CHT Exam Megan Revised Actual Exam
Questions and Answers
Ulnar nerve - order of innervation FCU - FDP (ring & small) - medial
cutaneous branch - ADM - ODM - FDM - ulnar lumbricals - palmar & dorsal
interossei - FPB (deep) - adductor pollicis
Radial nerve - order of innervation Triceps - anconeus - BR - ECRL - ECRB
(1/2 RN & 1/2 PIN) - PIN: supinator - EDC - EDM - ECU - APL - EPL - EPB -
EIP
Median nerve - order of innervation PT - FCR - PL - FDS (index thru small)
- AIN: FDP (index & middle) - FPL - PQ; palmar cutaneous branch - under
flexor retinaculum: APB - OP - FPB (superficial) - radial lumbricals
Order of sensory return Pain and Temperature
30 Hz Vibration
Moving Touch
Constant Touch
256 Hz Vibration
Touch Localization
Two Point Discrimination
Stereognosis
Steindler procedure Flexor pronator muscle-tendon transfer to promote
elbow flexion s/p C5/C6 BPI.
"Steindler.. which way to the beach?"
Quadrangular space Axillary nerve and posterior circumflex humeral artery
,Quadrigia phenomenon Flexion contracture of involved digit as well as
limited flexion of adjacent digits; results if FDP advanced >1cm during repair
(limits proximal excursion of other FDP tendons)
Egawa's Sign Ability to flex the LF, but cannot RD/UD; interosseous
paralysis (UN out)
(Egawa has road rage )
Guyon's canal Contains UN and UA; borders of canal are hook of hamate
& pisiform
*common UN pathology with cyclists
Anatomical snuffbox Borders are EPL dorsally & APL/EPB volarly; can
palpate the scaphoid
*radial artery passes through here
DISI deformity S-L injury - lunate extends Dorsally with the triquetrum;
dorsal S-L ligament is the strongest and vital for normal kinematics
VISI deformity L-T injury - lunate flexes Volarly with the scaphoid
PIP flexion contractures: structures involved Check rein ligaments, volar
plate, collateral ligament
Extensor tendon compartments 1. APL/EPB
2. ECRL/ECRB
3. EPL
,4. EDC/EIP
5. EDM (5th digit)
6. ECU
Acute compartment syndrome: causes & symptoms Causes: crush,
thermal/electrical burns
Symptoms: pain, paresthesias, paralysis, pulselessness (4 P's)
Often intrinsic minus hand
Increasing pressure = necrosis
Martin-Gruber anastomosis MN/UN connection in the FA; intrinsic muscles
can be innervated by MN in case of UN injury
- RF/SF FDP out
Riche-Cannieu anastomosis Occurs in palm - communicating branch
between deep branch of UN and recurrent branch of MN in thenar eminence
Berretini anastomosis Connection between UN/MN common digital nerves
"Bear claw - rawr"
Medial collateral ligament (MCL): anterior oblique bundle Medial
epicondyle to coronoid
Greatest constraint to valgus when elbow at 30-90 degrees
Injured in baseball pitchers
, Medial collateral ligament (MCL): posterior oblique bundle Medial
epicondyle to coronoid (below AOL)
Greatest constraint to valgus with elbow flexion > 90 degrees
Medial collateral ligament (MCL): transverse bundle Below AOL and POL;
functionally insignificant to valgus restraint
Bouvier test Tests if PIPJ and extensor mechanism is working
Place MP in slight flexion and see if IP's extend
Adson's Test Monitor pt's radial pulse with arm extended; pt. asked to
breathe in and tilt head towards ipsilateral arm
(+) Test = severely DEC/absent radial pulse
*indicates compression between anterior & middle scalene of the
neurovascular bundle
Finochietto-Bunnel Test Checks intrinsic tightness - MP hyperextended:
PIPJ tighter than with MP flexed
Brachial artery The major vessel in the upper extremity that supplies
blood to the arm; splits into the radial and ulnar arteries at the antecubital
fossa
Signs of arterial insufficiency Color (pale; worsened by elevation of
extremity; dusky red when extremity is lowered)
Temperature (cool, blood flow blocked to extremity)
Questions and Answers
Ulnar nerve - order of innervation FCU - FDP (ring & small) - medial
cutaneous branch - ADM - ODM - FDM - ulnar lumbricals - palmar & dorsal
interossei - FPB (deep) - adductor pollicis
Radial nerve - order of innervation Triceps - anconeus - BR - ECRL - ECRB
(1/2 RN & 1/2 PIN) - PIN: supinator - EDC - EDM - ECU - APL - EPL - EPB -
EIP
Median nerve - order of innervation PT - FCR - PL - FDS (index thru small)
- AIN: FDP (index & middle) - FPL - PQ; palmar cutaneous branch - under
flexor retinaculum: APB - OP - FPB (superficial) - radial lumbricals
Order of sensory return Pain and Temperature
30 Hz Vibration
Moving Touch
Constant Touch
256 Hz Vibration
Touch Localization
Two Point Discrimination
Stereognosis
Steindler procedure Flexor pronator muscle-tendon transfer to promote
elbow flexion s/p C5/C6 BPI.
"Steindler.. which way to the beach?"
Quadrangular space Axillary nerve and posterior circumflex humeral artery
,Quadrigia phenomenon Flexion contracture of involved digit as well as
limited flexion of adjacent digits; results if FDP advanced >1cm during repair
(limits proximal excursion of other FDP tendons)
Egawa's Sign Ability to flex the LF, but cannot RD/UD; interosseous
paralysis (UN out)
(Egawa has road rage )
Guyon's canal Contains UN and UA; borders of canal are hook of hamate
& pisiform
*common UN pathology with cyclists
Anatomical snuffbox Borders are EPL dorsally & APL/EPB volarly; can
palpate the scaphoid
*radial artery passes through here
DISI deformity S-L injury - lunate extends Dorsally with the triquetrum;
dorsal S-L ligament is the strongest and vital for normal kinematics
VISI deformity L-T injury - lunate flexes Volarly with the scaphoid
PIP flexion contractures: structures involved Check rein ligaments, volar
plate, collateral ligament
Extensor tendon compartments 1. APL/EPB
2. ECRL/ECRB
3. EPL
,4. EDC/EIP
5. EDM (5th digit)
6. ECU
Acute compartment syndrome: causes & symptoms Causes: crush,
thermal/electrical burns
Symptoms: pain, paresthesias, paralysis, pulselessness (4 P's)
Often intrinsic minus hand
Increasing pressure = necrosis
Martin-Gruber anastomosis MN/UN connection in the FA; intrinsic muscles
can be innervated by MN in case of UN injury
- RF/SF FDP out
Riche-Cannieu anastomosis Occurs in palm - communicating branch
between deep branch of UN and recurrent branch of MN in thenar eminence
Berretini anastomosis Connection between UN/MN common digital nerves
"Bear claw - rawr"
Medial collateral ligament (MCL): anterior oblique bundle Medial
epicondyle to coronoid
Greatest constraint to valgus when elbow at 30-90 degrees
Injured in baseball pitchers
, Medial collateral ligament (MCL): posterior oblique bundle Medial
epicondyle to coronoid (below AOL)
Greatest constraint to valgus with elbow flexion > 90 degrees
Medial collateral ligament (MCL): transverse bundle Below AOL and POL;
functionally insignificant to valgus restraint
Bouvier test Tests if PIPJ and extensor mechanism is working
Place MP in slight flexion and see if IP's extend
Adson's Test Monitor pt's radial pulse with arm extended; pt. asked to
breathe in and tilt head towards ipsilateral arm
(+) Test = severely DEC/absent radial pulse
*indicates compression between anterior & middle scalene of the
neurovascular bundle
Finochietto-Bunnel Test Checks intrinsic tightness - MP hyperextended:
PIPJ tighter than with MP flexed
Brachial artery The major vessel in the upper extremity that supplies
blood to the arm; splits into the radial and ulnar arteries at the antecubital
fossa
Signs of arterial insufficiency Color (pale; worsened by elevation of
extremity; dusky red when extremity is lowered)
Temperature (cool, blood flow blocked to extremity)
