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Flashcards in 10-2 HAND Deck (34):
1

Out of the 8 HAND Carpal Bones Point out AND Describe:

*Scaphoid [3]

1) boat shaped bone in proximal row most commonly FRACTURED---(1-15%)--->avascular necrosis

2) related to FOOSH injury [Fall On Out-Stretched Hand]

3) Articulates the radius

2

A: Out of the 8 HAND Carpal Bones Point out AND Describe:
2. Lunate
3. Triquetrum
4. Pisiform

B: These HAND Carpal Bones are found in which row?

A: 2. Lunar shaped bone most common DISLOCATED
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3. pyramid bone articulating distal radioulnar joint disc
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4. Pea shaped bone sitting on top of Triquetrum
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B: ALL OF THESE ARE PROXIMAL ROW

3

Out of the 8 HAND Carpal Bones Point out AND Describe::

5. Hamate
6. Capitate
7. Trapezoid
8. Trapezium

B: These HAND Carpal Bones are in which row?

5. Has a hook/hamulus projecting anteriorly / articulates 4th&5th metacarpals
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6. LARGEST carpal bone & articulates 3rd metacarpal
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7. wedge shaped / articulates 2nd metacarpal
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8. Scallop shaped articulating 1st &2nd metacarpals

B: THESE ARE DISTAL ROW!

4

A: What makes the Phalanges on digit 1 (___) different than the others?

B: What are the types of Phalanges?

A: Digit 1(THUMB) only has 2 Phalanges [Proximal & Distal] while all the others have 3!

B: PP vs. MP vs. DP (proximal/middle/distal PHALANX)

5

In the HAND Extensor Compartment Deep fascia is continuous with _____ _____ and Extensor tendons (with ____ sheaths) pass underneath the _____ _____ __

Deep fascia is continuous with ANTEBRACHIAL FASCIA and Extensor tendons (with SYNOVIAL SHEATHS) pass underneath the EXTENSOR RETINACULUM BAND

6

Extensor Retinaculum Band [4]

1. Overheads & Prevents bow-stringing of extensor tendons
2. Thickening of antebrachial fascia
3. Segregates extensor tendons into 6 compartments

4. Laterally attached to radius but Medially attached to pisiform & triquetrum

7

A: What are the boundaries of the Carpal Tunnel?
B: What 10 things are housed within the Carpal Tunnel?

C: What tendon lies JUST OUTSIDE this Carpal TunneL?

A: Carpal BONES Posteriorly &////
[ Flexor Retinaculum transverse carpal ligament] Anteriorly

B:
4 Flexor Digitorum superficialis tendons
4 DF-UDP tendons
1 DF-RPL tendon
1 MEDIAL NERVE

C:[ flexor carpi radialis] Tendon lies superficial to
[Flexor retinaculum transverse carpal ligament]
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DF-UDP=Deep Flexor Ulnar Digitorum Profundus
DF-RPL=Deep Flexor Radial Pollicis Longus

8

A: What is Carpal Tunnel Syndrome caused by?
B: Name 2 Common sx of this syndrome

C: Is thumb ADDuction affected by this syndrome?

A: Tendons/synovial sheath Swelling WITHIN the tunnel 2º to fluid retention, excessive exercise/motion or Infection
-->Median nerve compression

B:
1-Paresthesia/hypoesthesia/anesthesia of lateral 3.5 fingers

2- Weakness/Wasting of Thenar muscles-->loss of thumb movement
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C- thumb Adduction is spared because ADDuctor pollicis is innervated by [Ulnar nerve deep branch] (which is housed in CANAL OF GUYON along with Ulnar artery )

9

1: What muscles are in the Thenar compartment of the Hand? [3]

2: Muscles in the Hand HYPOthenar compartment [3]

3: Muscles in Hand ADDuctor compartment [1]

Thenar= •Abductor Pollicis brevis •Flexor Pollicis brevis
•Opponens pollicis
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HYPOthenar= ºAbductor digiti minimi
ºFlexor digiti minimi brevis ºOpponens digiti minimi
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ADDuctor= ADDuctor pollicis

10

Abductor Pollicis brevis [4]
(fact, nerve, function, location)

-1out3 muscle inside Hand THENAR compartment
-innervated by recurrent median n.

-ABducts thumb
-lies Anteriorly & laterally superficially

11

Flexor Pollicis brevis [4]
(fact, nerve, function, location)

º2out3 muscle inside Hand THENAR compartment
ºinnervated by recurrent median n.

ºFlexes Proximal Thumb phalanx
ºlies medial to ABductor pollicis brevis

12

Opponens Pollicis [4]
(fact, nerve, function, location)

1. 3out3 muscle inside Hand THENAR compartment
2. innervated by recurrent median n.

3. Medially rotates AND Opposes thumb to center of palm
4. lies DEEP to ABductor pollicis brevis

13

abductor digiti minimi [3]
(fact, nerve, location)

1. 1out3 muscle inside Hand HYPOthenar compartment
2. innervated by Ulnar n. deep branch

3. MOST superficial HYPOthenar muscle and originates from pisiform bone

14

flexor digiti minimi brevis [3]
(fact, nerve, location)

º2out3 muscle inside HYPOthenar compartment
ºinnervated by Ulnar n. deep branch

ºlies lateral to abductor digit minimi and originates from hamulus

15

[T or F] The [flexor digiti minimi Longus] lies lateral to flexor digiti minimi brevis

FALSE! THERE IS NO [flexor digiti minimi LONGUS]

16

[opponens digiti minimi]
(fact, nerve, function, location)

•3out3 muscle inside HYPOthenar compartment
•innervated by Ulnar n. deep branch

•Draws 5th pinky metacarpal anteriorly and rotates center of palm to meet thumb
•lies DEEP to abductor digiti minimi

17

ADDuctor Pollicis [5]

*Fan shaped muscle in adductor compartment of hand

*ADDucts thumb toward middle finger

*innervated by Ulnar n. deep branch

*Has 2 HEAD ORIGINS = Oblique head
& Transverse head(3rd metacarpal) origin

*perfused by Deep palmar arterial arch

18

Lumbricals [4]

1. Lumbricals 1&2 originate from lateral 2 tendons of
DF-UDP and innervated by median n.
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2. Lumbricals 3&4 DOUBLE-sided originating from 3 medial tendons of
DF-UDP and innervated by [[Ulnar n. deep branch]]
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3. Worm-looking muscles tht insert on lateral sides of extensor expansions digits 2-5

4. Flexes digits at MCP joints and extends IP joints allowing pulp of finger to oppose thumb and not just thumb fingertip= "pinch" feature

19

*Palmar interosseous muscles* [3]
(function vs. location vs. nerve)

(3 PAD) -->on PALM side

1--P: ADDucts fingers back toward 3rd midline middle finger

2--originates from side of M 2nd, L 4th & 5th metacarpals and attaches to bottom of PP{proximal phalanx}

3--innervated by Ulnar n. deep branch

20

*Dorsal interosseous muscles* [3]
(function vs. location vs. nerve)

(4 DABS)-->on hand DORSAL side
A--ABducts fingers away from 3rd midline middle finger

B--Found at the L 2nd/3rd metacarpals AND M 3rd/4th = 3RD METACRPL HAS 2 INSERTIONS/quadruple sided

C--innervated by Ulnar n. deep branch

21

How does the Ulnar Artery enter the hand and what happens once it gets in?

Enters via Ulnar Canal of Guyon and divides into Superficial Palmar Arch and Deep Branch once its in

22

Describe the [Ulnar artery SUPerFiciAL Palmar Arch] [4]

Ulnar artery Superficial Palmar Arch
a: anastamoses w/superficial Radial artery branch
b: extends across palm and perfuses finger digital branches
c: Common palm digital artery daughters pass INBETWEEN METACRPLS

d: Proper palm digital artery daughters run on either side of digits 2-5

23

Describe the [Ulnar artery DEEP Branch]

Ulnar artery DEEP branch

ºPasses inbetween [abductor digiti minimi] &
[ flexor digiti minimi]
ºAnastomoses with Radial artery Deep Palmar Arch

24

In regards to Palmar Arches..which artery branch [Radial vs. Ulnar] is DEEP?

U S R D !! {REFERS TO ARCHES ONLY}
Ulnar Palmar Arch = superficial

***RADIAL PALMAR ARCH = DEEP

25

Passage of Radial artery [4]

Gives off Superficial Palmar branch--(then)-->
extends across snuff box floor -->
wraps dorsally around 1st thumb metacrpl --->

pierces 1st dorsal interosseous muscle as the Radial artery DEEP Palmar Arch

26

Name the 3 daughter arteries of the
[Radial artery DEEP Palmar ARCH] and their significance

1. princeps pollicis=medial thumb
2. radialis indicis= lateral 2nd digit
3. [palmar metacarpal arteries]

...and then ARCH eventually anastomoses with

27

Which fingers receive DUAL Blood supply?

ALL FINGERS GET DUAL BLOOD SUPPLY EXCEPT
THUMB (only gets blood from princeps pollicis from Radial artery DEEP ARCH) !

28

What are the 4 Major facts regarding HAND Venous Return

1. Multiple veins (like Venae Comitantes) course with the singular radial and ulnar arteries in the hand

2. Finger venous return follows superficial palmar Arch to Ulnar Vein--> U S R D

3. Deep venous arcades follow DEEP palmar arch to RADIAL Vein ---> U S R D

4. Ulnar, Radial and interosseous veins ALL ultimately drain into Brachial Vein

29

A: Median Nerve enters hand under the _____ _____ thru the _____ _____.

B: Describe the 2 Branches that come from Median Nerve [Palmar Cutaneous branch(2) vs.
Recurrent Thenar Branch(4) ]

A: Median nerve enters hand under the FLEXOR RETINACULUM thru the CARPAL TUNNEL

B: Palmar Cutaneous BRanch
ºProvides cutaneous sensation to central palm
ºbranches just proximal to carpal tunnel but NOT ACTUALLY IN CARPAL TUNNEL

vs.

Recurrent Thenar Branch = 1/2 LOAF!
*Innervates 1st and 2nd lumbricals
*innervates Opp pollicis/ABductor pollicis/Flexor Pollicis brevis
*1st branch distal to flexor retinaculum
*enters the thenar eminence

30

A: The Ulnar nerve enters the hand via ___ __ ______.

B: name the 4 daughter branches of the Ulnar n.

A. Ulnar n. enters hand via Canal of Guyon

B:
1. Palmar cutaneous branch=medial palm
2.[ dorsal cutaneous branch] passes under FCU tendon, extends distally across hand dorsum

3. 2 branches come off Distal of Flexor Retinaculum = Superficial branch and Deep Branch

31

Describe the Ulnar nerve Superficial branch

"born" from Ulnar n. distal from flexor retinaculum
--->becomes common palmar digital nerves and then proper palmar digital nerves

32

Describe the [ Ulnar nerve DEEP branch ] and name the 6 muscles it innervates {DHAPP3}

A: passes between abdDM and FDMB tendons then passes deep to flexor tendons along deep palmar arch path

B: DHAPP3 muscles=Ulnar n. DEEP BRANCH
Dorsal Interossei/HYPOthenar/ADDuctor Pollicis/
Palmar Interossei/ Pollicis Brevis/ 3rd&4th Lumbricals

33

State key features of Radial Nerve IN THE HAND [3]

1. Radial n. STRICTLY CUTANEOUS in hand
2. Enters hand dorsum after passing over anatomical snuff box

3. creates dorsal digital nerves on dorsal lateral hand --> cutaneous sensation to dorsal lateral 3.5 digits inferior to DIP joint

34

Dupuytren's Contracture

Progressive Hand fibrosis in which fibrous tissues band palmar aponeurosis to phalange bases
---->pulls digits into marked flexion at Metacrpl joints= can't straightened out fingers