Wrist & Hand Flashcards
What are the major joints of the wrist?
Midcarpal joint
Radiocarpal joint
Distal radioulnar joint
Fibrocartilage Complex (FCC)
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
B, C, D, E
What are the ROM patterns of the wrist joint in degrees?
Flexion = 80
Extension = 70
Abduction (radial deviation) = 20
Adduction (ulnar deviation) = 30
The pisiform is part of the midcarpal joint (TRUE/FALSE)?
False
What makes up the radiocarpal joint?
Scaphoid, lunate and triquetrum with radius
What does the radius articulate with in the radiocarpal joint?
Scaphoid and lunate
The pisiform sits on top of which carpal bone?
Triquetrum
What is contained in the fibrocartilage complex of the wrist?
Meniscus and articular disc
Ligamentous and cartilaginous tissue
What type of joint is the radiocarpal (wrist) joint?
Condylar
What is the function of the fibrocartilage complex of the wrist?
Cushion between ulna, lunate, and triquetrum
Stabilization of the distal radioulnar joint
What is the fibrocartilage complex of the wrist also called?
Ulno-menisco-triquetral joint
What joint does the fibrocartilage complex of the wrist stabilize?
Distal radioulnar joint
What joints of the wrist does flexion and extension occur at?
Midcarpal and radiocarpal joints
What joints of the wrist does radial and ulnar deviation occur at?
Midcarpal and radiocarpal joints
What motions of the wrist are not part of the wrist motion proper?
Supination and pronation
What motions are part of the wrist proper?
Flexion/Extension and radial/ulnar deviation
What joint of the wrist does supination and pronation occur at to assist the elbow?
Distal radioulnar joint
What is a Colle’s fracture?
Distal radius fracture with posterior angulation of the distal fragment
What is the most common MOI for a Colle’s fracture?
FOOSH
What is the most commonly fractured carpal bone?
Scaphoid
What is the most common MOI for a scaphoid fracture?
FOOSH
Where will pain present in a patient with a scaphoid fracture?
Anatomical snuffbox
What tendons make up the borders of the anatomical snuffbox and can be inflamed in De Quervain’s tenosynovitis?
Extensor pollicis brevis and abductor pollicis longus
What is the most common site for an occult fracture?
Scaphoid
Dislocation of the carpal bones is relatively uncommon (TRUE/FALSE)?
t
What is the most commonly dislocated carpal bone?
Lunate
How does a lunate most commonly dislocate?
P ——> A
What is the second most commonly dislocated carpal bone?
Scaphoid
What is radial impaction?
Radius impacts onto the scaphoid causing pain
What is the MOI for a radial impaction?
Wrist hyperextension with axial loading (Yoga, Push-ups)
A patient with chronic pain in their radiocarpal joint will have pain where and in what pattern?
Band of pain near the flexor crease of the wrist
What is De Quervain’s tenosynovitis?
Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons in the wrist and hand
What are the most commonly involved tendons in tendonitis at the wrist?
Extensor pollicis brevis and abductor pollicis longus
What causes De Quervain’s tenosynovitis?
Excessive ulnar deviation
What orthopedic test positive can cause lateral wrist pain and indicate De Quervain’s Tenosynovitis?
Finkelstein’s test
What is a positive result for Finkelstein’s test?
Pain on the radial side of the wrist (lateral wrist pain)
What is a ganglion cyst?
Synovial cyst usually attached to a tendon sheath in the wrist, hand, or foot filled with mucopolysaccharide-rich fluid
Guyon’s ulnar tunnel syndrome is affectionately called what?
Handlebar syndrome
What is handlebar syndrome?
Entrapment neuropathy of the ulnar nerve in the tunnel of Guyon
Where is the Canal of Guyon located in the wrist?
Between the pisiform and hook of the hamate
What is contained within the Canal of Guyon?
Flexor carpi ulnaris
Ulnar artery
Ulnar nerve
What is the most common etiology of Guyon’s tunnel syndrome or Handlebar syndrome?
Chronic external compression from occupation, sports, or mass lesion (ganglion cyst)
What is the most common mass lesion causing handlebar syndrome?
Ganglion cyst
What will be the pattern of pain or paresthesia in a patient with handlebar syndrome or Guyon tunnel syndrome?
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)
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)?
False (ventral only)
What muscles in the hand are innervated by the ulnar nerve distal to the tunnel of guyon?
Interossei
Abductor digiti minimi
ADductor pollicis
What orthopedic test at the wrist can be used to diagnose Guyon tunnel syndrome or Handlebar syndrome?
Tinel tap
What testing can be performed if symptoms in the wrist are severe or if diagnosis is uncertain?
Electrodiagnostic testing
What is the most common entrapment neuropathy?
Carpal tunnel syndrome
What are the contents of the carpal tunnel?
Median nerve
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
How many finger flexor tendons are in the carpal tunnel? What are they?
9 total
4 = FDS
4 = FDP
1 = FPL
What nerve runs in the carpal tunnel?
Median
What nerve runs in the canal of guyon?
Ulnar
What nerve runs in the cubital fossa?
Median
What nerve runs in the cubital tunnel?
Ulnar
What is the roof of the carpal tunnel?
Flexor retinaculum
What makes up the medial border of the carpal tunnel?
Hamate and pisiform
What makes up the lateral border of the carpal tunnel?
Scaphoid and trapezium
What are the majority of cases of carpal tunnel syndrome due to?
Idiopathic probably due to non-specific tenosynovitis
What are examples of anatomic risk factors for carpal tunnel syndrome?
Reduction in carpal tunnel area
SOL
What are examples of metabolic or physiologic risk factors for carpal tunnel syndrome?
Fluid balance abnormalities (myxedema, pregnancy)
Inflammatory disorders (RA and tenosynovitis)
Diabetes
What is double crush syndrome?
When a peripheral nerve is entrapped in more than one location
What is the sensory distribution of the median nerve in the hand?
First three and a half digits and palm
What is a positive finding for any CTS orthopedic test?
Numbness, paresthesia, or pain in the sensory distribution of the median nerve
What is a flick sign and what does it indicate?
Patient shakes their hand briefly to relieve wrist or hand pain indicates carpal tunnel syndrome
Atrophy of thenar muscles upon physical exam likely indicates what?
Carpal tunnel syndrome
The Thenar eminence is part of the median nerve sensory distribution in the hand and wrist (TRUE/FALSE)?
False (area of sensory sparing)
What are the LOAF muscles in the hand innervated by the median nerve?
Lateral lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicus brevis
What muscle is the best or most useful to test for carpal tunnel syndrome (NOT THE FIRST TESTED FOR MEDIAN MRS)?
Abductor pollicis brevis
What are the best two muscles to test for carpal tunnel syndrome?
Opponens pollicis
Abductor pollicis brevis
What muscle is the most distal and tested first for a median nerve MRS? What muscles follow?
Flexor pollicis brevis = First
Flexor digitorum profundus for digits 2-3
Flexor carpi radialis
According to the literature what two nerves innervate the flexor pollicus brevis muscle?
Median and ulnar
All muscles in the hand, including the LOAF muscles, have significant innervation by the ____________ nerve root?
T1
What orthopedic tests can be used to diagnose carpal tunnel syndrome?
Tinel Tap
Phalen’s test
Prayer sign (Reverse Phalen’s)
English/Spygh/Tourniquet Test
What is a positive result for a Tinel tap test or Phalen’s test?
Numbness, paresthesia, or pain in the sensory distribution of the median nerve
What is the MRS for the C5 nerve root?
Muscle = Deltoid
Reflex = Biceps
Sensory = Lateral Arm
What is the MRS for the C6 nerve root?
Muscle = Wrist extensors
Reflex = Brachioradialis
Sensory = Lateral forearm and 1st/2nd digits/palm
What is the MRS for the C7 nerve root?
Muscle = Wrist flexors
Reflex = Triceps
Sensory = Middle of palm and middle finger (3rd digit) and some of central forearm
What muscles create the thenar eminence?
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
OAF
