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Block 4 > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

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1
Q

Label the features of the radius and ulna on the diagram

A
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2
Q

What attaches to the radial tuberosity?

A

Biceps brachii tendon

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3
Q

Name the bones of the hand

A
  • Scaphoid (S)
  • Lunate (L)
  • Triquetrum (T)
  • Pisiform (P)
  • Hamate (H)
  • Capitate (C)
  • Trapezoid (Td)
  • Trapezium (Tm)
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4
Q

What type of bone is the pisiform?

Where is it?

A

Sesamoid

Situated on the tendon of flexor carpi ulnaris

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5
Q

What is number 3 in the image?

What is marked by the red cross?

What sits medial to it?

A

3= Dorsal radial tubercle

3rd extensor wrist compartment sits medial to it.

Red cross= injection/aspiration point for the wrist

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6
Q

What bones form the wrist joint?

What type of joint is it?

What movements does it permit?

What separates the distal ulna from the joint?

A
  • Distal radius
  • Scaphoid
  • Lunate
  • Triquetrum

Synovial condyloid joint

Capable of flexion, extension, abduction and adduction (+circumduction)

Distal ulna separated by cartilagenous disc (articular disc)

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7
Q

Which ligaments support the wrist joint?

What are their roles?

A

Lateral collateral ligament

  • Radial styloid → scaphoid

Medial collateral ligament

  • Ulnar styloid → triquetrum
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8
Q

Which bone of the hand is often fractured by a fall onto outstretched hand?

What are the possible complications of this fracture?

What symptoms would the patient have?

A

Scaphoid fracture

Can cause avascular necrosis as the bone is supplied by distal → proximal unidirectional blood supply. Fracture can tear the arteries causing avascular necrosis of the proximal part of the scaphoid.

Patient would have tenderness in the anatomical snuffbox

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9
Q

What is a Bennett’s fracture?

A

Fracture of proximal metacarpal 1

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10
Q

What is a Smith’s fracture?

A

Ventral displacement of the radius following distal radius fracture

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11
Q

What is a Colle’s fracture?

A

Dorsal displacement of the radius following distal radius fracture

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12
Q

What marks the borders of the anatomical snuffbox?

What runs through it?

What can be palpated through it

A

Borders:

  • Extensor pollicis longus
  • Extensor pollicis brevis and abductor pollicis longus

Palpation:

  • Radial pulse
  • Scaphoid bone

Contents:

  • Radial artery
  • Superficial branch of radial nerve
  • Cephalic vein
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13
Q

What is the palmar aponeurosis?

A

Tough fibrous layer limiting the movement of palmar skin

Attaches to palmaris longus if it is present (absent in approx 20% of the population)

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14
Q

Name some disorders that can change the resting position of the hand

A

Dupuytrens contracture

  • Aponeurotic thickening causing passive flexion of medial digits

Ulnar claw hand

  • Lesion to the ulnar nerve

Stenosing tenosynovitis

  • Inflammation of tendons and synovial sheath causing a narrowing of pulley systems so swollen tendons get stuck.
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15
Q

Name the intrinsic muscles of the hand

What movements are they responsible for?

What is their innervation?

A

Thenar eminence (all median nerve):

  • Opponens pollicis: thumb opposition by medial rotation and flexion of metacarpal on trapezium.
  • Abductor pollicis brevis: thumb abduction
  • Flexor pollicis brevis: thumb flexion at MCP joint

Hypothenar eminence (all ulnar nerve):

  • Opponens digiti minimi: opposition of digit 5 by lateral rotation of metacarpal
  • Abductor digiti minimi: abduction of 5th digit
  • Flexor digiti minimi brevis: flexion of 5th digit at MCP joint
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16
Q

What is the golden rule for nerve supply to the hand?

A

Everything is C8-T1 supplied

Everything is ulnar nerve supplied except:

  • Thenar muscles (median nerve)
  • Lateral 2 lumbricals (to digits 2 & 3) (median nerve)
17
Q

What is the role of the lumbricals?

What is their nerve supply?

A
  • Flexion at MCP joints
  • Extension at DIP joints (as they insert onto the extensor expansion)

Medial 2 lumbricals (ulnar): ulnar nerve

Lateral 2 lumbricals (radial): median nerve

18
Q

What is the role of the palmar interossei?

What is their innervation?

Where is the axis of abduction and adduction on the hands?

A

Palmar interossei: adduction of digits (PAD)

Dorsal interossei: abduction of digits (DAB)

All supplied by ulnar nerve

Axis= middle digit

19
Q

What muscle is responsible for adduction of the thumb?

What could damage/deinnervation of this muscle cause?

A

Adductor pollicis

Damage (e.g. in ulnar lesion) = positive Froment’ sign:

  • Excess thumb flexion whilst pinching (thumb usually adducted)
20
Q

Label the synovial sheaths on the diagram

What is the significance of the common synovial sheath?

A

Common synovial sheath extends up the 5th digit: infection from 5th digit wounds can spread to the palm, carpal tunnel and proximal forearm.

21
Q

Label the palmar spaces on the diagram

Where do they sit?

A

Sit between the deep flexor tendons and the metacarpals/interossei in the palm

22
Q

What is the carpal tunnel?

Where is it?

What is it made up of?

A

Located on the anterior (volar) side of the hand, 2cm distal to the distal wrist crease.

Acts as a passageway for tendons of the digit flexor muscles passing into the hand from the forearm.

Formed from the carpal bones of the hand and the flexor retinaculum. 4 points marked by:

  • Hook of hamate
  • Pisiform
  • Scaphoid tubercle
  • Trapezium tubercle
23
Q

What does the carpal tunnel contain?

Which nerve travels superficial to it?

A

Ulnar nerve travels superficial to it in Guyon’s canal

Carpal tunnel contains:

  • Median nerve
  • x4 tendons of flexor digitorum superficialis
  • x4 tendons of flexor digitorum profundus
  • Flexor pollicis longus
24
Q

What is carpal tunnel syndrome?

What are the symptoms?

What can cause it?

A

Involves compression of the median nerve in the carpal tunnel

Symptoms:

  • Weakness of flexion of digits 1-3 at PIP and DIP joints
  • Prolonged CT syndrome can cause wasting of thenar eminence
  • Paraesthesias in median nerve distribution:
    • Often in digital distribution
    • Palm often unaffected as it is also supplied by a branch of the median nerve that runs superiorly to the carpal tunnel therefore is not compressed.

Causes:

  • Ganglion cyst
  • Giant cell tumour
  • Neuroma
  • Lipoma
  • Soft tissue thickening
  • Fluid retention
25
Q

Which digits to the ulnar and median nerves give cutaneous supply to?

A

Ulnar:

  • Digit 5
  • Medial half of digit 4

Median:

  • Lateral half of digit 4
  • Digits 1-3
26
Q

Describe the cutaneous innervation to the hand

A

Median nerve:

  • Palmar surface of lateral 31/2 digits and related palmar skin
  • Nail beds and proximal skin of digits 2, 3 and lateral half of 4

Ulnar nerve:

  • Palmar and dorsal surface of medial 1 1/2 digits
  • Dorsal surface of hand below digits 5, 4 and medial half of 3

Radial nerve:

  • Dorsal surface of digit 1
  • Skin covering first web space
  • Dorsal surface of palm related to the index finger and lateral half of middle finger.
27
Q

Where can the ulnar nerve be compressed?

What are the symptoms of this?

A

Can be compressed in Guyon’s canal lateral to the pisiform bone.

Symptoms:

  • Paraesthesia/change in sensation in medial palm, medial dorsal side of hand, digit 5 and medial half of digit 4
  • Difficulty in flexion of digit 5 and 4 at DIP joints
28
Q

How can digital cutaneous nerves be blocked anaesthetically?

A

Via the dorsal web space either side of the digit

29
Q

Where should the sensory innervation of the hand be tested?

A

Ulnar nerve:

Radial nerve:

Median nerve:

30
Q

What is Tinel’s test?

A

Tests for carpal tunnel syndrom:

  • Median nerve percussed close to carpal tunnel
  • In patients with carpal tunnel may elicit pain/tingling in sensory distribution of median nerve
31
Q

What is the Phalen test?

A

Reverse prayer test placed pressure on carpal tunnel and can elicit symptoms in patients with CT syndrome.

32
Q

Describe the blood supply to the hand

Label the arteries on the diagram

A

Ulnar artery enters the hand close to Guyon’s canal and lateral to pisiform bone and flexor carpi ulnaris tendon. Form the superficial palmar arch.

Radial artery enters posteriorly through the floor of the anatomical snuffbox, behind the thumb and enters deeply into the hand to form the deep palmar arch.

Deep and superficial palmar arches join together forming anastamotic supply.

33
Q

How is the anastamotic supply of the hand tested?

When must this test be done?

A

Allen’s test: occlude both radial and ulnar arteries until hand is pale.

Release ulnar artery to see if it re-perfuses the whole hand.

Test must be done prior to arterial blood gas or radial artery harvesting.

34
Q

Where are the radial and ulnar arteries located in the wrist?

A

Radial: lateral to flexor carpi radialis tendon

Ulna: lateral to flexor carpi ulnaris tendon

Block 4 (20 decks)

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