Anatomy clinical correlates: Wrist and hand


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Anatomy clinical correlates: Wrist and hand

Medical and surgical emergencies

Cardiology, cardiac surgery and vascular surgery

Advanced cardiac life support (ACLS): Clinical (To be retired)

Supraventricular arrhythmias: Pathology review

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Heart blocks: Pathology review

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Syncope: Clinical (To be retired)

Pericardial disease: Clinical (To be retired)

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Acid reducing medications

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Anticoagulants: Heparin

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Bites and stings: Clinical (To be retired)

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Protein synthesis inhibitors: Aminoglycosides

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Nephrology and urology

Hypernatremia: Clinical (To be retired)

Hyponatremia: Clinical (To be retired)

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Hypokalemia: Clinical (To be retired)

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Adrenergic antagonists: Alpha blockers

Neurology and neurosurgery

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Bronchodilators: Beta 2-agonists and muscarinic antagonists

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Rheumatology and orthopedic surgery

Joint pain: Clinical (To be retired)

Anatomy clinical correlates: Clavicle and shoulder

Anatomy clinical correlates: Axilla

Anatomy clinical correlates: Arm, elbow and forearm

Anatomy clinical correlates: Wrist and hand

Anatomy clinical correlates: Median, ulnar and radial nerves

Anatomy clinical correlates: Bones, joints and muscles of the back

Anatomy clinical correlates: Hip, gluteal region and thigh

Anatomy clinical correlates: Knee

Anatomy clinical correlates: Leg and ankle

Anatomy clinical correlates: Foot

Acetaminophen (Paracetamol)

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Opioid agonists, mixed agonist-antagonists and partial agonists

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Anatomy clinical correlates: Wrist and hand

USMLE® Step 1 questions

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USMLE® Step 2 questions

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USMLE® Step 1 style questions USMLE

of complete

USMLE® Step 2 style questions USMLE

of complete

A 42-year-old man is brought to the emergency department after sustaining a hand injury. The patient was jogging when he tripped and fell onto an area of concrete with scattered glass shards. He sustained lacerations to the left hand. He is otherwise healthy and does not take medications. Temperature is 37.0°C (98.6°F), blood pressure is 115/78 mmHg, and pulse is 103/min. Visual inspection of the left hand demonstrates a 4 cm laceration extending from the base of the hypothenar eminence to the thenar eminence. Which of the following should be evaluated to assess for underlying nerve injury?  



Viviana Popa, MD

Sam Gillespie, BSc

Alaina Mueller

Ursula Florjanczyk, MScBMC

In everyday life, we rely on our hands for a variety of reasons, from vigorously typing out notes while watching an Osmosis video to playing musical instruments or participating in sports.

Unfortunately, since we use them so much, the hands are quite prone to injury.

Alright, let's start by looking at distal forearm fractures.

There’s two kinds: Colles fracture, which are a direct result of falling on an extended wrist, and Smith fracture, which results from falling on a flexed wrist, or a direct blow to the posterior forearm.

With Colles fractures, the displaced radial fragment moves posteriorly, or dorsally, and the ulnar styloid process can also become fractured.

Clinically, when the distal radial segment moves dorsally this is called a “dinner fork deformity” because when viewed laterally, the hand and wrist are slightly curved anteriorly making it look like a fork.

With Smith fractures, on the other hand, the displaced distal radial fragment moves anteriorly, or ventrally, which clinically translates as a “garden spade” deformity.

Next, let’s look at carpal bone fractures, of which the most common are scaphoid fractures.

Scaphoid fractures occur as a result of falling on the lateral side of an outstretched hand in abduction.

Clinically, this results in pain and tenderness on the lateral side of the wrist and hand, in a location called the anatomical snuffbox, which is where you can palpate the scaphoid bone between the tendons of extensor pollicis longus on the medial side and extensor pollicis brevis and abductor pollicis longus on the lateral side.

The big problem with these fractures is that because the blood vessels supply the distal part of the scaphoid first then come back and supply the proximal part, a fracture in the middle of this bone disrupts the blood supply.

This can cause avascular necrosis and non union of the proximal fragment of the scaphoid, which is basically when the bone dies off because of lack of blood, and degenerative wrist joint disease.


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