TA Session #3

Question 1

Your pt has pain with movement into wrist extension. Which of the following bones would you expect to be injured if they have pain moving from full wrist flexion to a neutral wrist?

-Radius
-Lunate
-Trapezium
-Scaphoid

Answer 1

Trapezium

-Explanation: When moving from full flexion to full extension of the wrist, the distal row carpals move on the proximal row at first. At neutral wrist flexion/extension, capitate “locks” + the proximal row carpals then start to move on the radius. This pt has pain moving from flexion to a neutral position, which is when the distal row is moving. Thus, the answer has to be a carpal bone that is found in the distal row.

Question 2

When the elbow is in full extension and supination, this is what position?

-The close packed position of the humeroulnar joint
-The loose packed position of the humeroradial joint
-The loose packed position of the proximal radioulnar joint
-Both A and B
-Both A and C

Answer 2

Both A and B

Question 3

Ulnar deviation is most often limited by…

-Ligaments
-The carpal joints reaching a close-packed position
-The triquetrum bones movement is limited by the position of the ulna
-The 5th metacarpal can no longer slide on the hamate

Answer 3

Ligaments

-Explanation: Via Dr. Bishop’s “wrist complex” lecture slides, ligaments limit ulnar deviation. In full radial deviation the carpal joints are in a closed-packed position, so B would be correct if the question asked about radial deviation

Question 4

Thumb opposition occurs at what joint?

-Distal interphalangeal (DIP)
-Interphalangeal (IP)
-Metacarpophalangeal (MCP)
-Carpometacarpal (CMC)

Answer 4

CMC joint

-Explanation: Opposition of the thumb occurs at the saddle joint made up of the trapezium + the base of the 1st metacarpal (1st CMC joint).

Question 5

Which structure resists valgus stress of the elbow in 90 degrees of flexion?

-Bone
-UCL
-Capsule
-ACL

Answer 5

UCL

-Explanation: In extension, bone, UCL, + capsule all resist valgus force equally. In 90 degrees of flexion, the UCL is responsible for >50% of the stabilization. Because the elbow is now flexed there is a loss of stability + in a more loose packed position where we will now rely on the ligamentous stability.

Question 6

T/F- The radiocarpal joint is made up of the radius + ulna, + the distal row of carpal bones + is considered convex on concave.

Answer 6

False

-Explanation: The proximal row of the carpal bones are involved in this joint, not the distal row. It is indeed a convex on concave surface. We describe the convex/concave rule based on the moving surface on a fixed surface.

Question 7

If ____ wasn’t present, tendons wouldn’t stay attached on the finger

-Flexor hood
-Carpal tunnel
-Extensor hood
-Tarsal tunnel

Answer 7

Extensor hood

-Explanation: The extensor hood is a fibrous aponeurosis that wraps around the proximal phalanx + anchors to the palmar plates + ligaments.

Question 8

Your patient comes into the clinic complaining of numbness and tingling into the hand. Which structure could potentially be a cause for this?

-Radial collateral ligament
-Carpal tunnel
-Palmar aponeurosis
-Extensor hood

Answer 8

Carpal tunnel

-Explanation: Compression of the median nerve within the carpal tunnel can cause numbness + tingling in the hand.

Question 9

The carrying angle of the elbow is:

-Greater in men than women
-Equal in men and women
-Greater in women than men
-Absent in both sexes

Answer 9

Greater in women than men

-Explanation: The carrying angle is typically greater in women (10-15 degrees) compared to men (~5 degrees). This difference is thought to be due to the wider pelvis in women, which requires a larger angle at the elbow so the forearm can clear the hips during walking + carrying objects.

Question 10

Which bones form the proximal articular surface of the radiocarpal joint?

-Scaphoid, lunate, triquetrum
-Scaphoid, lunate, trapezium
-Capitate, hamate, triquetrum
-Radius, ulna, pisiform

Answer 10

Scaphoid, lunate, triquetrum

-Explanation: The proximal row of carpals (scaphoid, lunate, triquetrum,+ pisiform) articulates with the distal radius + the articular disc.

Question 11

A patient has a jammed finger after catching a ball, resulting in MCP hyperextension. which structure is most at risk?

-Collateral ligament
-Volar plate
-Extensor tendon
-Flexor digitorum profundus

Answer 11

Volar plate

-Explanation: In the hand complex video, Dr. Bishop talks about how the volar plate limits extension + flexion. The volar plate acts like a stopper, preventing the proximal phalanx from extending too far back + also prevents “pinching” of the joint structures during forceful flexion. So when a finger is hyperextended, the hyperextension stretches or tears the volar plate, because this structure is the primary restraint against excessive backward motion.

Question 12

Why is the thumb CMC joint considered a saddle joint?

-It only allows flexion and extension
-It has concave and convex surfaces in 2 directions
-It rotates like a wheel
-It cannot move

Answer 12

It has concave and convex surfaces in 2 directions

-Explanation: The thumb CMC joint is a saddle joint because the articulating surfaces are concave in one direction + convex in another, like a rider in a saddle. This shape allows movement in multiple planes, including flexion, extension, abduction, adduction, + opposition. It’s this design that gives the thumb its unique ability to touch the other fingers.

Question 13

A patient comes into the clinic with pain at her MCP joints when they are in the close-packed position. Which of the following movements would she experience pain with?

-Shaking someone’s hand
-Balling her fist
-High-fiving someone
-Abducting her fingers

Answer 13

Balling her fist

-Explanation: The close-packed position of the MCP joints is in full flexion, so balling her fist would cause her to have the most pain.

Question 14

What motion of the MCP joint is primarily limited by the volar plate?

-Flexion
-Extension
-Both A and B
-Neither A or B

Answer 14

Extension

-Explanation: As the MCP joint extends, the volar plate becomes taught to prevent hyperextension at the MCP joint. This is the primary function of the volar plate. This comes from slide 5 of the hand lecture.

Question 15

Which motions make up opposition of the thumb?

-Adduction and flexion
-Abduction and flexion
-Adduction and extension
-Abduction and extension

Answer 15

Abduction and flexion

-Explanation: This comes from slide 7 of the hand complex lecture. Opposition of the thumb describes the pad of the thumb touching the pad of the 5th digit. The thumb moves anteriorly away from the palm (abduction) then flexes across the palm.

Question 16

T/F- Extension of the PIP joint is always accompanied by DIP extension.

Answer 16

True

-Explanation: The PIP + DIP joints extend together because the extensor mechanism transmits force from the extensor digitorum through the central slip to the PIP + through the lateral bands to the DIP, causing coordinated extension.

Question 17

If I were to have my wrist in a neutral position, which 2 carpal bones would be in a close-packed position.

-Triquetrum and lunate
-Scaphoid and capitate
-Hamate and scaphoid
-Pisiform and capitate

Answer 17

Scaphoid and capitate

-Explanation: When the wrist is in a neutral position, extensor muscles will pull the capitate (only pulls on the distal row), which will approximate, or get close to the scaphoid + lock them in making them more stable.

Question 18

The joint capsule for the elbow that encloses the humeroulnar, humeroradial, and superior radioulnar joint is weaker in which directions?

-Weaker medially and anteriorly
-Weaker posteriorly and laterally
-Weaker laterally and anteriorly
-Weaker anteriorly and posteriorly

Answer 18

Weaker anteriorly and posteriorly

-Explanation: The reason is because there is already good bony stability anteriorly + posteriorly which means that there is not much more of a need for the capsule to cover that area of the elbow since it is already stable.

Question 19

T/F- Extension of the elbow is limited by the olecranon impacting onto the olecranon fossa.

Answer 19

True

-Explanation: Extension of the elbow is limited by the bony impact of the olecranon process of the ulna onto the olecranon fossa of the humerus.
-The main limitation of elbow FLEXION is soft tissue of bicep/forearm.

Question 20

A patient comes into your clinic after getting their finger caught in somebody’s pockets because your opponent didn’t wear pocketless shorts in flag football. After your evaluation, your notice their 3rd distal interphalangeal joint won’t extend. What do you suspect happened?

-Fractured PIP
-Torn extensor digitorum tendon
-Torn flexor digitorum tendon
-Torn lumbrical

Answer 20

Torn extensor digitorum tendon

-Explanation: The extensor digitorum extends the distal phalanges. A torn extensor digitorum results in mallet finger, where the distal phalanges will droop + be unable to fully extend.

Question 21

You ask your roommate for help with palpations but they just are not in the mood. Rudely they say, “Talk to the hand”. What carpal row moves first as they move their hand into the position? (flexion to extension)

-Proximal row
-Distal row
-Both move simultaneously
-Why won’t my roommate practice with me?

Answer 21

Distal row

-Explanation: When moving from a flexed to extended position, the distal carpal row moves first, dorsally. At neutral, the proximal row begins to move + they eventaully move together.

Question 22

A patient presents with limited shoulder abduction, no more than 30 degrees. You find no capsular limitations and all nerves are intact. They report shoulder tightness, what muscle do you suspect?

-Supraspinatus
-Upper trapezius
-Serratus anterior
-Pectoralis minor

Answer 22

Pectoralis minor

-Explanation: Due to the insertion of the pectoralis minor on the coracoid process + the action of anterior tilt of the scapula, a tight pec minor would result in pulling the scapula anteriorly + slightly inferiorly, limiting the scapula from upwardly rotating + preventing full glenohumeral ROM.

Question 23

It’s Sunday and you’re about to watch the LA Chargers play. You’re watching the players warm up and your roommate says “You’re a PT student, what’s that bump on Keenan Allen’s shoulder?” What do you say?.

-History of shoulder dislocation
-Bursitis of the GH joint
-Grade III AC joint sprain
-Bursitis of the AC joint

Answer 23

Grade III AC joint sprain

-Explanation: Keenan Allen has had a history of a grade III (complete tear) AC joint sprain. He opted to not get surgery + the joint healed with the clavicle protruding + leaving the noticeable bump. However, even if you don’t watch football you can tell your roommate you learned about the AC joint in your functional anatomy class + infer what likely happened to this player.