Farley's Review Session

• A patient has experienced a fall on their palm with a radially deviated hand. What bone is most likely to fracture?


  Scaphoid bone
• Carpal tunnel contents:

  Flexor digitorum profundus

  Flexor digitorum superficialis

  median nerve

  Flexor carpi radialis

  Flexor pollicis longus
• What are the motions at the mcp joint?

  flexion

  extension

  abduct/adduct
• What are the motions of the CMC joint at digit 1?

  flex/ext

  abd/add

  opposition/reposition
• Why is the hand so sensitive?

  Large region of the somatosensory cortex is devoted to sensation of the hand
• KNow sensory distribution of the hand

  Ulnar nerve-digit 5, 1/2 of 4

  Median nerve- digits 1,2,3, and palm

  Radial nerve- Lateral 1/2 of the dorsum of the hand
• This injury to the Ulnar nerve can be seen when patient tries to extend all the fingers, and digits 4/5 won't extend. This is due to paralysis of the lumbricals. 


  Claw hand
• Hyperextension at MCP joint and weakened extension at the IP joints is a sign of?

  claw hand
• Inability to flex index finger at the MCP and IP joints, due to loss of lateral lumbricals is a sign of?

  median nerve injury, or benediction hand
• This nerve injury can be seen when making a fist, can't flex thumb, index, or middle fingers.

  Median nerve, benediction hand
• Rheumatoid arthritis is more common in what sex? and what age?

  females

  30-50 years old
• In this deformity of the hand, the Wrists, MCP, and PIP joints are most

  commonly affected but the distal joint is spared?

  Rheumatoid arthritis
• Ulnar deviation of the MCPs are common in what deformity?

  Rheumatoid arthritis
• Seen mostly in those in their eighth decade, this case can be caused by obesity in younger individuals. 


  osteoarthritis
• A patient complains of pain within their hands during activity but no pain when resting their hand. Also complain of stiff joints wen not using their hand for a period of time, but with activity notice it loosens up. What could be the cause for this?

  osteoarthritis
• 3 muscles of the thenar eminence/compartment?

  Abductor pollicis brevis, Flexor pollicis brevis, Opponens pollicis
• Muscles of the thenar eminence are innervated by?

  recurrent median nerve
• Adductor compartment consists of what muscle? What is it innervated by?

  Muscle: Adductor pollicis (transverse and oblique heads)

  Nerve: Ulnar nerve (deep branch)
• Muscles of the hypothenar eminence?

  flexor digiti minimi brevis

  abductor digiti minimi

  opponens digiti minimi
• Hypothenar eminence/compartment is innervated by?

  ulnar nerve (deep branch)
• The compartment made up of the short muscles of the hand contains what muscles?

  lumbricals
• Lumbricals flexion digits 2-5 at the _ joint, and extend the digits at the _ joint?

  MCP joint

  IP joint
• Interosseous compartment consists of what muscles?

  4 dorsal interossei

  3 palmar interossei
• Interosseous compartment is innervated by?

  ulnar nerve (deep branch)
• What is the action of the dorsal interossei muscles?

  abduct digits 2 and 4
• Actions of the palmar interrosei?

  Adduct digits 2,4,5
• What nodes are at the DIP joints, and are affected by osteoarthritis?

  Herberden nodes
• What nodes are at the PIP joints, and are affected by osteoarthritis?

  Bouchard nodes
• Athlete comes into the clinic displaying hyperflexion at the DIP joint, what is this a sign of?

  Mallet finger
• An injury to the extensor hood of the distal phalanx can cause this deformity.

  mallet finger
• Patient states that they were playing basketball and went to catch the ball with an extended finger, but the ball hit the tip of their finger and forcibly flexed the DIP joint. What deformity is most likely to occur due to this?

  mallet finger
• Patient presents with additional PIP joint flexion, and DIP joint

  extension. This deformity is caused by an injury to the central slip

  insertion of the extensor hood.

  Boutonniere’s Deformity
• Patient presents with increased flexion at the DIP joint, and increased extension at the PIP joint. This deformity is caused by contracture of intrinsic hand muscles secondary to systemic diseases.

  Swan Neck deformity
• This deformity involves the first dorsal compartment of the wrist.

  gamer's thumb
• Patient presents with being unable to abduct or extend the thumb, pain when radially deviating, and has low-grade inflammation of the tenosynovial lining. What diagnosis would make sense for these signs? What muscles would be involved?

  De Quervain tenosynovitis.

  Muscles involved: Abductor pollicis longus, extensor pollicis brevis.
• The anatomical snuffbox consists of what 2 muscles?

  Extensor pollicis longus and extensor pollicis brevis
• Descending Trapezius Origin/Insertion

  Origin: Occipital bone and C1-C7 SP

  Insertion: Lateral 1/3 of clavicle
• Transverse Trapeizus Origin/Insertion

  Origin: T1-T4 SP, aponeurosis

  Insertion: Acromion process
• Ascending Trapezius Origin/Insertion

  Origin: T5-T12 SP

  INsertion: Scapular Spine
• The trapezius is innervated by?

  CN XI Accessory Nerve