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A2 ME3031 MSK > W12 - Hands & Wrist > Flashcards

W12 - Hands & Wrist Flashcards

1
Q

SUPERFICIAL Anterior Forearm Muscles

A

FLEXORS
*orientate medial epicondyle, and lateral aspect

BRFrFu (BR frick fuck iits cold)

BRACHIORADIALIS
(radial n.)
supracondular ridge -> styloid of radius

PRONATOR TERES = pronator
(median n.)
medial epicondyle -> radial aspect (goes under the brachioradialis)

FLEXOR CARPI RADIALIS = flexes forearm and elbow
(median n.)
passes across to radial
medial epicondyle -> attach to radial side of hand (metacarpal/carpal/2nd finger)

PALMARIS BREVIS = not all have it = elbow flexion; not strong

FLEXOR CARPI ULNARIS = elbow and forearm flexion
(ulnar n.)
medial epicondyle -> attach to ulnar side of hand

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2
Q

Posterior Forearm Muscles

A

EXTENSORS
*orientate lateral epicondyle

EXTENSOR CARPI ULNARIS
(radial n.)
stretches across from radial to ulnar side 5th metacarpal

EXTENSOR CARPI RADIALIS
(radial n.)
stretches to 1st MC

PALMARIS LONGUS
(radial n.)
stretches to third MC

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3
Q

Which muscle in the anterior forearm acting singularly would produce ulnar deviation?

A

FLEX. CARPI ULNARI = ADDUCTION/ULNAR DEVIATION

+ulnar posterior muscles assist

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4
Q

Which muscle in the anterior forearm acting singularly would produce radial deviation?

A

FLEX. CARPI RADIALIS = ABDUCTION/RADIAL DEVIATION

+radial posterior muscles assist

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5
Q

INTERMEDIATE ANTERIOR AND POSTERIOR FOREARM

A

ant. = flexors

FLEXOR DIGITORUM SUPERFICIALIS = flexion of fingers & elbow flexor
(median n.)
medial epicondyle & radial ulnar interosseus membrane surface => 4 tendons @ middle phalynx bifurcates

posterior = extension

EXTENSOR DIGITORUM
medial epicondyle => attaches to all phalanges

EXTENSOR DIGITI MINIMI
from extensor digitorum -> attaches to little finger = produces tendon (source of tendon in sx)

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6
Q

DEEP ANTERIOR FOREARM

A

ant = flexion

FLEXOR DIGITORUM PROFUNDUS = flexion of interpharyngeal joints
(ulnar n. = medial 2; median n. = lateral 2)
attaches to ulnar bone = gives off 4 tendons = to distal phalynx

FLEXOR POLLICIS LONGUS = flexion at interphalyngeal. joint
(median n.)
attach at radius to distal thumb phalynx

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7
Q

Significance of Carpal Tunnel

A

encloses intermediate and deep tendons attaching to the distal phalynx of fingers

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8
Q

DEEP POSTERIOR FOREARM

A

Post = Deep extensors abductor

  1. ANCONEUS

small musle o: lateral epicondyle => ulnar bone

  1. SUPINATOR
  2. EXTENSOR INDICES
    (radial n.)
    ulnar bone => pass to index finger
  3. EXTENSOR POLLICIS LONGUS (next to extensor indices)
    THUMB EXTENSION
    pass to thumb
  • SNUFF BOX-
  1. EXTENSOR POLLICIS BREVIS
    pass to thumb
  2. ABDUCTOR POLLICIS LONGUS (most lateral)
  • 5&6 share a sheath = lateral sheath
  • 4 part of other sheath
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9
Q

What produces suffbox

A

Extension of thumb

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10
Q

Interossei

A

(ulnar n.)
PALMAR INTEROSSEI = ADDUCT PAD

DORSAL INTEROSSEI = ABDUCT DAB
* deeper than Palmar

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11
Q

Why is the scaphoid more at risk of developing AVN

A

Avascular Necrosis

d/t scaphoids retrograde blood supply, thus difficult to heal
* more proximal the # more likely to develop AVN

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12
Q

What are the boundaries and palpable contents of the anatomical snuffbox

A

EXTENSOR POLLICIS LONGUS
EXTENSOR POLLICIS BREVIS
ADDUCTOR POLLICIS

  • radial artery
  • radial styloid process
  • scaphoid
  • tzm
  • Base of 1st MC
  • Cephalic vein
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13
Q

What is the site of common flexor origin?

A

Medial epicondyle

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14
Q

Which clinical landmark is best for approaching radius

A

Flexor Carpi Radialis

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15
Q

Significance of the Flexor Digitorum Profundus

A

Only tendon acting on the DIPJ thus can test FDP in isolation

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16
Q

Significance of the Flexor Digitorum Superficialis

A

Two tendons acting on the PIPJ , thus to isolate FDS have to isolate the FDP - common belly

17
Q

Significance of the Extensor Retinaculum

A

Tendinous band-like sheath that contains the extensors of the wrist

*attaches to Triquestrum and Pisiform

18
Q

Vascularisation of the Hands

A

ULNAR A. => SUPERFICIAL ARCH => COMMON DIGITAL ARTERIES

RADIAL ARTERY => RADIAL ARTERY

19
Q

Significance of Allens Test

A

Testing for presence/absence of ulnar and radial arteries

  • occlude both art at wrist
  • open and release fist until blanched
  • release ulnar = sould reperfuse in 15s
  • repeated ABGs or ABGs
20
Q

Clinical Features of Dupuytren’s Disease

A

M>F; 15-64yo / 75+; early development in males

*myofibroblast=contractile elements => dysregulated
+collagen
* nil pain
* loss of finger extension; gripping; washing face

21
Q

Clinical Features of trigger finger

A

F>M, 40-60s
*RA, DM, Gout
thickening of sheath; ring>thumb>middle

dx: clicking sensation w/ digit movement, progression to locking, lump in palm

22
Q

Clinical Features of De Quervain’s tenovaginitis

A

F>M, 50-60yo; post-partum, lactating females

  • 1st dorsal extensor compartment = EPB & AP retinaculum thickening = pain
  • radial pain, aggr by thumb movement, +swelling
  • consider thumb OArth.
23
Q

Clinical Features of Basal thumb OA

A

women

Commonest OA; pain stiff swelling deform + loss of function
@ base of thumb; thenar eminence

  • LOCALISED pain opening jars/pinching
    reduced thumb movement
    prominent metacarpal base

-

24
Q

Management of Dupuytren’s Disease

A

Sx
> Partial fasciectomy
2-3w heal; physio for stiffness; 50% recurrence @5y

> Dermo-fasciectomy
more radical, less recurrence, intense physio

> Percutaneous needle fasciotomy
Quicker, no wounds, higher recurrence, rpts, n. injury risk

> > RadiotherapyCollagenase.
recurrence risk, 3 flexor tendon rupture, cost

25
Q

Management of trigger finger

A

> Splintage
Steroid

Sx
> Percutaneous release
> Open Sx

26
Q

Management of De Quervain’s tenovaginitis

A

> Splints
Steroid injection

> Sx Decompression and divide up compartments

27
Q

Management of Basal thumb OA

A

> Lifestyle
NSAIDs
Splint
Steroid

> Sx: Trapezioectomy
+ligament reconstruction

> Fusion
Replacement

28
Q

Describe the presentation and principles of management of soft tissue ganglia

A

MYXOID DEGEN FROM JOINT SYNOVIA = lump outpouchings from joint capsule/tendon sheath/ligament

F>M, 20-40yo, Dorsal>Volar
*recurrent injury
commonest = LUNATE & SCAPHOID ganglion

*firm, non tender, change in size, not fixed

> observe
aspiration

> Sx: excision from the root; recurrence!

29
Q

Significance of Finkelstein’s test

A

In De Quervain’s = resisting thumb extension will produce pai

30
Q

Dupuytrens Associations

A
  • White ppl

- DM, Alcoho, Tobacco, HIV, Epilepsy

31
Q

Dupuytrens Diathesis

A

Points to worse prognosis

  • early onset
  • bilateral
  • FHx
  • Ectopic disease
32
Q

SMITHS Vs COLLES FRACTURE

A

SMITHS = flexed hand, palmar angulation of distal fragmented

COLLES = outstretched (stop!), dorsal angulation of fragmented bone

A2 ME3031 MSK (20 decks)

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