Hand & Forearm PPT 2

Question 1

The 5 carpi muscles are the muscles moving the hand at the _____

Answer 1

The 5 carpi muscles are the muscles moving the hand at the wrist

Question 2

The 3 digitorum muscles are going to ______

Answer 2

The 3 digitorum muscles are going to digits 2-5

Question 3

The 3 pronation/supination muscles in the forearm are:

2. 3.

Answer 3

The 3 pronation/supination muscles in the forearm are:

1. Supinator
2. Pronator teres
3. Pronator quadratus

Question 4

The 4 extrinsic pollicis muscles are muscles going to the ____ and originate ____ of the hand.

Answer 4

The 4 extrinsic pollicis muscles are muscles going to the thumb and originate ____ of the hand

Question 5

The three specialist muscles of the forearm arm:

2. 3.

Answer 5

The three specialist muscles of the forearm arm:

1. brachioradialis
2. extensor indicis
3. extensor digit minimi

Question 6

The 3 types of “sock puppet muscles” are:

2. 3.

Answer 6

The 3 types of “sock puppet muscles” are:

1. Lumbricals (4)
2. Palmar interossei (3)
3. Dorsal interossei (4)

Total of 11 muscles

Question 7

All of the “sock puppet” muscles perform ____ of the metacarpophalangeal joint and ______ of the interphalangeal joints

Answer 7

All of the “sock puppet” muscles perform flexion of the metacarpophalangeal joint and extension of the interphalangeal joints

Question 8

The palmar interossei perform flexion, extension, as well as _____

Answer 8

The palmar interossei perform flexion, extension, as well as adduction;

REMEMBER PAD

Question 9

The dorsal interossei perform flexion, extension, as well as _____

Answer 9

The dorsal interossei perform flexion, extension, as well as abduction

REMEMBER DAB

Question 10

What is the only pollicis (thumb) muscle innervated by the ulnar nerve?

Answer 10

Adductor pollicis

Question 11

Arterial Flow Chart

Answer 11

Question 12

The superficial palmar arch is formed mainly by the continuation of the _____ artery and anastomoses with the superficial branch of the ___ artery;

Answer 12

The superficial palmar arch is formed mainly by the continuation of the ULNAR artery and anastomoses with the superficial branch of the RADIAL artery;

Question 13

The deep palmar arch is formed b the continuation of the __ artery anastomosing with the deep palmar branch of the ____ artery.

Answer 13

The deep palmar arch is formed b the continuation of the radial artery anastomosing with the deep palmar branch of the ulnar artery.

Question 13

Follow the pathway of lymphatic drainage from the hand to the upper limb

Answer 13

Lymphatic vessels of the palm & digits drain –> DORSUM of hand –> forearm & arm toward the cephalic & basilic veins –> lymph coming from the lateral aspect of the arm (following the cephalic vein) –> axillary nodes

lymph coming from the medial aspect of the arm (following the basilic vein) –> cubital nodes –> humeral nodes –> central lymph nodes

Question 14

Ulnar nerve pathway: in the upper arm the ulnar nerve passes posterior to the ____ epicondyle; It does/does not pass through the carpal tunnel into hand

Answer 14

Ulnar nerve pathway: in the upper arm the ulnar nerve passes posterior to the medial epicondyle; It does/does not pass through the carpal tunnel into hand

Question 15

Ulnar nerve: palmar and dorsal cutaneous branches provide _____ to skin of ___ part of palm and ____

Answer 15

Ulnar nerve: palmar and dorsal cutaneous branches provide sensory to skin of medial part of palm and dorsum

Question 16

Ulnar nerve deep branch: provides ___ to all remaining muscles of hand (not ____ muscles or lateral 2 lumbricals)

Answer 16

Ulnar nerve deep branch: provides MOTOR to all remaining muscles of hand (not THENAR muscles or lateral 2 lumbricals)

Question 17

Ulnar nerve superficial branch: supplies _____ to medial 1 1/2 digits (palmar and dorsal surface)

Answer 17

Ulnar nerve superficial branch: supplies SENSORY to medial 1 1/2 digits (palmar and dorsal surface)

Question 18

Sensory innervation of the ulnar nerve: includes:
1. ____ part of palm & dorsum
2. half of digit __
3. All of digit _

Answer 18

Sensory innervation of the ulnar nerve: includes:
1. Medial part of palm & dorsum
2. half of digit 4 (ring finger)
3. All of digit 5 (pinky)

Question 19

Claw hand occurs anywhere C_ and T_ axons are damaged

Answer 19

Claw hand occurs anywhere C8 and T1 axons are damaged

Question 20

Damage to ulnar nerve at elbow results in patient unable to _____ the distal interphalangeal joint, making ____ hand more prominent

Answer 20

Damage to ulnar nerve at elbow results in patient unable to flex the distal interphalangeal joint, making “claw” hand more prominent

Question 21

Damage to ulnar nerve at the wrist results in the patient unable to ___ metacarpophalangeal joint and move digit _.

Answer 21

Damage to ulnar nerve at the wrist results in the patient unable to flex metacarpophalangeal joint and move digit 5.

Question 22

C8 ande T1 axons are damaged… which nerve are you concerned about?

Answer 22

Ulnar nerve

Question 23

Damage to the ulnar nerve at the elbow affects which muscles

Answer 23

medial half of flexor digitorum profundus in addition to the hypothenar muscles, 3rd and 4th lumbrical and interossei

Question 24

Damage to the ulnar nerve at the wrist affects which muscles

Answer 24

paralysis of hypothenar muscles, 3rd & 4th lumbricals, and interossei

Question 25

Does damage to the ulnar nerve affect the ability to flex at the proximal interphalangeal joint

Answer 25

NO, it affects the distal interphalangeal (damage at elbow) or metacarpophalangeal joint (damage at wrist. Flexor digitorum (responsible for flexion at the PIP joint) is innervated by median nerve

Question 26

Symptoms of claw hand deformity: 1. sudden severe onset of pain on ___ of _____ 2. _____ and _____ in forearm and __ & ____ digits; 3. ___ nerve irritation or injury

Answer 26

Symptoms of claw hand deformity: 1. sudden severe onset of pain on inside of elbow 2. numbness and tingling in forearm and 4th & 5th digits; 3. ULNAR nerve irritation or injury

Question 27

Causes of Claw Hand: Avulsion Fracture of Medial Epicondyle 1. Usually affects _____ age _ to __ years old 2. ______ (sport) 3. Fall causing severe _____ of an extended elbow

Answer 27

Causes of Claw Hand: Avulsion Fracture of Medial Epicondyle 1. Usually affects children age 9 to 14 years old 2. Pitchers (sport) 3. Fall causing severe abduction of an extended elbow

Question 28

Median nerve pathway: 1. Enters cubital fossa ___ to the brachial artery 2. Exits cubital fossa passing between heads of _____ _____ 3. courses through the forearm medially 4. Runs deep to palmaris longus and into the _____ _____ EXCEPT the cutaneous branch of the median nerve

Answer 28

Median nerve pathway: 1. Enters cubital fossa medial to the brachial artery 2. Exits cubital fossa passing between heads of pronator teres 3. courses through the forearm medially 4. Runs deep to palmaris longus and into the carpal tunnel EXCEPT the cutaneous branch of the median nerve

Question 29

Median nerve pathway in the hand: palmar cutaneous branch is/is not affected by carpal tunnel

Answer 29

Median nerve pathway in the hand: palmar cutaneous branch IS NOT affected by carpal tunnel

Question 30

Median nerve pathway in the hand: recurrent branch is ____ to the _____ muscles

Answer 30

Median nerve pathway in the hand: recurrent branch is motor to the thenar muscles

Question 31

Median nerve pathway in the hand: "other branches" 1. Motor to ___ & ___ lumbrical 2. Sensory to the _____ palm and distal, dorsal digits of 1, 2, 3, and 1/2 of 4

Answer 31

Median nerve pathway in the hand: "other branches" 1. Motor to 1st & 2nd lumbrical 2. Sensory to the anterior palm and distal, dorsal digits of 1, 2, 3, and 1/2 of 4

Question 32

Sensory territory of median nerve

Answer 32

Question 33

Supracondylar fracture of humerus: 1. mechanism of injury: fall onto outstretched hand 2. Clinical implications: a) ____ shaft fragment displaced anteriorly/posteriorly (limb shortening) b) risk of ____ artery laceration (ischemic contracture) c) risk of ____ nerve damage (Volkmann's) --> motor & sensory loss (Hand of Benediction when making a fist)

Answer 33

Supracondylar fracture of humerus: 1. mechanism of injury: fall onto outstretched hand 2. Clinical implications: a) DISTAL shaft fragment displaced posteriorly (limb shortening) b) risk of BRACHIAL artery laceration (ischemic contracture) c) risk of MEDIAN nerve damage (Volkmann's) --> motor & sensory loss (Hand of Benediction when making a fist)

Question 34

Pronator syndrome ____ nerve contrapment; Symptoms: a) pain and tenderness in the proximal anterior/posterior forearm b) hypesthesia/hypesthesia in ____ part of lateral 3 1/2 digits

Answer 34

Median nerve entrapment; Symptoms: a) pain and tenderness in the proximal anterior/posterior forearm b) hypesthesia/hypesthesia in LATERAL part of lateral 3 1/2 digits

Question 34

Damage to median nerve at wrist results in: Paralysis of _____ muscles and radial _____ similar to hand of benediction BUT RETAIN: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus LOSE: Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and lateral two lumbricals;

Answer 34

Damage to median nerve at wrist results in: ADDUCTED THUMB Paralysis of THENAR muscles and radial LUMBRICALS similar to hand of benediction BUT RETAIN: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus LOSE: Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and lateral two lumbricals;

Question 35

Damage to median nerve at the wrist is similar to hand of benediction BUT there is a loss of _____ from digit 1, and WEAKENED digit 1 ____ and ______

Answer 35

Damage to median nerve at the wrist is similar to hand of benediction BUT there is a loss of opposition from digit 1, and WEAKENED digit 1 flexion and abduction

Question 36

Any condition that reduces the size of the tunnel in the hand and results in compression of the ___ nerve

Answer 36

Any condition that reduces the size of the tunnel in the hand and results in compression of the median nerve

Question 37

Symptoms of carpal tunnel

Answer 37

sensory deficits muscle weakness with associated musculature

Question 38

Lateral epicondylitis also known as

Answer 38

tennis elbow

Question 39

Medial epicondylitis also known as

Answer 39

golfer's elbow

Question 40

Disease of palmar fascia and aponeurosis, typically in > 50yr old caucasian men;

Answer 40

Dupuyten contracture

Question 41

Dupuyten contracture causes shortening on the ____ end of hand resulting in ____ at the metacarpophalangeal and proximal PIP joints

Answer 41

Dupuyten contracture causes shortening on the medial end of hand resulting in flexion at the metacarpophalangeal and proximal PIP joints

Question 42

Mallet finger: long ____ tendon avulsion Presentation: ____ at the distal interphalangeal joint; inability to _____ DIP

Answer 42

Mallet finger: long EXTENSOR tendon avulsion Presentation: flexion at the distal interphalangeal joint; inability to EXTEND DIP

Question 43

Most commonly fractured carpal; Patient presents with pain and tenderness in anatomical ___ _____. Common complication: _____ ______ - damage to the palmar carpal branch of the _____ artery

Answer 43

SCAPHOID Most commonly fractured carpal; Patient presents with pain and tenderness in anatomical SNUFF BOX. Common complication: AVASCULAR NECROSIS - damage to the palmar carpal branch of the RADIAL artery

Question 44

Hamate fracture can compress the ___ nerve, leading to loss of sensation in the medial half of digit __ and the whole digit ___.

Answer 44

Hamate fracture can compress the ULNAR nerve, leading to loss of sensation in the medial half of digit 4 and the whole digit 5

Question 45

Extension fracture of the distal radius;

Answer 45

Colles fracture

Question 46

Flexion fracture of the distal radius (MUCH LESS COMMON)

Answer 46

Smith fracture

Question 47

Dermatomes of the Hand

Answer 47

Question 48

Radial nerve injury of the DEEP BRANCH ONLY: results in no loss of sensation and inability to extend ___ and fingers at the ___ joint

Answer 48

Radial nerve injury of the DEEP BRANCH ONLY: results in NO loss of sensation and inability to extend THUMP and fingers at the MCP joint

Question 49

Radial nerve injury at humerus mid-shaft (radial groove) results in: inability to extend wrist & fingers (metacarpophalangeal, PIP, DIP joints) wrist remain partly _____ due to supposed flexor tone and gravity

Answer 49

Radial nerve injury at humerus mid-shaft (radial groove) results in: inability to extend wrist & fingers (metacarpophalangeal, PIP, DIP joints) wrist remain partly flexed due to supposed flexor tone and gravity

Question 50

Anatomical SNUFF BOX

Answer 50

Question 51

Radial nerve pathway in forearm

Answer 51

1. enters cubital fossa between brachioradialis & brachial 2. branches ANTERIOR to LATERAL epicondyle into deep (MOTOR) & superficial (SENSORY) branches 3. Superficial branch divides into many superficial nerves 4. Deep branch penetrates supinator and becomes the posterior interosseous nerve