Anatomy Exam 2: Wrist And Hand

Front 1

The only intrinsic muscles of the hand located on the dorsal aspect are the...

Back 1

dorsal interossei muscles

Front 2

Vessels of the hand: the dorsal arch is formed by what?

Back 2

dorsal carpal artery of the radial artery

Front 3

Vessels of the hand: the superficial palmar arch is formed by what?

Back 3

ulnar artery. it is sometimes completed by the superficial palmar branch of the radial artery
(ulnar-superficial: US)

Front 4

Vessels of the hand: the deep palmar arch is formed by what?

Back 4

radial artery. (deep-radial: DR)
-completed by deep palmar branch of ulnar artery

Front 5

Vessels of the hand: the common palmar digital arteries are a continuation of what?

Back 5

the superficial palmar arch formed by the ulnar artery

Front 6

What nerve passes deep to the flexor retinaculum?

Back 6

median nerve

Front 7

A palmar laceration can affect the ___________, as this branch passes through the thenar compartment.

Back 7

recurrent branch of the median nerve

Front 8

The median nerve innervates what parts of the hand?

Back 8

the lateral (radial) 3 and 1/2 fingers and the lateral 2/3 of the palm

Front 9

What nerve passes superficial to the flexor retinaculum?

Back 9

ulnar nerve

Front 10

The superficial branch of the ulnar nerve innervates what parts of the hand?

Back 10

the medial (ulnar) 1 and 1/2 fingers and the medial 1/3 of the palm

Front 11

What nerve passes through Guyon's canal?

Back 11

the deep branch of the ulnar nerve

Front 12

A lesion in the ulnar nerve results in what kind of deformity?

Back 12

ulnar

Front 13

The _________________ envelops the flexor digitorum superficialis and profundus in the carpal tunnel

Back 13

ulnar bursa

Front 14

The ulnar bursa continues from the carpal tunnel into the _________________. This explains the spread of infections from the ____________________.

Back 14

-little finger
-palm to the little finger

Front 15

The radial bursa contains the tendon of the _______________.

Back 15

flexor pollicis longus

Front 16

Carpal tunnel syndrome is caused by...

Back 16

compression of the median nerve in the carpal tunnel, resulting in numbness/tingling in the lateral (radial side) 3 1/2 fingers and weakness of the thenar muscles (lumbricals 1 & 2)
(varying sensory and motor deficits)

Front 17

What type of joint is the radiocarpal joint?

Back 17

synovial condyloid

Front 18

What joint lies between the proximal and distal rows of carpal bones?

Back 18

midcarpal joint

Front 19

Which muscles function to flex the wrist (4)?

Back 19

flexor carpi radialis and ulnaris
flexor digitorum superficialis and profundus

Front 20

Which muscles function to extend the wrist?

Back 20

extensor carpi radialis longus and brevis
extensor digitorum

Front 21

What fracture of the wrist shows the characteristic dinner fork deformity?

Back 21

Colles' fracture

Front 22

A fractured scaphoid affects the __________ artery, causing ___________.

Back 22

radial artery, causing avascular necrosis

Front 23

Anterior dislocation of the lunate affects which nerve?

Back 23

the median nerve

Front 24

Fracture of the hook of hamate affects which nerve?

Back 24

ulnar nerve

Front 25

A fracture of the thumb carpometacarpal (CMC) joint is called

Back 25

Bennet's fracture

Front 26

A comminuted intra-articular fracture of the base of the first metacarpal is called

Back 26

Rolando's fracture

Front 27

Skier's thumb is due to

Back 27

chronic rupture of the ULNAR COLLATERAL LIGAMENT of the thumb's MP JOINT (hyperabduction)

Front 28

What is a boxer's fracture

Back 28

fracture of the neck of the 5th metacarpal

Front 29

The carpal tunnel is a confined space with rigid walls, any condition that significantly reduces the volume of the carpal tunnel may compress what nerve?

Back 29

median nerve

Front 30

Inflammation of the synovial sheaths due to repetitive motion or infection may lead to what?

Back 30

carpal tunnel syndrome
(relatively common)

Front 31

Carpal tunnel syndrome is characterized by pain and/or paresthesia in what part of the hand?

In severe cases there is loss of strength and atrophy of what muscles, with loss of precise movement of thumb?

Back 31

palmar surface of the lateral 3 and 1/3 digits, sometimes radiating proximally to the forearm

thenar compartment muscles

Front 32

What two structured may be used to partially replace the loss of function due to thumb amputation?

Back 32

great toe may be transplanted or index finger mobilized and repositioned

Front 33

What nerve may be compressed by any space-occupying lesion (ex ganglion cyst) in guyon's canal?

Back 33

ulnar nerve

Front 34

The brachioradialis may perform weak elbow flexion in a patient who has a lesion of the musculocutaneous nerve. What would this lesion do to the brachialis and biceps brachii?

Back 34

it would paralyze the brachialis and biceps brachii

Front 35

in lateral epicondylitis (tennis elbow), repeated forceful wrist extension causes inflammation of the humeral attachment of what muscle?

Back 35

extensor carpi radialis brevis

Front 36

The deep branch of what nerve may become entrapped within the supinator muscle or damaged by fracture of the neck of the radius?

Back 36

radial nerve

Front 37

Then tendons of abductor pollicus longus and extensor pollicus brevis share a tendon sheath and compartment deep to the extensor retinaculum. They may become inflammed deep to the retinaculum following repetitive motion, this is known as____________

Back 37

de Quervain's stenosing tynosynovitis
(de Quervain's syndrome)

Front 38

What does de Quervain's syndrome cause?

What does the differential diagnosis include?

Back 38

tenderness and lateral wrist pain that may radiate both proximally and distally

arthritis of the first carpometacarpal joint and scaphoid fracture

Front 39

what is the most frequently fractured carpal bone?

What are the characteristic symptoms of this fracture?

Back 39

scaphoid bone

pain w/ hand movement and tenderness on deep palpation in the anatomical snuffbox, following a fall on an outstretched hand

Front 40

A scaphoid fracture may not be visible on an x-ray until ________ days, until what has occurred at the fracture site?

Back 40

10-14 days, until bone reabsorption has occurred at the fracture site

Front 41

A scaphoid fracture may result in interruption of blood supply with what?

Back 41

with avascular necrosis of the proximal fragment

Front 42

The radial nerve typically sends branches to innervate the brachioradialis and extensor carpi radialis longus before doing what?

Back 42

before dividing into deep and superficial branches

Front 43

The deep branch of the radial nerve usually supplies the extensor carpi radialis brevis and supinator before piercing the supinator. What supplies the rest of the forearm extensor muscles?

Back 43

posterior interosseous nerve

Front 44

(true/false) Injury to the deep branch of the radial nerve at the supinator muscle spares wrist extension

Back 44

true

Front 45

What is the two point discrimination test?

Back 45

tests the finger pads as a sensory tool, can distinguish 2 points at least 2mm apart (45mm on calf)

Front 46

Wrist is made up of __ cuboid bones, __ in proximal row, __ in distal row.

Back 46

8 cuboid bones
4 proximal
4 distal

Front 47

What are the proximal cuboid bones (medial-->lateral)?

Back 47

scaphoid--> lunate --> triquetrum--> pisiform

Front 48

What are the distal cuboid bones (medial--> lateral)?

Back 48

trapezium--> trapezoid--> capitate--> hamate

Front 49

The carpal bones mediolaterally form 2 arches, each with a lateral and medial pillar, what are these 4 pillars?

Back 49

tubercle of scaphoid
pisiform bone
tubercle of trapezium
hook of hamate

Front 50

What connects the pillars of the carpal bones converting it into a tunnel for the long tendons and median nerve?

Back 50

flexor retinaculum

Front 51

What goes 6 muscles go through the carpal tunnel in addition to the median nerve?

Back 51

1. flexor carpi radialis
2, palmaris longus
3. flexor carpi ulnaris
4. flexor digitorum superficialis
5. flexor digitorum profundus
6. flexor pollicus longus

Front 52

What nerve and artery do NOT go through carpal tunnel?

Back 52

ulnar nerve and ulnar artery

Front 53

What are the boundaries of guyon's canal?

Back 53

flexor retinaculum
pisiform
hook of hamate
pisohamate ligament
volar carpal ligament

Front 54

What is palmar aponeurosis?

Back 54

thickened central part of palmar fascia

Front 55

What is the part of palmar fascia that extends past palms into fingers?

Back 55

digital sheaths

Front 56

What are the 5 diff hand compartments?

Back 56

1. central
2. hypothenar
3. thenar
4. adductor
5. interosseous

Front 57

What does the central compartment of the hand contain?

Back 57

long flexor tendons in synovial sheaths
lumbricals
superficial palmar arch
digital vessels and nerves (common palmar)

Front 58

Lumbricals
origin:
attachment:
innervation:

Back 58

origin: deep flexor tendons
attachment: lateral side of extensor expansions
innervation: 1 & 2 by ulnar n., 3 & 4 by median n.

Front 59

What does the thenar compartment of the hand contain?

Back 59

-abductor pollicus brevis
-flexor pollicus brevis
-opponens pollicus

Front 60

What innervates the thenar compartment of the hand?

Back 60

recurrent branch of median nerve

Front 61

What does the hypothenar compartment of the hand contain?

Back 61

-abductor digiti minimi
-flexor digiti minimi brevis
-opponens digiti minimi

Front 62

What innervates the hypothenar compartment?

Back 62

deep branch of ulnar nerve

Front 63

What does the adductor compartment contain?
What innervates it?

Back 63

-transverse head (anterior shaft of metacarpal 3)
-oblique head (capitate & base of metacarpal 2&3)
-deep palmar arch

innervated by deep branch of ulnar nerve

Front 64

What does the interosseous compartment contain?

Back 64

-palmar interossei
-dorsal interossei

Front 65

what innervates the interosseous compartment?

Back 65

deep branch of ulnar nerve

Front 66

describe the palmar interossei

Back 66

-3-4 muscles, first can be small as part of adductor pollicis
-all are unipennate attached from the metacarpals to the base of proximal phalange and extensor expansion
-adduction of all fingers except the 3rd

Front 67

describe the dorsal interossei

Back 67

-4 muscles
-all bipennate muscles attached from the metacarpals to the base of the proximal phalange and extensor expansion
-abduction of 2nd, 3rd, and 4th finger

Front 68

What are the extensor expansions?

Back 68

extensor digitorum
extensor indicis
extensor digiti minimi
-flattened extensor digitorum tendons from metacarpal area (mainly)

Front 69

Where do the extensor expansion bands attach?

Back 69

-hood anchors to palmar ligament in metacarpal area
-central median band attaches to middle phalange
-lateral bands attach to distal phalanges

Front 70

The superficial palmar arch gives off what arteries?

Back 70

-palmar digital artery
-3 common palmar digital arteries (joined by palmar metacarpal artery from deep palmar arch)

Front 71

The deep palmar arch gives off what arteries?

Back 71

-palmar metacarpal arteries (joins common palmar digital arteries, then proper digital arteries

Front 72

All muscles in the hand are supplied by the ulnar nerve except _____________ and ______________ which are supplied by what nerve?

Back 72

thenar muscles and lumbricals 1 & 2 are supplied by median nerve

(motor hand supply = median and ulnar nerve)

Front 73

nerve injuries lead to what sensory and motor deficits

Back 73

sensory- total anesthesia, varying amount of sensory deficits or nerve irritation

motor- total paralysis, varying degrees of weakness

Front 74

Primary sensory neuron is (pseudounipolar/multipolar). Peripheral process ends in transducer. Where is the soma of this neuron found?

Back 74

psuedounipolar

psuedounipolar soma is found in the dorsal root ganglion

Front 75

upper motor neurons travel along pathway from where to where?

Back 75

from cerebral cortex to ventral horn of spinal cord or motor nucleus of a cranial nerve

Front 76

lower motor neurons are alpha motor neurons, where do they send their axons?

Back 76

sends its axon to a motor end plate on a muscle

Front 77

How does paralysis from an upper motor neuron differ from paralysis from a lower motor neuron

Back 77

upper motor neuron paralysis can be spastic with hyperflexia, lower motor neuron muscle paralysis is flaccid and antagonist muscle is now unopposed

Front 78

Ulnar nerve palsy/claw hand is caused by?
and affects what muscles?

Back 78

injury to ulnar nerve at elbow

affects all intrinsic hand muscles except 1st and 2nd lumbricals and thenar muscles leading to loss of MCP flexion of 4th and 5th finger (palm flat w/ pinky and ring finger flexed toward palm, rest of fingers lay flat)

Front 79

What muscles are not affected by ulnar nerve palsy?

what muscles are unopposed?

Back 79

flexor carpi ulnaris and medial flexor digitorum profundus unaffected, allowing flexion of PIP and DIP

long extensors unopposed, leading to extension of MCP

Front 80

Klumpke's palsy is caused by lesion/injury where?

Back 80

injury to C8 and/or T1 ventral rami roots

Front 81

Median nerve palsy is caused by what injury and leads to what?

Back 81

injury at carpal tunnel or above elbow

leads to sensory deficit in median nerve areas and weakened thumb opposition
(if injury above elbow, leads to no abduction also, benediction hand or ape hand)

Front 82

radial nerve palsy caused by injury where, leads to what?

Back 82

injury at wrist

no muscles affected, sensory deficit in radial nerve area

Front 83

radial nerve palsy can also be caused by injury above the elbow, this leads to what?

Back 83

affects all forearm extensor muscles and sensory deficit around elbow