Exam 4: Hand Worksheet Flashcards

Question

How do you find/palpate the hook of the hamate?

Answer 1

Put DIP of one thumb on the pisiform of the other hand, then lay the thumb down on palm in the direction of the index finger. The hook of the hamate should be palpable close to the tip of the thumb in this position.

Answer 2

Bordered by flexor retinaculum and carpal bones (trapezium, Trapezoid, Capitate, and Hamate) Contains the median nerve and 9 flexor tendons (the tendons of the Flexor digitorum profundus [4 deepest], Flexor digitorum superficialis [two sets of two more superficial], and FPL tendon) Can get carpal tunnel syndrome from pinching the median nerve in the carpal tunnel. \*\*Ulnar nerve, ulnar artery, and palmaris longus tendon run outside of carpal tunnel on palmar side. \*\*radial artery runs outside of carpal tunnel on dorsum of hand \*\*The flexor retinaculum is attached radially to the scaphoid tubercle and the ridge of trapezium, and on the ulna side to the pisiform and hook of hamate

Answer 3

2nd and 3rth mtacarpals are more stable 4th and 5th metacarpals are more flexible This allows spherical grasp and stability in the hand

Answer 4

I have come up with two answers: * Tendon of Adductor Pollicis (Oblique Head) * Tendon of Extensor Carpi Radialis Brevis It makes more sense to me that we should remember the Adductor Pollicis Oblque head, since the thumb is a major consideration for creating hand splints. I emailed Dr. Bringman. Here is what he said: "You are correct [about thinking the Adductor Pollicis Oblique Head was more important for us to remember]. Extensor carpi radialis brevis is also a prime extensor of the wrist and should be given due credit as well. As this muscle extends it also passive creates finger flexion and is of the utmost importance for individuals that would be using a tenodesis grip." I would remember both

Answer 5

used to diagnose De Quervain's tenosynovitis

Answer 6

Tinel's sign is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve For example, in carpal tunnel syndrome where the median nerve is compressed at the wrist, Tinel's sign is often "positive" causing tingling in the thumb, index, middle finger and the radial half of the fourth digit. (most associated with carpal tunnel syndrome, but can be used to test other nerves)

Answer 7

Phalen’s test is a provocative test used in the diagnosis of carpal tunnel syndrome Press dorsum of hands together (reverse prayer position) and maximally flex wrists for at least 1 minute. Positive is reproduction of symptoms (pain, tingling, etc in the median nerve distribution)

Answer 8

a condition in which there is fixed forward curvature of one or more fingers, caused by the development of a fibrous connection between the finger tendons and the skin of the palm.

Answer 9

Trigger finger, also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis), is a condition in which one of your fingers gets stuck in a bent position. Your finger may straighten with a snap — like a trigger being pulled and released. Trigger finger occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position. More: Stenosing tenosynovitis is a condition commonly known as “trigger finger.” It is sometimes also called “trigger thumb.” The tendons that bend the fingers glide easily with the help of pulleys. These pulleys hold the tendons close to the bone. This is similar to how a line is held on a fishing rod (Figure 1). Trigger finger occurs when the pulley becomes too thick, so the tendon cannot glide easily through it (Figure 2).

Answer 10

The palmar interosseous muscles adduct the fingers towards the middle finger.

Answer 11

the dorsal interossei abduct the fingers away from the middle finger.

Answer 12

The lumbricals are intrinsic muscles of the hand that flex the metacarpophalangeal joints and extend the interphalangeal joints.[1]

Answer 13

(PIP joint is hyperextended, DIP is hyperflexed); caused by slippage of the flexors to dorsal side the joint line in PIP

Answer 14

PIP is hyperflexed, DIP is hyperextended; caused by slippage of extensors to palmar side of PIP)

Answer 15

Extensor detaches from distal phalange: forceful flexion of a fully extended finger.

Answer 16

rupture flexor tendon Flexor profundus: Grabs jersey, strong extension and it pops off. Only distal phalange cannot flex. Surgery has a very very poor success rate. Better outcomes if surgery is done early.

Answer 17

FOOSH onto wrist hyperextension extension with pronated forearm, Distal radius fractures and displaces dorsally. Typically occurs to elderly population

Answer 18

Reverse of Colles fracture. FOOSH. Direct blow to dorsum of hand (wrist hyperflexes, and is supinated. Typically from a backwards fall. Typically occur in elderly individuals. Volar displacement.

Answer 19

Could be FOOSH. Avascular necrosis is a risk.

Answer 20

AVN (avascular necrosis) of lunate, Nice thing about bone is it will hang out for a while even if it doesn’t have vascularity. Will eventually break down and hand function will slowly diminish because of displacement of ray and carpals

Answer 21

Base of the first metacarpal bone (CMC). Thumb is extended and axial force on thumb causes fracture at CMC joint. Pop someone in helmet, or shoulder pad. Horrible place to have a fracture. Thumb will be going to be out of sync for a while.

Answer 22

More common than Bennett’s fracture. Drunk friend punches wall (and hits stud). Breaks head of the metacarpal (most commonly fourth or fifth)

Answer 23

pops thumb UCL. Repetative stress. Or skiing. Also called Skier’s thumb. Causes instability and decreased ability to hold on to things.

Answer 24

Precision grip Power grip

Answer 25

1. fine motor, 2. strength mostly from intrinsic muscles, 3. performed in functional wrist position, 4. a little ulnar drift at wrist 5. requires thumb)

Answer 26

1. hand is in neutral so we can 2. use extrinsic muscles 3. doesn't always require thumb

Answer 27

* Tip to tip * Pulp to pulp * Key (pulp to hand) * Pencil grip, three fingered pinch, chuck, digital prehension (chuck is a painter)

Answer 28

pulp to hand

Answer 29

* Pencil grip, * three fingered pinch, * chuck, (remember chuck is a painter) * digital prehension

Answer 30

* Hook (does not require thumb) * Cylinder, Darth Vader choke (need a thumb) * Spherical (door knob) * Fist grip, hammer, pistol grip

Answer 31

* hammer, * pistol grip

Answer 32

**Basic:** Motor: Innervates the triceps brachii, responsible for extension at the elbow. Innervates the majority of the extensor muscles in the forearm, responsible for extension of wrist and fingers and supination of the forearm **More Detail:** The radial nerve innervates muscles located in the arm and forearm. In the arm, it directly innervates the three heads of the triceps brachii. This muscle performs extension at the elbow. In the forearm, the deep branch of the radial nerve innervates the muscles in the posterior compartment of the forearm. These muscles generally extend at the wrist and finger joints.

Answer 33

**Basic;** Sensory: Innervates most of the skin of the posterior side of forearm, and the dorsal surface of the lateral side of the palm, and lateral three and a half digits. Nerve roots: C5-T1. **Detailed:** Sensory Functions There are four branches of the radial nerve that provide cutaneous innervation to the skin of the upper limb: * Lower lateral cutaneous nerve of arm – Innervates the lateral aspect of the upper arm, below the deltoid muscle. * Posterior cutaneous nerve of arm – Innervates the posterior surface of the upper arm. * Posterior cutaneous nerve of forearm – Innervates a strip of skin down the middle of the posterior forearm. * Superficial branch of the radial nerve – Innervates the dorsal surface of the lateral three and half digits, and their associated palm area.

Answer 34

**Basic:** Motor functions: Innervates the flexor muscles in the anterior compartment of the forearm (except the flexor carpi ulnaris and part of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand. **Detailed:** The median nerve innervates the majority of the muscles in the anterior forearm, and some intrinsic hand muscles. _The Anterior Forearm_ In the forearm, the median nerve directly innervates muscles in the superficial and intermediate layers: * Superficial layer: Pronator teres, flexor carpi radialis and palmaris longus. * Intermediate layer: Flexor digitorm superficialis. The median nerve also gives rise to the anterior interosseous nerve, which supplies the deep flexors: * Deep layer: Flexor pollicis longus, pronator quadratus, and the lateral half of the flexor digitorum profundus (the medial half of the muscle is innervated by the ulnar nerve). In general these muscles perform pronation of the forearm, flexion of the wrist and flexion of the digits of the hand.

Answer 35

**Basic:** Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the lateral part of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand. Nerve roots: C5 – T1. **Detailed:** The median nerve is responsible for the cutaneous innervation of part of the hand. This is achieved via two branches: * Palmar cutaneous branch – Arises in the forearm and travels into the hand. It innervates the lateral aspect of the palm. This nerve does not pass through the carpal tunnel, and is spared in carpal tunnel syndrome. * Palmar digital cutaneous branch – Arises in the hand. Innervates the palmar surface and fingertips of the lateral three and half digits.

Answer 36

**Basic:** Motor functions: Innervates the muscles of the hand (apart from the thenar muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor digitorum profundus. **Detailed:** The ulnar nerve innervates muscles in the anterior compartment of the forearm, and in the hand. _The Anterior Forearm_ In the anterior forearm, the muscular branch of the ulnar nerve supplies two muscles: * Flexor carpi ulnaris – Flexes and adducts the hand at the wrist. * Flexor digitorum profundus (medial half ) – Flexes the fingers. The remaining muscles in the anterior forearm are innervated by the median nerve. _The Hand_ The majority of the intrinsic hand muscles are innervated by the deep branch of the ulnar nerve. The hypothenar muscles (a group of muscles associated with the little finger) are innervated by the ulnar nerve. It also innervates some other muscles of the hand: * Medial two lumbricals * Adductor pollicis * Interossei of the hand The other muscles in the hand (such as the thenar eminence) are innervated by the median nerve.

Answer 37

**Basic:** Sensory functions: Innervates the anterior and posterior surfaces of the medial one and half fingers, and the associated palm area. Spinal roots: C8-T1. **Detailed:** There are three branches of the ulnar nerve that are responsible for its cutaneous innervation. Two of these branches arise in the forearm, and travel into the hand: * Palmar cutaneous branch: Innervates the skin of the medial half of the palm. * Dorsal cutaneous branch: Innervates the skin of the medial one and a half fingers, and the associated palm area. The last branch arises in the hand itself: * Superficial branch – Innervates the palmar surface of the medial one and a half fingers.

Answer 38

Grade 1: Neuropraxia Grade 2: Axonotmesis Grade 3: Neurotmesis

Answer 39

* Grade One: Neuropraxia, * Slight myelin disruption * Crush injury * Recovery 0 days -3 months * How do I know it will get better in 3 months? (do nerve conduction velocity exam). Great diagnostic tool. * PTs can do this (if they get certified)!! * Expect pt to still have some ability * Saturday night palsy falls under this * Football player who hangs on crutches (brachial plexus injury)

Answer 40

* Grade Two: Axonotmesis * Axon damage * Neural sheath is still intact * Important because it guides regrowth (will not be lost wandering) * Recovery 3-6 months * Waiting on nerve to re-grow. Can grow at 1 mm/day * We worry about atrophy, but don’t wear out stuff that is super weak (something below 3/5). Can do a bit more if there is no other neuro issues going on, but go easy on 1-2/5 * Contractures, ROM issues * Work all the stuff around it and above it to preserve function * NMES could help, but make sure they have sensation

Answer 41

* Grade Three: Neurotmesis * Cut, Avulsion * Fracture (especially worried if it was an open fracture) * Crush injury * Stab/gunshot * Recovery time * 6 months – 18 months – to never * will continue to grow, but can get lost now because there is no neural sheath * Could get axonal sprouting (but he said this doesn’t matter that much) * Current research: making neural sheaths with 3D printing.

Answer 42

Compression of **median nerve occurs** beneath the transverse carpal ligament. The carpal tunnel is a fibro-osseous tunnel formed by the tubercles of the scaphoid and trapezium laterally, the pisiform and hook of the hamate medially, the carpal bones dorsally, and the flexor retinaculum volarly (Fig. A6-16). The median nerve supplies the **thenar muscles** (abductor pollicis brevis, opponens pollicis, and superficial part of flexor pollicis brevis) and the **first and second lumbricals** in the hand. Sensory branches supply the palmar surface of the lateral three and one-half fingers. * Clinical findings:* * Burning wrist pain and paresthesia in thumb, index, middle, and radial aspect of fourth finger that is worse at night and with wrist flexion or extension or during strenuous gripping * Weakness of **thenar muscles**, clumsiness in hand

Answer 43

Also commonly referred to as Ulnar Tunnel Syndrome, it is caused by compression of the ulnar nerve at the ulnar tunnel. · *Clinical findings:* * Depending on location of impingement, findings vary from sensory deficit in the ulnar distribution only, motor deficit of ulnar intrinsic hand muscles only, or both. * Generally, there is decreased strength during pinching and gripping, and abduction deformity of the small finger (Wartenberg’s sign). More on Gyan's Canal Syndrome: The ulnar tunnel is a triangular fibro-osseous tunnel formed by the pisiform and pisohamate ligament medially, the hook of the hamate laterally and distally, the superficial transverse carpal ligament volarly, and the deep transverse carpal ligament (or flexor retinaculum) dorsally (Fig. A6-19). The ulnar nerve passes through the ulnar tunnel along with the ulnar artery. Proximal to the tunnel, the ulnar nerve gives off the dorsal branch, which runs superficial to the ulnar tunnel and provides sensation to the ulnar side of the dorsal hand. Due to its superficial course to the ulnar tunnel, compression neuropathy at the ulnar tunnel spares the dorsal branch and spares sensation of the dorsal ulnar hand. This distinguishes ulnar tunnel neuropathy from ulnar nerve entrapment at the elbow. Within the ulnar tunnel, the ulnar nerve divides into the superficial sensory and deep motor branches. The deep motor branch makes a sharp turn laterally at the hook of the hamate and passes under a fibrotendinous arch (pisohamate hiatus), where it is most vulnerable for compression. The superficial sensory branch supplies sensation to the fifth and ulnar half of the fourth finger. The deep motor branch supplies the hypothenar muscles (abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi), adductor pollicis, third and fourth lumbricals, and all interosseus muscles in the hand.

Answer 44

Also known as Wartenberg’s syndrome, cheiralgia paresthetica, handcuff neuropathy, or watch-strap nerve compression, it is caused by entrapment of the sensory branch of the radial nerve. · *Clinical findings:* * Paresthesia in the distribution of the superficial radial nerve More Information: · Only the superficial branch of the radial nerve reaches the hand. · The superficial branch originates from the radial nerve at the level of the lateral epicondyle and runs dorsal to the wrist in a superficial subcutaneous location (see Fig. A6-14). It supplies the radial side of the dorsal hand from the wrist to the proximal interphalangeal joint, the web space between the thumb and index, and extrinsic hand muscles. The intrinsic muscles are not innervated by this nerve. · A lesion of the superficial radial nerve at the wrist results in loss of sensation of the radial side of the dorsal hand.

Answer 45

1. Reach 2. Prehension (grip) 3. Carry 4. Release

Answer 46

1. Pronator Syndrome 2. Anterior Interosseous Nerve Syndrome 3. Cubital Tunnel Syndrome 4. Posterior Interosseous Nerve Syndrome

Answer 47

· Compression of the median nerve occurs at the level of the pronator teres muscle. · Potential sites of entrapment include the space between the superficial (humeral) and deep (ulnar) heads of the pronator teres muscle, at the origin of the flexor digitorum superficialis muscle where a fibrous arch exists, at the lacertus fibrosus, also known as bicipital aponeurosis, and, less commonly, at the supracondylar process of the distal anteromedial humerus (avian spur) (Figs. A6-7 and A6-8). * Clinical findings:* * Chronic forearm pain and paresthesias in the radial three and one-half digits * No muscle weakness * Pain on palpation of the pronator teres muscle

Answer 48

· Also known as Kiloh-Nevis syndrome, it is caused by compression of the anterior interosseous nerve in the proximal forearm (Fig. A6-10). · The anterior interosseous nerve is a motor branch that innervates the deep ventral muscles of the forearm, including the radial half of the flexor digitorum profundus, flexor pollicis longus, and pronator quadratus muscles. Causes included **cast pressure** · *Clinical findings:* * Dull pain in volar aspect of forearm with acute onset of weakness of the thumb and index finger and weakness of the pinch mechanism. * Inability to form an “O” with thumb and index finger (circle sign) owing to lack of innervation of flexor pollicis longus and flexor digitorum profundus muscle. Pronator quadratus also affected. * No sensory deficit because this is a purely motor nerve. This helps to distinguish it from pronator and carpel tunnel syndromes.

Answer 49

· Compression of the ulnar nerve occurs within the cubital tunnel at the elbow. · The cubital tunnel is formed by the medial epicondyle anteriorly, the medial edge of the trochlea, olecranon, and ulnar collateral ligament laterally, and the cubital tunnel retinaculum (also known as the arcuate ligament or Osborne band) posteriorly as the roof (Fig. A6-11). · The ulnar nerve innervates the skin and muscles of the ulnar side of the forearm and hand, including the flexor carpi ulnaris and ulnar half of the flexor digitorum profundus muscles. * Clinical findings:* * Pain and paresthesias along ulnar side of elbow, hand, and fourth and fifth fingers that are worse with elbow flexion * Weakness in pinching of thumb and forefinger

Answer 50

Also called radial tunnel syndrome or supinator syndrome, this is caused by compression of the posterior interosseous branch of the radial nerve within the radial tunnel (Fig. A6-14). · The radial tunnel is formed by the capitellum posteriorly, the brachioradialis and the extensor carpi radialis longus and brevis muscles anterolaterally, and the brachialis muscle and biceps tendon medially. · The posterior interosseous nerve supplies the supinator and extensor muscles of the forearm, including the extensor carpi ulnaris, extensor digitorum, extensor digiti minimi, extensor indicis, extensor pollicis longus and brevis muscles, and abductor pollicis longus. · *Clinical findings:* * Nonspecific forearm pain and tenderness in nerve at level of supinator muscle * Weakness of extensor muscles with impaired ability to extend fingers and radial deviation of hand during wrist extension secondary to weakness of extensor carpi ulnaris

Answer 51

· *Etiology:* * **Elbow trauma**, repetitive elbow flexion, supination and pronation of forearm, or, less commonly, anatomic variants (e.g., accessory bicipital aponeurosis, accessory head of the flexor pollicis longus muscle, palmaris profundus), bicipital bursitis, and soft tissue masses * Closed reduction of elbow dislocation can also result in intra-articular entrapment of the median nerve.

Answer 52

· *Etiology:* * Trauma, cast pressure * Bulky tendinous origin of the ulnar head of the pronator teres * Soft tissue masses such as lipoma or ganglion * Anomalous or accessory muscles and vessels * Fibrous bands (e.g., from superficial flexor)

Answer 53

* “**Sleep palsy**”—prolonged elbow flexion, which decreases volume of cubital tunnel, during sleep, resulting in severe symptoms * **External compression** with pressure from the operating table during surgery, during unconsciousness, in wheelchair-bound patients, and in drivers who lean their elbows against hard surfaces * Trauma (e.g., humeral fractures with loose bodies or callus formation, hematoma, elbow dislocation, avulsed medial epiphyses) * Thickened cubital tunnel retinaculum (Osborne’s ligament) * Anomalous muscles such as anconeus epitrochlearis * Tumors including ganglions, lipoma, osteophytes, and osteochondroma

Answer 54

· Radial Nerve * Etiology:* * Most commonly by arcade of Fröhse (proximal edge of superficial head of supinator muscle) * At site of exit from supinator muscle * Abnormal recurrent blood vessels that cross the posterior interosseous nerve (leash of Henry) * Intermuscular septum between the extensor carpi ulnaris and extensor digitorum minimi * **External compression** (e.g., from crutches) * Radial head fracture and callus formation, hematoma * Soft tissue tumors (e.g., ganglion, lipoma)

Exam 4: Hand Worksheet Flashcards

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