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CHT EXAM STUDY GUIDE
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CHT EXAM STUDY GUIDE
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CHT EXAM STUDY GUIDEUlnar nerve - order of innervation - Answers -FCU - FDP (ring & small) - medial
cutaneous branch - ADM - ODM - FDM - ulnar lumbricals - palmar & dorsal interossei -
FPB (deep) - adductor pollicis
Radial nerve - order of innervation - Answers -Triceps - anconeus - BR - ECRL - ECRB
(1/2 RN & 1/2 PIN) - PIN: supinator - EDC - EDM - ECU - APL - EPL - EPB - EIP
Median nerve - order of innervation - Answers -PT - FCR - PL - FDS (index thru small) -
AIN: FDP (index & middle) - FPL - PQ; palmar cutaneous branch - under flexor
retinaculum: APB - OP - FPB (superficial) - radial lumbricals
Order of sensory return - Answers -Pain and Temperature
30 Hz Vibration
Moving Touch
Constant Touch
256 Hz Vibration
Touch Localization
Two Point Discrimination
Stereognosis
Steindler procedure - Answers -Flexor pronator muscle-tendon transfer to promote
elbow flexion s/p C5/C6 BPI.
"Steindler.. which way to the beach?"
Quadrangular space - Answers -Axillary nerve and posterior circumflex humeral artery
Quadrigia phenomenon - Answers -Flexion contracture of involved digit as well as
limited flexion of adjacent digits; results if FDP advanced >1cm during repair (limits
proximal excursion of other FDP tendons)
Egawa's Sign - Answers -Ability to flex the LF, but cannot RD/UD; interosseous
paralysis (UN out)
(Egawa has road rage 😡)
Guyon's canal - Answers -Contains UN and UA; borders of canal are hook of hamate &
pisiform
*common UN pathology with cyclists
Anatomical snuffbox - Answers -Borders are EPL dorsally & APL/EPB volarly; can
palpate the scaphoid
,*radial artery passes through here
DISI deformity - Answers -S-L injury - lunate extends Dorsally with the triquetrum; dorsal
S-L ligament is the strongest and vital for normal kinematics
VISI deformity - Answers -L-T injury - lunate flexes Volarly with the scaphoid
PIP flexion contractures: structures involved - Answers -Check rein ligaments, volar
plate, collateral ligament
Extensor tendon compartments - Answers -1. APL/EPB
2. ECRL/ECRB
3. EPL
4. EDC/EIP
5. EDM (5th digit)
6. ECU
Acute compartment syndrome: causes & symptoms - Answers -Causes: crush,
thermal/electrical burns
Symptoms: pain, paresthesias, paralysis, pulselessness (4 P's)
Often intrinsic minus hand
Increasing pressure = necrosis
Martin-Gruber anastomosis - Answers -MN/UN connection in the FA; intrinsic muscles
can be innervated by MN in case of UN injury
- RF/SF FDP out
Riche-Cannieu anastomosis - Answers -Occurs in palm - communicating branch
between deep branch of UN and recurrent branch of MN in thenar eminence
Berretini anastomosis - Answers -Connection between UN/MN common digital nerves
"Bear claw - rawr"
Medial collateral ligament (MCL): anterior oblique bundle - Answers -Medial epicondyle
to coronoid
Greatest constraint to valgus when elbow at 30-90 degrees
Injured in baseball pitchers
Medial collateral ligament (MCL): posterior oblique bundle - Answers -Medial epicondyle
to coronoid (below AOL)
,Greatest constraint to valgus with elbow flexion > 90 degrees
Medial collateral ligament (MCL): transverse bundle - Answers -Below AOL and POL;
functionally insignificant to valgus restraint
Bouvier test - Answers -Tests if PIPJ and extensor mechanism is working
Place MP in slight flexion and see if IP's extend
Adson's Test - Answers -Monitor pt's radial pulse with arm extended; pt. asked to
breathe in and tilt head towards ipsilateral arm
(+) Test = severely DEC/absent radial pulse
*indicates compression between anterior & middle scalene of the neurovascular bundle
Finochietto-Bunnel Test - Answers -Checks intrinsic tightness - MP hyperextended:
PIPJ tighter than with MP flexed
Brachial artery - Answers -The major vessel in the upper extremity that supplies blood
to the arm; splits into the radial and ulnar arteries at the antecubital fossa
Signs of arterial insufficiency - Answers -Color (pale; worsened by elevation of
extremity; dusky red when extremity is lowered)
Temperature (cool, blood flow blocked to extremity)
Pulse (decreased or absent)
Edema (absent or mild)
Skin changes (thin, shiny skin; decreased hair growth; thickened nails)
Pain (increased)
Cleland's ligament - Answers -Originated from flexor tendon sheath, passes DORSAL to
neurovascular bundle, inserts into skin
*prevents rotary movement of the skin around the fingers with grasp
Grayson's ligament - Answers -Originated from flexor tendon sheath, passes VOLAR to
neurovascular bundle, inserts into skin
*prevents rotary movement of the skin around the fingers with grasp
, *may contribute to Dupuytren's PIP contractures
Scaphoid fracture - Answers -MOI: axial load to hyperextended and radially deviated
wrist
Waist: 65%
Proximal pole: 25% (more avascular)
Distal pole: 10% (more common in kids)
Preiser's disease - Answers -AVN of the scaphoid, resulting from a fracture or repeated
trauma
Cubital fossa - boundaries - Answers -SUPERIOR: imaginary line through epicondyles
LATERAL: Brachioradialis muscle
MEDIAL: Pronator teres muscle
Signs of venous insufficiency - Answers -Cyanosis (blue tint caused by reduced
amounts of hemoglobin)
Abnormal capillary refill
Snapping lateral bands - Answers -Pain and snapping at lateral PIPJ with flexion
TRL loosens - solution: oval 8 splint
Transverse retinacular ligament (TRL) - Answers -Connects lateral bands (LB) to ORL;
restrains the LB's from dorsal subluxation - guides LB's volarly with flexion
Lacertus fibrosus (aka: bicipital aponeurosis) - Answers -Fibrous band originating from
biceps aponeurosis; active flexion with pronation may contribute to compression of MN
Hook of hamate fracture - Answers -Pain at HH; pain with wrist extension, UD, and
RF/SF flexion
*common with golf, racquet sports, baseball
*39% (-) x-ray rate
Common flexor origin (CFO) - Answers -PT, FCR, FCU, FDS, PL
Cubital tunnel - Answers -Arcuate ligament of Osborne and fascia of FCU
*roof slackens in extension, tightens with flexion - with full elbow flexion, 55% reduction
in size of tunnel
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