Wrist and Hand

1. Concerning the palmar spaces

a. The hypothenar space contains the long flexor tendons to the 5th digit –
midplamar space contains the lond tendons
b. The septum from the radial border of the palmar aponeurosis attaches to the
2nd metacarpal – 3rd
c. The thenar space is bounded posteriorly by adductor pollicis – adductor pollicis
is deep to the thenar in the adductor compartment, with the thenar space
between
d. The midpalmar space is continuous proximally with anterior compartment of
the forearm <= correct, via the carpal tunnel
e. All of the above

2. Regarding flexion of the fingers

a. Flexor digitorum superficialis inserts at the base of the distal phalanx - middle
b. Flexor digitorum profundus enters the fibrous sheath superficial to the flexor
digitorum superficialis tendon - deep
c. When palmar and dorsal interossei contract together, flexion of the
metacarpophalangeal joints results <=
d. The lumbricals are attached to the extensor expansions and to the proximal
phalanges – no boney attachment, lateral 2 are unipennate, from FDP to extensor
expansion
e. In the flexor sheath, the tendons of flexor digitorum profundus and flexor
digitorum superficialis are invested by separate synovial sheaths – common, FPL
is exception

3. Concerning the blood supply of the hand

a. The radial artery crosses the anatomical snuffbox over trapezoid – scaphoid
and trapezium
b. The superficial palmar arch is a direct continuation of the radial artery - ulna
c. The superficial palmar arch is usually a complete arch <- true
d. The superficial palmar arch supplies the thumb – no, gives off 3 common digital
that anastomose with the palmar metacarpal arteries to digital arteries, the
thumb is from preceps pollicis from the deep palmar arch from the radial
e. The radial artery gives off the radialis indicis artery and the princeps pollicis
artery <= correct

4. Regarding tendons across the wrist

a. Flexor carpi ulnaris passes deep to the flexor retinaculum – no attaches to the
pisiform (and thus to hook of hamate and base of 5th
b. Extensor carpi radialis brevis inserts into the base of the 3rd metacarpal <=
correct
c. Flexor digitorum profundus tendons insert into the base of the proximal
phalanx - distal
d. Extensor carpi radialis longus passes through the carpal tunnel - extensor
e. Flexor carpi radialis lies superficial to the flexor retinaculum – all flexors
beneath
5. Movements of the thumb include
a. Radial abduction by abductor pollicis brevis and extensor pollicis brevis
b. Opposition by opponens pollicis <=
c. Palmar abduction by abductor pollicis longus
d. Adduction by flexor pollicis longus
e. Opposition is not important in the power grip

6. The anatomical snuffbox

a. Has the extensor pollicis longus on its ulnar side <= and EPB w/ AbdPL on
radial side
b. Lies between extensor pollicis longus and abductor pollicis longus – true, but
EPB also
c. Has the trapezoid palpable in its base – radial styloid, scaphoid, trapezium and
base of 1st MC
d. Is most obvious with the thumb fully abducted - extended
e. Contains the posterior interosseous artery – radial

7. The flexor retinaculum attaches to all of the following bones except

a. Scaphoid
b. Hamate
c. Trapezium
d. Pisiform
e. Capitate <=

8. Compression of structures in the carpal tunnel usually results in

a. Weakness of forearm flexors
b. Weakness of flexion of the terminal phalanx of the thumb – FPL is a forearm
muscle
c. Weakness of the interossei muscles – deep branch ulnar
d. Unaffected sensation on the palmar surface of the little finger <= ulnar
distribution
e. Weakness of all the lumbrical muscles – medial 2

9. With respect to the thenar muscles

a. Abductor pollicis brevis inserts into the base of the distal phalanx of the thumb
– prox phalanx
b. All arise from the flexor retinaculum <= depends if you count adductor pollicis
c. Flexor pollicis is usually supplied by a branch from the ulnar nerve – usually
median (recurrent muscular)
d. Abductor pollicis brevis has no role in opposition of the thumb - helps
e. Opponens pollicis is the most superficial muscle of the group – deep to FPB
(it’s in the web)

10. With respect to the flexor retinaculum

a. It attaches to the scaphoid, hamate, pisiform and trapezium <=
b. The tendons of palmaris longus passes deep to it – inserts into it
c. The median nerve passes superficial to it – deep (but is shallow)
d. The ulnar artery passes deep to it – in own canal of Guyon
e. It is pierced by the tendon of flexor carpi ulnaris
11. In the hand, the deep palmar arch
a. Is normally incomplete
b. Is formed by the superficial branch of the ulnar artery – dorsal branch of the
radial
c. Crosses the palm 1cm distal to the superficial arch – proximal
d. Gives off 3 metacarpal arteries <= correct
e. Does not anastomose with the anterior carpal arch – does via the metacarpals
-> common digitals

12. Regarding digital nerves

a. Common digital nerves lie superficial to the superficial arch
b. Palmar nerves only supply palmar surface
c. Digital nerves are only sensory <=
d. Digital nerve lie posterior to digital artery – palmar to dorsal: NAV
e. ?

13. Regarding the interossei of the hand, which is INCORRECT

a. Insert into proximal phalanx
b. Insert into the dorsal expansion
c. When act together, the dominant action is adduction <=
d. When act together, flex the MCP joint
e. ?

14. With regard to the deep spaces of the hand the following are correct EXCEPT:
a. The thenar space always contains the first lumbrical muscle – lumbricals in the
central compartment w/ long flexors, superficial arch, digital nerves and vessels
b. The thenar space is overlaid by the flexor tendons to the index finger
c. Infection in the midpalmar space can involve the ulnar three lumbricals
d. The hypothenar space encloses only the hypothenar muscles <= pg 773
e. The thenar space contains the common flexor sheath

15. Regarding the carpal tunnel

a. Flexor pollicis longus has its own synovial sheath <=
b. The flexor retinaculum is attached to the scaphoid, trapezium, hamate and
triquetrum
c. The median nerve lies medial to flexor digitorum superficialis - lateral
d. Median nerve compression causes paraesthesia of the thenar eminence – no,
the palmar cutaneous branch comes off proximally
e. Palmaris longus runs lateral to the median nerve – inserts into the retinaculum

16. The palmar carpal arch

a. Supplies the skin of the digits
b. Supplies the skin of the thumb
c. Does not anastomose radial and ulnar arteries
d. Is deep to the long flexor tendons <=
e. Is level with the metacarpal bases

17. Regarding the small muscles of the hand

a. Thenar eminence muscles are supplied mainly by C8 <=
b. Abductor pollicis brevis causes radial abduction
c. Lumbricals are supplied by the ulnar nerve only
d. Palmar and dorsal interossei cancel the effect of each other out, when acting
simultaneously
e. Flexor pollicis brevis is inserted into the base of the distal phalanx

18. The following muscles are involved in ulnar and transpalmar adduction of the
thumb
a. Flexor pollicis brevis and flexor pollicis longus
b. Opponens pollicis and adductor pollicis
c. Flexor pollicis longus and opponens pollicis
d. Adductor policis and flexor pollicis breviss <= i.e. flexion and adduction
e. Opponens pollicis and abductor pollicis brevis

19. The carpal tunnel

a. Has four separate superficial flexor tendons that lie in two rows <=
b. Has eight superficial tendons which share a common synovial sheath that
completely invests them
c. Contains the ulnar nerve
d. Is a shallow concave fibro-osseous canal
e. has tendon flexor pollicis longus with a shared synovial sheath

20. The deep space of the hand

a. Is composed of hypothenar and thenar spaces alone
b. Is continuous between midpalmar space and lumbrical canal
c. Is superficial to the palmar aponeurosis
d. Is an open space with no dividing septa
e. Can be divided by margins that are clearly defined

21. The radial artery in the palm

a. Passes between the two heads of opponens pollicis
b. Has the deep branch of the ulnar nerve in its concavity
c. Gives off the princeps pollicis artery to the index finger
d. Runs across the palm distal to the superficial palmar arch
e. Is usually continuous with the ulnar artery via the deep palmar arch <=

22. The lumbricals

a. Are attached to the flexor expansion
b. Have no bony attachment <=
c. Flex the proximal interphalangeal joint
d. Are all supplied by the ulnar nerve
e. Oppose the action of the interossei

23. Interossei
a. Arise from flexor retinaculum
b. Palmar cause abduction
c. Palmar have two heads of origin
d. Innervated by deep branch of the ulnar nerve <=
e. Combined palmar and dorsal causes abduction

24. Palmar interossei

a. ?
b. have two heads
c. abduct the fingers
d. chiefly responsible for flexion at MCP and extension at PIP joints <=
e. ?

25. Midpalmar space

a. ?
b. extends into lumbrical canals distally
c. ?
d. is continuous with common carpal space
e. extends proximally to the origin of FDS <=

26. In relation to the movement of the thumb

a. Abductor pollicis brevis is inserted into the ulnar side of the base of the
proximal phalanx
b. Thenar eminence is supplied by the muscular (remnant) branch of the median
nerve <=
c. Adduction is by adductor pollicis brevis and longus – there is only one,
adductor pollicis
d. Opponens pollicis rotates the 1st metacarpal on the triquetral - trapezium
e. Opponens pollicis inserts to the base of the proximal phalanx – base of 1 st MC

27. Regarding the carpal tunnel

a. The flexor pollicis longus has its own synovial sheath <=
b. The flexor retinaculum is attached to the scaphoid, trapezium, hamate and
triquetral
c. The median nerve lies medial to flexor digitorum superficialis
d. Median nerve compression causes paraesthesia of the thenar eminence
e. Palmaris longus runs lateral to the median nerve

28. The radial artery

a. Is lateral to the biceps tendon in the cubital fossa
b. Can be palpated in the floor of the anatomical snuffbox <=
c. Disappears between the tendons of abductor pollicis longus and extensor
pollicis brevis
d. Is rarely thrombosed during cannulation
e. In the middle 1/3 of its course has the radial n. medial to it

29. The palmar carpal arch

a. Supplies the skin of the digits
b. Supplies the skin of the thumb
c. Does not anastomose radial and ulnar arteries
d. Is deep to the long flexor tendons <=
e. Is level with the metacarpal base

30. Regarding small muscles of the hand

a. Thenar eminence muscles are supplied mainly by C8 <=
b. Abductor pollicis brevis causes radial abduction
c. Lumbricals are supplied by ulnar nerve only
d. Palmar and dorsal interossei cancel the effect of each other out when acting
simultaneously
e. Flexor pollicis brevis is inserted into the base of the distal phalanx

31. The following muscles are involved in ulnar and transpalmar adduction of the
thumb
a. Flexor pollicis brevis and flexor pollicis longus
b. Opponens pollicis and adductor pollicis
c. Flexor pollicis longus and opponens pollicis
d. Adductor pollicis and flexor pollicis brevis
e. Opponens pollicis and abductor pollicis brevis

32. The carpal tunnel

a. Has 4 separate superficial flexor tendons that lie in 2 rows <=
b. Has 8 superficial tendons which share a common synovial sheath that
completely invests them
c. Contains the ulnar nerve
d. Is a shallow concave fibro-osseous canal
e. Has tendon flexor pollicis longus with a shared synovial sheath

33. Regarding the wrist joint

a. It is supplied by the ulnar nerve <=
b. The capitate is involved in the articulation
c. It is a synovial hinge joint
d. The majority of flexion occurs at the midcarpal joint
e. Abduction is by flexor carpi ulnaris

34. The deep space of the hand

a. Is composed of thenar and hypothenar spaces alone
b. Is continuous between midpalmar space and lumbrical canal
c. Is superficial to the palmar aponeurosis
d. Is an open space with no dividing septa
e. Can be divided by margins that are clearly defined
35. Concerning the wrist joint
a. The distal radius is not part of the joint
b. The joint capsule is thicker posteriorly
c. The triquetral bone forms part of the wrist joint <= correct, the proximal
carpals except pisiform
d. It usually communicates with the distal radioulnar joint
e. It usually communicates with the midcarpal joint

36. With regard to the median nerve distribution in the hand:

a. The muscular branch to the thumb is given off prior to passing below the flexor
retinaculum
b. Lateral branch supplies the nail bed of the thumb <=
c. Medial branch supplies the skin of the thenar eminence
d. The 1st lumbrical is supplied by the ulnar nerve
e. Digital nerves lie deep to the digital arteries – palmar to dorsal NAV

37. The lunate articulates with all of the following EXCEPT:

a. Scaphoid
b. Triquetral
c. Capitate
d. Radius
e. Hamate <=

38. The skin of the tip of the index finger is supplied by:
a. The radial nerve only
b. The median nerve only <=
c. The ulnar nerve only
d. The radial and median nerves
e. The radial and ulnar nerves

39. Following a laceration to the anterior surface of the wrist, a patient is unable
to flex the proximal interphalangeal joint of his middle finger when his other
fingers are held in extension. The tendon of which muscle has been divided?
a. Palmaris longus
b. Flexor indicis
c. Flexor digitorum profundus
d. Flexor digitorum superficialis <= attaches to the base of the middle phalanx
e. None of the above

40. With respect to the carpus

a. The intercarpal joints share one continuous synovial space <= with the
exception of the CMCJ of the thumb
b. The intercarpal synovial space is usually contunous with the wrist joint
c. The proximal row consists of scaphoid, lunate and trapezium
d. The scaphoid is the only carpal bone which articulates with the radius
e. In pronation-supination the carpus moves with the ulna - radius

41. The radial artery in the palm

a. Passes between the two heads of opponens pollicis – 1st dorsal interosseus
b. Has the deep branch of the ulnar nerve in its concavity
c. Gives off the princes pollicis artery to the index finger
d. Runs across the palm distal to the superficial palmar arch
e. Is usually continuous with the ulnar artery via the deep palmar arch <=

42. In regards to movements at the wrist joint

a. Adduction is limited to 15 degrees
b. Midcarpal joint movement is greater in flexion than extension
c. Adduction is performed by flexor and extensor carpi ulnaris <=
d. The axis of the metacarpus is in line with the axis of the forearm
e. 360 degrees of circumduction is possible

43. The lumbricals

a. Are attached to the flexor expansion
b. Have no bony attachment <=
c. Flex the proximal interphalangeal joint
d. Are all supplied by the ulnar nerve
e. Oppose the action of the interossei

44. The anatomical snuffbox

a. Has the extensor pollicis longus on its ulnar side
b. Lies between extensor pollicis longus and abductor pollicis longus
c. Has the trapezoid palpable in its base
d. Is most obvious with the thumb fully abducted
e. Contains the posterior interosseous artery

45. the flexor retinaculum attaches to all of the following bones EXCEPT:
a. scaphoid
b. hamate
c. trapezium
d. pisiform
e. capitate