Hand Surgery

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Author:
bunhead321
ID:
162463
Filename:
Hand Surgery
Updated:
2012-07-16 14:12:22
Tags:
Ortho Hand Surgery
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Description:
Anatomy and examination of the hand, wrist, forearm, and elbow
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  1. 7 basic maneuvers performed by the hand
    • 1. precision (terminal) pinch (e.g., picking up a pin)
    • 2. oppositional pinch (e.g., holding a paper)
    • 3. key pinch
    • 4. directional (chuck) grip (e.g., using a screwdriver)
    • 5. hook grip (e.g., lifting a suitcase)
    • 6. power grasp (e.g., holding a bat)
    • 7. span grasp (e.g., holding a ball)
  2. Precision (terminal) pinch
    • picking up a pin
    •  
  3. Oppositional pinch
    Holding a paper
  4. Key pinch
  5. Directional (chuck) grip
    • Using a screwdriver
    •  
  6. Hook grip
    • Lifting a suitcase
    •  
  7. Power grasp
    • Holding a bat
    •  
  8. Span grasp
    Holding a ball
  9. Which finger contributes to approximately 40% of hand function and is necessary for precision and power grip?
    Thumb
  10. The tendons with muscles originating proximal to the wrist are referred to as what?
    Extrinsic muscles
  11. The motor units with mucles originating within the hand are referred to as what?
    Intrinsic muscles
  12. The carpal tunnel contains the median nerve and what else?
    9 extrinsic flexor tendons
  13. Guyon's canal lies _____ to the carpal tunnel and contains what?
    • Ulnar
    • Ulnar nerve and artery
    •  
  14. From which joint does most of the thumb's ROM generate?
    Trapeziometacarpal (TM) joint
  15. The sensory innervation to the palmar surface of the hand is via which nerve(s)?
    Median and ulnar nerves
  16. The sensory innervation to the dorsal surface of the hand is via which nerve(s)?
    Radial and ulnar
  17. Which nerve innervates most of the intrinsic muscles?
    Ulnar nerve
  18. Which nerve controls thumb opposition by innervating the majority of the thenar muscles?
    Median nerve
  19. Which nerve(s) innervate the extrinsic extensor tendons to the thumb, fingers, and wrist? 
    Radial nerve and its posterior interosseous (PIN) branch
  20. The trochlea and capitellum of the distal humerus articulate with what surfaces to form the elbow?
    • Trochlea - Trochlear notch of the ulna
    • Capitellum - Radial head 
  21. How many axes of motion does the elbow have?
    One: flexion and extension
  22. Which carpal bones articulate with the distal radius? 
    • Scaphoid - scaphoid fossa
    • Lunate - lunate fossa 
  23. This carpal bone is a sesamoid bone within which tendon?
    • Pisiform
    • Flexor carpi ulnaris 
  24. The anatomic snuff box is between which dorsal compartments?
    1st and 3rd
  25. No tendons have a major inserion on the carpus other than the ________, which is where the _____ ____ _______ attaches.
    • Pisiform
    • Flexor carpi ulnaris (FCU) 
  26. Theses caprometacarpal joints have minimal motion & form the stable central ray of the hand.
    2nd and 3rd digit CMC joints
  27. These metacarpals are mobile and can flex and rotate toward the midline of the palm to enhance grip.
    4th and 5th MC joints
  28. Greater mobility is the reason that larger degrees of fracture malalignment can be tolerated with metacarpal neck fractures of these fingers as compared to these fingers.
    4th and 5th as compared to 2nd and 3rd. 
  29. Which ligament is the most important stabilizer of the thumb CMC joint? 
    • Palmar oblique ligament 
    •  
  30. This anatomical area gives origin to the extensor and flexor muscles of the wrist and hand and to the pronators and supinators of the forearm.
    The elbow
  31. The lateral epicondyle of the humerus gives origin to the _____ ________ ______ and to the origin of the _______ carpi ________ brevis.
    • Common extensor tendon (origin of the anconeus, extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum)
    • Extensor carpi radialis brevis 
  32. The medial epicondyle is the origin of the _____ ______ ______ and the humeral origin of the ______ _________ _____________.
    • Common flexor tendon (origin of the humeral head of the pronator teres, flexor carpi radialis, palmaris longus, and FCU)
    • Humeral origin of the flexor digitorum superficialis 
  33. The "mobile wad of three" help to initiate elbow extension. Name the muscles.
    • Extensor carpi radialis brevis (ECRB)
    • Extensor carpi radialis longus (ECRL)
    • Brachioradialis (BR)

    ECRL and ECRB also extend and radially deviate the wrist 
  34. What muscle is the primary extensor of the elbow?
    Triceps
  35. To test for the function of the supinator, test the patient's ability to supinate with the elbow ______, because the biceps can supinate the forearm with the elbow ________.
    • Flexed
    • Extended 
  36. This muscle pronates the forearm with the elbow extended. 
    This muscle pronates the forearm with the eblow flexed. 
    • Extended - Pronator teres
    • Flexed - Pronator quadratus 
  37. How many compartments are formed at the wrist as the extensor tendons pass under the extensor retinaculum?
    • Six
  38. This compartment is most commonly involved in tenosynovitis, which is commonly referred to as deQuervain's syndrome.
    • First compartment
    • EPB and APL
    • APL - abd and ext of the thumb at TMC joint
    • EPB - ext thumb MCP joint 
  39. This compartment contains the ECRL and the ECRB, which extend and radially deviate the wrist.
    Second compartment
  40. 3rd dorsal compartment: This muscle attaches to the base of the distal phalanx of the thumb and generates extension of the thumb IP joint. Only this muscle can cause true hyperextension of the IP joint. This muscle crosses those of the 2nd compartment and forms the anatomic snuff box along with the tendons of the 1st dorsal compartment.
    EPL
  41. 4th dorsal compartment: Extensor digitorum communis blends with the extensor hood of all 4 fingers. The extensor indicis proprius bleds with the extensor tendon of the index finger. Which muscle's tendon is on the ulnar side at the level of the MCP joint making it identifiable for tendon transfers?
    • EIP - extensor indicis proprius
    •  
  42. This muscle (in the 4th dorsal compartment) allows for independent index finger extension (at the IP joints), whereas this other muscle provides combined extension of all 4 digits at the IP joints.
    • EIP - extensor indicis proprius
    • EDC - extensor digitorum communis
  43. 5th dorsal compartment: These muscles allow for the independent extension of the small and index fingers, respectively (which is essential in forming the "hook 'em horns" sign). 
    • Extensor digiti minimi - 5th digit
    • Extensor indicis proprius - 2nd digit
  44. Sixth dorsal compartment: This muscle attaches on the ulnar side of the 5th digit metacarpal and causes wrist extension and ulnar deviation.
    ECU - extensor carpi ulnaris
  45. This dorsal compartment moves from dorsal, in supination, to palmar, in promation.
    6th dorsal compartment
  46. This is considered the most powerful wrist flexor and is innervated by which nerve?
    • Flexor carpi ulnaris
    • Ulnar nerve
  47. These are the only 3 flexor tendons that pass outside the carpal tunnel. 
    • Palmaris longus
    • Flexor carpi radialis
    • Flexor carpi ulnaris
    •  
  48. This muscle crosses the carpal tunnel as 4 tendons, with these 2 being superficial to the other 2.
    • Flexor digitorum superficialis
    • 34 > 25 - tendons to ring & middle finger superficial to tendons to index and small finger. 
  49. This muscle causes flexion of the PIP joints of the digits.
    Flexor digitorum superficialis
  50. This muscle causes flexion of the DIP joints.
    Flexor digitorum profundus
  51. This muscle is a single muscle to the middle, ring, and small fingers, which prevents it from independently flexing each digit.
    Flexor digiroum profundus
  52. Which nerve generally innervates the flexors of the forearm/wrist/hand?
    • Median nerve
    • Most powerful wrist flexor (FCU) is innervated by ulnar nerve. 
  53. This nerve is generally responsible for innervation of the extensor muscles.
    • Radial nerve 
    • or Posterior interosseous nerve (deep branch of radial nerve)
  54. Test the median nerve (sensory & motor).
    • Compress nerve in carpal tunnel to cause sensory deficit in the fingers. 
    • Motor: APB is examined by asking the pt to oppose the thumb to the small finger while palpating the muscle to determine if it contracts. 
  55. Test the ulnar nerve (sensory & motor).
    • Exclusively innervates the digital pad of the 5th digit. Test for sensory loss on the dorsum of the ulnar side of the hand to distinguish between an injury proximal or distal to the wrist.
    • Motor: thumb pinch strength - Froment's paper sign, abduct/adduct fingers, cross-finger test (3rd over 2nd) 
  56. Test the radial nerve (sensory & motor).
    • Sensation should be tested over the dorsum of the thumb-index web space.
    • Motor can be tested by asking the pt to extend the digits & thumb while extended the wrist.  

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