Wrist and hand

Question 1

What forms the roof of the Carpal Tunnel?

Answer 1

Flexor Retinaculum - attaches to pisiform, hook of hamate, scaphoid tubercle and trapezium tubercle

Question 2

What bones make up the Carpal of the hand?

Answer 2

Scaphoid 
Lunate 
Triquetral 
Pisiform 
Trapezium 
Trapezoid 
Capitate
Hamate

“Some Lovers Try Positions That They Can’t Handle”

Question 3

What type of joint is the wrist?

Answer 3

Condyloid synovial joint

Question 4

What movements can the wrist do?

Answer 4

Flexion-extension

Abduction-adduction

Question 5

What are the attachments of the medial collateral ligaments of the wrist?

Answer 5

Ulnar styloid

Triquetrum

Question 6

What are the attachments of the lateral collateral ligaments of the wrist?

Answer 6

Radial styloid

Scaphoid

Question 7

What would tenderness in the anatomical snuffbox indicate?

Answer 7

Scaphoid fracture

Question 8

What is the possible consequence of a scaphoid fracture?

Answer 8

Avascular necrosis to proximal section of Scaphoid

Question 9

What is a Bennett’s Fracture and how is it caused?

Answer 9

Fracture of the proximal metacarpal 1

Caused by force exerted on a partially flexed metacarpal (i.e. punching something)

Question 10

What is a Colles’ Fracture and how is it caused?

Answer 10

Complete fracture of distal radius with dorsal displacement

Caused by fall onto outstretched hand (extended wrist)

Question 11

What is a Smith’s Fracture and how is it caused?

Answer 11

Complete fracture of distal radius with ventral displacement
Caused by fall onto flex wrist

Question 12

What are the borders of the anatomical snuffbox?

Answer 12

Medial = Extensor Pollicis Longus
Lateral = Extensor Pollicis Brevis + Abductor Pollicis
Proximal = Styloid process of Radius 
Floor = Carpal bones (Scaphoid + Trapezium)
Roof = Skin

Question 13

What is the contents of the anatomical snuffbox?

Answer 13

Cephalic Vein
Radial artery
Superficial (cutaneous) branch of radial nerve

Question 14

What is the palmar aponeurosis and it’s function?

Answer 14

Deep fascia over palm, limiting movement of the palmar skin

Question 15

What tendon is the palmar aponeurosis continuous with?

Answer 15

Palmaris Longus tendon

Question 16

What disorders can affect the resting position of the hand?

Answer 16

Dupuytren’s Contracture (aponeurotic thickening causes passive flexion of digits)
Stenosing Tenosynovitis
Ulnar Claw Hand

Question 17

What muscles are in the Thenar eminence?

Answer 17

Flexor Pollicis Brevis
Abductor Pollicis Brevis
Opponens Pollicis

Question 18

What muscles are in the Hypothenar eminence?

Answer 18

Flexor Digiti Minimi Brevis
Abductor Digiti Minimi
Opponens Digiti Minimi

Question 19

What nerve innervates the Thenar eminence muscles?

Answer 19

Recurrent branch of Median Nerve (C8, T1)

Question 20

What nerve innervates the Hypothenar eminence muscles?

Answer 20

Deep branch of Ulnar Nerve (C8, T1)

Question 21

What is the general function of intrinsic hand muscles?

Answer 21

Precise control of digit movement

Question 22

What is the function of the lumbrical muscles?

Answer 22

Extend digits at IP joints

Flexes digits at MCP joints

Question 23

What nerves innervate the lumbrical muscles?

Answer 23

Medial (ulnar) lumbricals (x2) - Ulnar nerve

Lateral (radial) lumbricals (x2) - Median nerve

Question 24

What symptoms could indicate lower motor neurone damage in the hand?

Answer 24

Weakness/ paralysis
Muscle wasting
Changes in resting position of digits

Question 25

What is the function of the interossei muscles?

Answer 25

Flexion of MCP joints Extension of IP joints Palmar interossei = Adduct Dorsal Interossei = Abduct

Question 26

What nerves innervate the interossei muscles?

Answer 26

Ulnar nerve

Question 27

What does Froment's Sign test for?

Answer 27

Ulnar nerve palsy by testing function of the Adductor Pollicis

Question 28

What would a positive Froment's Sign look like?

Answer 28

Patient would be unable to continue pinching paper between thumb and index finger as it is pulled away due to inability to adduct thumb. Patient would instead flex thumb at IP joint to try to maintain grip

Question 29

What nerve innervates the Adductor Pollicis?

Answer 29

Ulnar nerve

Question 30

What is the clinical relevance of synovial sheaths?

Answer 30

Can be involved in the spread of infection, ganglion formation or tenosynovitis

Question 31

Where is the ulnar bursa found?

Answer 31

Extends distally along the 5th digit (little finger) and through the carpal tunnel into the forearm

Question 32

What are the surface landmarks of the Carpal Tunnel?

Answer 32

``` Entrance = distal wrist crease Roof = medial landmarks are pisiform and hook of hamate; lateral landmarks are scaphoid and trapezium ```

Question 33

Which branch of the median nerve does NOT pass through the Carpal Tunnel?

Answer 33

Palmar branch of Median nerve (cutaneous nerve to palm of hand)

Question 34

Where does the ulnar nerve run through to reach the hand?

Answer 34

Guyon's Canal

Question 35

What are the symptoms associated with Carpal Tunnel Syndrome?

Answer 35

Loss of sensation/ tingling to digits 1-3 + half of digit 4 Thenar muscle wasting Pain particularly at night (that is alleviated by shaking wrist)

Question 36

What can cause compression of the median nerve in the Carpal Tunnel?

Answer 36

``` Ganglion Cyst Giant cell tumour Neuroma Lipoma Soft tissue thickening Fluid retention ```

Question 37

Where do you test for sensory nerve damage on the hands?

Answer 37

Palmar surface, distal portion of digit 2 Palmar surface, distal portion of digit 5 Dorsal surface, anatomical snuffbox

Question 38

How can Carpal Tunnel Syndrome be tested for?

Answer 38

Tinel's Test (tapping on median nerve to elicit pain or tingling) Phalen's Test (flexion of wrists to elicit pain or tingling)

Question 39

What is the blood supply to the hand?

Answer 39

Radial artery enters on lateral side Ulnar artery enters on medial side Superficial and deep palmar arches anastamose on palm of hand Digital arteries supply digits