Wrist and Hand Viva

Question 0

Give the attachments of the ligaments at the wrist

Answer 0

Ulnar collateral carpal ligament: ulna styloid process to base of pisiform and medial surface of triquetral. Limits radial deviation.
Radial collateral carpal ligament: radial styloid process to scaphoid with a few fibres passing to the lateral aspect of trapezium. Limits ulnar deviation.

Question 1

Give the bones involved in the joints at the wrist and classify these joints

Answer 1

Radiocarpal joint: distal radius, proximal row of carpal bones (pisiform, triquetral, lunate, scaphoid).
Synovial ellipsoid joint.
Midcarpal joint: proximal row of carpal bones and distal row of carpal bones (hamate, capitate, trapezoid, trapezium).
Synovial complex saddle joint.

Question 2

Give the attachments and actions of Palmaris Longus

Answer 2

Proximal: common flexor tendon.
Distal: palmar aponeurosis and flexor retinaculum.
Actions: weak wrist flexor.

Question 3

Give the attachments and actions of Flexor Carpi Radialis

Answer 3

Proximal: common flexor tendon.
Distal: palmar surface of the base of the 2nd metacarpal, sends a slip to the base of the 3rd metacarpal.
Actions: wrist flexion. Works with ECRL & ECRB to radially deviate the wrist.

Question 4

Give the attachments and actions of Flexor Digitorum Superficialis

Answer 4

Proximal: anterior border of the radius and common flexor tendon.
Distal: sides of middle phalanx.
Actions: flexes the MCP and PIP joints. Flexes the wrist.

Question 5

Give the attachments and actions of Flexor Digitorum Profundus

Answer 5

Proximal: coronoid process of ulna and anterior and medial surfaces of the ulna.
Distal: splits into four tendons which insert onto the palmar surface of the base of the distal phalanx.
Actions: flexes DIP joints. Also flexes PIP, MCP and wrist joints.

Question 6

Give the attachments and actions of Flexor Carpi Ulnaris

Answer 6

Proximal: common flexor tendon, posterior border of ulna and olecranon process.
Distal: attaches to and invests pisiform. Tendon prolongs to reach the hook of hamate and base of the 5th metacarpal via the pisohamate and pisometacarpal ligaments.
Actions: flexes the wrist. Works with ECU to ulnar deviate the wrist.

Question 7

Give the attachments and actions of Extensor Digitorum

Answer 7

Proximal: common extensor tendon.
Distal: splits into 4 tendons which insert into the dorsal digital expansion, which attaches to the dorsal aspect of the base of the middle phalanx and base of the distal phalanx.
Actions: extends the MCP joints. Assists extension of IP and wrist joint. As it extends the fingers it also abducts the index, ring and little fingers.

Question 8

Give the attachments and actions of Flexor Pollicis Longus

Answer 8

Proximal: Anterior aspect of the radius.
Distal: palmar surface of the base of the distal phalanx of the thumb.
Actions: flexes the IP joint of the thumb. Flexes MCP, CMC and wrist joints.

Question 9

Give the attachments and actions of Extensor Indicis

Answer 9

Proximal: posterior surface of ulna.
Distal: dorsal digital expansion on proximal phalanx of index finger.
Actions: extension of IP and MCP joints of the index finger. Assists in wrist extension.

Question 10

Give the attachments and actions of Extensor Digiti Minimi

Answer 10

Proximal: common extensor tendon.
Distal: on the dorsum of the hand the tendon splits in two, inserting into the dorsal digital expansion of the little finger, medial to ED.
Actions: extension of MCP joint of little finger. Assists extension of IP joint of little finger, abduction of little finger and extension of the wrist.

Question 11

Give the attachments and actions of Extensor Pollicis Longus

Answer 11

Proximal: posterolateral aspect of ulna.
Distal: dorsal surface of the base of the distal phalanx of the thumb.
Actions: extends IP, MCP and CMC joints of the thumb. Assists wrist extension.

Question 12

Give the attachments and actions of Extensor Pollicis Brevis

Answer 12

Proximal: posterior surface of the radius.
Distal: dorsal surface of the base of the proximal phalanx of the thumb.
Actions: extends the MCP and CMC joints of the thumb. Abducts and extends the wrist.

Question 13

Give the attachments and actions of Abductor Pollicis Longus

Answer 13

Proximal: posterior aspect of radius and ulna.
Distal: radial side of base of 1st metacarpal, with a slip passing to trapezium.
Actions: puts the thumb into an abducted and mid-extended position. Assists extension and abduction of the thumb at the CMC joint. Assists radial deviation at the wrist.

Question 14

Give the attachments of the flexor retinaculum

Answer 14

Hook of hamate
Pisiform
Tubercle of scaphoid
Tubercle of trapezium

Question 15

Describe the anatomical snuffbox

Answer 15

Medial border: Extensor Pollicis Longus.
Lateral border: Extensor Pollicis Brevis and Abductor Pollicis Longus.
Floor: distal radius, scaphoid and trapezium
Roof: skin and fascia.
Contents: tendons of ECRL and ECRB, cephalic vein, radial artery.

Question 16

Describe the carpal tunnel

Answer 16

Floor: carpal sulcus (distal row of carpal bones).
Roof: flexor retinaculum.
Contents: four tendons of FDS, four tendons of FDP, tendon of FPL, median nerve, which can become compressed causing carpal tunnel syndrome.

Question 17

Bony points to palpate in hand

Answer 17

Proximal row of carpal bones (pisiform, triquetral, lunate and scaphoid).
Distal row of carpal bones (hamate, capitate, trapezoid, trapezium).
Metacarpals.
Phalanges.

Question 18

Describe Opponens Pollicis

Answer 18

Proximal: flexor retinaculum, tubercle of trapezium.
Distal: anterolateral aspect of metacarpal of the thumb.
Nerve supply: Median Nerve T1.
Actions: opposition of the thumb.
Deep to palpation.

Question 19

Describe Abductor Pollicis Brevis

Answer 19

Proximal: flexor retinaculum, tubercles of scaphoid and trapezium.
Distal: radial side of base of proximal phalanx of thumb.
Nerve supply: Median Nerve T1.
Actions: abduction and medial rotation of thumb at CMC and MCP joints.
Most lateral and superficial in thenar eminence.

Question 20

Describe Flexor Pollicis Brevis

Answer 20

Proximal: superficial part- flexor retinaculum and tubercle of trapezium. Deep part- capitate and trapezoid.
Distal: radial side of base of proximal phalanx of thumb, deep to APB.
Nerve supply: half by Median Nerve T1, half by Ulnar Nerve T1.
Actions: flexion and medial rotation of thumb at CMC and MCP joints.
Medial to APB.

Question 21

Name the muscles found in the thenar eminence

Answer 21

Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis
Adductor Pollicis

Question 22

Describe Adductor Pollicis

Answer 22

Found in the web space of the hand.
Nerve supply: Ulnar Nerve C8, T1.
Actions: adduction of the thumb.

Question 23

Give the nerve supply of the following:
Flexor Carpi Radialis
Palmaris Longus
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Flexor Carpi Ulnaris
Flexor Pollicis Longus

Answer 23

Flexor Carpi Radialis: Median Nerve C6, C7.
Palmaris Longus: Median Nerve C7, C8.
Flexor Digitorum Superficialis: Median Nerve C7, C8, T1.
Flexor Digitorum Profundus: index and middle fingers- Anterior Interosseous branch of Median Nerve C7, C8, T1. Ring and little fingers- Ulnar Nerve C8, T1.
Flexor Carpi Ulnaris: Ulnar Nerve C7, C8.
Flexor Pollicis Longus: Anterior Interosseous branch of Median Nerve C8, T1.

Question 24

Give the nerve supply of the following:
Extensor Digitorum
Extensor Indicis
Extensor Digiti Minimi
Extensor Pollicis Longus
Extensor Pollicis Brevis
Abductor Pollicis Longus

Answer 24

Posterior Interosseous branch of the Radial Nerve C7, C8 (all muscles)