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NYCC Extremities Tech II > Wrist & Hand > Flashcards

Wrist & Hand Flashcards

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1
Q

What are the major joints of the wrist?

A

Midcarpal joint
Radiocarpal joint
Distal radioulnar joint
Fibrocartilage Complex (FCC)

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2
Q

A 65 year old male complains of intermittent pins and needles in the 4th and 5th digits on the left of 4 days duration without a precipitating event. What are potential diagnoses? (Choose all that apply).

A. C6
B. C8
C Lesion of the lower brachial plexus
D. Peripheral neuropathy at cubital tunnel
E. Peripheral neuropathy at Canal of Guyon

A

B, C, D, E

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3
Q

What are the ROM patterns of the wrist joint in degrees?

A

Flexion = 80
Extension = 70
Abduction (radial deviation) = 20
Adduction (ulnar deviation) = 30

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4
Q

The pisiform is part of the midcarpal joint (TRUE/FALSE)?

A

False

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5
Q

What makes up the radiocarpal joint?

A

Scaphoid, lunate and triquetrum with radius

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6
Q

What does the radius articulate with in the radiocarpal joint?

A

Scaphoid and lunate

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7
Q

The pisiform sits on top of which carpal bone?

A

Triquetrum

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8
Q

What is contained in the fibrocartilage complex of the wrist?

A

Meniscus and articular disc
Ligamentous and cartilaginous tissue

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9
Q

What type of joint is the radiocarpal (wrist) joint?

A

Condylar

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10
Q

What is the function of the fibrocartilage complex of the wrist?

A

Cushion between ulna, lunate, and triquetrum
Stabilization of the distal radioulnar joint

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11
Q

What is the fibrocartilage complex of the wrist also called?

A

Ulno-menisco-triquetral joint

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12
Q

What joint does the fibrocartilage complex of the wrist stabilize?

A

Distal radioulnar joint

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13
Q

What joints of the wrist does flexion and extension occur at?

A

Midcarpal and radiocarpal joints

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14
Q

What joints of the wrist does radial and ulnar deviation occur at?

A

Midcarpal and radiocarpal joints

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15
Q

What motions of the wrist are not part of the wrist motion proper?

A

Supination and pronation

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16
Q

What motions are part of the wrist proper?

A

Flexion/Extension and radial/ulnar deviation

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17
Q

What joint of the wrist does supination and pronation occur at to assist the elbow?

A

Distal radioulnar joint

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18
Q

What is a Colle’s fracture?

A

Distal radius fracture with posterior angulation of the distal fragment

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19
Q

What is the most common MOI for a Colle’s fracture?

A

FOOSH

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20
Q

What is the most commonly fractured carpal bone?

A

Scaphoid

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21
Q

What is the most common MOI for a scaphoid fracture?

A

FOOSH

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22
Q

Where will pain present in a patient with a scaphoid fracture?

A

Anatomical snuffbox

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23
Q

What tendons make up the borders of the anatomical snuffbox and can be inflamed in De Quervain’s tenosynovitis?

A

Extensor pollicis brevis and abductor pollicis longus

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24
Q

What is the most common site for an occult fracture?

A

Scaphoid

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25
Dislocation of the carpal bones is relatively uncommon (TRUE/FALSE)?
t
26
What is the most commonly dislocated carpal bone?
Lunate
27
How does a lunate most commonly dislocate?
P ——> A
28
What is the second most commonly dislocated carpal bone?
Scaphoid
29
What is radial impaction?
Radius impacts onto the scaphoid causing pain
30
What is the MOI for a radial impaction?
Wrist hyperextension with axial loading (Yoga, Push-ups)
31
A patient with chronic pain in their radiocarpal joint will have pain where and in what pattern?
Band of pain near the flexor crease of the wrist
32
What is De Quervain's tenosynovitis?
Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons in the wrist and hand
33
What are the most commonly involved tendons in tendonitis at the wrist?
Extensor pollicis brevis and abductor pollicis longus
34
What causes De Quervain's tenosynovitis?
Excessive ulnar deviation
35
What orthopedic test positive can cause lateral wrist pain and indicate De Quervain's Tenosynovitis?
Finkelstein's test
36
What is a positive result for Finkelstein's test?
Pain on the radial side of the wrist (lateral wrist pain)
37
What is a ganglion cyst?
Synovial cyst usually attached to a tendon sheath in the wrist, hand, or foot filled with mucopolysaccharide-rich fluid
38
Guyon's ulnar tunnel syndrome is affectionately called what?
Handlebar syndrome
39
What is handlebar syndrome?
Entrapment neuropathy of the ulnar nerve in the tunnel of Guyon
40
Where is the Canal of Guyon located in the wrist?
Between the pisiform and hook of the hamate
41
What is contained within the Canal of Guyon?
Flexor carpi ulnaris Ulnar artery Ulnar nerve
42
What is the most common etiology of Guyon's tunnel syndrome or Handlebar syndrome?
Chronic external compression from occupation, sports, or mass lesion (ganglion cyst)
43
What is the most common mass lesion causing handlebar syndrome?
Ganglion cyst
44
What will be the pattern of pain or paresthesia in a patient with handlebar syndrome or Guyon tunnel syndrome?
Pain and paresthesia in the medial half of the fourth digit and all of the 5th digit and palm only on the VENTRAL SURFACE (PALM)
45
A patient with Guyon tunnel or Handlebar syndrome will have pain and paresthesia on the ventral and dorsal aspects of the 4th and 5th digits (TRUE/FALSE)?
False (ventral only)
46
What muscles in the hand are innervated by the ulnar nerve distal to the tunnel of guyon?
Interossei Abductor digiti minimi ADductor pollicis
47
What orthopedic test at the wrist can be used to diagnose Guyon tunnel syndrome or Handlebar syndrome?
Tinel tap
48
What testing can be performed if symptoms in the wrist are severe or if diagnosis is uncertain?
Electrodiagnostic testing
49
What is the most common entrapment neuropathy?
Carpal tunnel syndrome
50
What are the contents of the carpal tunnel?
Median nerve Flexor digitorum superficialis Flexor digitorum profundus Flexor pollicis longus
51
How many finger flexor tendons are in the carpal tunnel? What are they?
9 total 4 = FDS 4 = FDP 1 = FPL
52
What nerve runs in the carpal tunnel?
Median
53
What nerve runs in the canal of guyon?
Ulnar
54
What nerve runs in the cubital fossa?
Median
55
What nerve runs in the cubital tunnel?
Ulnar
56
What is the roof of the carpal tunnel?
Flexor retinaculum
57
What makes up the medial border of the carpal tunnel?
Hamate and pisiform
58
What makes up the lateral border of the carpal tunnel?
Scaphoid and trapezium
59
What are the majority of cases of carpal tunnel syndrome due to?
Idiopathic probably due to non-specific tenosynovitis
60
What are examples of anatomic risk factors for carpal tunnel syndrome?
Reduction in carpal tunnel area SOL
61
What are examples of metabolic or physiologic risk factors for carpal tunnel syndrome?
Fluid balance abnormalities (myxedema, pregnancy) Inflammatory disorders (RA and tenosynovitis) Diabetes
62
What is double crush syndrome?
When a peripheral nerve is entrapped in more than one location
63
What is the sensory distribution of the median nerve in the hand?
First three and a half digits and palm
64
What is a positive finding for any CTS orthopedic test?
Numbness, paresthesia, or pain in the sensory distribution of the median nerve
65
What is a flick sign and what does it indicate?
Patient shakes their hand briefly to relieve wrist or hand pain indicates carpal tunnel syndrome
66
Atrophy of thenar muscles upon physical exam likely indicates what?
Carpal tunnel syndrome
67
The Thenar eminence is part of the median nerve sensory distribution in the hand and wrist (TRUE/FALSE)?
False (area of sensory sparing)
68
What are the LOAF muscles in the hand innervated by the median nerve?
Lateral lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicus brevis
69
What muscle is the best or most useful to test for carpal tunnel syndrome (NOT THE FIRST TESTED FOR MEDIAN MRS)?
Abductor pollicis brevis
70
What are the best two muscles to test for carpal tunnel syndrome?
Opponens pollicis Abductor pollicis brevis
71
What muscle is the most distal and tested first for a median nerve MRS? What muscles follow?
Flexor pollicis brevis = First Flexor digitorum profundus for digits 2-3 Flexor carpi radialis
72
According to the literature what two nerves innervate the flexor pollicus brevis muscle?
Median and ulnar
73
All muscles in the hand, including the LOAF muscles, have significant innervation by the ____________ nerve root?
T1
74
What orthopedic tests can be used to diagnose carpal tunnel syndrome?
Tinel Tap Phalen's test Prayer sign (Reverse Phalen's) English/Spygh/Tourniquet Test
75
What is a positive result for a Tinel tap test or Phalen's test?
Numbness, paresthesia, or pain in the sensory distribution of the median nerve
76
What is the MRS for the C5 nerve root?
Muscle = Deltoid Reflex = Biceps Sensory = Lateral Arm
77
What is the MRS for the C6 nerve root?
Muscle = Wrist extensors Reflex = Brachioradialis Sensory = Lateral forearm and 1st/2nd digits/palm
78
What is the MRS for the C7 nerve root?
Muscle = Wrist flexors Reflex = Triceps Sensory = Middle of palm and middle finger (3rd digit) and some of central forearm
79
What muscles create the thenar eminence?
Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis OAF

NYCC Extremities Tech II (7 decks)

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