Dissection 6/7

Question 1

How can infections in the deep hand spread to the anterior compartment of the forearm?

Answer 1

Via the midpalmar space and via the carpal tunnel

Question 2

Optimal grip power of the hand occurs in the wrist in which position?

Answer 2

Extended

Question 3

Movement produced by the interossei muscles

Answer 3

Abduct/adduct (PAD DAB)

Question 4

Movement produced by the lumbricals?

Answer 4

Flexion of the MCP joints

Extension of PIP joints of the figners

Question 5

Venous drainage of the hand

Answer 5

Deep: follows arteries
Superficial: dorsal venous network

Question 6

How does lymph drain from the hand?

Answer 6

Via the cubital and axillary nodes

Question 7

In the DRUJ, which bone pivots around the other?

Answer 7

The radius pivots around the ulna

Question 8

Another name for the transverse carpal ligament?

Answer 8

The flexor retinaculum

Question 9

The tendon of which muscle fuses with the retinaculum?

Answer 9

Palmaris longus

Question 10

What is the carpal tunnel?

Answer 10

The carpal bones and the flexor retinaculum

Question 11

Which tendons enter the carpal tunnel?

Answer 11

FDS, FDP, FPL

median nerve also

Question 12

Which branch of median nerve is spared in carpal tunnel syndrome?

Answer 12

Palmar cutaneous branch

Question 13

Why is the central palm spared in carpal tunnel syndrome?

Answer 13

Supplied by palmar cutaneous branch (does not pass through carpal tunnel = not compressed)

Question 14

Supplies the palmaris brevis

Answer 14

Palmar cutaneous branch

Question 15

Supplies the muscles of the thenar eminence?

Answer 15

Recurrent branch of the median nerve

Question 16

Which nerve and artery course immediately lateral to this carpal bone?

Answer 16

Ulnar nerve and artery

Question 17

Which arteries form the superficial palmar arch?

Answer 17

The superficial palmar branch of the ulnar artery and the superficial palmar branch of the radial

(superficial palmar arch is immediately deep to the palmar aponuerosis)

Question 18

Arteries which form the deep palmar arch?

Answer 18

The deep branch of the radial artery and the deep branch of the ulnar artery

(deep branch runs across the anterior aspects of the bases of the metacarpals)

Question 19

Pathology affecting the palmar fascia. It causes thickening and shortening (contracture) leading to fixed flexion deformity

Answer 19

Dupuytrens

Question 20

How to identify FPL tendon?

Answer 20

It has its own sheath (posterior to median nerve)

Do not get this confused with PALMARIS longus which attaches to flexor retinaculum)

Question 21

What are the common palmar digital arteries?

Answer 21

Arise from superficial palmar arch

Then bifurcate into a pair of proper palmar digital arteries near the base of the fingers

Question 22

Where does the radial artery bifurcate?

Answer 22

Proximal to the carpal tunnel

Question 23

What is a ring block?

Answer 23

Anaesthetic put in a “ring” around the finger to anaesthetise all four proper digital nerves
(adrenaline must not be used)

Question 24

Neurovascular supply of the fingers

Answer 24

Each finger has 4 neurovascular bundles supplying it:

• medial palmar
• lateral palmar
• medial dorsal
• lateral dorsal

Question 25

Part of the hand supplied by the ulnar nerve?

Answer 25

Medial part of palm Little finger Medial half of the ring finger

Question 26

Part of the hand supplied by the median nerve

Answer 26

Central/lateral palm Medial half of the ring finger Middle and index finger Thumb (APART FROM SKIN AT THE BASE)

Question 27

Part of the hand supplied by the radial nerve

Answer 27

Skin at the base of the thumb

Question 28

Nerve supply to abductor pollicis brevis

Answer 28

Median

Question 29

Nerve supply of flexor pollicis bevis

Answer 29

Median

Question 30

Nerve supply of opponens pollisi

Answer 30

Median

Question 31

Superficial muscles of the thumb

Answer 31

Abductor pollicis brevis (proximal) | Flexor pollicis brevis (distal)

Question 32

Deep muscle of the thumb

Answer 32

Opponens pollicis

Question 33

Superficial muscles of the hypothenar eminence?

Answer 33

Abductor digiti minimi (medially) | Flexor digit minimi brevis (laterally)

Question 34

Deep layer of the hypothenar eminence?

Answer 34

Opponens digiti minimi

Question 35

The tendons of the FDS attach to which phalanges?

Answer 35

Proximal phalanges

Question 36

The tendons of the FDP and FPL attach to which phalanges?

Answer 36

Distal phalanges

Question 37

Borders of the anatomical snuffbox?

Answer 37

Anterior: abductor pollicis longus tendon, extensor pollicis brevis tendon Posterior: extensor pollicis longus tendon Floor (deep): scaphoid, trapezium

Question 38

How many lumbricals do you have?

Answer 38

4 (1 for each finger)

Question 39

Nerve supply to the lumbricals

Answer 39

Medial 2 lumbricals: ulnar | Lateral 2 lumbricals: median

Question 40

Action of the lumbricals and where they span?

Answer 40

Flexion at the MCPs and extension at the PIP - span anterior aspect of MCPs - span posterior aspect of DIPs

Question 41

Where do the interosseous muscles attach?

Answer 41

MCPs to PIP (different from lumbricals which are MCP to DIP) yaaaay finally makes sense

Question 42

Nerve supply to the interossei

Answer 42

Ulnar nerve