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Orthopedic Surgery Ultimate > Wrist/Hand Anatomy > Flashcards

Wrist/Hand Anatomy Flashcards

1
Q
A

styloid process of middle finger metacarpal

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2
Q
A

ECU

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3
Q
A

lunate fossa

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4
Q
A

lister’s tubercle

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5
Q
A

ECRB

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6
Q
A

ECRL

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7
Q
A

APL

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8
Q
A

EPB

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9
Q
A

EPL

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10
Q

what is in the snuff box

A

fat

radial artery

branch of radial nerve

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11
Q

how do we split up the palmar surface of the hand?

A

with 4 main lines:

kaplan’s cardinal: from 1st web space through hook of hamate

longitudinal 1: from radial side of D3

longitudinal 2: from ulnar side of D4

transverse: from radial prox crease to ulnar distal crease

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12
Q
A

superficial arch

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13
Q
A

digital nerve to D5

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14
Q
A

hook of hamate

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15
Q
A

motor branch of ulnar nerve

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16
Q
A

pisiform

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17
Q
A

ulnar nerve

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18
Q
A

tendon of FCR

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19
Q
A

scaphoid tubercle

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20
Q
A

crest of trapezium

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21
Q
A

deep palmar arch

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22
Q
A

deep branch of ulnar nerve

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23
Q
A

digital nerve to index

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24
Q

what happens here?

A

recurrent branch of the median nerve enters the thenar muscle mass

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25
Q

explain the 9 zones of extensor tendon injury

A

starting with zone I at the DIP, each joint and subsequent interjoint space is labelled a zone. So, for example, the MCP joints will be zone V, and the CMC joints will be VII, the distal radius with radio-ulnar-carpal joints zone VIII, and the last zone (IX) will be proximal radius at the origin of these tendons

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26
Q

what is contained in the 6 compartments of the hand?

A

1 = APL, EPB

2 = ECRB, ECRL

3 = EPL

4 = EI, ED, PIN

5 = EDM

6 = ECU

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27
Q

what are the 6 flexor tendon injury zones?

A

1 = FDP to FDS insertion

2 = FDS to A1 pulley (just proximal to metacarpal heads)

3 = A1 pulley to carpal tunnel

4 = carpal tunnel

5 = tendons of forearm flexors

6 = muscles of forearm flexors

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28
Q

normal volar tilt of the distal radius

A

11°

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29
Q

normal radial inclination

A

22°

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30
Q

normal radial height

A

11 mm

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31
Q

what happens as the radius rotates into pronation?

A

it moves around a fixed ulna, therefore, it shortens with respect to the ulna

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32
Q

what is the sigmoid notch?

A

the spot on the distal radius where the ulna articulates

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33
Q

list the 5 stabilizers of the DRUJ

A

TFCC

joint capsule

IO membrane

pronator quadratus

ECU tendon and sheath

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34
Q

while the ECU tendon, ECU sheath, PQ and IO are extrinsic stabilizers of DRUJ, what are the intrinsic stabilizers?

A

bony contact

superficial radioulnar ligaments

deep radioulnar ligaments

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35
Q

what is the main stabilizer of the DRUJ in supination?

A

deep dorsal radioulnar ligament stops dorsal subluxation of the radius

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36
Q

what is the main stabilizer of the DRUJ in pronation?

A

deep volar radioulnar ligament, main restraint to volar subluxation of radius

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37
Q

list the 5 components of the TFCC

A

articular disc

dorsal and volar radioulnar ligaments

meniscus homolog (disc-carpal ligaments)

volar ulnocarpal ligaments

sheath of ECU

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38
Q
A

triangular articular disc

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39
Q
A

ulnolunate ligament

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40
Q
A

palmar distal radioulnar ligament

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41
Q
A

ulnocapitate ligament

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42
Q
A

dorsal distal radioulnar ligament

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43
Q
A

ulnotriquetral ligament

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44
Q
A

ECU tendon sheath

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45
Q
A

triangular articular disc

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46
Q
A

palmar distal radioulnar ligament

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47
Q
A

dorsal distal radioulnar ligament

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48
Q
A

ulnolunate ligament

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49
Q

which carpal bone aligns with the 4th and 5th metacarpals?

A

hamate

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50
Q

most commonly fractured carpal bone

A

scaphoid

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51
Q

most commonly dislocated carpal bone

A

lunate

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52
Q

which tendons attach to the proximal carpal row?

A

none!

this means they are passive responders to action on the distal row

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53
Q

what is the order of ossification of the carpal bones?

A

capitate first, then hamate, then clockwise (looking from dorsal surface)

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54
Q

how do the carpal bones move with respect to each other?

A

well, they are secured by palmar, dorsal and interosseous ligaments between each bone, so very little gliding goes on

they are also stabilized by extrinsic ligaments that span their joints but do not attach here

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55
Q

list the 6 volar extrinsic wrist ligaments

A

RSC

RSL

LRL

SRL

UL

UT

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56
Q
A

radioscaphocapitate ligament

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57
Q
A

long radiolunate ligament

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58
Q
A

radioscapholunate ligament

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59
Q
A

short radiolunate ligament

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60
Q
A

ulnolunate ligament

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61
Q
A

ulnotriquetral ligament

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62
Q

what is the ligament of testut?

A

RSL

*this is actually an NV bundle that does not contribute to carpal stability

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63
Q

strongest volar extrinsic ligament of the wrist

A

RSC

*must repair in volar approach to the scaphoid

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64
Q

what is the primary restraint to perilunate dislocations?

A

long RL ligament

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65
Q

keystone of the wrist

A

lunate

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66
Q

what happens with disruption of the proximal row of carpal bones?

A

dissociative carpal instability

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67
Q

what happens with disruption between proximal and distal carpal rows?

A

non-dissociative disruption

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68
Q

what is the space of poirier?

A

where the palmar capsule between capitate and lunate is torn

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69
Q

what can you infer from a lesser arc injury?

A

that it is ligamentous

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70
Q

what can you infer from a greater arc injury?

A

there is a # around the lunate

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71
Q

what is significant about this space?

A

this is the space of poirier

the lunate can displace through it

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72
Q

4 stages of progressive perilunar instability

A

scapholunate failure

capitolunate failure

lunotriquetral failure

dorsal radiocarpal ligament failure

*clockwise from scaphoid

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73
Q
A

volar CT

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74
Q
A

volar TT

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75
Q
A

volar STT

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76
Q
A

volar SC

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77
Q
A

volar SL

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78
Q
A

volar LT

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79
Q
A

volar TH

80
Q
A

volar TC

81
Q
A

volar CH

82
Q
A

dorsal CT

83
Q
A

dorsal CH

84
Q
A

dorsal LT

85
Q
A

dorsal SL

86
Q
A

dorsal TT

87
Q

3 parts of the SL ligament

which part is strongest?

A

dorsal (strongest)

palmar

proximal

88
Q

2 dorsal general ligaments

A

dorsal radiocarpal ligament (DRC - also called DRTriquetral)

dorsal intercarpal ligament (DIC)

89
Q

function of the DRC

A

to stabilize the lunotriquetral joint

90
Q

function of the DIC

A

to stabilize the proximal pole of the scaphoid

91
Q

function of the SL ligament

A

resists dorsal intercalated segment instability

92
Q

2 components of the LT ligament

A

volar (strongest)

dorsal

93
Q

function of the LT ligament

A

resists volar intercalated segment instability

94
Q

which CMC joints can abduct and adduct as well as flex and extend?

A

1st and 5th

95
Q
A

extensor hood

96
Q
A

deep transverse metacarpal ligament

97
Q
A

volar plate

98
Q
A

pulley

99
Q
A

FDP

100
Q
A

FDS

101
Q
A

palmar carpal ligament

102
Q
A

flexor retinaculum

103
Q

what are the attachments of the transverse carpal ligament?

A

hook of hamate and pisiform ulnarly to scaphoid tubercle and trapezial tuberosity radially

104
Q
A

trapezial tubercle

105
Q
A

scaphoid tubercle

106
Q
A

FCR tendon

107
Q
A

FCU tendon

108
Q
A

pisiform

109
Q
A

hook of hamate

110
Q

contents of the carpal tunnel

A

8 flexor tendons of FDS and FDP

median nerve

FPL

111
Q
A

FPL

112
Q
A

FCR

113
Q

boundaries of Guyon’s canal

A

roof: volar carpal ligament
floor: flexor retinaculum
radial: hamate
ulnar: pisiform

114
Q

contents of Guyon’s canal

A

ulnar nerve

ulnar artery

115
Q

explain the 3 zones of Guyon’s canal

A

I: proximal to the ulnar nerve bifurcation

II: deep motor branch as it passes hook of hamate

III: superficial sensory branch on the other side of the canal

116
Q

what is the septum of legueu and juvara?

A

deep palmar fascia that connects the metacarpal heads to the palmar skin

117
Q
A

interossei tendon

*note these are dorsal to DTML

118
Q
A

deep transverse metacarpal ligament

119
Q
A

lumbrical tendon

*note these are volar to DTML

120
Q
A

cleland’s ligament

121
Q
A

lateral digital sheath

122
Q
A

spiral band

123
Q
A

natatory ligament

124
Q
A

grayson’s ligament

125
Q

which two fascia bands are NOT affected in Dupuytren’s contracture?

A

transverse fibers

Cleland’s ligament

126
Q

how can a ‘horseshoe’ abscess arise in the hand?

A

when there is a variant in flexor tendon sheath as below (normally only the 5th digit is completely communicating with the sheath of the wrist)

127
Q

3 potential spaces in the hand

A

thenar

midpalmar

hypothenar

128
Q

which potential space superficial to PQ communicates with the midpalmar and thenar spaces?

A

Parona’s space

129
Q

APB origin and insertion

A

originates from:

scaphoid tuberosity

trapezium ridge

transverse carpal ligament

inserts on:

lateral base of proximal 1st phalanx

130
Q

FPB origin and insertion

A

origin:

trapezium

trapezoid

capitate

insertion:

radial side of base of 1st proximal phalanx

131
Q

innervation of FPB

A

superficial is median

deep is ulnar

132
Q

OP origin and insertion

A

origin:

trapezium

transverse carpal ligament

insertion:

radial side of 1st metacarpal shaft

133
Q

AddP origin and insertion

A

origin:

capitate

base of 2/3 metacarpals

more of the 3rd shaft

insertion:

ulnar side of base of 1st proximal phalanx

134
Q

Abd DM origin and insertion

A

origin:

pisiform

insertion:

ulnar side base of 5th proximal phalanx

135
Q

FDM origin and insertion

A

origin:

hamate

transverse carpal ligament

insertion:

ulnar side of proximal 5th phalanx

136
Q

ODM origin and insertion

A

origin:

hook of hamate

transverse carpal ligament

insertion:

ulnar border of 5th metacarpal

137
Q

where do the palmar interossei originate and insert?

what to they do?

A

there are only 3*: ulnar side of 2, radial side of 4 and 5

they all insert on the extensor expansions of the digits from which they arose

138
Q

discuss the dorsal interossei

A

arise from the space between metacarpals and insert on the proximal part of the proximal phalanx of radial 2, both sides 3, ulnar 4

139
Q

the only muscle in the body to originate and insert from and to tendon

A

lumbricals:

they orginate from the tendons of FDP and insert into the extensor expansion of each digit on the radial side

odd in that they both flex MCP and extend DIP and PIP

140
Q

palmaris brevis origin and insertion

A

origin:

flexor retinaculum

insertion:

palmar surface skin on ulnar side of hand

141
Q

what is the ‘safe’ position of the wrist and hand?

A

wrist in 30° extension

MCP 70° flexion

IP neutral

142
Q
A

Lister’s tubercle

143
Q

which tendons are in compartment 1?

A

APL

EPB

(from radial to ulnar)

144
Q

which tendons are in compartment 2?

A

ECRL

ECRB

145
Q

which tendons are in compartment 3?

A

EPL

146
Q

which tendons are in compartment 4?

A

EI

ED

147
Q

which tendons are in compartment 5?

A

EDM

148
Q

which tendons are in compartment 6?

A

ECU

149
Q

through which extensor compartment of the wrist does the dorsal branch of PIN lie?

A

4th

150
Q

which is the only extensor tendon of the wrist with a true sheath?

A

ECU

151
Q

what are the juntura tendinae?

A

the connections that help stabilize the extensor tendons in flexion between the individual tendons of ED

also known as intertendinous connections or retaining ligaments

152
Q

what is the extensor hood?

A

a combinatorial structure made up of:

ED tendons

DI and PI tendons

lumbricals

central tendon

oblique retinacular ligaments

sagittal bands

153
Q
A

central slip

154
Q
A

lateral slip

155
Q
A

central slip

156
Q
A

lumbrical

157
Q
A

dorsal and volar interossei respectively

158
Q
A

sagittal band

159
Q
A

transverse retinacular ligament

160
Q
A

oblique retinacular ligament

161
Q

where does the common extensor tendon insert? how does it move the entire finger?

A

at the base of the middle phalanx

the lateral slips extend farther to attach to the base of the distal phalanx

162
Q

which side of the digits do the lumbricals attach to?

A

radial only!

163
Q

what are the medial and lateral interosseous bands?

A

the confluence of the lumbrical and interosseous tendons that merge

MIB joins the central slip at PIP

LIB joins the lateral slip at DIP

164
Q

what does the sagittal band do?

A

attaches the ED tendon to sides of volar plate limiting proximal excursion of ED in extension and stabilizing it in flexion

165
Q

what causes a swan-neck deformity?

A

rupture of the transverse retaining ligament, which will release the ED tendon from its connection to the volar plate causing dorsomedial displacement of this tendon resulting in hyperextended PIP, relative elongation of ED resulting in DIP flexion (swan-necking)

166
Q

function of the oblique retinacular ligament

A

links extension of PIP to extension and flexion of DIP

i.e. when one goes the other must follow

167
Q

what causes a boutonniere deformity?

A

incompetence of the triangular ligament between the 2 lateral bands on the dorsum of the middle phalanx

168
Q

what would happen if the triangular ligament contracted (as opposed to rupturing)?

A

a fixed swan-neck deformity

169
Q

4 causes of dorsal subluxation of transverse retinacular ligament

A

RA

PIP joint effusion

volar plate laxity

TRL laxity

170
Q

rupture of the distal extensor tendon

A

mallet finger

171
Q

besides triangular ligament rupture, what else could cause boutonniere deformity?

A

central slip rupture at PIP

172
Q

what is elson’s test?

A

essentially just looking for a boutonniere deformity

173
Q

list the pulley system in a finger

A

flexor surface to prevent bowstringing:

A1 = MCP

A2 = proximal proximal phalanx

C1 = distal proximal phalanx

A3 = PIP

C2 = proximal middle phalanx

A4 = middle middle phalanx

C3 = distal middle phalanx

A5 = DIP

*note ‘A’ just means annular, ‘C’ means cruiciate*

*thumb has only A1 = MCP, A2 = IP, and oblique between them

174
Q

how do the flexor tendons receive a blood supply?

A

diffusion and vincular system

each tendon has a short (near insertion) and long (more proximal) vinculum

175
Q
A

dorsal intercarpal arch

176
Q
A

2,3 intercompartmental supraretinacular artery

177
Q
A

1,2 intercompartmental supraretinacular artery

178
Q

% of scaphoid covered in articular cartilage

A

75%

179
Q

blood supply of the scaphoid

A

80% from the dorsal carpal branch of the radial artery

20% from the superficial palmar branch of the radial artery

180
Q

what is Keinbock disease?

A

AVN of the lunate

181
Q

to which arches do the radial and ulnar arteries contribute most?

A

radial = deep

ulnar = superficial

182
Q

which 3rd major artery supplies the hand?

A

the anterior interosseous artery, which bifurcates into dorsal and palmar branches at PQ

183
Q

where does the digital nerve give off its dorsal cutaneous branch?

A

mid P2

*note that the digital nerve itself is the most volar structure in the finger

184
Q

which nerve to the hand leaves the median before the carpal tunnel?

A

the palmar cutaneous branch of the median nerve

185
Q

what is wartenberg’s syndrome?

A

entrapment of the superficial radial nerve (sensory) as it exits the deep forearm 8 cm proximal to the wrist between BR and ECRL

186
Q
A

dorsal roof

187
Q
A

ventral floor

188
Q
A

hyponychium

189
Q
A

sterile matrix

190
Q
A

lunula

191
Q
A

eponychium

192
Q
A

germinal matrix

193
Q

how do you best check median nerve motor function?

A

1st MCP abduction (last muscle to be innervated by median nerve)

194
Q

how do you best check ulnar nerve motor function?

A

2nd MCP abduction (adductor pollicus last muscle)

195
Q

what is Gamekeeper’s thumb (aka Stener’s lesion)?

A

injury to UCL of 1st MCP

where UCL flips over adductor pollicus after avulsion off proximal phalanx

won’t reattach if in this position

results in a radial deviation of 1st MCP joint

196
Q

order of ossification of the carpal bones

A

Orthopedic Surgery Ultimate (88 decks)

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