CHT prep Exam Questions And Answers Graded A+!!!

Keinbock's disease - ANS Lunate AVN Preiser's Disease - ANS AVN of scaphoid Proximal scaphoid has less vasculature. Prox fx 6 wk immob. Scaphoid nonunion advanced collapse wrist may occur w scaphoid fx Lumbricals - ANS Moving origins Lumbricle 3&4: ulnar nerve Lumbricle 1&2: median nerve Opponens pollicis - ANS O: trapezium n transverse carpal lig Inserts along the body of the first metacarpal and rotates the thumb medially N: recurrent branch of median nerve Volar interossei - ANS Addicts the thumb, index, ring, small fingers Ulnar nerve Adductor pollicis - ANS Adducts thumb to palm, gives power for grasping, inserts into extensor mechanism to assist the IP joint of the thumb to O deg of ext Strongest intrinsic muscles Interossei - ANS Inserts on the medial or lateral aspects of the proximal phalanx into the lateral band of extensor mechanism Ulnar nerve innervation Abductor digiti minimi - ANS Increases span of grasp and assists w flexion of the 5th MCP joint Abductor pollicis brevis - ANS Originates from trapezium & transverse carpal ligaments and inserts on proximal phalanx & extensor mechanism of thumb helps extend IPJ to 0deg ext Palmaris brevis - ANS Wrinkles skin of ulnar side of palm Opponens digiti minimi - ANS Rotates n draws 5th MC anteriorly 1st dorsal interossei - ANS Assists with thumb adduction and plays a significant role in writing and typing MCP collateral ligament - ANS W MCP extension ligament is loose, w MCP flexion is tighten prevents lateral shift of digits during flexion Quadrangular space - ANS Bordered by teres minor superiorly, teres major inferiorly, humerus laterally, tricep medially, axillary nerve and posterior circumflex artery pass thru this Steindler procedure - ANS Flexor pronator muscle tendon transfer to promote elbow flexion. due to c5c6 brachial plexus injury. C6 quad. What tendon transfer may be used to restore elbow extension - ANS Biceps to tricep tendon transfer. Still have brachialis and supinators so bicep can be spared. Space of poireir - ANS Weakness from the absence of ligamentous support between capitate and lunate articulation. Bolar extrinsic ligaments for a V, lunate is able to dislocate w high velocity injury Extensor lag test - ANS Tests supraspinatus and infraspinatus. ER to near full then abd to 20deg, release if lag then supraspinatus tear Drop arm test - ANS Tests infraspinatus, ER near full then abd to 90 deg, release if lag then tear in infraspinatus Flexor digitorum profundus - ANS Small/ring : Ulnar nerve innervated. Flexor pollicis brevis - ANS Deep head innervated by ulnar nerve Oblique retinacular ligament - ANS Landsmeer's ligament, originates volar aspect of pp, inserts on extensor tendon dorsal axis of DIPJ, helps w PIP flex w DIP ext If contracted in extension DIP is unable to flex contributes to boutonniere def Swan neck deformity - ANS Boutonnière deformity - ANS Lacertus Fibrosus - ANS Bicepital apneurosis. Tendon from bicep brachii, tighten w pronation. Active flexion w pronation may contribute to compression of median nerve at LF Hook of hamate fracture - ANS Ulnar side pain w extension, ulnar deviation and flexion of small ring finger. Pain distal to pisiform. Commonly neg on xray. Common w racket sports, golf, baseball, using hand to close lids. Use ulnar gutter splint. Orif or excision Common flexor origin muscles - ANS Pronator teres, flexor carpi radialis/ulnaris, flexor digitorum superficialis, palmaris longus Arcade of Froshe - ANS Common impingement site for PIN (radial tunnel stndrome) Fibrous band that arises as a semi circular structure from tip of medial aspect of lateral epi. Located at proximal edge of supinator Cubital tunnel - ANS Roof is formed by acruate ligament of osborne and investing fascia of FCU Roof slacks w extension and tightens in flexion Ulnar nerve - ANS 1site of compression: as pierces medial intermuscular spetum at level of coracobrachialis mm. Nerve passes thru acrade of struthers to formally enter cubital tunnel. High ulnar N injury w intrinsic loss n 2ndary loss of 4 n 5 th FDP loss of 60-80% of grasp occurs Cubital tunnel syndrome: numbness in 4/5th digits, intrinsic weakness (1st webspace 1st dorsal int) and ulnar side pain Median nerve - ANS Enters forearm thru anticubital fossa innervating pronator teres, FCRL palmaris Longus, FDS,. Nerve bifurcates giving rise to anterior interosseous nerve innervating flexor pollicis longus n flexor digitorum profundus(2/3) index n long. And pronator quadratus. Terminal ain is carpal sensory branch. Main brach enters hand thru carpal tunnel innervating Abd PB, OP, FPB, lumbricle 1/2 index middle Carpal tunnel: nocturnal pain Pronator syndrome: no muscle weakness. Pain n parathesia in forearm, thumb, index Splint in neutral wrist w 2deg flexion and 3 def ulnar dev Lumbricles occupy carpal tunnel w finger flexion, mcpj block at 20-40 deg will decrease pressure of lumbricle sin carpal tummel and and decrease FDP excursion AIN syndrome: no parathesia only motor. Pain proximal volar forearm. Dif w fine motor Radial Nerve - ANS Tricep, anconeus, brachradialis, ECRL. Then EVRB. Bifurcates into sensory and PIN: supinator, ED,EDM, ECU, Abd PL, EPL, EPB, EI. Compression: arcade of froshe covering supinator compression of PIN. Sensory nerve compression as it exits fascia adjacent to brachiradialis tendon Horners syndrome - ANS Occurs w loss of sympathetic ganglionic function after avulsion of T1 nerve root and is recognized by meiosis(papillary constriction), endophthalmas(insert orbit), ptosis(droppy eye lid), anhydrosis (dry eye) due to distuption of sympathetic outflow from and to the head and neck from sympathetic ganglion of T1 level Poland syndrome - ANS Aplsia of pec mj, brachydactyly, syndactyly of digits and hypoplasia of hand. Aperts syndrome - ANS Craniofacial deform n complex syndactyly hand n feet VACTERL syndrome - ANS Congenital malformation involving radial deficiency and other anomalies. Posterior interosseus nerve - ANS Radial nerve innervates flexor carpi radi longus then bifurcates at level of FCRL becoming PIN and sensory nerve. Innervation: ECRB, ECU EDC EIP EPL EDM APL EPB, LOSS OF FUNCTION: radial wrist ext and inability to extend MCP & retropulse thumb. PIN patient will present motor abnormalities. No sensory innervation however provides proprioception to wrist, runs along 4th dorsal compartment terminally Resisted supination increase pain At risk w volar and dorsal surgery Anterior interosseus nerve - ANS From median nerve. Injury: motor deficits only. Innervates FDP of index, FPL, pronator quadratus. Impinged by deep head of pronator teres. Test: unable to make OK sign, weak grip. Pain w writing picking up small objects. Syndrome: most often w trauma or slow progression w pain. Consider parsonage-turner syndrome as differential diagnosis. Not sensory, motor only At risk w volar surgical approach to stabilize radius fx Pinch make an O test Radial tunnel syndrome - ANS Tenderness distal to lat epi. Worse following pronation n wrist flexion Compression of PIN with pain only, no motor or sensory deficits Long finger test, supinator resist w elbow and wrist extended, passive pronation w wrist flexion Lat epi - ANS Pain w resisted wrist extension Long thoracic nerve injury symptoms - ANS Dull ache or pain around the shoulder, winging of scapula, decreased active shoulder motion. Winging of scap is painless. Nerve originates from ventral rami of C5-7 travels beneath brachial plexus and clavicle over first rib Can be injured w blow to chest wall or shoulder or prolonged stretch on shoulder