Wrist & Hand Conditions

Question 1

6 tissues of the hand + common pathologies in each

Answer 1

1) Skin - ganglion cyst, OA (heberden/bouchard nodes)
2) Joint - RA hands
3) Vessels - haemangioma
4) Nerves - ulnar, median, radial nerve palsies
5) Muscle - De Quervain’s tenosynovitis, RA swan neck/Boutonniere deformities, Trigger finger
6) Bone - fractures, dislocation

Question 2

There are ___ annular pulleys in the finger. ___ involved in trigger finger, ___ and ___ most impt, will ___ during ___ if cut

Answer 2

5

A1 - trigger finger
A2, A4 will bowstring during flexion

Question 3

Types of pulleys in the flexor tendon sheath

Answer 3

Annular (A1-A5)
Cruciate (C1-C3)
Palmar aponeurosis pulley

Question 4

Trigger finger occurs due to ___

Answer 4

tendon of the finger catching under thickened pulleys (most commonly A1).

Question 5

Alignment of carpal bones on X-ray is seen using the ___ lines

Answer 5

Gilula lines

Question 6

Arrangement of carpal bones

Answer 6

Lateral to medial

Proximal row: scaphoid, lunate, triquetrum, pisiform

Distal row: trapezoid, trapezium, capitate, hamate

Question 7

how are nerve injuries classified?

Answer 7

1) neurapraxia: segmental demyelination -> full recovery potential

2) axonotmesis: increasing severity of damage -> incomplete recovery

3) neurotmesis: complete loss of nerve continuity -> no recovery

Question 8

Hand actions to elicit particular nerve lesions

Answer 8

1) Cross fingers - ulnar
2) Thumbs up (abduction) - median
3) MCPJ extension - radial
4) ‘OK’ sign - anterior interosseus (branch of median)

Question 9

Where to test sensation of each nerve on hand

Answer 9

1) Radial: dorsum of 1st webspace
2) Median: tip of thumb
3) Ulnar: tip of little finger

Question 10

Ulnar nerve course

Answer 10

Nerve roots C8-T1

Passes medial to triceps muscle, posterior to medial epicondyle

Runs b/w flexor carpi ulnaris & flexor digitorum profundus

Enters hand superficial to flexor retinaculum in Guyon’s canal

Question 11

Motor supply of ulnar nerve in the hand

Answer 11

OAA

Opponens digiti minimi
Abduction: dorsal interosseus
Adduction: palmar interosseus

Question 12

What is the ulnar paradox

Answer 12

Lower ulnar nerve lesion -> more flexor digitorum profundus sparing -> more flexion at DIP -> claw appears worse

Closer to the paw, the worse the claw

Question 13

What signs can be seen in ulnar nerve palsies?

Answer 13

Froment’s sign - weak adductor pollicis, compensatory flexion of thumb by flexor pollicis longus (median nerve)

Wartenburg’s sign - slightly greater abduction of 5th digit due to weakness of palmar interosseus

Question 14

What is cubital tunnel syndrome?

Answer 14

Compression to the ulnar nerve within the cubital tunnel (near medial epicondyle), causing sensory deficits and muscle weakness

Question 15

Course of the radial nerve

Answer 15

Roots C5-T1

Runs posterior of arm, within radial groove, branches off to supply extensior carpi radialis

Passes anterior to lateral epicondyle, branches deep and superficial. Superficial runs in posterior forearm. Deep branch becomes posterior interosseus nerve

Question 16

Posterior interosseus nerve syndrome and Wartenberg syndrome are both due to ___ palsies.

PIN: purely ___ symptoms
Wartenberg: purely ___ symptoms

Answer 16

radial nerve

motor
sensory

Question 17

Course of median nerve

Answer 17

Roots C5-T1

Travels laterally down arm, enter forearm via cubital fossa. Branch to pronator teres

Gives off anterior interosseus nerve (flexors) & palmar cutaneous branch

Enters carpal tunnel & give off terminal branches (lateral 2 lumbricals, opponens/abductor/flexor pollicis brevis)

Question 18

How is carpal tunnel release performed?

Answer 18

Surgeon cuts the flexor retinaculum to release compression on median nerve

Question 19

Anterior interosseus nerve syndrome is a ___ palsy, commonly trapped at the ___

presents with pure ___ symptoms

Answer 19

median nerve, deep head of pronator teres
motor

ape hand: thumb adducted
hand of benediction: cannot flex

flat ‘ok’ sign - flexor digitorum profundus, flexor pollicis longus