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NYCC Extremities Tech II > Wrist & Hand > Flashcards

Wrist & Hand Flashcards

1
Q

What are the major joints of the wrist?

A

Midcarpal joint
Radiocarpal joint
Distal radioulnar joint
Fibrocartilage Complex (FCC)

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2
Q

A 65 year old male complains of intermittent pins and needles in the 4th and 5th digits on the left of 4 days duration without a precipitating event. What are potential diagnoses? (Choose all that apply).

A. C6
B. C8
C Lesion of the lower brachial plexus
D. Peripheral neuropathy at cubital tunnel
E. Peripheral neuropathy at Canal of Guyon

A

B, C, D, E

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3
Q

What are the ROM patterns of the wrist joint in degrees?

A

Flexion = 80
Extension = 70
Abduction (radial deviation) = 20
Adduction (ulnar deviation) = 30

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4
Q

The pisiform is part of the midcarpal joint (TRUE/FALSE)?

A
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5
Q

What makes up the radiocarpal joint?

A

Scaphoid, lunate and triquetrum with radius

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6
Q

What does the radius articulate with in the radiocarpal joint?

A

Scaphoid and lunate

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7
Q

The pisiform sits on top of which carpal bone?

A

Triquetrum

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8
Q

What is contained in the fibrocartilage complex of the wrist?

A

Meniscus and articular disc
Ligamentous and cartilaginous tissue

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9
Q

What type of joint is the radiocarpal (wrist) joint?

A

Condylar

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10
Q

What is the function of the fibrocartilage complex of the wrist?

A

Cushion between ulna, lunate, and triquetrum
Stabilization of the distal radioulnar joint

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11
Q

What is the fibrocartilage complex of the wrist also called?

A

Ulno-menisco-triquetral joint

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12
Q

What joint does the fibrocartilage complex of the wrist stabilize?

A

Distal radioulnar joint

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13
Q

What joints of the wrist does flexion and extension occur at?

A

Midcarpal and radiocarpal joints

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14
Q

What joints of the wrist does radial and ulnar deviation occur at?

A

Midcarpal and radiocarpal joints

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15
Q

What motions of the wrist are not part of the wrist motion proper?

A

Supination and pronation

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16
Q

What motions are part of the wrist proper?

A

Flexion/Extension and radial/ulnar deviation

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17
Q

What joint of the wrist does supination and pronation occur at to assist the elbow?

A

Distal radioulnar joint

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18
Q

What is a Colle’s fracture?

A

Distal radius fracture with posterior angulation of the distal fragment

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19
Q

What is the most common MOI for a Colle’s fracture?

A

FOOSH

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20
Q

What is the most commonly fractured carpal bone?

A

Scaphoid

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21
Q

What is the most common MOI for a scaphoid fracture?

A

FOOSH

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22
Q

Where will pain present in a patient with a scaphoid fracture?

A

Anatomical snuffbox

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23
Q

What is the floor of the anatomical snuffbox?

A

Scaphoid

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24
Q

What artery runs in the anatomical snuffbox?

A

Radial

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25
Q

What tendons make up the borders of the anatomical snuffbox and can be inflamed in De Quervain’s tenosynovitis?

A

Extensor pollicis brevis and abductor pollicis longus

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26
Q

What is the most common site for an occult fracture?

A

Scaphoid

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27
Q

Dislocation of the carpal bones is relatively uncommon (TRUE/FALSE)?

A

t

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28
Q

What is the most commonly dislocated carpal bone?

A

Lunate

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29
Q

How does a lunate most commonly dislocate?

A

P ——> A

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30
Q

What is the second most commonly dislocated carpal bone?

A

Scaphoid

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31
Q

What is radial impaction?

A

Radius impacts onto the scaphoid causing pain

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32
Q

What is the MOI for a radial impaction?

A

Wrist hyperextension with axial loading (Yoga, Push-ups)

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33
Q

A patient with chronic pain in their radiocarpal joint will have pain where and in what pattern?

A

Band of pain near the flexor crease of the wrist

34
Q

What is De Quervain’s tenosynovitis?

A

Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons in the wrist and hand

35
Q

What are the most commonly involved tendons in tendonitis at the wrist?

A

Extensor pollicis brevis and abductor pollicis longus

36
Q

What causes De Quervain’s tenosynovitis?

A

Excessive ulnar deviation

37
Q

What orthopedic test positive can cause lateral wrist pain and indicate De Quervain’s Tenosynovitis?

A

Finkelstein’s test

38
Q

What is a positive result for Finkelstein’s test?

A

Pain on the radial side of the wrist (lateral wrist pain)

39
Q

What is a ganglion cyst?

A

Synovial cyst usually attached to a tendon sheath in the wrist, hand, or foot filled with mucopolysaccharide-rich fluid

40
Q

Guyon’s ulnar tunnel syndrome is affectionately called what?

A

Handlebar syndrome

41
Q

What is handlebar syndrome?

A

Entrapment neuropathy of the ulnar nerve in the tunnel of Guyon

42
Q

Where is the Canal of Guyon located in the wrist?

A

Between the pisiform and hook of the hamate

43
Q

What is contained within the Canal of Guyon?

A

Flexor carpi ulnaris
Ulnar artery
Ulnar nerve

44
Q

What is the most common etiology of Guyon’s tunnel syndrome or Handlebar syndrome?

A

Chronic external compression from occupation, sports, or mass lesion (ganglion cyst)

45
Q

What is the most common mass lesion causing handlebar syndrome?

A

Ganglion cyst

46
Q

What will be the pattern of pain or paresthesia in a patient with handlebar syndrome or Guyon tunnel syndrome?

A

Pain and paresthesia in the medial half of the fourth digit and all of the 5th digit and palm only on the VENTRAL SURFACE (PALM)

47
Q

A patient with Guyon tunnel or Handlebar syndrome will have pain and paresthesia on the ventral and dorsal aspects of the 4th and 5th digits (TRUE/FALSE)?

A
48
Q

What muscles in the hand are innervated by the ulnar nerve distal to the tunnel of guyon?

A

Interossei
Abductor digiti minimi
ADductor pollicis

49
Q

What orthopedic test at the wrist can be used to diagnose Guyon tunnel syndrome or Handlebar syndrome?

A

Tinel tap

50
Q

What testing can be performed if symptoms in the wrist are severe or if diagnosis is uncertain?

A

Electrodiagnostic testing

51
Q

What is the most common entrapment neuropathy?

A

Carpal tunnel syndrome

52
Q

What are the contents of the carpal tunnel?

A

Median nerve
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus

53
Q

How many finger flexor tendons are in the carpal tunnel? What are they?

A

9 total

4 = FDS
4 = FDP
1 = FPL

54
Q

What nerve runs in the carpal tunnel?

A

Median

55
Q

What nerve runs in the canal of guyon?

A

Ulnar

56
Q

What nerve runs in the cubital fossa?

A

Median

57
Q

What nerve runs in the cubital tunnel?

A

Ulnar

58
Q

What is the roof of the carpal tunnel?

A

Flexor retinaculum

59
Q

What makes up the medial border of the carpal tunnel?

A

Hamate and pisiform

60
Q

What makes up the lateral border of the carpal tunnel?

A

Scaphoid and trapezium

61
Q

What are the majority of cases of carpal tunnel syndrome due to?

A

Idiopathic probably due to non-specific tenosynovitis

62
Q

What are examples of anatomic risk factors for carpal tunnel syndrome?

A

Reduction in carpal tunnel area
SOL

63
Q

What are examples of metabolic or physiologic risk factors for carpal tunnel syndrome?

A

Fluid balance abnormalities (myxedema, pregnancy)
Inflammatory disorders (RA and tenosynovitis)
Diabetes

64
Q

What is double crush syndrome?

A

When a peripheral nerve is entrapped in more than one location

65
Q

What is the sensory distribution of the median nerve in the hand?

A

First three and a half digits and palm

66
Q

What is a positive finding for any CTS orthopedic test?

A

Numbness, paresthesia, or pain in the sensory distribution of the median nerve

67
Q

What is a flick sign and what does it indicate?

A

Patient shakes their hand briefly to relieve wrist or hand pain indicates carpal tunnel syndrome

68
Q

What nerve fibers accompany the median nerve through the carpal tunnel? What symptoms can occur because of this?

A

Sympathetic fibers to sweat glands and blood vessels

Can cause finger swelling, dry palms, and erythema

69
Q

Atrophy of thenar muscles upon physical exam likely indicates what?

A

Carpal tunnel syndrome

70
Q

The Thenar eminence is part of the median nerve distribution in the hand and wrist (TRUE/FALSE)?

A
71
Q

What are the LOAF muscles in the hand innervated by the median nerve?

A

Lateral lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicus brevis

72
Q

What muscle is the best or most useful to test for carpal tunnel syndrome (NOT THE FIRST TESTED FOR MEDIAN MRS)?

A

Abductor pollicis brevis

73
Q

What are the best two muscles to test for carpal tunnel syndrome?

A

Opponens pollicis
Abductor pollicis brevis

74
Q

What muscle is the most distal and tested first for a median nerve MRS? What muscles follow?

A

Flexor pollicis brevis = First

Flexor digitorum profundus for digits 2-3

Flexor carpi radialis

75
Q

According to the literature what two nerves innervate the flexor pollicus brevis muscle?

A

Median and ulnar

76
Q

All muscles in the hand, including the LOAF muscles, have significant innervation by the ____________ nerve root?

A

T1

77
Q

What orthopedic tests can be used to diagnose carpal tunnel syndrome?

A

Tinel Tap
Phalen’s test
Prayer sign (Reverse Phalen’s)
English/Spygh/Tourniquet Test

78
Q

What is a positive result for a Tinel tap test or Phalen’s test?

A

Numbness, paresthesia, or pain in the sensory distribution of the median nerve

79
Q

What is the MRS for the C5 nerve root?

A

Muscle = Deltoid
Reflex = Biceps
Sensory = Lateral Arm

80
Q

What is the MRS for the C6 nerve root?

A

Muscle = Wrist extensors
Reflex = Brachioradialis
Sensory = Lateral forearm and 1st/2nd digits/palm

81
Q

What is the MRS for the C7 nerve root?

A

Muscle = Wrist flexors
Reflex = Triceps
Sensory = Middle of palm and middle finger (3rd digit) and some of central forearm

82
Q

What muscles create the thenar eminence?

A

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

OAF

NYCC Extremities Tech II (7 decks)

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