Anatomy- Hand and Wrist

Question 1

what type of joint is the 1st CMC

Answer 1

saddle type

Question 2

what type of joint are the MCPs

Answer 2

condyloid

Question 3

what is flexion, extension, abduction and adduction of the thumb

Answer 3

Extension of thumb= thumbs up, flexion back towards fingers. Abducting thumb palms flat facing ceiling, thumb up to ceiling

Question 4

what muscles are in the thenar eminence

Answer 4

abductor pollicis brevis
flexor pollicis brevis
opponens pollicis

Question 5

what is the innervation of the thenar eminence

Answer 5

recurrent branch of the median nerve (affected by carpal tunnel)

Question 6

what muscles are in the hypothenar eminence

Answer 6

abductor digiti minimi
flexor digiti minimi brevis
opponens digiti minimi

Question 7

what is the innervation of the hypothenar eminence

Answer 7

deep branch of the ulnar nerve

Question 8

what are the muscle groups of the hand

Answer 8

lumbricals and interossei

Question 9

what do the lumbricals do

Answer 9

attached to tendons of flexor digitorum profundus

cause flexion of MCP joints and extension of PIP joints

Question 10

what do the interossei do

Answer 10

dorsal- abduction of digits
palmar- adduction of digits
(DAB and PAD)

Question 11

what is the innervation of the lumbricals

Answer 11

lateral 2 = median nerve

medial 2 = ulnar nerve

Question 12

what is the innervation of the interossei

Answer 12

all ulnar nerve

Question 13

what forms the carpal tunnel

Answer 13

flexor retinaculum (anteriorly) 
carpals (posteriorly)

Question 14

what are the contents of the carpal tunnel

Answer 14

long tendons of the forearm flexor muscles (flexor digitorum superficialis (x4)
flexor digitorum profundus (x4)
flexor pollicis longus (x1))
median nerve

Question 15

describe the features of carpal tunnel syndrome

Answer 15

compression of the median nerve due to swelling in the tunnel

weakness in the thenar muscles
numbness in digits 1-3 and lateral half of digit 4

Question 16

what is the volar surface

Answer 16

the anterior wrists

Question 17

what are the compartments of the hand

Answer 17

central, thenar, hypothenar, adductor, interosseous

Question 18

what are the spaces of the hand

Answer 18

midpalmar space (posterior to the central compartment)
thenar space (posterior to thenar compartment)

Question 19

how might deep hand infections spread to the forearm

Answer 19

via the midpalmar space into the anterior compartment of the forearm via the carpal tunnel

Question 20

what is the superficial fascia of the hand

Answer 20

ligaments within connecting skin to deep fascia

Question 21

what are the movements of the thumb

Answer 21

flexion, extension, abduction, adduction, opposition

Question 22

what are the different grips of the hand

Answer 22

power (fist)
precision (opposition of thumb and index fingers)
hook (carrying bag in fingers)

Question 23

when does optimal power grip occur

Answer 23

with wrist joint extended

Question 24

what type of arteries are digital arteries

Answer 24

end arteries

Question 25

how does lymph drain from the hands

Answer 25

via cubital and axillary nodes

Question 26

what forms the flexor retinaculum

Answer 26

the antebrachial (deep) fascia of the anterior forearm thickens distally- firstly as the palmar carpal ligament (at wrist joint) then distally and deeper as the flexor retinaculum

Question 27

what is the transverse carpal ligament

Answer 27

the flexor retinaculum

Question 28

where does the flexor retinaculum attach

Answer 28

to the scaphoid/ trapezoid laterally and the pisiform and hamate medially

Question 29

what is the role of the flexor retinaculum

Answer 29

prevents bowstringing of the tendons during flexion which would reduce muscle efficiency

Question 30

what fuses with and strengthens the flexor retinaculum

Answer 30

the distal tendon of palmaris longus

Question 31

why is the centre of the palm unaffected by carpal tunnel syndrome

Answer 31

as the palmar cutaneous branch of the median nerve is given off proximal to the tunnel and travels superficially to reach the skin of the palm

Question 32

what are the two branches of the radial nerve

Answer 32

superficial and deep

Question 33

how is the superficial palmar arch formed and where

Answer 33

The superficial palmar branch of the ulnar artery anastomoses with the superficial palmar branch of the radial artery immediately deep to the palmar aponeurosis

Question 34

what does the deep branch of the radial artery do

Answer 34

forms the deep palmar arch by anastomosing with the deep branch of the unlar artery

Question 35

where does the deep palmar arch gi

Answer 35

runs across the anterior aspects of the bases of the metacarpals

Question 36

what is dupuytrens contracture

Answer 36

pathology affecting the palmar fascia. It causes thickening and shortening (contracture) leading to fixed flexion deformities of, in particular, the ring and little fingers.

Question 37

what does each finger have nerve supply wise

Answer 37

4 neurovascular bundles: medial palmar, lateral palmar, medial dorsal, lateral dorsal

Question 38

what is ring block

Answer 38

involves depositing local anaesthetic in a “ring” around the base of the finger to anaesthetise all four proper digital nerves. Suturing or minor surgery can then be performed painlessly distal to the block.

Question 39

what does the ulnar nerve supply in the palmar aspect

Answer 39

medial part of palm little finger medial half of ring finger

Question 40

what does the median nerve supply in the palmar aspect

Answer 40

central/ lateral palm lateral half of the ring finger middle and index finger thumb (excluding skin over the base)

Question 41

what does the radial nerve supply in the palmar aspect

Answer 41

skin over the base of the thummb

Question 42

what are the fibrous digital sheaths continuous with

Answer 42

the longitudinal digital bands of the palmar aponeurosis

Question 43

where do the fibrous digital sheaths attach

Answer 43

to both sides of the phalanges

Question 44

what is the role of the fibrous digital sheaths

Answer 44

from a secure tunnel through which the FDS, FDP, FPL and their synovial sheaths travel distally

Question 45

where do the tendons of FDS, FDP and FPL attach

Answer 45

FDS middle phalanges FDP and FPL distal phalages

Question 46

what does tenderness in the floor of the anatomical snuffbox following trauma suggest

Answer 46

scaphoid fracture

Question 47

what does the median nerve supply in the dorsal aspect

Answer 47

skin over distal phalanges/ nail beds of thumb, index, middle and ring finger

Question 48

what does the ulnar nerve supply in the dorsal aspect

Answer 48

medial part of the dorsum of the hand little finger medial half of ring finger

Question 49

how many lumbricals are there

Answer 49

4- one for each finger

Question 50

where do the lumbricals attach

Answer 50

between the FDP tendon and the extensor expansion of the same digit

Question 51

what do the lumbricals span

Answer 51

the anterior aspect of the 2nd to 5th MCP joints and then the posterior aspect of the 2nd to 5th PIP joints

Question 52

what is the median plane of the hand

Answer 52

runs through the midline of the middle finger (fingers abd/ adduct from/ to this)