Biomechanics - Wrist/Hand Questions

A physical therapist performs a goniometric measurement of the wrist on a patient with carpal tunnel syndrome. Which value would be the MOST anticipated assuming the patient has a normal wrist ROM for radial deivations?

0-20 degrees

How many degrees of freedom are present at the thumb carpometacarpal joint?

2 degrees

Which of the following degrees represents the functional position of the wrist and hand?

20 degrees wrist extension, 10 degrees ulnar deviation, 45 degrees metacarpophalangeal (MCP) flexion, 30 degrees proximal interphalangeal (PIP), slight distal interphalangeal flexion

Which of the following degrees best represents the functional position of the wrist?

30 degrees wrist extension, 10 degrees ulnar deviation

Which best describes the kinematics of the medial wrist compartment of the midcarpal joint?

A convex distal segment articulates with a concave proximal segment. Assuming distal on proximal motion the arthrokinematics occur as a roll and slide in opposite directions

Which movements of carpometacarpal joint of the thumb constitute opposition?

Abduction, flexion, medial rotation

Which of the following statements BEST describes hand mobility that allows greater closure of the hand?

Available joint range of motion increases from radial to ulnar aspects of the hand, starting at the second ray

Supination of the hand and forearm would be diminished by loss of radial nerve function. But one very powerful supinator would remain intact and unaffected, namely:

Biceps brachii

Interruption of the median nerve in the cubital fossa affects what movement(s) of the thumb?

Both

Structures within the carpal tunnel include the:

Both

After falling on the ice, it was determined that a patient had a Colles' fracture. Care must be taken to relieve tension on the broken distal end of the radius created by the pull of which muscle?

Brachioradialis

Which carpal is the origin of the medial lateral axis and anterior posterior axis of rotation in the wrist?

Capitate

Bleeding from a superficial cut in the middle of the palm of the hand near the proximal transverse crease comes mainly from what vessel?

Superficial palmar arch

In a car accident, glass slashed the ventral side of the wrist, the two tendons of the flexor digitorum superficialis located most superficially were completely severed. What movement would be affected?

Flexion of the PIP joints of digits 3 and 4

If the tendon of palmaris longus were transected, what movement would be affected?

Flexion of the wrist

Which of the following identifies the relative mobility permitted at the distal and proximal transverse arch?

Mobility of the proximal traverse arch is slight, whereas the mobility of the distal transverse arch is extension

A patient sustained multiple deep lacerations on the palm of his hand and anterior surface of his wrist. During examination, the physician put a piece of paper between adjacent surfaces of the patient's index and middle fingers and found him unable to squeeze them together with sufficient force to hold the paper. The most specific nerve branch to these muscles is the:

Deep branch of the ulnar nerve

What arterial vessel accompanies the deep branch of the ulnar nerve across the palm?

Deep palmar arterial arch

After suffering a cut deep to the hypothenar eminence, the patient is unable to hold a sheet of paper between the second and third digits. The nerve most likely injured was the:

Deep ulnar

Which of the following structures comprise the radiocarpal joint?

Distal radius, articular disc, scaphoid, lunate

A 20 year old football player with a 1-week history of right index finger pain which started after his hand got caught in a facemask during a tackle. Physical exam shows swelling of the digit with no breaks in the skin and no active flexion. AP, lateral, and oblique radiographs reveal no fractures (DIP slide posteriorly). Which of the following structures most often prevents this injury?

Dorsal capsule

A person has 85 degrees of right wrist flexion, 45 degrees of extension, and 21 degrees of ulnar and radial deviation. Which directions of motion are limited for this person compared with the average norms?

Extension, ulnar deviation

Which of the following muscles stabilize the wrist during a powerful grip by the hand?

Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris

The extensor expansion of the ring finger receives tendons from all of the following EXCEPT:

Extensor carpi ulnaris

While watching her boyfriend split wood, a teenager was struck on the back of her carpals by a sharp- edged flying wedge. Her extensor digitorum tendons were exposed, though not severed, indicating that the surrounding synovial sheath had been opened. What other muscle has its tendon surrounded by the same synovial sheath?

Extensor indicis

In order to check the pulse of a child whose forearm is in a cast, the pediatrician presses her finger into the depth of the "anatomical snuffbox". The tendon lying immediately medial (ulnar) to the physician's finger belongs to what muscle?

Extensor pollicis longus

Which of the following structures pass through the carpal tunnel?

Finger flexor tendons, median nerve

What movement of the thumb would be most affected by lesion of the median nerve in the cubital fossa:

Flexion

Which of the following statements BEST describes the thumb carpometacarpal joint motions?

Flexion/extension of the 1st CMC joint occurs in the frontal plane whereas the abduction/adduction occurs in the sagittal plane

The pulse of the radial artery at the wrist is felt immediately lateral to which tendon?

Flexor carpi radialis

If the medial epicondyle of the humerus is fractured and the nerve passing dorsal to it is injured, which muscle would be most affected?

Flexor carpi ulnaris

What muscle is innervated by branches of both the median and ulnar nerves?

Flexor digitorum profundus

What muscle is supplied by both the median and ulnar nerves?

Flexor digitorum profundus

Compression of the median nerve in the carpal tunnel affects which hand muscle(s)?

Flexor pollicis brevis

In carpal tunnel syndrome, compression of the median nerve in the carpal tunnel affects which hand muscle?

Flexor pollicis brevis

What muscle tendon is enclosed within its own synovial sheath in the carpal canal?

Flexor pollicis longus

The function of the triangular fibrocartilage complex includes all of the following EXCEPT?

Helps form the convex nature of the distal radioulnar joint

A worker doing repetitive lifting develops an inflammation in the tendon of origin of the extensor carpi radialis brevis muscle, commonly called "tennis elbow". The focal point of pain would most likely be near which palpable bony landmark?

Lateral epicondyle of humerus

When falling on an outstretched hand, the most commonly dislocated carpal bone is the

Lunate

During an industrial accident, a sheet metal worker lacerates the anterior surface of his wrist at the junction of his wrist and hand. Examination reveals no loss of hand function, but the skin on the thumb side of his palm is numb. Branches of which nerve must have been severed?

Median

The anterior interosseous is a branch of which nerve?

Median

A healthy 28 year old women at 30 gestational age, has gained 35 lbs since becoming pregnant. She complains of several weeks of bilateral numbness and tingling of her palms, thumbs, index, and middle fingers which is worse at night. She also notes weakness in gripping objects at the office. Which nerve is most likely affected?

Median nerve

The signs and symptoms of carpal tunnel syndrome may vary among patients, but they always result from compression of what structure in the carpal canal?

Median nerve

The point of insertion of the flexor digitorum superficialis tendon to the index finger is on the:

Middle phalanx

What is the influence of the medial tilt of the radial styloid process on movement of the wrist?

Movement through a larger range of ulnar deviation compared with radial deviation

A girl playing softball cuts the palm of her hand as she scoops up a piece of glass along with the ball. If the only nerve damaged is the recurrent branch of the median nerve, she would lose what movement of the thumb?

Opposition

In order to evaluate the carpal-metacarpal joint of the thumb, the median nerve must be deadened at the wrist (causing paralysis of the muscles supplied by it distal to the injection) to test the joint. Which movement of the thumb would be most affected by the anesthetic?

Opposition

Which joint(s) of the hand has the check-rein ligaments?

PIP

Which extrinsic ligament(s) resist an ulnar translocation of the carpals as a unit relative to the radius?

Palmer and dorsal radiocarpal ligaments

What sesamoid bone develops in the tendon of flexor carpi ulnaris and is therefore not a part of the wrist joint?

Pisiform

Fractures to what aspect of the scaphoid bone is most at risk for avascular necrosis?

Proximal pole

The main source of blood to the superficial palmar arterial arch is the:

Radial artery

Structures within the carpal tunnel include:

Radial bursa

What are the arthrokinematics of the first metacarpal during carpometacarpal abduction?

Rolls and slides anteriorly

Which of the following carpals are located in the floor of the anatomical snuff box?

Scaphoid, trapezium

A patient sustained multiple deep lacerations on the palm of his hand and anterior surface of his wrist. During examination, the physician put a piece of paper between adjacent surfaces of the patient's index and middle fingers and found him unable to squeeze them together with sufficient force to hold the paper. What muscles are being tested?

Second dorsal and first palmar interosseous muscles

A 42 year old man presents to your office with thumb pain after sustaining a fall. His radiograph demonstrates a fracture to the beak of his 1st metacarpal (Bennet fracture). Which structure(s) is responsible for keeping the small fracture fragment connect to the trapezium?

The anterior oblique

Which of the following describes best categories the articulating surface of the base of the 1st metacarpal?

The longitudinal diameter of the base of the 1st metacarpal is concave and the transverse diameter is convex

A physical therapist is palpating the metacarpals of a patient that punches a filing cabinet in the fit of rage while at work. What aspect of the metacarpal is most susceptible to fracture and when palpated would elicit a pain response?

The neck

Which of the following statements is MOST correct about the longitudinal arch of the hand?

The second and third metacarpals are central pillars, and the thumb and fourth and fifth digits move around them

A physical therapist is using the external anatomy of the palmar creases to guide their palpation of deeper structures. What statement best describes the palmer crease the associated deeper structure(s)?

The transverse carpal ligament is deep to the distal wrist crease

Which of the carpometacarpal joints is the most stable functioning as the central pillar of the hand?

Third

Which rank order best describes the passive mobility of the carpometacarpal joints of the hand from least to most?

Third, second, fourth, fifth, thumb

In an industrial accident, the artery passing lateral to the pisiform bone is cut. This artery is the

Ulnar

A deep puncture wound in the palmar surface of the little finger near the proximal IP joint might introduce infection into which synovial cavity:

Ulnar bursa

What motion is produced when extensor carpi ulnaris and flexor carpi ulnaris are activated together?

Ulnar deviation

Which of the following maximally stretches the extensor carpi radialis longus?

Wrist flexion, ulnar deviation, forearm pronation

A person carrying a soft drink in their right hand slipped on some ice and the bottle broke in their hand. A shard (jagged piece) of glass entered the hand and severed all of the tissue from the skin down to the metacarpal bone. The cut extended on the lateral side of the index finger, following the proximal transverse crease, clear to the proximal portion of the head of the second metacarpal bone. It did not extend over the third metacarpal. The clinical manifestations were as follows: 1. The subject could not flex any part of the index finger 2. The subject had trouble abducting and adducting the index finger 3. The subject had total anesthesia on the palmar side of the index finger and the dorsal side of the distal part of the same digit 4. There was considerable bleeding from severed vessels Repair proceeded and required six hours of surgery. Which of the following nerves was most likely cut?

common palmar digital branches of the median nerve

The fourth dorsal interosseous muscle is innervated by the:

deep branch of the ulnar nerve

While going up for a rebound, a basketball player jams her middle finger against the ball. She experiences severe pain and the trainer notes that she can no longer extend the distal phalanx of the finger. The injury has avulsed (torn away from the bone) which structure from her distal phalanx to produce this condition?

extensor expansion

The tendons on the dorsal side of the wrist are held in place by a thickening of the antebrachial fascia called the:

extensor retinaculum

A boy fell onto a sharp object and cut his deep radial nerve as it emerged from the supinator muscle. The artery joining it at this point was also injured. The injured artery is the:

posterior interosseous

A person carrying a soft drink in their right hand slipped on some ice and the bottle broke in their hand. A shard (jagged piece) of glass entered the hand and severed all of the tissue from the skin down to the metacarpal bone. The cut extended on the lateral side of the index finger, following the proximal transverse crease, clear to the proximal portion of the head of the second metacarpal bone. It did not extend over the third metacarpal. The clinical manifestations were as follows: 1. The subject could not flex any part of the index finger 2. The subject had trouble abducting and adducting the index finger 3. The subject had total anesthesia on the palmar side of the index finger and the dorsal side of the distal part of the same digit 4. There was considerable bleeding from severed vessels Repair proceeded and required six hours of surgery. The excessive bleeding most likely came from which of the following arteries?

radialis indicis artery

A patient is severely limited in extension at the wrist joint after several months in a cast following a Colles fracture. Which joint would be especially important in therapy to regain full extension?

radiocarpal

A student is rollerblading, while trying to avoid a bicyclist, he trip and falls heavily on his right wrist. After the fall he notes severe pain in the anatomical snuff box. Radiological studies reveal a fracture of the bone deep to the snuff box called the

scaphoid.

The function of the posterior interosseous nerve is:

sensory from the wrist joint

A person carrying a soft drink in their right hand slipped on some ice and the bottle broke in their hand. A shard (jagged piece) of glass entered the hand and severed all of the tissue from the skin down to the metacarpal bone. The cut extended on the lateral side of the index finger, following the proximal transverse crease, clear to the proximal portion of the head of the second metacarpal bone. It did not extend over the third metacarpal. The clinical manifestations were as follows: 1. The subject could not flex any part of the index finger 2. The subject had trouble abducting and adducting the index finger 3. The subject had total anesthesia on the palmar side of the index finger and the dorsal side of the distal part of the same digit 4. There was considerable bleeding from severed vessels Repair proceeded and required six hours of surgery. Which of the following muscle tendons was NOT involved?

the second palmar interosseous muscle