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Flashcards in Wrist Deck (57):
1

Ossification begins where in carpal bones?

Capitate (present at 1 year)

2

Ossification order of carpal bones?

Counterclockwise

3

Last carpal bone to ossify?

Pisiform (9 years)

4

Order of carpal ossification?

Capitate--hamate--triquetrum--lunate--scaphoid--trapezium--trapezoid--pisiform

5

Location of ossification centers for metacarpals?

Body (primary--8 weeks gestation) and neck (secondary--3 years)

6

Which metacarpal is a primordial phalanx and why?

First metacarpal--its secondary ossification center is located at the base (like the phalanges)

7

Which metacarpal has a styloid process?

3rd (middle)

8

Which metacarpal has a tubercle and what attaches there?

5th (small) = ECU

9

Strongest ligament of radiocarpal joint?

Palmar/volar radiocarpal ligament

10

Where is the weak spot of the volar radiocarpal ligament?

Space of Poirier (radial side)--lends less support to the scaphoid, lunate and trapezoid

11

Proximal row?

Scaphoid, lunate, triquetrum

12

Strongest ligaments of dorsal row?

Dorsal intercarpal ligaments

13

Which ligaments help extend the pull of the FCU?

Pisohamate and pisometacarpal ligaments

14

Distal row?

Trapezium, trapezoid, capitate, hamate

15

How many synovial sheaths are in the extensor retinaculum?

6

16

1st dorsal compartment?

1) APL--contains multiple tendon slips which should be addressed during de Quervain's
2) EPB

17

2nd dorsal compartment?

1) ECRL
2) ECRB

18

3rd dorsal compartment?

EPL

19

4th dorsal compartment?

1) EDC
2) extensor indicis proprius
3) PIN

20

5th dorsal compartment?

EDM

21

6th dorsal compartment?

ECU

22

de Quervain's involves which tendons?

APL and EPB

23

Intersection syndrome (extensor tendinitis)

ECRL and ECRB

24

Which tendon passes around Lister's tubercle?

EPL--can be ruptured after wrist fxs

25

What tendon can rupture in RA and Vaughn-Jackson syndrome?

EDM

26

What tendon can snap at the ulnar styloid?

ECU

27

Transverse carpal ligament attachments?

Medially = pisiform and hook of hamate
Laterally = tuberosity of scaphoid and ridge of trapezium

28

What wrist motion decreases volume of carpal tunnel?

Flexion

29

Contents of carpal tunnel?

Median n, FPL, 4 FDS, 4 FDP

30

Orientation of tendons in carpal tunnel?

FDS of middle and ring fingers are volar to tendons of index and small fingers

31

Floor of Guyon's canal?

Flexor retinaculum

32

Roof of Guyon's canal?

Volar carpal ligament

33

Sagittal band action?

MCP extension

34

Transverse (sagittal) band action?

MCP flexion (interossei)

35

Lateral band action?

PIP extension (lumbricals)

36

Oblique retinacular ligament (Landsmeer) action?

DIP extension (passive)

37

How many annular pulleys and cruciates?

A1-5 and C1-3

38

Which pulleys attach to bone?

A2 and A4 (A1, 3, 5 orignate from palmar plates of metacarpal, PIP, and DIP joints)

39

Most critical pulley?

A2 (covers proximal phalanx), followed by A4 (covers middle phalanx)

40

Which pulley involved in trigger fingers?

A1

41

Which branch of the median n enters wrist proximal to TCL?

Palmar cutaneous branch--innervates thenar skin

42

Superficial branch of ulnar n innervates what?

Palmaris brevis and skin

43

Deep branch of ulnar n passes bt what 2 muscles?

Abductor digiti minimi and flexor digiti minimi brevis

44

Radial artery reaches the dorsum of the carpus by passing bt what structures?

1) FCR
2) APL and EPB tendons (snuffbox)

45

Deep palmar arch of hand?

Radial a

46

Superficial palmar arch of hand?

UInar a

47

Blood supply to scaphoid?

Dorsal carpal branch of radial a

48

What artery lies on the TCL?

Ulnar a

49

Surgical approaches to wrist?

1) Dorsal wrist
2) Volar (Russe's) wrist
3) Volar scaphoid
4) Dorsolateral scaphoid

50

Interval for dorsal approach?

1) 3rd extensor compartment (EPL)
2) 4th extensor compartment (ED)

51

Risk during dorsal approach?

Interosseous scapholunate ligament

52

What line is used to make incision during CTR?

Kaplan's line--from crease of thumb to hook of Hamate

53

Intersection of Kaplan's line and webspace of 2-3rd digits?

Recurrent motor branch of median n

54

Interval of volar (Russe's) approach?

1) FCR
2) Radial a

55

How do you protect superficial radial n and radial a during the dorsolateral approach?

Make incision within anatomic sniffbox

56

Bunnell's approach?

Volar approach to flexor tendons (zigzag incision)

57

How do you avoid neurovascular structures during the midlateral approach to digits?

Avoid being too volar