THE HAND 1. The carpal bones in the hand are arranged in two rows. How many carpal bones are there? 4 6 8 9 10 Fine. No, the answer is C. Proximal row scaphoid, lunate, triquetrum and pisiform. Distal row trapezium, trapezoid, capitate and hamate. 2. Actually, the pisiform is anterior to the Lunate Triquetrum Scaphoid Capitate Trapezoid Very good. Wrong, B is the answer. Thus, there are really 3 bones in the proximal row which articulate with the radius. 3. Since there are 3 proximal bones articulating with 4 distal carpal bones, one of the proximal row articulates with 2 distally. This proximal bone is the Scaphoid Lunate Triquetrum Pisiform Hamate Great! No, A is the answer. The scaphoid articulates with both the trapezium and the trapezoid in the distal row. 4. The 5 metacarpal bones articulate with the 4 distal carpal bones. Which carpal bone articulates with 2 metacarpals? Trapezoid Capitate Hamate Trapezium Triquetrum Right. Wrong, C is correct. The Hamate articulates with both of the 4th and 5th metacarpal bones. 5. The arched or hollow condition of the palm of the hand is maintained by Palmar aponeurosis Volar carpal ligament Flexor retinaculum Terrific! No, the answer is C. The distal part of the Flexor retinaculum stretches between the hook of the hamate and the tubercle of the trapezium. 6. One ridge of the trapezium is the lateral lip of a groove for the tendon of Flexor Carpi Radialis Flexor Digitorum Profundus Flexor Carpi Ulnaris Flexor digitorum superficialis Palmaris longus Hooray! No, the answer is A. This tendon continues to insert on the bases of the second and third metacarpal. 7. There is enough room between the hook of the hamate and the pisiform to allow the passage of Ulnar artery Ulnar nerve Both Neither Bravo! No, C is the correct answer. 8. The articular cartilage of scaphoid, lunate and triquetrum extends far dorsally which accounts for the ease of wrist Dorsi-flexion Palmar flexion Right. No, the answer is A. When the fist is closed, the wrist automatically becomes extended -- try it. 9. There are 3 short muscles of the thumb and 3 of the little finger. They arise partly from the Scaphoid Trapezium Flexor retinaculum Volar carpal ligament Pisiform Very good. No, the answer is C. No muscles insert into the carpal bones - if one accepts that the pisiform is a sesamoid bone that develops in the tendon of the Flexor Carpi Ulnaris. 10. The metacarpal of the thumb has an antero-lateral (radial) surface which provides for the fleshy insertion of the 1st Dorsal Interosseous Abductor Brevis Opponens pollicis 1st palmar interosseous Adductor brevis Correct. No, C is correct. The 1st Dorsal Interosseous originates from the antero-medial surface of the thumb metacarpal. 11. With the fingers flexed, the uncovered heads of the metacarpals are spheroidal. Thus the bases of the proximal phalanges are Saddle-shaped Cup-shaped Correct. No, B is the answer. In the flexed position, the fingers cannot be adducted or abducted because the round heads of the metacarpals become flattened in front and the collateral ligaments become taut. 12. Posteriorly, there are no ligaments at the metacarpo-phalangeal joints and interphalangeal joints. True False Very good. No, the statement is true. However, anteriorly there is a fibro-cartilagenous plate, the palmar ligament. The sides of the palmar ligament are held together by the deep transverse ligaments of the palm which help prevent spreading of the metacarpals. 13. The palmar surfaces of the 1st and second phalanges contain fibrous tunnels which contain Extensor tendons Flexor tendons You are right. No, B is the answer. 14. Besides the crests for the fibrous tunnel insertion, the crests on the second phalanx also receives fibers from Flexor Digitorum Profundus Flexor Digitorum Superficialis Flexor Carpi Ulnaris Hooray! No, B is the answer. The Flexor Digitorum Profundus inserts in the distal phalanx. 15. The epiphysis in the metacarpals is in the heads and in the phalanges the epiphysis is in the Heads Bases Both Neither Right. No, B is correct. There is only one epiphysis in the long bones. The epiphyses start to ossify in the 2nd - 3rd year and fuse 17-19. 16. Adduction and abduction of the thumb occurs at the Metacarpo-phalangeal joint Carpo-metacarpal joint Great! No, the answer is B. 17. The flexor retinaculum with the carpal bones forms the Transverse arch Carpal tunnel Volar tunnel Certainly. No, B is correct. 18. The 3 thenar muscles (muscles of the ball of the thumb) originate from the flexor retinaculum (abductor also arises from the tubercle of the scaphoid) and ridge of the trapezium. The Abductor Pollicis Brevis is inserted on the lateral base of Proximal metacarpal of the thumb Proximal phalanx of the thumb Hooray! No, B is correct. This muscle abducts the thumb (draws the thumb forward). 19. A second of the thenar muscles inserts along the radial border of the 1st metacarpal and medially rotates the thumb. This is the Opponens Pollicis Flexor Pollicis Brevis Adductor Pollicis Magnificent! No, the answer is A. A superior extension of the Opponens Pollicis inserts on Proximal phalanx, the Flexor Pollicis Brevis. 20. The nerve to the 3 thenar muscles (abductor Pollicis Brevis, Opponens Pollicis and Flexor Pollicis Brevis) exits from the lower border of the flexor retinaculum and lies subcutaneously over the thenar muscles. It is a branch of the Radial nerve Median nerve Ulnar nerve Correct. No, B is correct. A laceration over the thenar eminence can easily damage this recurrent branch. 21. The three hypothenar muscles are mirror images of the thenar muscles. The Abductor Digiti Minimi arises from the Hamate Triquetrum Pisiform Scaphoid Lunate Bravo! Too bad, C is the answer. The Abductor Digiti Minimi inserts into the base of the proximal phalanx of the little finger. As the name implies, this muscle abducts the little finger. 22. The Opponens Digiti Minimi and the Flexor Digiti Minimi arise from the flexor retinaculum and the Scaphoid Hook of the hamate Lunate Capitate Trapezoid Fine answer. No, B is the correct answer. These muscles flex the carpo-metacarpal joint of the little finger. 23. The nerve supply to the hypothenar muscles is the Radial nerve Median nerve Ulnar nerve Excellent! Not so, the correct answer is C. 24. An additional muscle of the hand is the Adductor Pollicis. This muscle lies deep in the palm and draws the thumb medially (adducts) across the palm. It is supplied by the You are right! Wrong, C is correct. This is different from the thenar group which are supplied by the median nerve. 25. Most delicate movements of the thumb (writing, pinching etc.) are performed by opposition, the movement of the thumb to the pad of a finger. The thumb joint primarily responsible for this is the Metacarpo-phalangeal joint Carpo-metacarpal joint Inter-phalangeal joint Hooray! No, the answer is B. 26. The recurrent branch of the median nerve supplies the thenar muscles (Abductor Pollicis Brevis, Opponens Pollicis and Flexor Pollicis Brevis) as well as 1st and 2nd Lumbricals All Lumbricals Interossei Marvelous! Wrong, the answer is A. The median nerve enters the palm through the carpal tunnel just deep to the flexor retinaculum and becomes distributed to 5 muscles (thenar group and 2 lumbricals) and sensory to the lateral 3 and 1/2 digits. 27. Structures passing through the carpal tunnel include the tendons of the Flexor Pollicis Longus and Flexor Digitorum Profundus. On passing through the tunnel, the position of these tendons to each other is Side by side Fl. Poll. Long in front of Fl. Dig. Prof. Exactly! No, A is correct. 28. The position of the Flexor Digitorum Superficialis tendons through the carpal tunnel are; 3 and 4 lie in front of 2 and 5 as they enter the tunnel and as they leave the tunnel 3 and 4 are between 2 and 5 3 and 4 are behind 2 and 5 3 and 4 remain in front of 2 and 5 Correct. Wrong, A is correct. 29. The Flexor Carpi Radialis has a separate tunnel through the carpal tunnel as it crosses in front of a "pulley" composed of the tubercle of the Scaphoid Lunate Trapezium Triquetrum Trapezoid Hooray! Wrong, A is correct. After passing over this pulley, the Fl. Carpi Rad. tendon enters a groove in the trapezium, then continues to insert on the base of metacarpals II and III. 30. Each Profundus tendon is inserted into the breadth of the anterior aspect of the base of Proximal phalanx Middle phalanx Distal phalanx All of the above None of the above Very good. No, C is correct. 31. Each Fl. Digitorum Superficialis tendon splits with part of each half rotating around the Profundus tendon and inserting into the Proximal phalanx Middle phalanx Distal phalanx All the above A and C above Excellent! Wrong, B is correct. The more outer portions of the superficialis tendon actually wrap around, pass beneath the profundus tendon and cross to the other side of the middle phalanx for insertion. 32. Superficialis and Profundus tendons are anchored to the phalanges and interphalangeal joints by vascular fibrous bands called Synovial sheaths Vincula Retinaculum Fine. Sorry, B is correct. 33. The lumbricals are 4 in number and arise from the Flexor retinaculum Metacarpals Profundus tendons Superficialis tendons B and C above Exactly. Wrong, C is correct. They lie deep to the digital arteries and nerves and follow them into the radial side of the digits where they insert into the extensor expansions on the dorsal surface of the digits, distal to the attachments of the interossei. 34. The lumbricals are chiefly Flexors of the interphalangeal joint Extensors of the interphalangeal joint Right. Wrong, B is right. 35. There are 7 interossei, 4 dorsal and 3 palmar. With reference to a line drawn through the middle finger, the dorsal interossei cause the fingers to Abduct Adduct Very good. No. The correct answer is A. Conversely, the palmar interossei cause adduction of the fingers toward the midline. 36. The palmar interossei arise from one side of metacarpals with one head. No palmar interossei muscles insert on the Little finger Middle finger Index finger Ring finger B & C above Yes. No, B is correct. 37. The primary action of the interossei on the metacarpophalangeal joint is Flexion Extension Bravo! No, A is the answer. They are also weak extensors of the interphalangeal joints. 38. The interossei are supplied by the Median nerve Ulnar nerve Radial nerve A and C above None of the above Great! Wrong, B is the answer. The deep branch of the ulnar nerve innervates the interossei. 39. The nerve injury which would most affect the fine movements of the fingers would be the Median Radial Ulnar A and B above None of the above Good answer. Wrong, C is the answer. The ulnar nerve supplies all the interossei, 3rd and 4th lumbricals, adductor pollicis and usually the deep head of the flexor pollicis brevis. 40. The radial artery enters the palm by passing between the heads of the first dorsal interosseous muscle, turns medially between the heads of the adductor pollicis and forms the deep palmar arch by anastomosing with the Superficial branch of the ulnar artery Deep branch of the ulnar artery Very good. Wrong, B is correct. In addition to the deep palmar arch, there is a superficial palmar arch formed from anastomosis of the superficial branch of the radial artery with the ulnar artery. 41. Synovial sheaths are lubricating devices for tendons. The long flexors (Superficialis, Profundus, Pollicis) have Carpal synovial sheaths Digital synovial sheaths Both Neither Terrific! No. The correct answer is C. The carpal sheaths of the 4 Superficialis and 4 Profundus tendons usually become one, the Common Flexor Sheath.