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Y2 LCRS Anatomy of Limbs > the hand > Flashcards

the hand Flashcards

hand organisation: describe the organisation, innervation, blood supply and function of the intrinsic muscles of the hand; digits: describe and demonstrate the movements of the fingers and thumb; describe the position, function and nerve supply of the muscles and tendons involved in these movements, differentiating between those in the forearm and those intrinsic to the hand

1
Q

what is the deep fascia of the palm of the hand called, and 2 features of skin of palm

A

palmar fascia (thicker skin with no hair follicles)

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2
Q

what 2 specialisations of the palmar fascia form

A

palmar aponeurosis, fibrous digital sheaths

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3
Q

location of palmar aponeurosis in relation to long flexor tendons

A

well-defined region of palmar fascia in hand, overlying long flexor tendons of hand

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4
Q

proximal end of palmar aponeurosis

A

continuous with flexor retinaculum (transverse carpal ligament) and palmar longus tendon

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5
Q

distal end of palmar aponeurosis

A

forms four bands which are continuous with the fibrous digital sheaths of each finger

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6
Q

what are fibrous digital sheaths

A

tubes which contain flexor tendons and their synovial sheaths

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7
Q

what is the space between the palmar aponeurosis and bones of the hand separated into compartments by

A

extensions of fascia called septa (medial and lateral)

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8
Q

2 septa locations

A

medial septum (to little finger metacarpal) and lateral septum (to middle finger metacarpal)

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9
Q

what are the 3 compartments created by septa

A

hypothenar (medial, little finger), central, thenar (lateral, thumb)

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10
Q

what compartment is deep to the thenar compartment

A

adductor compartment

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11
Q

what muscle is contained within the adductor compartment

A

adductor pollicis muscle

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12
Q

5 bones/groups of bone in wrist and hand

A

radius, ulna (articulates via articular disc), carpals, metacarpals, phalanges

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13
Q

what are the 8 carpals (from lateral to medial and proximal then distal row)

A

scaphoid, lunate, triquetrum, pisiform (only proximal carpal to not articulate proximally), trapezium, trapezoid, capitate, hamate

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14
Q

3 groups of muscles in wrist and hand

A

anterior compartment of forearm (superficial and deep compartment muscles), posterior compartment of forearm muscles, intrinsic muscles of hand

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15
Q

4 (compartment) muscles of intrinsic muscles of hand

A

thenar compartment muscles, adductor compatment muscles, hypothenar compartment muscles, interossei and lumbricals

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16
Q

5 muscles of superficial anterior compartment of forearm

A

pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis

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17
Q

3 muscles of deep anterior compartment of forearm

A

flexor digitorum profundus, flexor pollicis longus, pronator quadratus

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18
Q

extensor compartment of forearm: 3 muscles that move wrist joint

A

extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris

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19
Q

extensor compartment of forearm: 3 muscles that move digits

A

extensor digiti minimi, extensor indicis, extensor digitorum

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20
Q

extensor compartment of forearm: 3 muscles that move thumb

A

extensor pollicis brevis, extensor pollicis longus, abductor pollicis longus

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21
Q

2 other muscles of forearm

A

brachioradialis, supinator

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22
Q

intrinsic muscles of hand: 3 thenar muscles

A

abductor pollicis brevis, flexor pollicis brevis, opponens policis

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23
Q

intrinsic muscles of hand: adductor muscle, and attachments

A

adductor pollicis, with a broad attachment to middle metacarpal bone, and narrow attachment to base of proximal phalanx of thumb

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24
Q

intrinsic muscles of hand: 3 hypothenar muscles

A

abductor digiti minimi, flexor digiti minimi, opponens digiti minimi

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25
Q

intrinsic muscles of hand: where do 4 lumbricals flex and extend at

A

flex at metacarpals, extend at interphalangeal joints

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26
Q

intrinsic muscles of hand: 2 types of interossei, and how many of each

A

palmar interossei (3), dorsal interossei (4)

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27
Q

intrinsic muscles of hand: function of palmar interossei muscles (PAD)

A

adduct digits

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28
Q

intrinsic muscles of hand: function of dorsal interossei muscles (DAB)

A

abduct digits

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29
Q

anterior tendinous anatomy: proximal and distal attachments of fibrous digital sheaths

A

level of metacarpal head to base of distal phalanx

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30
Q

anterior tendinous anatomy: what do fibrous digital sheaths and underlying bone form

A

osseo-fibrous tunnels

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31
Q

anterior tendinous anatomy: what run through the osteo-fibrous tunnels

A

long flexor tendons and their synovial sheaths

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32
Q

anterior tendinous anatomy: what is the name of the condensations formed by parts of the fibrous digital sheath

A

pulleys

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33
Q

anterior tendinous anatomy: function of pulleys

A

allow more functional use of long flexor tendons

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34
Q

anterior tendinous anatomy: name of 2 pulleys

A

annular, cruciform

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35
Q

anterior tendinous anatomy: what 2 tendons pass deep to flexor retinaculum in carpal tunnel, after passing the wrist joint, to enter a common synovial sheath

A

tendons of flexor digitorum profundus and flexor digitorum superficialis

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36
Q

anterior tendinous anatomy: how do the tendons of flexor digitorum profundus and flexor digitorum superficialis pass to respective digits

A

via digital synovial sheath (lubricate and prevent friction), contained within fibrous digital sheath

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37
Q

anterior tendinous anatomy: what digits have continuous sheaths with the common synovial sheath

A

little finger and thumb

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38
Q

anterior tendinous anatomy: what happens to the flexor digitorum superficialis tendon at the base of the proximal phalanx

A

splits around flexor digitorum profundus

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39
Q

anterior tendinous anatomy: where does the flexor digitorum superficialis tendon attach

A

anterior surface of middle phalanx

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40
Q

anterior tendinous anatomy: where does the flexor digitorum profundus tendon attach

A

distal phalanx (hence pierces flexor digitorum superficialis)

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41
Q

anterior tendinous anatomy: where does flexor pollicis longus have its own synovial sheath at

A

flexor retinaculum

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42
Q

anterior tendinous anatomy: where does flexor pollicis longus run to

A

distal phalanx of thumb

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43
Q

posterior tendinous anatomy: what holds all the extensor tendons of the hand to the dorsum of the wrist region

A

extensor retinaculum (at wrist, not as tough as flexor retinaculum, holding tendons down)

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44
Q

posterior tendinous anatomy: what surround the tendons on the posterior side of the hand

A

synovial tendon sheaths

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45
Q

posterior tendinous anatomy: function of synovial tendon sheaths

A

facilitate free movement of tendons

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46
Q

posterior tendinous anatomy: what joins long extensor tendons to digits on dorsum of hand

A

inter-tendinous bands

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47
Q

posterior tendinous anatomy: function of inter-tendinous bands

A

prevent free movement of one extensor tendon independently of others

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48
Q

posterior tendinous anatomy: what do the long extensor tendons flatten to form at the level of the metacarpals

A

extensor expansions, forming a hood on back of digit

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49
Q

posterior tendinous anatomy: what muscles distally attach to the extensor expansions of long extensor tendons (not bone), and what are their proximal continuation or attachments from

A

lumbricals (4, with proximal continuation from flexor digitorum profundus muscle) and interossei (proximal attachment between adjacent metacarpals, arranged along axial line of hand)

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50
Q

posterior tendinous anatomy: function of extensor expansions

A

intricately involved in movements of digits

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51
Q

posterior tendinous anatomy: what 3 joints does the extensor digitorum extend

A

metacarpal and interphalangeal joints, some part in extending wrist joint after maximal extension of digits

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52
Q

posterior tendinous anatomy: what 2 digits have their own individual long extensors

A

index finger and little finger

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53
Q

6 joints of region

A

distal radio-ulnar joint, wrist joint, intercarpal joints, carpo-metacarpal and inter metacarpal joints, metacarpo-phalangeal joints, interphalangeal joints

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54
Q

distal radio-ulnar joint type

A

pivot-type synovial joint

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55
Q

function of distal radio-ulnar joint

A

allows radius to rotate around ulna

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56
Q

what ligament is within the distal radio-ulnar joint, and what is it

A

triangular ligament, which is a triangular fibrocartilage articular disc

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57
Q

muscles moving distal radio-ulnar joint

A

supinator, biceps, pronator quadratus, pronator teres

58
Q

wrist joint type

A

elipsoid synovial joint

59
Q

location of wrist joint

A

between distal radius and its associated triangular fibrocartilage articular disc, with the proximal row of the carpal bones (not pisiform)

60
Q

6 strong ligaments stabilising wrist joint

A

ulnar collateral ligament, radial collateral ligament, palmar radio-carpal ligament, palmar ulnocarpal ligament, dorsal radio-carpal ligament, inter-carpal ligaments

61
Q

3 movements of wrist

A

flexion/extension, radial deviation (abduction) and ulnar deviation (adducion), circumduction

62
Q

what 2 other joints allow flexion in wrist region

A

midcarpal joints, carpo-metacarpal joints

63
Q

5 muscles providing flexion at wrist joint

A

flexor carpi radialis, flexor carpi ulnaris, long flexors of thumb and fingers, palmaris longus, abductor pollicis longus

64
Q

4 muscles providing extension at wrist joint

A

extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, long extensors of thumb and fingers

65
Q

5 muscles providing radial deviation (abduction) at wrist joint

A

flexor carpi radialis, extenor carpi radialis longus, extensor carpi radialis brevis, abductor pollicis longus, extensor pollicis brevis

66
Q

2 muscles providing ulnar deviation (adduction) at wrist joint

A

extensor carpi ulnaris, flexor carpi ulnaris

67
Q

intercarpal joints type

A

synovial

68
Q

3 sets of intercarpal joints

A

joints between proximal carpal bones, joints between distal carpal bones, joints between proximal and distal carpal bones (midcarpal joints)

69
Q

main movement occuring at carpal joints

A

gliding, augmenting the movement occurring at the wrist joint itself (especially flexion and radial deviation of the wrist)

70
Q

carpo-metacarpal joint of thumb type

A

synovial joint of saddle variety

71
Q

carpo-metacarpal joint of thumb location

A

articulation between trapezium and thumb metacarpal

72
Q

why is the carpo-metacarpal joint of thumb clinically important

A

often becomes osteoarthritic

73
Q

other carpo-metacarpal joints type

A

synovial elipsoid joints

74
Q

other carpo-metacarpal joint locations

A

between the trapezoid, capitate and hamate with the metacarpals of the digits

75
Q

order of rigidity of other carpo-metacarpal joints

A

index and middle finger > ring finger > little finger

76
Q

what joints are present between metacarpals at their bases

A

plane synovial intermetacarpal joints

77
Q

3 movements occuring at carpo-metacarpal and intermetacarpal joints

A

flexion/extension, radial deviation (abduction) and ulnar deviation (adducion), circumduction

78
Q

metacarpophalangeal joints type

A

condylar synovial joints

79
Q

metacarpophalangeal joints location

A

between metacarpal heads and proximal phalanges (knuckles)

80
Q

2 movements occuring at metacarpophalangeal joints

A

flexion/extension, abduction and adduction

81
Q

interphalangeal joints type

A

hinge synovial joints

82
Q

movement occuring at interphalangeal joints

A

flexion/extension

83
Q

what ligaments hold metacarpophalangeal and interphalangeal joints together, and function

A

radial and ulnar collateral ligaments (prevent abduction and adduction)

84
Q

what collateral ligament of the thumb is clinically important, and why

A

ulnar collateral ligament of thumb, as often injured in skiing by falling on the outstretched thumb

85
Q

location of volar plate

A

anterior surface of the proximal interphalangeal joint

86
Q

what is the volar plate

A

dense condensation of fibrous tissue formed by collateral ligaments at front of proximal interphalangeal joint, and is frequently damaged

87
Q

5 movements of thumb

A

abduction, adduction, extension, flexion, opposition

88
Q

2 muscles that allow abduction of thumb

A

abductor pollicis longus, abductor pollicis brevis

89
Q

2 muscles that allow adduction of thumb

A

adductor pollicis, first dorsal interosseous

90
Q

3 muscles that allow extension of thumb

A

extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus

91
Q

2 muscles that allow flexion of thumb

A

flexor pollicis longus, flexor pollicis brevis

92
Q

muscle allowing opposition of thumb, and location

A

opponens pollicis (working at carpo-metacarpal joint, underneath palmaris brevis)

93
Q

where else does opposition of thumb occur at, and what does it involve

A

metacarpo-phalangeal joint, involving abduction, flexion and then adduction

94
Q

2 arteries supplying blood to hand

A

ulnar, radial

95
Q

where does ulnar artery run in forearm, and where does it pass in the wrist

A

anterior compartment of the forearm, passing on ulnar side of palmar surface of wrist

96
Q

what lies medial to the ulnar artery at the wrist

A

flexor carpi ulnaris (more medial), ulnar nerve (less medial)

97
Q

3 branches of ulnar artery in forearm

A

common interosseous, anterior interosseous, posterior interosseous (behind interosseous membrane)

98
Q

what does the ulnar artery run over, lateral to and through to reach the hand

A

runs over flexor retinaculum, lateral to pisiform, and through semi-rigid ulnar (Guyon’s) canal (with ulnar nerve)

99
Q

2 branches of ulnar artery after reaching the hand

A

superficial palmar arch, deep palmar arch of ulnar artery

100
Q

what else does the superficial palmar arch receive a contribution from

A

superficial palmar branch of the radial artery

101
Q

what does the superficial palmar arch give off

A

3 common palmar digital arteries

102
Q

what do the 3 common palmar digital arteries divide into

A

palmar digital arteries

103
Q

where does radial artery run in forearm, and where does it lie in the wrist

A

lateral aspect of forearm, under cover of brachioradialis, and lies superficially on palmar aspect of radial side of wrist

104
Q

how does the radial artery pass into the hand

A

crosses floor of anatomical snuff box, entering palm between two heads of first dorsal interosseous muscle, then passes between two heads of adductor pollicis muscle

105
Q

what does the radial artery anastomose with to form the deep palmar arch

A

deep palmar branch of ulnar artery

106
Q

what does the deep palmar arch give origin to

A

palmar metacarpal arteries

107
Q

what do the superficial and deep palmar arterial arches have to drain them

A

palmar venous arches (deep drainage)

108
Q

what do dorsal digital veins drain into

A

dorsal venous arch (superficial system), on dorsum of hand

109
Q

what superficial veins does the dorsal venous arch give rise to laterally and medially; describe deep venous drainage of arm and forearm

A

cephalic vein laterally, basilic vein medially (join by median cubital veins); in forearm and arm, deep radial and ulnar veins exist, with drainage into venae comitantes and brachial veins

110
Q

3 main nerves to hand

A

median, ulnar, radial

111
Q

what does median nerve supply in forearm

A

main nerve of anterior compartment

112
Q

what does ulnar nerve supply in forearm

A

contribution to medial muscles of anteiror compartment, but mostly pass into hand

113
Q

what does radial nerve supply in forearm

A

posterior compartment

114
Q

what nerves are purely sensory (muscles mainly in forearm and palmar region) and supply the digits

A

digital nerves

115
Q

what does division of a digital nerve cause

A

anaesthesia in part of the digit

116
Q

median nerve spinal cord levels

A

C6,7,8 T1

117
Q

where does median nerve lie in wrist

A

superficially between tendons of flexor digitorum superficialis and flexor digitorum profundus, deep to palmaris longus

118
Q

what accompanies the median nerve in carpal tunnel (except palmar cutaneous branch)

A

9 flexor tendons (flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus)

119
Q

what does the median nerve pass under in the hand

A

flexor retinaculum

120
Q

what 5 muscles is the median nerve motor supply of

A

3 thenar muscles, lateral (first and second) lumbricals

121
Q

what are the 3 thenar muscles

A

abductor pollicis brevis, flexor pollicis brevis, opponens pollicis

122
Q

how does the recurrent branch of the median nerve usually leave the main trunk

A

within carpal tunnel

123
Q

what does the median nerve supply sensory supply to

A

palmar surface of thumb (palmar cutaneous branch), index and middle ringers, and lateral half of ring finger, as well as some of dorsal surface of these digits

124
Q

ulnar nerve spinal cord levels

A

C8, T1

125
Q

proximal to the wrist, what 2 branches does the ulnar nerve give off

A

palmar cutaneous branch, dorsal cutaneous branch

126
Q

what does the palmar cutaneous branch supply

A

medial palm of hand

127
Q

what does the dorsal cutaneous branch supply

A

medial half of dorsum of hand, including ring and little fingers

128
Q

where does the ulnar nerve lie in the wrist

A

anteriorly, between the flexor carpi ulnaris medially and ulnar artery laterally (doesn’t go through carpal tunnel)

129
Q

where does the ulnar nerve pass beyond the wrist, before dividing

A

passes over flexor retinaculum in ulnar canal with ulnar artery, just lateral to pisiform bone

130
Q

2 branches of ulnar nerve distal to flexor retinaculum

A

superficial branch, deep branch

131
Q

what does the superficial branch of the ulnar nerve supply

A

sensory to palmar surface of little finger, and medial side of wring finger

132
Q

what does the deep branch of ulnar nerve supply

A

motor to hypothenar muscles, adductor pollicis, medial (third and fourth) lumbricals, all interossei (hence controls most muscles involved in fine movements of hand)

133
Q

what are the 3 hypothenar muscles

A

abductor digiti minimi, flexor digiti minimi, opponens digiti minimi

134
Q

radial nerve spinal cord levels

A

C5,6,7,8 T1

135
Q

what are the 2 branches of the radial nerve after dividing superior to elbow

A

superficial radial nerve (sensory cutaneous), deep radial nerve (motor)

136
Q

what does superficial branch of radial nerve supply sensory innervation to in hand

A

lateral two-thirds of the dorsum of the hand, dorsum of thumb, proximal portions of dorsal index and middle fingers

137
Q

what is the direct continuation of the deep radial nerve, and where does this continuation occur

A

posterior interosseous nerve, as it passes between heads of supinator

138
Q

what do the radial nerve and its continuations (deep radial

nerve and posterior interosseous nerve) supply

A

all extensor compartment muscles of arm and forearm (doesn’t supply any muscles in the hand)

139
Q

structure of phalanges

A

base, shaft, head

140
Q

how many phalanges in each digit

A

3, except thumb which has 2

Y2 LCRS Anatomy of Limbs (25 decks)

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