4: Hand

Question 1

What is the palmar fascia?

Answer 1

The fascia of the palm (continous with the forearm), specilises into

1. Aponeurosis
2. Fibrous digital sheaths

Question 2

What is the Palmar aponeurosis?

What are its key features?

Answer 2

well-defined region of palmar fascial that overlies the long flexor tendons of the hand

–> proximal continuous with flexor retinaculum and palmaris longus

Question 3

What is the fibrous digital sheath of the hand?

Answer 3

It is the distal continuation of the fibrous sheaths and contains the flexor tendons and synovial sheaths of each finger

Question 4

Answer 4

Question 5

Answer 5

Question 6

What is the thenar compartment of the hand?

Answer 6

The intrinsic muscles of the hand that move the thumb:

1. Abductor pollicis brevis
2. Flexor pollicis brevis
3. Opponens pollicis

+ (Adductor pollicis)= technically not a thenar muscles but sometimes also counted as one

Question 7

Answer 7

Question 8

Answer 8

Question 9

What are the hypothenar muscles of the hand?

Answer 9

The intrinsic muscles of the hand that move the little finger

1. Abductor digiti minimi
2. Flexor digiti minimi
3. opponens digiti minimi

Question 10

Which nerves supplies the thenar muscles of the hand?

Answer 10

Recurrent branch of the Median nerve C8-T1

Question 11

Which nerves supplies the adductor pollicis?

Answer 11

The Ulnar nerve (C8-T1)

Question 12

Which nerve supplies the hypothenar compartment of the hand?

Answer 12

The Ulnar nerve C8-T1

Question 13

What is the function of the interossei muscle of the hand?

Answer 13

1. The palmar interossei: adduct the digits
2. The dorsal interossei: abduct the digits

Question 14

Which nerves innervates the interossei muscles of the hand?

Answer 14

The deep branch of the Ulnar nerve (C8-T1)

Question 15

What are the lumbrical muscles of the hand?

What is their function?

Answer 15

Flexion of metacarpalphalangeal joints

Extionsion of proximal and distal interphalangeal joints

Question 16

What is the innervation of the lumbircal muslces of the hand?

Answer 16

2+3 Median Nerve (C8-T1) (index+ middle finger)

4+5 Ulnar Nerve (C8-T1) (ring+ little finger)

Question 17

Which bones form the attachment for the flexor retinaculum?

Answer 17

On the lateral side it attaches to the

• Trapezium
• Scarphoid

Medial side

• Pisiform
• Hook of Hamate

Question 18

What are the structures passing through the carpal tunnel?

Answer 18

1. Median Nerve
2. Tendons of the
   
   • Flexor digitorium superficialis
   • Flexor digitorium profundus
   • Flexor Pollicis longus

Question 19

What are the fibrous digital sheaths in the hand?

Which structures do they contain?

How do you call the fibrous digital sheath together with their structures an the bone?

Answer 19

They are the fibrous tubes around the digits containing

1. Flexor tendons (incl. synovial sheaths)

–> together they are called osseo-fibrous tunnels

Question 20

Explain the organisation of vessels, nerves and tendons in the digits

Answer 20

From Deep to superficial

1. Deep: Bone (phalynxes)
2. Tendons
   
   • Flexor tendons anteriorly (surrounded by fibrous + synovial sheath)
   • Extensor tendons Posteriorly
3. Structures form Deep (in this case posteriorly) to superificial (in this case anteriorly), embedden in Skin(Grayson) ligament
   
   • Vein
   • Artery
   • Nerve

Question 21

What is the name of vessels and nerves in the digits?

Answer 21

Proper palmar digital vein/artery/nerve

Question 22

How are the extensions of facia that devide the hand into different compartments called?

Answer 22

Septa (sing. Septum)

Question 23

Name the different septa in the hand

Answer 23

1. medial septum (to the little finger metacarpal)
2. lateral septum (to the middle finger metacarpal)

Question 24

In which compartements do the septa of the hand devide the hand?

Answer 24

1. hypothenar compartment
2. central compartment
3. thenar compartment
4. adductor compartment (contains the adductor pollicis muscle)

Question 25

Explain the routes of the FDP and the FDS in the hand

Answer 25

1. Enter the hand via the Carpal tunnel 2. Run together in a common synovial sheath 3. Pass into respective digit in digital synovial sheath 4. * FDS splits around the FDP at the proximal phalanx, attaches to the middle phalanx (picture) * FDP attaches to the distal phalanx

Question 26

How are the condensations of the fibrous digital sheath at the fingers called?

Answer 26

They are called pulleys 1. Annular pulleys 2. Cruciform pulleys

Question 27

What is the function of the pulley in the digits?

Answer 27

They allow a more functional use of the long flexor tendon

Question 28

How is the structure at the back of the hand called that fixates all the extensor tendons?

Answer 28

The extensor retinaculum

Question 29

What is the role and function of the intertendenous bands of the hand?

Answer 29

these bands limit free movement of one extensor tendon independently of the others.

Question 30

What is the extensor expansion?

Answer 30

The long extensor flattening at level of the metacarpals

Question 31

What is the function of the extensor expansion?

Answer 31

Involved in movement of the digits It is an attachment for the interossei and the lumbrical muscles

Question 32

How is the joint between the distal and the proximal row of the carpal bones called?

Answer 32

The midcarpal joint

Question 33

What are the main movements occuring at the intercarpal joint?

Answer 33

Normally a gliding movement

Question 34

What type of joint is the carpo-matacarpal joint of the thumb? Which bones are involved?

Answer 34

It is the joint between the trapezium and the 1st metarcarpal bone It is a saddle joint (type of synovial joint)

Question 35

What type of joint are the carpometacarpa joints?

Answer 35

They are synovial elipsoid joints

Question 36

How are the main ligaments called that stabelise the MCP and IP joints called?

Answer 36

Collateral ligaments, one on each side 1. One ulnar collateral ligament 2. Radial collateral ligament

Question 37

What is the clinical significane of the ulnar collateral ligament of the thumb?

Answer 37

It often gets damaged e.g. during skiing when falling onto outstreched thumb

Question 38

What is a mallet finger?

Answer 38

Avulsion of extensor digitorum longus tendon at the base of distal phalanx

Question 39

Which artery forms the superficial palmar arch of the hand?

Answer 39

Ulnar artery

Question 40

The median nerve passes laterally to the tendon of which muscle just before entering the carpal tunnel?

Answer 40

Palmaris Longus