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Musculoskeletal Anatomy I > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

What are the bones that make up the hand?

A

8 carpal bones, 5 meta carpals, and 14 phalanges

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2
Q

Where is the saddle joint in the hand and what is its purpose

A

Located between trapezium and metacarpal 1, this saddle joint provides flexibility for the thumb.

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3
Q

Which metacarpals are the most mobile

A

4 and 5 are more mobile than 2 and 3 because carpal articular surfaces

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4
Q

What is an MCP joint?

A

Condyloid synovial joint between metacarpal and proximal phalanx

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5
Q

What is an IP

A

Joint between phalanges with bi-condyloid facets that permit flexion-extention

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6
Q

What is the palmar ligament

A

Thickened anterior portions of the joint capsules of MCP and IP joints

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7
Q

What is the deep transverse ligament

A

Ligament that interconnects the MCP joints for added stability, except the thumb

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8
Q

What are the collateral ligaments of the hand

A

CT bands on each side of an IP or MCP joint

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9
Q

What is the purpose of Collateral ligaments of the hand

A

Flexion pulls them tight which limits adduction/abduction, extension is the opposite

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10
Q

What is the palmar aponeurosis

A

Protective CT covering of the flexor tendons

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11
Q

Where is the superficial transverse ligament

A

Across the MPC joints on the palmar side

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12
Q

What types of synoviocytes line synovial membranes

A

Type A which is macrophage-like and type B which secretes hyaluronic acid to increase the viscosity

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13
Q

What types of proteins are in synovial fluid

A

hyluronic acid, lubricin, proteinases, and collagenases

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14
Q

What does synovial fluid transport

A

Oxygen, nutrients, CO2, and waste products

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15
Q

Where do the thenar muscles originate

A

The Abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis originate from the flexor retinaculum, scaphoid bone, and the trapezium

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16
Q

Where do the thenar muscles insert

A

Flexor pollicis brevis and abductor pollicis brevis insert on the proximal phalanx of the thumb. Opponens pollicis inserts onto the 1st metacarpal

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17
Q

What innervates the thenar muscles

A

median nerve

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18
Q

Where do the hypothenar muscles originate

A

Abductor digiti minimi originates from the pisiform bone. Opponens digiti minimi and flexor digiti minimi originate from the flexor retinaculum and hook of the hamate

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19
Q

Where do the hypothenar muscles insert

A

abductor and flexor digiti minimi insert onto the proximal phalanx and the opponents digiti minimi inserts onto the 5th metacarpal

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20
Q

What innervates the hypothenar muscles

A

Ulnar nerve

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21
Q

What is the origin, insertion, and innervation of the adductor pollicis

A

Originates: oblique head from the 2nd and 3rd MC and capitate bone, Transverse head from the 3rd MC
Insertion: proximal phalanx of the thumb
Innervation: Ulnar nerve

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22
Q

What are the movements of the thumb

A

Ab/adduction perpendicular to palm

ext/flexion parallel to palm

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23
Q

What are the movements of the fingers

A

ab/adduction: away and towards middle finger

ext/flexion: away and towards the palm (respectively)

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24
Q

What is the origin and insertion of the lumbricals

A

Origin: tendons of flexor digitorum profundus
insertion: dorsal expansions

25
Q

What is the innervation of the lumbricals

A

1,2 by the median nerve, 3,4 by ulnar nerve

26
Q

Why are there only 4 lumbricals

A

Because the flexor pollicis longus doesn’t have a lumbrical

27
Q

What is the action of the lumbricals

A

The “tata” motion; flex MC-P joint, extend IP joints

28
Q

What is the origin and insertion of the dorsal and palmar interossei

A

Origin: metacarpals
Insertion: bases of proximal phalanges via dorsal expansions

29
Q

What is the innervation of the dorsal and palmar interossei

A

Both are innervated by the ulnar nerve

30
Q

What is the action of the dorsal interossei

A

Abduct fingers from midline

31
Q

What is the action of the palmar interossei

A

adduct fingers towards midline

32
Q

What muscles are used to pinch

A

1st dorsal interosseus and adductor pollicis act to clench the thumb against the index finger for a strong pinch

33
Q

Where is LI-4 located (acupuncture point)

A

On the first dorsal interosseus

34
Q

What is trigger finger

A

Chronic irritation causes a nodule to form along the flexor tendon. This prevents the smooth action of the tendon and may even lock the finger in a flexed position

35
Q

What is the bowstring phenomenon

A

When a fibrous flexor sheath over the flexor tendon breaks, the tendon then pushes agains the skin when in flexion instead of staying on the bone

36
Q

What is mallet finger injury

A

injury of the extensor digitorum tendon of the fingers at the distal interphalangeal joint (DIP) that leads to a permanent flexion of the distal phalanx

37
Q

What is Boutonniere’s finger

A

Flexion deformity of the PIP joint is due to interruption of the central slip of the extensor tendon such that the lateral slips separate and the head of the proximal phalanx pops through the gap like a finger through a button hole (thus the name, from French boutonnière “button hole”)

38
Q

What is the function of link ligaments

A

Provide a connection between dorsal expansions and flexor tendon sheaths to coordinate movement

39
Q

What is the function of fibrous flexor sheaths

A
  1. Act as a pulley system to assist action of flexor muscles on phalanges 2. Keep the tendon against the bone for better pull and protection
40
Q

What is the cutaneous innervation of the median nerve in the hand

A

First 3.5 digits and thenar eminence

41
Q

What is the muscular innervation of the median nerve in the hand

A

Thenar muscles except the adductor pollicis, lumbricals 1,2

42
Q

What is the carpal tunnel

A

Space formed by flexor retinaculum spanning across carpal bones

43
Q

What 10 things are in the carpal tunnel

A

median nerve, flexors digitorum superficialis and profundus, flexor pollicis longus

44
Q

What hand structures are NOT in the carpal tunnel

A

Ulnar nerve, radial and ulnar arteries, palmaris longus, flexors carpi ulnaris and radialis

45
Q

What causes carpal tunnel syndrome

A

compression of the median nerve due to a reduction in the carpal tunnel space

46
Q

What causes a reduction in the size of the carpal tunnel

A

local inflammation or tenosynovitis, fluid overload, dislocation of carpal bones, arthritis

47
Q

What are the symptoms of carpal tunnel syndrome

A

loss of sensation over median nerve distribution, loss of function of thenars and 1,2 lumbricals, thenar wasting (ape hand)

48
Q

What causes thenar wasting in carpal tunnel syndrome

A

Muscles are constantly receiving nerve signals. When a muscle stops receiving nerve signals it starts to atrophy

49
Q

What is the flick sign

A

Ask your patient what they do when their pain gets too great and if they flick their wrist there is a 91% chance they have carpal tunnel syndrome

50
Q

How do you test the median nerve

A

Tinel’s or Phalen’s test, Sensory test with tuning fork or 2 point discrimination, strength testing, EMG

51
Q

What is the cutaneous innervation of the Ulnar nerve in the hand

A

digits 5 and 1/2 of 4, ulnar side of both palm and dorsum

52
Q

What hand muscles does the ulnar nerve innervate

A

hypothenars, adductor pollicis, lumbricals 3,4 dorsal and palmar interossei

53
Q

What is the tunnel of Guyon

A

Space between pisiform and hook of hamate, interconnected by pisohamate ligament

54
Q

what forms the floor and roof of the tunnel of Guyon

A

Floor: flexor retinaculum
Roof: palmar carpal ligament

55
Q

What goes through the tunnel of Guyon

A

Ulnar nerve, Ulnar artery and vein

56
Q

What happens to the hand if the ulnar nerve is damaged

A

Claw hand due to lack of MCP flexion and IP extension in fingers (Benediction hand), atrophy of interossei, cutaneous loss of 1.5 digits

57
Q

How does one test the ulnar nerve

A

Tinel’s test, sensation testing, have patient cross his finger, EMG and nerve conduction tests

58
Q

How does one test the radial nerve

A

Wrist and elbow extension, sensation around dorsum of the thumb, nerve conduction studies

Musculoskeletal Anatomy I (8 decks)

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