Flashcards in Anterior Hand-Sievert Deck (156)
How is the anterior hand divided?
thenar & hypothenar compartments
*this applies to muscles, lumbricals, interossei
T/F There are intrinsic hand muscles in the dorsum of the hand.
False. There are not.
Where do you flex your hand?
at the creases of your thumb & fingers
What is the palmar aponeurosis?
this is a tendinous thing that covers the intrinsic muscles of your palm
**it makes it more difficult to peel the skin away from the palm of the hand
What are the sections of your palms that aren't covered by the palmar aponeurosis called? Where are they located?
Thenar compartment: thumb area
Hypothenar compartment: pinky area
**these are areas on either side of the palmar aponeurosis.
How many muscles are found in the thenar & hypothenar compartments? What names do they share? Are these compartments covered by the palmar aponeuroses?
3 muscles are in each compartment
OAF: opponens; abductor, flexor
**NOT covered by the aponeurosis
What is something bad that can happen to your palmar aponeurosis ?
it can undergo contractures-->Dupuytren's Contracture
**disease of the palmar fascia, thickening & shortening of fibrous bands on the palmar surface of the hand & fingers
What connects to the palmar aponeurosis?
the palmaris longus tendon
What are the thenar muscles exactly? What innervates them?
O: opponens pollicis
A: abductor pollicis brevis
F: flexor pollicis brevis
Nerve: median nerve
What are the hypothenar compartment muscles exactly? What innervates them?
O: opponens digiti minimi
A: abductor digiti minimi
F: flexor digiti minimi (brevis)
Nerve: ulnar nerve
What's the deal w/ the adductor pollicis?
this is not a thenar compartment muscle
therefore, it isn't innervated by the median nerve
**considered an adductor of the thumb, innervated by the ulnar nerve.
Which of the OAF muscles is most lateral in the thenar compartment?
abductor pollicis brevis
Where does the flexor pollicis brevis go?
to the metacarpal pharyngeal joint
Where does the opponens pollicis attach?
to a metacarpal
What does the median nerve travel thru? What does the ulnar nerve travel thru?
Median Nerve-->carpal tunnel
Ulnar Nerve-->Guyon's canal (gets compressed w/ cyclists resting their wrist on the handlebar)
What happens when the median nerve is damaged?
then the thenar carpal muscles are useless
can't grasp if you don't have thumb movements
can be damaged w/ carpal tunnel syndrome
What passes thru the carpal tunnel?
9 tendons w/ an associated bursa
**this includes flexor digitorum superficial is, flexor digitorum profundus, flexor pollicis longus
As far as which fingers are supplied...describe the orientation w/i the carpal tunnel.
The middle 2 fingers' supply is located right above the lateral 2 fingers' supply.
Which ligament makes up the carpal tunnel, that is on the superior surface?
What is the first thing that you will probably recognize if you have carpal tunnel?
numbness, tingling in your thumb, index finger, middle finger, half of your ring finger--that is the structures which are supplied by the median nerve.
What is the name of the muscles that connect the metacarpals?
What is the name of the muscle type that is associated w/ the tendons?
What can cause an infection in the midpalmar space?
rupture of the synovial tendon sheath of digits 3, 4, or (theoretically) 5.
**this is dangerous b/c it can cause adhesions to tendons as they pass thru the midpalmar space.
**middle finger is infected...you could lose your whole hand.
**have to inject an antibiotic
What can cause an infection of the thenar space?
rupture of the synovial tendon sheath of digit 2 & (theoretically 1).
Which fingers usu create infections in the midpalmar or thenar space & which ones don't? Why?
Digits 2, 3, 4 create infections.
3 & 4 in midpalmar space
2 in thenar space
**digits 1 & 5 usu don't because their sheaths extend into the forearm. If they ruptured, they would likely rupture in the forearm.
What are the bursa associated w/ the thumb & pinky finger?
Thumb: radial bursa
Pinky Finger: ulnar bursa-->passes thru the carpal tunnel
What are fibrous tendinous sheaths? What is their function? What are the 2 types?
they are osseofibrous bands on the fingers
they hold the long flexor tendons tightly against the metacarpals & phalanges
Anular & Cruciate
Describe the anular & cruciate bands.
Cruciate: cross over the finger in a cross formation. Less important.
Anular: bands that go across (A1-A5) More important
Where are the following anular bands located? A1, A2, A3, A4, 5?
A1: MP joint
A2: middle of the proximal phalanx
A3: PIP joint
A4: middle of the middle phalanx
A5: DIP joint
T/F There is a synovial tendon sheath associated w/ the finger.
True. There is a tendon sheath that is located beneath the anular & cruciate bands & above the finger tendon.
It slides back & forth b/w movement of the finger.
Tendons don't really have a blood supply. Explain the blood supply that the tendons of the finger sorta have.
They do have some blood supply that comes in from the inferior aspect via an extension of the synovial tendon sheath.
Where do the lumbrical muscles originate from? Where do they go to?
Origin: off the deep tendons that come from the flexor digitorum profundus tendon.
Go to: phalanges, to the extensor hood.
Lumbricals are always on which side of the finger?
What is the action of the lumbricals?
Flex @ the MP joint b/c they pass anterior to it
Extend @ the PIP & DIP b/c they pull on the extensor hood
What is the innervation of the lumbricals?
radial half innervated by the median nerve (first 2 lumbricals)
ulnar half innervated by the ulnar nerve (second 2 lumbricals)
When we are talking generally about the hand what does the ulnar nerve innervate?
everything except for the thenar compartment muscles (there are 3) & the radial half of the lumbricals (there are 2)
When we are talking about the forearm what does the median nerve innervate?
everything except the ulnar half of the flexor digitorum profundus & the flexor carpi ulnaris
Where do interosseus muscles start & end? Where are they located?
Start: @ the metacarpals
End: @ the extensor hoods
**they are located in b/w fingers on the anterior & posterior sides of the hand BUT they are considered anterior compartment muscles
Why are all the interosseus muscles considered anterior compartment muscles even tho some of them are located on the dorsum of the hand?
this is b/c of their innervation. They are all innervated by the ulnar nerve.
How many interosseus muscles are found on the palmar surface of the hand? What is their action?
3 palmar interosseus muscles (mostly unipenate)
How many interosseus muscles are found on the dorsal surface of the hand? What is their action?
4 dorsal interosseus muscles (mostly bipenate)
The abductor digiti minimi is on the dorsal surface of the hand, to the medial side of the pinky finger. It abducts the finger. Why in the world isn't it considered an interosseus muscle?
b/c it is considered to be a part of the hypothenar compartment
When the interosseus muscles pass the MP joint are they anterior or posterior?
they are anterior to the joint
similar in this way to the lumbricals
What is the significance of both lumbricals & interosseus muscles inserting in the extensor hood?
significance is that they will both cause flexion @ the MP joint (b/c they pass anterior) & extension @ the PIP & the DIP (b/c they pull on the extensor hood & pass dorsal to the finger)
T/F there are bands of the lumbricals & interosseus muscles that appear to pass dorsal to the phalanx.
TRUE This is a part of the explanation of their action, like the extension of the PIP & DIP or something.
Describe the basic structure of the tendons near the end of the finger, including the extensor hood.
palmar side of the finger:
FDS splitting @ PIP & FDP going underneath until it reaches the DIP.
dorsal side of the finger:
long extensor tendon becoming central band which ends @ the PIP. interosseus muscles seem to give good contribution to this.
lateral band on either side of the central band which ends @ the DIP. lumbrical muscles seem to give a good contribution to this.
What could happen to your finger if you suddenly lost your central band?
your lateral band could slip off to the side & you would get extension @ the DIP but flexion @ the PIP
What could happen to your finger if you suddenly lost your lateral band?
you wouldn't be able to extend @ DIP, your distal phalanx.
You would get mallet finger.
Which muscle is located closer to the bone--interosseus or lumbricals?
What are the actions of the FDP & FDS on the finger?
FDP flexes DIP
FDS flexes PIP
If you are using your FDP & FDS & flexing your fingers...what else is needed to make a tight fist?
extensor tendons @ your wrist
Describe the collateral flow in the hand.
Radial artery forms the deep palmar arch. This anastomoses w/ the ulnar artery's deep palmar branch. It gives off 3 palmar metacarpal arteries that join the common palmar digital arteries from the superficial arch. Ulnar artery forms the superficial palmar arch. This anastomoses w/ the superficial palmar branch of the radial artery. It gives off common palmar digital arteries (which joint palmar metacarpal arteries) & split into proper palmar digital arteries.
What is the Allen test used for? How does this relate to the collateral flow of the hand?
used to determine the source of dominant blood supply in the hand.
sometimes people want to use the radial artery for bypass. Need to first make sure it isn't dominant.
Everybody's collateral flow is different!
What is the most common wrist fracture in children?
fracture of the scaphoid
Describe a scaphoid fracture.
radial artery gives off the palmar carpal branch. this supplies the scaphoid. When you have a fracture of the scaphoid it compromises your blood supply & becomes difficult to heal. Non-union can become a problem. the proximal portion of the scaphoid can even start to undergo necrosis.
Okay, so we are talking cutaneous nerve innervation patterns. What branch of the radial nerve takes care of the back of the hand? Which branch takes care of the back of the arm & forearm?
Arm & Forearm: posterior cutaneous of the radial nerve
Back of the Hand: superficial radial nerve
Which cutaneous nerve takes care of the radial side of the forearm? What is this a branch off of? Which cranial nerves can it be traced back to?
lateral antebrachial cutaneous nerve
branch of the musculocutaneous nerve
this comes from the brachial plexus & is a C5, C6, C7 deal.
Anterior compartment of the arm is innervated by?
Anterior compartment of the forearm is innervated by?
All median nerve
Except: ulnar half of the flexor digitorum profundus & the flexor carpi ulnaris (ulnar nerve)
Anterior hand is innervated by?
all ulnar nerve except thenar compartment muscles & radial half of the lumbricals
**median nerve innervates these exceptions
The posterior compartment of the shoulder is innervated by?
axillary nerve-->goes to the deltoid & teres minor
The posterior arm & forearm is innervated by what?
What does long standing damage to a nerve cause?
What are the 2 brachial plexus conditions? Which nerves are affected in each of these?
Erb Duchenne Paralysis or Palsy: C5, C6
Klumpke's Paralysis or Palsy: C7, C8, T1
How could someone get Erb Duchenne's?
fall that pushes the head away from the shoulder & depresses the shoulder, puts tension on the upper roots of the brachial plexus
pulling on the head during birth & getting the shoulders stuck.
What movements are affected when you have Erb Duchenne's?
mainly shoulder movements affected (axillary nerve) but other things too (weakness of the forearm, loss of extension at the elbow)
What would a kid's arm look like if they had Erb Duchenne's? An adult's arm?
Kid: elbow extended & wrist flexed
Adult: Waiter's tip-->elbow extended, wrist flexed, internal rotation
How could someone get Klumpke's?
extended arm & abducted shoulder like if you were trying to stop your fall.
if you were yanking on the arm of baby to get them out of their mother's womb.
**damage to the lower trunk of the brachial plexus.
What movements are mainly affected when you have Klumpke's?
biggest effect is for hand movements & some forearm
upper limb becomes wasted after a while w/ atrophy
What is Horner's Syndrome? How does this related to Klumpke's?
sympathetics that go to the head come off of T1.
Sympathetics cause dilation of the eyes
**if you have this: pupils will look constricted on affected side where the brachial plexus damage was done.
Where is the axillary nerve most prone to injury? Which muscle would be most affected if it were injured?
Axillary nerve prone to injury @ the surgical neck
deltoid most affected
Which actions would be affected if the axillary nerve were injured? Which muscles would pick up the slack?
severely weakened abduction (supraspinatus could still help for the first 10-15 degrees of abduction)
weakened lateral rotation (infraspinatus could still help)
Which nerve supplies the infraspinatus?
Which muscles would be most affected if the musculocutaneous nerve were injured?
muscles of the anterior arm
Which actions would be compromised if the musculocutaneous nerve were injured? Which muscles could step up & help?
almost no forearm flexion
weakened arm flexion
**brachioradialis could help w/ forearm flexion
What is the most vulnerable area that could allow for a radial nerve injury?
mid humeral shaft fracture
Which actions would be compromised w/ a radial nerve injury? What would your arm & forearm look like?
no arm/forearm extension
**your arm would be slightly flexed & your forearm would be slightly flexed (b/c w/o the extensors activated, the flexors will dominate)
What does motor innervation to the muscles of the posterior arm? Posterior forearm? Posterior hand?
Posterior Arm: radial nerve
Posterior Forearm: deep branch of the radial nerve
Posterior Hand: no motor innervation from the radial nerve
What does the cutaneous innervation to the posterior arm? Posterior forearm? Posterior hand?
Posterior Arm: Posterior Brachial Cutaneous Nerve (branch of radial nerve)
Posterior Forearm: Posterior Antebrachial Cutaneous Nerve (branch of the radial nerve)
Posterior Hand: superficial branch of the radial nerve
What will be the effect of damage to the radial nerve high in the arm?
weak wrist extension
weak digit extension
no extension at the elbow
weak grip strength
What will be the effect of damage to the radial nerve in the forearm?
weakened wrist extension
weakened digit extension
weakened grip strength
What are the motor branches off of the musculocutaneous nerve?
branches to the anterior arm muscles
What are the cutaneous branches off of the musculocutaneous nerve?
lateral cutaneous nerve of the forearm
What is the motor innervation to the anterior forearm?
the median nerve
the ulnar half of the flexor digitorum profundus & the flexor carpi ulnaris-->this is the ulnar nerve
What is the motor innervation to the anterior hand?
radial half of the lumbricals
thenar compartment: OAF
ulnar half of the lumbricals
hypothenar compartment: OAF
What does the median nerve do in terms of cutaneous innervation of the hand?
posterior hand: tips of 31/2 digits
What is the main motor innervation of the hand?
ulnar nerve. does everything except the thenar compartment muscles (OAF) & the radial half of the lumbricals
Where is the easiest place to damage the ulnar nerve?
@ the elbow @ the medial epicondyle. Called funny bone.
this damage expresses itself all the way down in the hand, however.
could also be damaged @ wrist with how cyclists ride their bikes.
How does the ulnar nerve travel thru the wrist?
thru Guyon's canal
What type of hand formation does ulnar nerve damage create? Describe it.
4th & 5th fingers are hyperextended @ MP joint & flexed @ PIP & DIP.
2nd & 3rd fingers are somewhat extended @ MP joint, not flexed @ PIP & DIP.
Why does the hand become a claw hand w/ ulnar nerve damage?
you lose innervation to all the interossei muscles. you also lose lumbricals to the 4th & 5th fingers. These 2 types of muscles cause flexion @ the MP joint. Without them, there is hyperextension @ the MP joint for the 4th & 5th fingers. THis naturally causes the flexion @ the PIP & DIP. There is only slight extension @ the 2nd & 3rd fingers b/c they still have their lumbricals intact.
What does damage to the radial nerve @ the elbow cause?
hand of papal blessing/benediction hand
4th & 5th fingers relaxed & slightly flexed
2nd & 3rd fingers extended b/c of loss of radial half of FDP & radial half of the lumbricals.
thumb derotated b/c extensor pollicis longus & abductor pollicis longus still pull & will rotate the thumb out of its axis
What does damage to the radial nerve @ the wrist cause? How might this happen?
Carpal Tunnel Syndrome
papal blessing/benediction hand
but w/ severe wasting of the thenar compartment.
How is the benediction hand different from the hand you get from a palmar contracture?
w/ the contracture you don't get the derotated thumb
Following tendon & ligament injuries, the hand takes on distinctive positions due to?
loss of movement
Note: long term tendon damage can cause shortening of tendons & contractures.
What is the Jersey Finger?
when you tear the FDP off the distal phalanx
What is the test you do to see if someone has an FDP injury?
you passively extend the MP & PIP of the affected finger
you ask them to try to flex the DIP. If their FDP is messed up, they won't be able to.
What is the test you do to see if someone has an FDS injury to their finger?
You passively extend all of the unaffected fingers. You ask them to flex the affected finger. If they can't, messed up FDS.
How do you get a mallet finger?
damaging the lateral bands
What is the difference b/w a ruptured tendon & an avulsion fracture?
ruptured tendon: literally break the tendon
avulsion fracture: break the tendon off the distal phalanx
both result in mallet finger if this applies to the distal phalanx.
What is a boutonniere deformity?
this is when your central band is messed up
you get volar migration of your lateral bands
**you get flexion @ the PIP & extension @ the DIP
Where are the transverse metacarpal ligaments located? How can they help you heal?
they are ligaments that are transverse b/w metacarpals, kinda @ the knuckles.
they tighten up when your fingers are flexed.
If you have a fracture of your 4th or 5th metacarpal, they can help by keeping the metacarpal from shortening too much if you have the hand secured in a flexed finger position.
What can the GH joint do on the AP axis?
What can the GH joint do on the vertical axis?
What can the GH joint do on the transverse axis?
flex & extend
What can the humeroulnar joint do on the transverse axis?
flex & extend
What can the humeroradial joint do on the transverse axis?
flex & extend
What can the humeroradial joint do on the vertical axis?
What can the radioulnar joint do on the vertical axis?
rotation--pronation & supination
What can the radiocarpal joint do on the transverse axis?
What can the radiocarpal joint do on the AP axis?
What is so special about the carpometacarpal joint?
this joint is important for the apposition of the fingers.
this mainly applies to the 1st & 5th digits.
1st carpometacarpal joint is especially cool b/c it is multi axial & allows for:
Which carpometacarpal joint is frequently damaged?
the 1st digit's joint
there is often damage b/w the trapezium & the thumb metacarpal
What are the axes of the MP joints of each finger? Which actions can they accomplish @ these joints?
Fingers 2-5 biaxial:
Thumb Digit 1 is uniaxial:
Where is MP joint laxity esp common? What can they do to fix this?
especially common with the MP joint of the thumb. They fuse it to fix it.
What is the axis of the interphalangeal joints? What can they do on that axis?
flexion & extension
What is the definition of a joint? What are the 2 types?
a union b/w 2 or more rigid elements
(bone or cartilage)
2 types: synovial & nonsynovial
Describe synovial joints.
skeletal elements are separated by a joint cavity or space that contains synovial fluid
has an articular capsule
these are freely moveable
Describe nonsynovial joints.
these skeletal elements are directly connected to each other or continuous w/ one another
"non-moveable" but not always true
What are the 2 types of nonsynovial joints?
Describe fibrous joints.
Here, skeletal elements are connected to each other via CT.
interosseus membrane (quite moveable--even called the middle radioulnar joint)
the rest are not really moveable
Describe cartilagenous joints.
skeletal elements connected by cartilage
sometimes capable of slight movements
intervertebral discs (fibrocartilagenous)
epiphyseal plate of humerus-->slips w/ slipped humeral head
What types of joints do most of the upper limbs have?
**have synovial fluid that are contained in articular capsule.
**hyaline cartilage usu covers their articular surfaces
**these are freely moveable
**fibrous joint capsule
**have a synovial membrane
T/F Joints can be classified based off of their # of axes.
True. Uniaxial, Biaxial, Multiaxial.
What is the function of a ligament? What are the 3 types of ligaments that you can have?
fcn: to help stabilize a joint & prevent or limit unwanted movement of that joint
What is the most common type of ligament for a person to have?
these are continuations of ligamentous connections of the joint cavity
What's the deal w/ intracapsular ligaments?
these ligaments are within the capsule & are covered by a synovial membrane but are NOT in contact w/ synovial fluid
What is the function of the acromioclavicular joint?
allows a little bit of gliding movement as you elevate & depress the clavicle
allows the scapula to move w/o retracting outward
What are some of the ligaments that are positioned near the AC joint?
What is the function of the coracoclavicular ligaments?
helps to stabilize everything,
w/o these ligaments, AC separations would be more frequent
this is why the clavicle usu breaks in the place that it does.
What is the function of the coracoacromial ligament?
this is a shelf for the humerus
What does the glenohumeral ligament do?
this ligament forms the capsule of the shoulder joint anteriorly
it is strengthened by the rotator cuff muscles
What is the glenoid labrum?
a continuous ring of cartilage (even tho it looks like 2 separate pieces of cartilage)
it goes around the glenoid fossa & deepens the socket
How could you damage the glenoid labrum?
the part of the glenoid labrum near the supraglenoid tuberosity where the long head of the biceps brachii is attached...if you pull the biceps in the wrong way, could pull off a piece of the glenoid labrum
**also, the long head of the triceps goes to the inferior glenoid tuberosity & can rip off a part of the glenoid labrum
What is the deal w/ the bursa that is near the long head of the biceps tendon as it emerges from the GH joint b/w the greater & lesser tubercles?
this is a common site for bursitis, bicipital tenosynovitis
What supports the shoulder anteriorly?
glenohumeral ligaments: superior, middle, inferior
subscapularis (of the SITS)
If a pitcher gets a shoulder dislocation, in what direction will the humeral head burst out? What do you have to be aware of when putting it back in?
the humeral head will go out in the inferior & anterior direction
have to be aware of the brachial plexus
What happens in shoulder separation? What else can happen?
the acromioclavicular ligaments break
sometimes: the coracoclavicular ligaments can break, but if they break it is really more likely that the clavicle would just break.
What is the most common part of the clavicle to break?
the middle & distal 1/3.
What are the 3 articulations in the elbow joint? Where does each occur?
humeroulnar: @ the trochlea
humeroradial: @ the capitulum
proximal/superior radioulnar: b/w each other
Where is the radial notch? What is its purpose?
it is located on the side of the ulna, allows the radial head to sorta slide along.
What are the actions that are allowed at the elbow & which joints make that happen?
pronation/supination-->superior radioulnar jt
Which actions are prohibited @ the elbow? How are these actions prevented?
abduction-->ulnar collateral ligaments prevent (made of 3 bands)
adduction-->radial collateral ligaments prevent
How is the ulnar collateral ligament often torn?
Where is the anular ligament? What is its fcn?
this attaches the radial head & the ulna (& the radial collateral ligament) ...sorta looks transverse
fcn: holds the head of the radius against the capitulum
T/F the elbow joint is tight so that abduction & adduction don't occur.
FALSe. the joint is baggy so that it can flex/extend pronate/supinate. The ligaments prevent abduction & adduction.
What is an experience that children sometimes have w/ their anular ligament?
sometimes they get subluxation of their radial head out of their anular ligament. Easy to do (not necessarily abuse) b/c of how underdeveloped the head of the radius is in kids.
What will a child's arm look like if they have experience a subluxation out of their anular ligament? How do you repair this?
arm will look slightly flexed & supinated
Repair: put thumb on the head of the radius & with the other hand pronate the arm. Puts the radial head back in its spot in the anular ligament.
What are the 3 joints b/w the radius & the ulna? What action are they all involved in?
superior/proximal radioulnar joint (anular ligament)
middle radioulnar joint (interosseus membrane)
distal radioulnar joint (a few ligaments)
**all involved in pronation & supination
The interosseus membrane is designed to transfer force in a certain direction. Which direction is that?
from the radial carpal joint TO
the radius TO
the interosseus membrane TO
the ulna TO
T/F The distal radioulnar joint has a disc.
What is the transverse carpal ligament also called? What does it attach to medially? Laterally?
also called the flexor retinaculum
laterally attaches to: scaphoid & trapezium
medially attaches to: pisiform & hamate
What is the order of the carpal bones? What is the mnemonic?
**start near the wrist near the thumb. Then start again near the fingers near the thumb.
What happens if you damage the median nerve @ the wrist?
thumb is derotated b/c thenar compartment muscles are messed up.
everything else is basically fine
What happens if you damage the median nerve @ the elbow?
then you get the benediction hand
thumb is still derotated