarpal and intermetacarpal ligaments

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30
Q

The metacarpals articulate with the respective proximal phalanges in what type of joint? Multi axial, uniaxial or biaxial?

A

Biaxial joints

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31
Q

The MCP joints allow for what type of movements?

A

Flexion-extension

Medial-Lateral Deviation with a slight degree of axial rotation

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32
Q

What joints in the body are consider to be “Sellar”

A

1st Carpometacarpal Joint

Calcaneal and Cuboid joint

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33
Q

Describe a Bennett’s Fracture

A

Fracture through the base of the first metacarpal neck with dorsal and radial displacement of the shaft. Bone goes Posterior and Lateral

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34
Q

T or F

Bar room fracture consists of a posterior displacement of the head of the 4th or 5th metacarpal neck.

A

False

Anterior displacement

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35
Q

How does a Boxer’s Fracture compare to a Bar Room

A

Boxer = 2nd or 3rd finger

Bar Room = 4th or 5th

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36
Q

What are Heberden’s Nodes?

A

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

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37
Q

T or F

Heberden’s Nodes are painful and motion is unlimited

A

False

Painless

38
Q

How does Bouchard’s Nodes differ from Heberden’s?

A

Involves the PIP

39
Q

Does RA usually present unilaterally or bilaterally?

A

Bilaterally

40
Q

When a patient comes in suffering from Bouchard’s nodes as a good DC what should we check?

A

For an increase in ADI

41
Q

MOI for Swan Neck Deformity

42
Q

Describe how someone’s finger would look with a Swan Neck deformity

A

PIP joint deforms into hyperextension and the DIP joint is flexed

43
Q

What is a Boutonniere Deformity?

A

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
Q

T or F

The extrinsic palmar ligaments provide the majority of rotational restraints, binding the proximal row into a unit of rotational stability

A

False

This is describing the intrinsic ligaments
Extrinsic = wrist stability

45
Q

What are the medial and lateral collateral ligaments of the fingers named?

A 
LCL = Cleland's 
MCL = Grayson's
46
Q

This dense connective tissue bracelet encases the forearm and maintains the relationship of the tendons that cross the wrist.

A

Antebrachial Fascia

47
Q

What prevents the tendons of the wrist area from “bow-stringing” when the tendons turn a corner at the wrist?

A

Extensor Retinaculum

48
Q

The extensor retinaculum compartments contains the tendons of what muscles from medial to lateral?

A

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
Q

Proximally where does the retinaculum attach?

Distally?

A 
Prox = To the tubercle of the scaphoid and the pisiform
Dist = hook of the hamate and the tubercle of Trapezium
50
Q

Avulsion of the Flexor Digitorum Profundus tendon is known as?

A

Jersey Finger

51
Q

MOI for Jersey Finger

A

The finger gets caught in an object and actively flexed DIP joint is suddenly and forcibly extended resolution gin a rupture

52
Q

What makes up the floor of the Carpal Tunnel

A

The palmar radiocarpal ligament + palmar ligament complex

53
Q

T or F

The roof of the Carpal Tunnel is made of the Extensor Retinaculum (Transverse Carpal Ligament)

A

False

Flexor Retinaculum babyyyy

54
Q

What is the name of the tunnel that serves as a passage way for the ulnar nerve and artery into the hand?

A

Tunnel of Guyon

55
Q

Name the structures that form the Roof of the Tunnel of Guyon

A

The palmar (solar) carpal ligament, palmaris brevis muscle and the palmar aponeurosis

56
Q

Tunnel of Guyon is located between what two carpal bones?

A

The hook of the hamate and the pisiform

57
Q

T or F

Cyclist hand is irritation to the median nerve

A

false

Ulnar

58
Q

Describe Dupuytren’s Contracture

A

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
Q

Are you able to palpate nodules with Dupuytren’s Contracture?

A

There is evidence of a small painless nodule that can be palpated in the palmar aponeurosis near the base of the digit.

60
Q

The extensor hood is formed from a combination of the tendons and insertion from what muscles?

A

Extensor Digitorum
Extensor Indicis
Extensor Digiti minimi

61
Q

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

A

Mallet Finger

62
Q

T or F

Mallet Finger is caused by a rupture of the flexor tendon that inserts on the terminal phalanx

A

False

Extensor tendon

63
Q

The hills/mounds/peaks on the palm of the hands are formed from what?

A

Neuromuscular bundles that supply the fingers and lumbricals.

64
Q

The valleys on the palm are made from what?

A

The paths of the flexor tendons at the point where they cross the joints.

65
Q

Surgical No Man’s Land is located where on the hand?

A

The distal palmar crease approximately at the knuckles of the MCP’s

66
Q

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?

A

Trigger Finger

67
Q

Name the Anterior Compartment Superficial muslces

A

Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris

68
Q

Name the Intermediate Muscle of the Anterior Compartment

A

Flexor Digitorum Superficialis

69
Q

How many deep muscles or the Anterior Compartment are there? Name them

A

3
Flexor pollicis longus
Flexor digitorum profundus
Pronator Quadratus

70
Q

Name the Superficial muscles of the posterior compartment

A

Ext Carpi Radialis Longus
Ext Carpi Radialis Brevis
Ext Digitorum & Ext digiti minimi
Ext Carpi Ulnaris

71
Q

Deep muscles of the Posterior Compartment

A

Abd Pollicis Longus
Abd Pollicis Brevis
Ext Pollicis Longus
Extensor Indicis

72
Q

What soft tissue structures lie on the floor of the Anatomical Snuff Box

A

The deep branch of the radial artery and the tendinous insertion of the ECRL

73
Q

What tendons form the Anatomical Snuff Box

A

APL

EPB and the ulnar border formed by the EPL

74
Q

What bone forms the floor of the snuff box?

75
Q

Do males or females suffer from De Quervain’s Disease?

A

8:1 Female

76
Q

Ulnar Collateral Ligament Avulsion of the MCP joint is known as?

A

Skier’s Thumb aka Gamekeeper’s Thumb

77
Q

Name the short muscles of the thumb (4)

A

Abd pollicis brevis
Flex pollicis brevis
Opponins pollicis
Add pollicis

78
Q

Name the short muscles of the 5th digit

A

Abd digiti minimi
Flex digiti minimi
Opponens digiti minimi

79
Q

Functions of the Lumbricales

A

Function to perform the motion of the IP joint extension with the MCP joint held in extension and can assist in MCP flexion.

80
Q

Name the Functional Arches of the Hand

A

Transverse Arch
Metacarpal Arch
Longitudinal Arch
Oblique Arch

81
Q

What arch of the hand is formed by the 3rd and 5th digit pans lengthwise

A

Longitudinal Arch

82
Q

Avascular Necrosis of Lunate aka?

A

Keinboch’s Disease

83
Q

Is Keinboch’s more common in men or women?

A

Males 20-40yrs

84
Q

What structure limits supination?

A

the interosseous membrane, and the bony impaction between the ulnar notch of the radius and the ulnar styloid process.

85
Q

T or F

During wrist flexion most of the motion occurs in the mid carpal joint

A

True

60% or 40 degrees versus 40% or 30 degrees at the radoiocarpal joint.

86
Q

Where does the majority of wrist extension occur?

A

Radiocarpal joint 66.5%

87
Q

T or F

Thumb flexion and extension occur in the sagittal plane that is perpendicular to the frontal plane of finger flexion and extension

A

False

Occurs in the frontal plane

88
Q

Name the power grips

A

Fist Grip
Cylindrical Grip
Ball Grip
Hook Grip

89
Q

What joints are mainly involved with precision or prehension grips

90
Q

What is Felon?

A
  • Inflammation of the terminal finger pad is confined by tough fascia attached to the periosteum
  • tenderness is intense
  • swelling of the fingertips
91
Q

Paronychia aka?

92
Q

What is a functional range of motion for the hand?

A

Is the range in which the hand can perform most of its grip and other functional activities

Ortho Dx (17 decks)

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