03-08: The Hand Flashcards

1
Q

Joints of the Thumb (3)

A

Carpometacarpal (CMC or CM) joint - Trapezium articulates with base of 1st metacarpal
Metacarpophalangeal (MCP or MP) joint - 1st metacarpal articulates with proximal phalanx
Interphalangeal (IP) joint - Articulation between proximal and distal phalanx

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2
Q

Thumb Motion - Flexion/Extension

A

Frontal plane about a sagittal axis (Cave on vex)

Flexion - 40˚, combines with slight rotation, medial glide
Extension - Lateral glide

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3
Q

Thumb Motion - Abduction/Adduction

A

Sagittal plane about a frontal axis (Vex on cave)

Abduction - Posterior roll, anterior glide
Adduction - Anterior roll, posterior glide

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4
Q

Thumb Motion - Opposition/Reposition

A
  • Opposition is THREE movements - Abduction, flexion, rotation (rotary component)
  • Opposition/Reposition separates us from primates (opposable thumbs)
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5
Q

Apehand Deformity

A

Condition in which there is an Inability to oppose thumb

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6
Q

Joints of fingers (Digits 2-5)

A

Carpometacarpal - Carpals and metacarpals
Metacarpophalangeal - “knuckles”
Proximal interphalangeal - PIP
Distal interphalangeal - DIP

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7
Q

CMC Joint of the Thumb

A

Gives mobility and stability

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8
Q

CMC Joint of the Fingers

A

Provides more stability than mobility

2nd-3rd digits: stationary
4th-5th digits: more mobile
5th digit has most CMC mobility (fist)

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9
Q

Boxer’s Fracture

A

Fx of the neck of distal 5th metacarpal

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10
Q

Range of Motion (MCP, PIP, DIP)

A

MCP: Flexion, extension, abduction, adduction, hyperextension
PIP: Flexion, extension
DIP: Flexion, extension

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11
Q

Arthrokinematics of hand joints

A

Radiocarpal - Vex on Cave (opposite glide/roll)
Intercarpal - Non-axial
CMC - Non-axial gliding (2-5), Saddle (1st digit)
1st CMC - Saddle - Sagittal (Vex on Cave), Frontal (Cave on Vex)
MCP - Cave on vex (Biaxial)
IP - Cave on Vex (Uniaxial)

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12
Q

Flexor Retinaculum Ligament

A
  • Prevents bowstringing
  • Fibrous band on anterior surface
  • Transverse carpal, palmar carpal ligament
  • Structures (10) run underneath and distal to FR
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13
Q

Extensor Retinaculum Ligament

A

Fibrous band on posterior surface

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14
Q

Extensor Expansion Ligament

A
  • Extensor hood, attaches to distal phalanx

- Provides attachment for several muscles

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15
Q

Tunnel of Guyon

A

Canopy formed by pisohamate ligament; ulnar nerve runs underneath

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16
Q

Anterior extrinsic muscles

A

Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus

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17
Q

Posterior extrinsic muscles

A

Extensor digitorum communis
Extensor digitorum indicis
Extensor digiti minimi

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18
Q

Lateral extrinsic muscles

A

Abductor pollicis longis
Extensor pollicis brevis
Extensor pollicis longus

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19
Q

Flexor Digitorum Superficialis

A

O: Medial epicondyle of humerus, coracoid process of ulna, Middle of anterior radius
I: Lateral aspects of middle phalanges 2-5
A: Flexes PIP, MCP, radiocarpal joint
N: Median nerve

  • Origin forms canopy for median nerve to pass underneath - can be area of impingement
  • Most superficial finger flexors - deep to wrist flexors
  • Bifurcates at middle phalange
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20
Q

Flexor Digitorum Profundus

A

O: Anterior aspect of proximal ulna, interosseous membrane
I: Volar aspect of the base of distal phalanges 2-5 (runs deep to FDS)
A: Flexes DIP, PIP, MCP, radiocarpal joints
N: Median nerve (Digits 2-3), Ulnar nerve (Digits 4-5)

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21
Q

Flexor Pollicus Longus

A

O: Anterior aspect of radius, interosseous membrane
I: Volar aspect of distal phalange 1 (1st digit)
A: Flexes IP, MCP, assists with radial radiocarpal joint flexion
N: Median nerve

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22
Q

Extensor Digitorum Communis

A

O: Common extensor tendon
I: Extension hood (Dorsum of distal phalange) Digits 2-4
A: Extends DIP, PIP, MCP, radiocarpal joint
N: Radial nerve

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23
Q

Extensor Digitorum Indicis

A

O: Posterior aspect of ulna
I: Extensor hood of 2nd digit
A: Extends DIP, PIP, MCP, Radiocarpal joint of digit 2
N: Radial nerve

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24
Q

Extensor Digiti Minimi

A

O: Common extensor tendon
I: Extensor hood of 5th digit
A: Extends DIP, PIP, MCP, Radiocarpal joint of digit 5
N: Radial nerve

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25
Q

Abductor Pollicis Longus

A

O: Posterior aspect of ulna, interosseous membrane, posterior radius
I: Base of 1st metacarpal
A: Abduction of 1st digit
N: Radial nerve

26
Q

Extensor Pollicis Brevis

A

O: Posterior aspect of radius, interosseous membrane
I: Base of proximal phalange of 1st digit
A: Extends MCP, radiocarpal joint
N: Radial nerve

27
Q

Extensor Pollicis Longus

A

O: Posterior ulna, interosseous membrane
I: Base of distal phalange of 1st digit
A: Extends DIP, MCP, radiocarpal joint; assists with supination
N: Radial nerve

28
Q

Anatomical Snuffbox

A
  • Depression on the lateral side of the hand/thumb
  • Made up of APL, EPB, EPL
  • Base is the scaphoid
29
Q

“Sign of the Pope”

A
  • Median nerve injury
  • Making fist: Can’t bend 1st three digits, wrist
  • Not deformity, just sign when making fist
  • No opposing to bring thumb forward
30
Q

“Jersey finger”

A

Avusion injury - tendon ripped from bone in DIP, cannot activate phalange

31
Q

Thenar Muscles

A
  • Flexor pollicis brevis
  • Abductor pollicis brevis
  • Opponens pollicis (Deepest muscles)
  • Ennervated by median nerve
32
Q

Hypothenar Muscles

A
  • Flexor digiti minimi
  • Abductor digiti minimi
  • Opponens digiti minimi (Deepest muscles)
  • Ennervated by ulnar nerve
33
Q

Deep Palmar Muscles

A
  • Lumbricals
  • Palmar interossei (Lies between metacarpals)
  • Dorsal interossei (Lies between metacarpals)
  • Adductor pollicis
34
Q

Flexor Pollicis Brevis

A

A: Flexes 1st digit
N: Median nerve

  • Thenar
35
Q

Abductor Pollicis Brevis

A

A: Abducts 1st digit
N: Median nerve

  • Thenar
36
Q

Opponens Pollicis

A

A: Opposes 1st digit
N: Median nerve

  • Thenar
37
Q

Flexor Digiti Minimi

A

A: Flexes 5th digit
N: Ulnar nerve

  • Hypothenar
38
Q

Abductor Digiti Minimi

A

A: Abducts 5th digit
N: Ulnar nerve

  • Hypothenar
39
Q

Opponens Digiti Minimi

A

A: Opposes 5th digit
N: Ulnar nerve

  • Hypothenar
40
Q

Adductor Pollicis

A

A: Adduction of 1st digit
N: Ulnar nerve

  • Deeper palmar
  • Last muscle ennervated by ulnar nerve
41
Q

Dorsal Interossei (DAB)

A

O: Adjacent to metacarpals
I: Base of lateral aspects of proximal phalanx 2-4
A: Abducts digits 2-4
N: Ulnar nerve

  • Deeper palmar
42
Q

Palmar Interossei (PAD)

A

O: Adjacent to respective metacarpals
I: Base of respective proximal phalanx
A: Adducts digits 2, 4, 5
N: Ulnar nerve

  • Deeper palmar
43
Q

Lumbricals

A

O: Tendons of Flexor Digitorum Profundus 2-5
I: Extension hood of digits 2-5
A: Flexes MCP, Extends IP
N: Median nerve (Digits 2-3), Ulnar nerve (Digits 4-5)

44
Q

Extensor Tendons at Wrist

A

Comp 1 - Abductor Pollicis Longus, Extensor Pollicis Brevis
Comp 2 - Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis
Comp 3 - Extensor Pollicis Longus
Comp 4 - Extensor Digiti Communis, Extensor Digitorum Indicis
Comp 5 - Extensor Digiti Minimi
Comp 6 - Extensor Carpi Ulnaris

45
Q

Colles Fracture

A
  • FOOSH (Fall on an outstretched hand)

- Posterior displacement of distal radius (Fx)

46
Q

Smith’s Fracture

A

Anterior displacement of distal radius (Fx)

47
Q

Ganglion Cyst

A
  • Benign tumor mass filled with clear, jelly-like fluid

- Located on either dorsal or volar aspect of hand

48
Q

De Quervain’s Disease

A
  • Inflammation of the sheath containing the EPB and APL

- Test using Finklestein’s Test, treat as tendinosis

49
Q

Dupuytren’s Contracture

A
  • Deformity
  • Thickening in the palmar aponeurosis = fixed position that cannot be fixed with PT on its own
  • Can be treated post-surgery (excise fibrous tissue)
50
Q

Trigger Finger

A
  • Tendon unable to slide in sheath due to swelling of either tendon or sheath
  • Tendon passes during flexion, but locks in position (manual reposition)
51
Q

Swan Neck Deformity

A
  • Hyperextension of PIP and flexion of DIP

- Late stage results in ulnar drift

52
Q

Boutonniere’s Deformity

A

Flexion of the PIP and extension of the DIP

53
Q

Claw Hand

A
  • Ulnar nerve
  • Hyperextension of MCP
  • Passive insufficiency of flexor tendons
54
Q

Grind Test

A
  • 1st metacarpal approximation
55
Q

Finklestein’s Test

A
  • De Quervain’s Syndrome

- Thumb in fist, test ulnar deviation

56
Q

Phalen’s Test

A
  • Carpal Tunnel Syndrome

- Hold dorsal surface of hands together to see if it affects fingers

57
Q

Tinel’s Test

A
  • Nerve irritation

- Tap, test to see if it sends signals of nerve irritation

58
Q

Froment’s Sign

A
  • Ulnar nerve test
  • Adductor Pollicus
  • Hold paper between 1st-2nd digit and test strength
59
Q

Power Grip

A

Cylindrical grasp - fingers ADD, flex at MCP (bottle)
Spherical grasp - ABD and flexed fingers (doorknob)
Hook grasp - ABD and flexes at IPs (suitcase)

60
Q

Prehension Grip

A

Pad to pad - finger pad to finder pad (pinch salt)
Pad to side - Pad of thumb to side of finger (keys)
Side to side - side of finger to side of finger (cigarette)
Lumbrical - Flexed MCP, extension of IP (water cup)
3-Jaw Chuck - 1st three digits come together (pulling a pickle out of jaw