Question 1

Why is surgery required for neurotmesis?&#10;A) Because it would take too long to wait for the nerve to regenerate&#10;B) Because the nerve is contused&#10;C) Because there is a complete laceration of both nerve and fibrous tissues&#10;D) Because nerve fibers distal to the injury degenerate, despite the fact that the internal organization of the nerve is intact

Accepted Answer

Neurotmesis is a complete laceration of both nerve and fibrous tissues.Surgical intervention is required.Microsurgical repair of the fascicles is common.Nerve grafting may be necessary in situations in which there is a gap between nerve endings.

Question 2

A client arrives for evaluation with loss of sensation of the volar surface of the thumb,index,and middle fingers.What nerve is involved?&#10;A) Radial nerve&#10;B) Ulnar nerve&#10;C) Posterior interosseous nerve&#10;D) Median nerve

Accepted Answer

Sensory distribution of the median nerve is to the volar surface of the thumb,index,and middle fingers; radial half of the ring finger and dorsal surface of the index and middle fingers; and radial half of the ring finger distal to the proximal interphalangeal (PIP)joints.

Question 3

Explain why the tip of the thumb flexes when trying to grasp a piece of paper between the thumb and index finger in a client who has ulnar nerve paralysis.&#10;A) Because the flexor pollicis longus substitutes for the absent adductor pollicis muscle&#10;B) Because the extensor pollicis longus is absent in ulnar nerve injuries&#10;C) Because the index flexor tendons are absent in ulnar nerve injuries&#10;D) Because the thumb opponens pollicis is absent in ulnar nerve injuries

Accepted Answer

One test for ulnar nerve paralysis involves asking a client to grasp a piece of paper between the thumb and index finger.When the examiner pulls away the paper,the tip of the thumb flexes because of the absence of the adductor pollicis muscle.This is called Froment's sign.If the metacarpophalangeal (MP)joint of the thumb also extends at the same time,it is known as Jeanne's sign.

Question 4

What does digital clawing indicate?&#10;A) Weakness or absence of the extensor muscles&#10;B) Weakness or absence of the intrinsic muscles of the hand&#10;C) Weakness or absence of the flexor muscles of the hand&#10;D) Flexor tenosynovitis

Accepted Answer

The ulnar nerve in the forearm innervates only the flexor carpi ulnaris and the median half of the flexor digitorum profundus.It travels down the volar forearm through the canal of Guyon,innervating the intrinsic muscles of the hand,including the palmaris brevis,abductor digiti minimi,opponens digiti minimi,flexor digiti minimi,dorsal and volar interossei,third and fourth lumbricals,and medial head of the flexor pollicis brevis.The sensory distribution of the ulnar nerve is the dorsal and volar surfaces of the small finger ray and the ulnar half of the dorsal and volar surface of the ring finger ray.

Question 5

A client arrives for evaluation with the inability to extend her wrist,thumb,or MP joints of her right dominant hand.What nerve is involved?&#10;A) Ulnar nerve&#10;B) Radial nerve&#10;C) Median nerve&#10;D) Musculocutaneous nerve

Accepted Answer

This clinical picture is called the drop wrist and indicates radial nerve involvement.The radial nerve innervates the extensor-supinator group of muscles of the forearm,including the brachioradialis,extensor carpi radialis longus,extensor carpi radialis brevis,extensor digitorum communis,extensor digit minimi,extensor indicis,extensor carpi ulnaris,supinator,abductor pollicis longus,extensor pollicis brevis,and extensor pollicis longus.

Deck 43: Hand and Upper Extremity Injuries