Hand and Wrist

Question 1

Describe the superficial palm

Answer 1

Proximally :

• Flexor retinaculum
• Palmar aponeurosis
• Fibrous digital sheaths
• Thenar eminence
• Hypothernar eminence
• Dupuytren’s contracture

Question 2

What is the palmar aponeurosis ?

Answer 2

Has deep attachments - 3rd and 5th metacarpals

Palmar longus and brevis

Question 3

Function of the palmar aponeurosis

Answer 3

Anchor your skin to deeper tissues
Helps with grip

Question 4

Where are fibrous digital sheaths found ?

Answer 4

Over each digit on the palmar side

Question 5

What is Dupuytren’s contracture ?

Answer 5

When you get a contraction in the palmar aponeurosis, affects the 3rd digit.

Pulls the 3rd digit down

Question 6

State the palmar spaces

Answer 6

Thenar space

Midpalmar space continuous with forearm

Question 7

Long flexor tendons

Answer 7

Common flexor synovial sheath wrist –> mid palm

Flexor policis longus; separate sheath –> distal phalynx

Synovial sheaths for each digit

Digiti mini sheath; continuous to the palm

Question 8

Where are fibrous sheaths found ?

Answer 8

Superficial to the synovial sheaths

Question 9

Function of the fibrous sheaths

Answer 9

Pulleys:

Annular over bone
Cruciform near the joints

“Osseofibrous” tunnel

Question 10

In order to allow the deeper tendon (flexor digitorum profundus) to get to the deeper phalynx what happens ?

Answer 10

Tendon of Flexor digitorum superficialis splits to allow flexor digitorum profundus through distally.

Question 11

What does the median nerve supply on the anterior hand ?

Answer 11

Supplies :

• Palm of hand laterally
• The lateral 3 + 1/2 digits

Question 12

What does the median nerve supply on the posterior hand ?

Answer 12

Supplies :

• Distal ends of the lateral 3 + 1/2 digits
• (nail beds)

Question 13

Describe the palmar cutaneous branch of the median nerve

Answer 13

Supplies skin of the palm

Doesn’t pass through the carpal tunnel like the rest of the median nerve.

Emerges before the carpal tunnel

Question 14

In carpal tunnel syndrome, why won’t you get pain in the palm of the hand ?

Answer 14

As the palmar cutaneous branch of the median nerve emerges before the carpal tunnel.

Question 15

What does the radial nerve supply on the anterior hand ?

Answer 15

Supplies :

• Area of anatomical snuffbox
• Lower thumb

Question 16

What does the radial nerve supply on the posterior hand ?

Answer 16

Supplies :

• Lateral dorsum of the hand

Question 17

What does the ulnar nerve supply on the anterior hand ?

Answer 17

Supplies :

• Medial border of the hand
• Medial 1 + 1/2 digits

Question 18

What does the ulnar nerve supply on the posterior hand ?

Answer 18

Supplies :

• Medial aspect of the dorsal of the hand
• Fingertips of 1 + 1/2 digits

Question 19

If you want to test for sensation from the medial nerve, where should you press

Answer 19

Tip of index finger

Question 20

If you want to test for sensation from the ulnar nerve, where should you press

Answer 20

Tip of little finger
OR
Medial border of the hand

Question 21

If you want to test for sensation from the radial nerve, where should you press

Answer 21

Over the dorsal webspace

Question 22

Where do palmar nerves lie ?

Answer 22

Neuromuscular structures lie superficially

Common digital arteries and nerves run together

Question 23

Where does the ulnar nerve and artery emerge ?

Answer 23

Through Gyon’s canal.

The Ulnar artery into the palm of the hand, forming superficial palmar arch.

Question 24

What does the recurrent branch of the median nerve supply ?

Answer 24

Supplies :

• Thenar muscles of the hand

Question 25

Name the thenar muscles

Answer 25

Abductor Pollicis Brevis Opponens Pollicis Flexor Pollicis Brevis Adductor Pollicis

Question 26

Where are the thenar muscles found ?

Answer 26

At the base of the thumb

Question 27

What supplied the abductor pollicis brevis ?

Answer 27

Recurrent median

Question 28

Describe flexor pollicis brevis

Answer 28

2 heads : Superficial (supplied by the recurrent median nerve) [Deep (supplied by the deep ulnar nerve) T1]--> not required

Question 29

Describe opponens pollicis

Answer 29

Supplied by : - The recurrent branch of the median nerve C8 Allows grip and tool use (opposition of the thumb)

Question 30

Function of opponens pollicis

Answer 30

Opposition of the thumb

Question 31

Describe the adductor pollicis muscle

Answer 31

Deep branch of ulnar (T1) 2 heads : - Transverse - Oblique

Question 32

What are the deep thenar muscles ?

Answer 32

Flexor Pollicis Brevis Opponens pollicis

Question 33

Name the hypothenar muscles

Answer 33

Abductor digiti minimi Opponens digiti minimi Flexor digiti minimi brevis

Question 34

What are the hypothenar muscles supplied by ?

Answer 34

The deep branch of the ulnar nerve

Question 35

What is found in the extensor hood ?

Answer 35

Extensor expansion Extensor digitorum tendon

Question 36

Describe the origin of the lumbrical muscles

Answer 36

Radial side of the flexor digitorum profundus tendon. Lateral 2 - unipennate Medial 2 - bipennate

Question 37

State the insertion of the lumbrical muscles

Answer 37

Extensor expansion

Question 38

State the action of the lumbrical muscles (Exam type Q)

Answer 38

Flex metacarpal phalangeal joint and extend interphalangeal joint Flex MCP AND extend IP

Question 39

State the innervation of the lumbrical muscles

Answer 39

Medial 2 : deep ulnar Lateral 2 : median

Question 40

Where are interossei muscles found ?

Answer 40

Found between the bones (particularly metacarpals)

Question 41

What innervates interossei muscles ?

Answer 41

Deep ulnar nerve (C8, T1)

Question 42

What are the 2 groups of interossei ?

Answer 42

Dorsal (4) DAB Palmar (3) PAD

Question 43

Function of the dorsal interossei

Answer 43

Abduct digits Bipennate DAB

Question 44

Function of palmar interossei

Answer 44

Adduct digits Unipennate PAD

Question 45

Action of interossei

Answer 45

Can act together with each other, and lumbricals

Question 46

What are the muscles of the hand innervated by ?

Answer 46

The ulnar nerve (C8, T1) EXCEPT : L - Lumbricals (lat 2) O - Opponens Pollicis A - Abductor Pollicis Brevis F - Flexor Pollicis Brevis

Question 47

State the origin of dorsal interossei

Answer 47

Metacarpals

Question 48

State the insertion of dorsal interossei

Answer 48

Base of proximal phalynx and extensor hood

Question 49

Describe dorsal interossei

Answer 49

1st and 5th digits have their own intrinsic abductors

Question 50

Describe palmar interossei

Answer 50

No adduction at middle finger

Question 51

State the origin of the palmar interossei

Answer 51

Adductor side of metacarpal

Question 52

State the insertion of the palmar interossei

Answer 52

Proximal phalynx and extensor hood

Question 53

Describe ulnar nerve injury

Answer 53

Claw hand - Ulnar paradox - Determined by Froment's sign

Question 54

What muscles lose innervation in an ulnar nerve injury

Answer 54

Median 2 lumbricals All interossei 1/2 FDP (flexor digitorum profundus)

Question 55

Describe claw hand

Answer 55

Extension @ metacarpal phalangeal joint Flexion @ interphalangeal joint

Question 56

Describe the ulnar paradox

Answer 56

Distal injury appears worse FDP action

Question 57

Describe the test for carpal tunnel syndrome

Answer 57

Phalens test

Question 58

What is carpal tunnel syndrome ?

Answer 58

Compression of the carpal tunnel Weakness of thenar muscles

Question 59

Describe median nerve injury

Answer 59

Hand of benediction Ape hand

Question 60

What muscles are affected by median nerve injury ?

Answer 60

Lateral 2 lumbricals FDS and 1/2 FDP Thenar muscles

Question 61

Describe the hand of benediction

Answer 61

Inability to form a fist

Question 62

Describe ape hand

Answer 62

Loss of opposition

Question 63

Anterior interosseous nerve damage

Answer 63

FDP Flexor Pollicis Longus