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43 Cards in this Set
- Front
- Back
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What is the back of the hands and fingers called?
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The dorsal surface
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What is the palm side of the hand called?
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Palmar or volar surface
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Where does swelling of the palmar surface often manifest?
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Dorsally - this can be misleading without proper physical examination
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What is the flexor retinaculum?
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A strong membranous band that bridges the carpal bones on their volar surface
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What do the carpal bones and the flexor retinaculum form?
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the carpal tunnel
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Which joints are more stable: the IP or the MCP joints?
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The IP joints are more stable by virtue of their bicondylar configuration
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What is the anatomical basis for the preferred position of hand immobilization?
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The IP collaterals are tight throughout the entire range of motion while the MCP collateral are tightest at flexion. The preferred position for immobilization of the PIP joints is extension whereas the MCP joints are more properly placed in flexion
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Where are the epiphyses located in the phalanges and thumb metacarpals?
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Proximally
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Where are the epiphyses located in the finger metacarpals?
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Distally
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What is the definition of the intrinsic muscles of the hand?
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Those that have their origins and insertions within the hand
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What is the definition of the extrinsic muscles of the hand?
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Those that have their origins and muscle bellies in the forearm and tendinous insertions on bones in the hand
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What muscles make up the thenar eminence?
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abductor pollicis brevis, opponens pollicis and flexor pollicis brevis
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What nerve typically innervates the thenar eminence?
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The median nerve
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How do you test the adductor pollicis?
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Have the patient forcibly hold a piece of paper between the thumb and radial side of the index proximal phalanx
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What is Froment's signs?
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When the thumb IP flexes when testing a weak adductor pollicis
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What are the functions of the interossei and lumbricals?
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The lumbricals flex at the MCP and the interossei extend. To isolate the interossei from the extrinsic muscles, place hand on a flat surface and have the patient extend the finger and wave it from side to side
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What are the muscles of the hypothenar eminence?
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opponens digiti minimi, abductor digiti minimi and flexor digiti minimi
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What nerve innervates the intrinsic muscles of the little finger?
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Ulnar nerve
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How many extensor fibre-osseous canals are there?
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6
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Why do extensor tendons lie in fibro-osseous canals?
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To prevent the tendons from bowstringing dorsally during active finger extension
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What passes around Lister's tubercle?
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The extensor pollicis longus (EPL)
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What tendons form the borders of the anatomic snuffbox?
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-EPL (extensor pollicis longus - dorsal) and APL (abductor pollicis longus - volar)
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How do you evaluate the function of EPL?
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Place the hand flat on the table and have the patient lift only the thumb off the surface
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Describe the anatomy of the distal extensor tendons?
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The extensor expansion divides into a central slip (which attaches to the middle phalanx) and two lateral bands that join with the tendons of the lumbrical and interosseous muscles and attaches to the base of each distal phalanx
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Which flexors flex the wrist and deviate the wrist radially and ulnarly?
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Flexor carpi ulnaris, flexor carpi radialis and palmaris longus
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How many flexors insert into the thumb? Into the other digits?
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1 - flexor pollicis longus
2 - flexor digitorum superficialis and flexor digitorum profundus |
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Where does FDS insert?
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It bifurcates at the level of the proximal phalanx and inserts into the middle phalanx
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Where does FDP insert?
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It perforates FDS at the level of the MCP and inserts into the base of the distal phalanx
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What is trigger finger?
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Pathologic nodular swelling of one of the long flexor tendons resulting in intermittent catching on a thickened flexor sheath anterior to the MCP joint
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Which tendons (extensor or flexor) are enclosed in sheaths?
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Flexor tendons
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What are Kanavels signs of flexor tenosynovitis?
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-sausage shaped finger (incomplete flexion)
-flexed posture of the digit -pain on passive extension of the digit -tenderness of the synovial sheath |
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Which nerve in the hand is purely sensory?
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The Radial nerve
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What is the presentation of proximal injury to the radial nerve?
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-wrist drop, fingers in flexion at the MCP, thumb adducted
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How does the ulnar nerve enter the hand?
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Through Guyon's canal
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What is Duchenne's sign
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Clawing of the ring and little finger. This is a late sign of distal ulnar damage
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What are the 2 branches of the median nerve?
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Anterior interosseous nerve
recurrent median nerve |
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What is the normal two-point discrimination on the fingertips? on the palm base? on the dorsum of the hand?
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2-5mm
7-10mm 7-12mm |
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How is 2-point discrimination tested? (practically speaking)
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linearly along the digit (not transversely because there is a digital nerve running on each side of the digit)
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What are the standard radiographic views of the hand?
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-PA
-lateral -oblique |
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How is sensation in the hand best tested?
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radia - dorsal 1st web space
ulnar - volar tip of the little finger median - volar tip of the index finger |
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How should ulnar motor testing be performed?
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forcibly pinch a piece of paper between the thumb and proximal phalanx of the index finger
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How do you assess the interosseous muscle function?
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the ability of abduct fingers from the midline of the hand
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How do you assess the function of the lumbricals?
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flex at the ring and little finger MCP and extend at the ring and little finger PIP
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