Exam 2 Flashcards
0
Q
Type II AC separation
A
Torn AC capsule and ligament c slight elevation of lateral end of clavicle relative to acromion
1
Q
Type I AC separation
A
STRAINED AC capsule and ligament (collagen microtears)
2
Q
Type III AC separation
A
Torn AC capsule, ligament, coracoclavicular ligament c MARKED elevation of lateral clavicle
3
Q
Ligaments of SC joint
A
Thin anterior SC
Thick posterior SC
interclavicular
costoclavicular
4
Q
Bankart lesion
A
torn anterior glenoid labrum
5
Q
Hill-Sachs deformity
A
flattened/defective humeral head; increases likelihood of anterior GH dislocation
6
Q
Structures to go through in anterior surgical approach of GH joint (2 muscles, 3 tendons, 1 bursa, 1 other)
A
Deltoid, pec
corabrachialis, short head biceps
subscapular bursa
capsule
7
Q
enlargement of what structures would reduce space between humeral head and coracoacromial arch? (1 bone, 2 lig, 2 tendons, 1 bursa)
A
acromion
coracoacromial L., coracohumeral L.
supraspinatus tendon, long head of bicep tendon
subacromial bursa
8
Q
damage to suprascapular nerve would affect sensation in which joint(s)? what about to axillary nerve?
A
Both: GH and AC joints
9
Q
scapular GH group (5 muscles)
A
trapezius rhomboid minor rhomboid major levator scapulae serratus anterior
10
Q
serratus anterior (nerve, action, attachments)
A
Long thoracic N. (C5-7)
Scap. protract., upward rotation, stabilize scapula against ribs
vertebral border (ant. scap.)//ribs 1-9
11
Q
Muscles of anterior GH group (6)
A
Pec major Pec minor Subclavius Coracobrachialis Long head Biceps Short head Biceps
12
Q
Pectoralis Major (nerve, attachment, action)
A
Lateral pectoral N. (C5-7):clavicular, upper sternal
Medial pectoral N. (C8,T1): lower sternal, costal
Medial clavicle, sternum, costal cartilage 1-6//crest of gr. tubercle
- Ant. tendon (clavicular/upper sternal)
- post tendon (lower sternal/costal)
GH adduction, IR,flexion (in ext. position), extension (in flexed position)
13
Q
Pectoralis Minor (nerve, attachment, action)
A
Medial Pectoral N. (C8,T1)
medial coracoid//mid ribs 3-5
scapular depression, anterior tilt, downward rotation, stabilize against rib cage
14
Q
Subclavius (nerve, attachment, action)
A
Nerve to subclavius (C5,6*)
subclavius groove//superior 1st rib-cartilage junction
clavicular depression, stabilize
*little if any contribution
15
Q
3 muscles of posterior GH group
A
Teres Major
Latissimus Dorsi
Long Head Triceps
16
Q
Teres Major (nerves, attach, action)
A
Lower Subscapular N (C5,6)
inferior dorsal scapula (lateral border)//crest of lesser tbrcle
GH adduction, IR, extension?
17
Q
Muscles of sup. GH group (3)
A
Ant delt
Mid delt
Post delt
18
Q
Deltoid (nerve,attach,action)
A
Axillary N. (c5,6) Ant delt:distal clavicle//delt tub Flex,and,IR of humerus Mid delt: acromion//delt tub Abd Post delt: distal scap spine//delt tub Ext,abd,ER
19
Q
Infraspinatus(nerve,trunk)
A
Suprascapular(c5,6)
Superior trunk
20
Q
Supraspinatus(nerve,trunk)
A
Suprascapular(c5,6)
Superior trunk
21
Q
Teres minor(nerve)
A
Axillary(c5,6)
22
Q
Subscapularis N.(nerve, cord)
A
Upper Subscapular N. (*lower Subscapular n)
Posterior cord
23
Q
Scapulothoracic upward rotators
A
Upper/lower trap, serratus ant
24
Scapulathoracic downward rotators
Rhomboids, levator, pec minor
25
Boundaries of axillary region
A/P: Pec major, scapula
| M/L: ribs (1-7),bicipital groove
26
Anterior/Posterior axillary fold
```
Pec Major (ant)
Lats,teres major (post)
```
27
Axillary A. (Boundary, branch)
Lateral border 1st rib//superior border of pec minor
| Supreme (highest) thoracic A. (1st/2nd intercostal space, upper serratus ant.)
28
part II of Axillary A. (Boundary, branches)
```
Deep to pec minor
1.thoracoacromial A.
A. acromial: acromion, AC joint
B.pectoral: pec major
C. deltoid: deltoid, pec major
D. clavicular: SC joint
```
2.Lateral thoracic A. (pec major/minor, serratus ant, breast)
29
Part III of Axillary A. (boundary, branches)
Inferior border of Pec minor//inferior border of teres major
Subscapular A.
A. circumflex scapular A: posterior scapular muscles
B.Thoracodorsal A: lats
Anterior humeral circumferential A. (delt, ant. GH jt)
Posterior humeral circumferential A. (delt, triceps,post/lat GH jt)
*communicates c ant circumferential A. at anterolateral surgical neck
*often branches off Subscapular A. rather than Axillary A.
30
Borders of Axillary v.
Inferior teres major//lateral border 1st rib
31
Boundaries of part I, II of Axillary A?
Part I: lateral first rib//sup pec minor
| Part II: sup pec minor//inf pec minor
32
Blockage of part II of Axillary A will affect what branches of this artery?
```
Thoracoacromial A:
A.acromial: acromion, AC joint
B.clavicular: SC joint
C.pectoral: pec major
D.deltoid: deltoid, pec major
```
Lateral Thoracic A: pec major/minor, serratus anterior, breaststststs
33
Blockage of part III of Axillary A. will affect which branches of Axillary A?
1.Subscapular A:
A. Circumflex scapular A:posterior scapular muscles
B. Thoracodorsal A: lats
2. Anterior humeral circumflex A: anterior GH joint, deltoid
3. Posterior humeral circumflex A: posterior/lateral GH joint, deltoid, triceps.
* often arises from Subscapular A. versus Axillary A.
* anastomoses w/ anterior humeral circumflex A. at posterolateral surgical neck
34
Axillary Vein location
Inferior Teres Major//lateral border first 1st rib
| Basilic V. -->Axillary V. -->Subclavian V. -->Brachiocephalic V.
35
Basilic Vein
superficial medial arm, forearm, hand
36
Cephalic V.
lateral arm, forearm, hand
| Runs through deltopectoral groove (ant delt//pec major)-->enters Axillary V. here at deep proximal end
37
Veins at cubital fossa
median cubital vein (runs medially upward from cephalic --> basilic)
median antebrachial vein: drains superficial ant. forearm; runs between basilic and cephalic on anterior forearm
38
Veins that enter Axillary V?
1. Supreme Thoracic V.
2. Lateral Thoracic V.
3. Cephalic V. (instead of thoracoacromial)
4. Subscapular V.
5. Anterior Humeral Circumflex V.
6. Posterior Humeral Circumflex V.
39
Musculocutaneous N (spinal segment, cord)
C5,6,7*
lateral cord
biceps, brachialis (5,6)
coracobrachialis (5,6,7)
40
Axillary N (segment, cord)
C5,6
posterior cord
deltoid
teres minor
41
Medial N (segment, cord)
C5*,6,7,8,T1
| medial and lateral
42
Radial N (seg, cord)
C5,6,7,8,T1*
| posterior
43
Ulnar N (seg, cord)
C8,T1
| medial
44
Dorsal Scapular N
C5 ventral ramus
| Rhomboid minor/major, levator scap
45
suprascapular N
C5,6
superior trunk
supraspinatus, infraspinatus
46
Nerve to Sublcavius
C5,6*
superior trunk
Subclavius
47
Long Thoracic N
ventral rami C5,6,7
| serratus anterior
48
Musculocutaneous N
```
C5,6,7*
lateral cord
Brachialis (C5,6)
Biceps (C5,6)
Coracobrachialis (C5,6,7)
```
49
Lateral Antebrachial Cutaneous N
C5,6,7
continuation of musculocutaneous N
lateral cord
sensory to lateral forearm
50
Lateral root of median N
C5 (sensory),6,7
| muscles of forearm, hand, skin of hand
51
Lateral Pectoral N
C5,6,7
posterior cord
pec major
52
Medial Pectoral N
C8,T1
Medial cord
Pectoralis Major/Minor
53
Medial Brachial Cutaneous N
C8,T1
Medial Cord
sensory medial arm, upper forearm
54
Medial Antebrachial Cutaneous N
C8,T1
medial cord
sensory to medial forearm
55
Medial root of Median N
C8,T1
medial cord
muscles of hand
56
Ulnar N
C8,T1
medial cord
muscles of forearm/hand, skin of hand (digits 4,5)
57
upper subscapular N.
C5,6, 7*
posterior cord
subscapularis m.
58
thoracodorsal N.
C6,7,8
posterior cord
lats
59
lower subscapular N.
C5,6,7*
posterior cord
subscapularis, teres major
60
lateral brachial cutaneous N.
C5,6
off of musculocutaneous N.
sensory for skin of lateral upper arm
61
radial N.
c5,6,7,8
posterior cord
deep radial:triceps, anconeus, brachioradialis, extensors of hand, wrist
posterior antebrachial N: skin of posterior arm/forearm
superficial radial: sensory for skin of hand
62
lymphangitis
inflamed lymph vessel
63
lymphadenitis
inflamed lymph node
64
what is lymph composed of?
| where does it drain from and to?
1. plasma proteins and lymphocytes
| 2. drained from interstitial fluid, transported to lymph node (mass of lymphoid cells)
65
Lateral (brachial) lymph node
Below pec minor at lateral border of axilla
Medial, posterior aspects of Axillary V.
Drain upper limb below shoulder
66
Pectoral lymph nodes
Inferior border of pec minor
Along Lateral Thoracic A. & V. (part 2 of axillary A.)
Drain mammary glands, upper anterior thoracic wall
67
Subscapular lymph nodes
Near costal surface of subscapularis muscle
Along Subscapular A. & V.
Drain scapular region, upper posterior thoracic wall
68
Central lymph nodes
Lie behind pec minor along axillary V.
| Drain lateral, pectoral, subscapular nodes
69
Apical lymph nodes
above pec minor
runs along medial aspect of first part of axillary v.
Drains central nodes-->empties into venous circulation at junction of subclavian V.//internal jugular V.
70
boundaries of posterior cervical triangle
SCM, superior nuchal line, trapezius, clavicle
Superficial region: between superficial/prevertebral fascia
Deep region: deep to prevertebral layer
-muscular floor: splen. capitis, lev scap, scalenes
71
Nerves of superficial posterior cervical triangle
1. lesser occipital N. (scalp behind & above ear)
2. greater occipital N. (skin of posterior scalp)
3. greater auricular N.(skin over parotid gland, angle of jaw, post ear)
4. spinal accessory N. (trapezius, SCM)
5. dorsal scapular N. (levator, rhomboid major/minor)
6. supraclavicular N. (SC->Acromion, lat.neck,ant. upper thoracic wall)
- lateral, intermediate, medial supraclavicular
7. suprascapular N. (supraspinatus, infraspinatus)
72
nerves of Deep Posterior Triangle
1. spinal accessory N (SCM, Trapezius)
2. Dorsal Scapular N (levator, rhomboids)
3. long thoracic N (serratus ant)
4. suprascapular N (infraspinatus, supraspinatus)
73
Occipital Triangle
superior part of post cerv triangle (above inferior omohyoid)
74
supraclavicular triangle
inferior part of post cerv triangle (below inferior omohyoid)
75
prevertebral layer
deepest layer
forms fascial floor of posterior cervical triangle
covers deep neck muscles in posterior cerv triangle
-splenius capitis, levator, scalenes
76
superficial layer of posterior cervical triangle
cervical sp, ligamentum nuchae --> infrahyoid region ventral to trachea
77
pretracheal layer of posterior cervical triangle
deep to superficial layer in anterior neck
| covers trachea, esophagus, thyroid gland
78
trauma to only the superficial part of post cervical triangle will affect which sensory nerves and impair sensation to which part of head and neck? will there be any motor nerve involvement with this trauma? if so, what nerves and muscles will be involved?
Sensory nerves affected:
1. lesser occipital N. (skin behind/above ear)
2. greater occipital N. (posterior skin of scalp)
3.greater auricular N. (parotid gland, angle of jaw)
4. supraclavicular N. (skin from acromion-->SC joint, lateral neck, ant
upper thoracic wall)
motor nerves:
1. spinal accessory (SCM, traps)
2. dorsal scapular (levator, rhomboids)
3. suprascapular (supraspinatus, infraspinatus)
79
Trauma to only deep part of posterior cervical triangle will affect which motor nerves? What effect will this have on the brachial plexus? Which nerves of the brachial plexus will be affected?
1. spinal accessory N. (traps, scm)
2. dorsal scapular N. (levator, rhomboids)
3. long thoracic N. (serratus anterior)
4. suprascapular N. (infraspinatus, supraspinatus)
Only C5,6 of brachial plexus affected
80
Tightness of middle scalene will affect which nerves?
Long thoracic N. (serratus ant)
Dorsal Scapular N. (levator, rhomboids)
-passes through V-shaped opening in middle scalene
81
What is the difference between supraclavicular nerves and supraclavicular part of brachial plexus?
Supraclavicular nerves: C3,4
- sensory to acromion-->SC joint, lateral neck, ant upper thoracic wall
- lateral,intermediate,medial
supraclavicular part of brachial plexus:
-involves ventral rami and trunks: superior to clavicle
82
sensation of elbow joint comes from which nerves?
- mainly by musculocutaneous, radial nerves
| - to a lesser extent by median, ulnar nerves
83
which 3 joints make up the elbow joint?
1. humeroulnar
2. humeroradial
3. proximal radio-ulnar
84
Which ligaments make up elbow joint?
radial collateral lig.
ulnar collateral lig.
annular lig.
oblique cord( annular lig -->below radial tuberosity, posterior radius)
85
4 bursae of elbow
Olecranon (2)
A. subcutaneous:between skin/olecranon
B. subtendinous olecranon:between tricep tendon//superior aspect of olecranon
Bicipital Bursae: between biceps and radial tub.
radioulnar bursae: between extensor digitorum m. & underlying hum-rad jt, supinator
86
posterior dislocation (elbow)
- fall c extended elbow
- humerus goes anteriorly
- hyperextension
87
Two common elbow injuries in children
1. supracondylar fx (falls, hyperextension)
2. nursemaid's elbow
- sublux radial head (tear distal annular lig)
- prox annular lig trapped between capitulum and rad head-->blocks motion
88
most common cause of nursemaid elbow (radial head dislocation)? second most? what are the localized physical signs?
1. axial traction 2. fall
3. ABSENT of erythema, warmth, edem, signs of trauma
- Distal circulation, sensation, motor activity are normal
- maybe tender at radial head
- resist pro/sup, flex/ext
89
what is a monteggia fracture? mechanism?
fracture of proximal 1/3 ulna
ant dislocation of radial head
direct blow, hyperpronation, hyperextension
90
galeazzi fx
fx radial shaft
| ulnar head dislocat @ distal rad-uln jt
91
compartments of hand
thenar (thumb side)
hypothenar (opposite side)
central (superficial and deep)
92
nerves, artery, muscles of anterior brachial compartment
nerves:
- musculocut.
- median
- ulnar
- radial
brachial artery
flexor muscles of GH and elbow jts
93
which elbow jts permit flexion/extension?
| supination/pronation?
flex/ext: humeroradial, humeroulnar jts
| sup/pro: proximal radioulnar jt, humeroradial jt.
94
what movements would be most affected by tearing of the following lig?
a. medial collateral
b. lateral collateral
c. annular
d. annular and lateral
a. flexion/extension
b. flexion/extension
c. pro/sup
d. pro/sup, flex/ext
95
Nerves of anterior and posterior compartment
Radial
- motor: triceps (C6,7,8), anconeus(C7,C8), brachioradialis (C5,6,7*), posterior compartment of forearm (extensors)
- sensory (cutaneous): posterior arm (post brach cutaneous), posterior forearm, posterior radial half of hand (superficial rad N)
96
Nerve injuries of anterior brachial compartment
1. Musculocutaneous N.
- entrapped by tight/hypertrophied coracobrachialis
- tingling/numbness/weakness from GH abd, ER, ext
2. Ulnar N. (in the cubital tunnel)
- compression against med epicondyle
- repetitive press
- stretch
- trauma
97
muscles innervated by ULNAR N in anterior forearm compartment
FCU (C8,T1)
| FDP III, IV (digits 4,5)-->C8,T1
98
muscles innervated by median N at anterior forearm compartment
Pronator Teres (C6,7)
Flexor Carpi Radialis (C6,7)
Palmaris Longus (C7)
Flexor Digitorum Superficialis (C7,C8,T1*)
99
muscles innervated by Anterior Interosseous Branch (Med. N) in the anterior forearm compartment
*oklahoma butthole sign
1. Flexor Digit Profund I,II (digits 2,3)-->(C7),C8,T1
2. flexor pollicis longus-->(C7),C8,T1
3. pronator quadratus-->C8,T1
100
muscles innervated by Radial N in posterior forearm compartment
1. Brachioradialis:C5,6, (7)
2. Extensor Carpi Radialis Longus:C6,7
- lateral supracondylar ridge//base of 1st MC
Radial/Post Interosseous
1. Extensor Carpi Radialis Brevis: (C6),7,(C8)
2. Supinator: C5,6
101
muscles innervated by Posterior Interosseous N (deep Rad N) in posterior forearm compartment
1. extensor digitorum: C7,8
2. extensor digiti minimi: C7,8
3. extensor carpi ulnaris: C7,8
4. abductor pollicis longus: C7,8
5. extensor pollicis longus: C7,8
6. extensor pollicis brevis: C7,8
7. extensor indicis: C7,8
102
Branches of Brachial A.
1. Profunda Brachii A:
- radial groove w/ Radial N.
- supplies triceps
- arises distal to teres major
- ant & post collateral branch (relative to lat epi)
- ant branch-->radial recurrent A.-->radial A. (cubital fossa)
2. Superior ulnar collateral A:
- emerges from brachial A (middle,medial humerus)
- runs posterior to med epicondyle
3. Inferior ulnar collateral A:
- emerges from distal brachial A (lower than sup uln collat A)
- runs anterior to med epicondyle
4. Radial A-->superficial (sensory) & deep (extensor m.) near lat epi
5. Ulnar A: gives rise to common interosseous A-->ant/post interosseous A.
103
superficial veins of arm
cephalic
basilic
median cubital (connects cephalic to basilic at cubital fossa)
104
deep veins of arm
brachial: inferior to teres major
axillary: between inferior teres major and lateral border 1st rib
subclavian: above lateral border 1st rib
105
supreme thoracic A.
1st part of axillary A.
106
2nd part of axillary A.
thoracoacromial A.
| lateral thoracic A.
107
3rd part of Axillary A.
1. Subscapular A.
- circumflex scapular A.(curves under and behind lateral border of scapula): posterior scapular muscles
- thoracdorsal A: lats
2. Anterior humeral circumflex A: ant GH jt, deltoid
3. Posterior humeral circumflex A: deltoid, tricep, post,lat GH joint
108
Quadrangular space
- Boundaries: Teres Major/Minor & humerus/long head triceps
- Axillary N
- posterior humeral circumflex A
109
Triangular Space
- Boundaries: Teres Major/Minor/long head Tricep
| - scapular circumflex A.
110
Triangular Interval
- Boundaries: Medial Tricep/Lateral Tricep/Teres Major
- Radial N
- Profunda Brachial A
111
suprascapular notch
- transverse scap lig
- suprascapular N (under lig): infraspinatus,supraspinatus
- suprascapular A (over lig): infraspinatus,supraspinatus, scapula
112
muscles of common flexor tendon (superficial muscles that attach to medial epicondyle)
1. pronator teres: C6,7 (median N)
2. flexor carpi radialis: C6,7 (median N)
3. palmaris longus: C7 (median N)
4. flexor digitorum superficialis (median N): C7,8
5. flexor carpi ulnaris: C8,T1 (ulnar N)
113
deep muscles of anteromedial forearm
1. flexor digitorum profundus (Median N: 1,2//Ulnar N:3,4)
- C8,T1
2. flexor pollicis longus
- ant interosseous N: C8,T1
3. pronator quadratus
- ant interosseous N: C8,T1
114
Muscles of superficial lateral forearm
1. brachioradialis: radial N (C5,6)
2. extensor carpi radialis longus: radial N (C6,7)
3. extensor carpi radialis brevis: Deep Radial N (C7)
115
Muscles of superficial posterior forearm
1. extensor digitorum: deep radial N (C7,8)
2. extensor digiti minimi: deep radial N (C7,8)
3. extensor carpi ulnaris: deep radial N (C7,8)
116
Muscles of Deep posterolateral forearm
1. supinator: deep radial N. (C5,6)
2. abductor pollicis longus: deep radial N. (C7,8)
3. extensor pollicis brevis: deep radial N. (C7,8)
4. extensor pollicis longus: deep radial N. (C7,8)
5. extensor indicis: deep radial N. (C7,8)
117
flexor retinaculum boundaries
- bridges distal/prox rows
| - trapezium/scaphoid-->pisiform/hook of hamate
118
Nerves/tendons in carpal tunnel (10 structures)
1. median N
2. tendons of FDS/FDP (8 total)
3. tendon of FPL
4. synovial sheaths surrounding tendons of FDS, FDP
- 2nd sheath for tendon of FPL
119
what lies in Guyon's Tunnel?
ulnar A
- superficial
- deep
ulnar N
- superficial: skin of D4,5; exception: palmaris brevis
- Deep: muscles of hand
120
contents of carpal tunnel from bottom to top (in terms of digits)
top: median N
FDS 4 3
5 2 FPL
FDP 5 4 3 2
121
boundaries of guyon's canal/tunnel
- volar carpal lig (superficial/roof)
| - flexor retinaculum (deep/floor)
122
1st extensor tunnel
abductor pollicis longus
extensor pollicis brevis
lateral/radial margin of distal radius
"bottom of snuff box"
123
2nd extensor tunnel
extensor carpi radialis L & B
posterolateral surface of distal radius (medial to 1st tunnel)
"floor of snuff box"
radial to lister's tubercle
124
3rd extensor tunnel
Extensor Pollicis Longus
Middle posterior surface of distal radius
top/roof of snuff box
ulnar to lister's tubercle
125
4th extensor tunnel
ED & EI
| ulnar side of distal radius
126
5th extensor tunnel
Extensor Digiti Minimi
| between distal radius and head of ulna
127
6th extensor tunnel
extensor carpi ulnaris
| radial side of ulnar styloid process (almost in the middle of ulnar head)
128
lateral epicondylitis
- repeated forceful supination, wrist ext, rad dev
- ECRB and Ext Dig usually involved
- tightness-->compress deep radial nerve
- could have tenderness at lateral epicondyle or radial tunnel (belly of ED)
129
medial epicondylitis
- repeated forceful pronation, finger flexion
| - pronator teres & FCR
130
DeQuervains Tenosynovitis
- tendons slide between radius and ext retinaculum
- APL,EPB in 1st tunnel
- ECR L&B in 2nd tunnel
131
Intersection syndrome
- APL and EPB cross over ECR L&B
| - pain, swelling, redness, squeaking
132
cubital tunnel syndrome
Area of pain/numbness:
- palmar cutaneous ulnar distal wrist
- 4th/5th hand/digits
133
5 annular ligaments of hand
- A1 head of MC
- A2 base of prox phalanx
- A3 head of prox phalanx
- A4 middle of mid phalanx
- A5 base of distal phalanx
134
3 cruciate pulley-like ligaments of hand
- C1 between A2&A3 (distal half of prox phalanx)
- C2 between A3&A4 (prox end of mid phalanx)
- C3 between A4&A5 (distal end of mid phalanx)
135
common flexor tendon sheath of digits (5 annular, 3 cruciate lig)
- guides tendons of FDS,FDP
| - within flexor tendon sheath, tendon wrapped with synovial memb
136
Trigger finger
- inflamed tendon (at MCP) caught on proximal end of A1 pulley
- prevents smooth passage through A1
- locks finger in flexion when attempting to extend finger
137
Extensor Assembly
- function
- joints
- what it consists of
Strengthens dorsal surface of MCP, proximal/distal IP joints
Extend PIP, DIP jts
tension from ext digitorum, lumbricals, interossei
1. extensor expansion
2. median band (central)
3. two lateral bands
4. terminal tendon
138
Extensor expansion (fibrous hood)
- flat tendinous expansion of ext dig
| - lumbricals, interossei insert into expansion
139
Median band (central slip)
- arises centrally from extensor expansion
- inserts at base of middle phalanx
- extends PIP
140
Lateral bands (two of them) of extensor assembly
- arise from sides of extensor expansion
- lie on each side of median band (PIP)
- tighten terminal tendon-->extend DIP
141
Terminal tendon of extensor assembly
- formed by union of two lateral bands at distal end of proximal phalanx
- inserts at base of distal phalanx
142
deformities of phalangies
1. PIP dysfunction
- Swan neck deformity: lateral bands dorsal to PIP-->hyperextension
- Boutonniere deformity: lateral bands palmar to PIP-->flexion
2. Mallet finger: flexion of DIP (ruptured terminal tendon)-->unable to extend DIP
143
Bursae in palmar hand
deep to flexor retinaculum
Radial: flexor pollicis longus
Ulnar: FDS & FDP
144
purpose of tendon sheaths in palmar hand
- prevents friction on annular pulleys
| - prevents friction of FDP passing through FDS
145
5 palmar compartments
1. thenar (thumb side)
2. hypothenar
3. mid-palmar (central)
4. adductor
5. intermetacarpal
146
thenar compartment: muscles, nerves, arteries
- abductor pollicis brevisa:recurrent branch of median N
- opponens pollicis:recurrent branch of median N
- flexor pollicis brevis
- deep head: deep ulnar N
- superficial head: recurrent branch of median N
- tendon of FPL
- proper digital nerves to skin of thumb
- princeps pollicis A.
- proper digital arteriole to palmar surface of thumb
147
Innervation of hypothenar compartment
Deep Ulnar Branch
- abductor digiti minimi
- flexor digiti minimi
- opponens digiti minimi
Superficial ulnar branch
-palmaris brevis
148
Central compartment: arteries and nerves
Superficial
- Median N and 3 common digital nerves
- superficial Ulnar N and its common digital nerves to ring/little fingers
- superficial palmar branch and 3 common digital A (superficial Ulnar A)
Deep
- tendons/synovial sheaths of FDS and FDP
- 4 lumbricals
- deep palmar arch (deep radial/ulnar A)
149
deep central compartment of hand
Lumbricals
- flex MCP, extend PIP/DIP of digits 2-5
- Median N to index/middle
- Deep Ulnar N little/ring
- prox attachment: FDP tendons
- distal attachment: extensor assembly 2-5
150
Ulnar A in hand
Superficial Palmar Arch
-common and proper digital A
Deep Palmar Arch
151
Radial A in hand
- Deep Palmar Arch
- Palmar Metacarpal A
- Princeps Pollicis A
- Radialis Indicis A
152
Radial A course in hand
Branch from brachial A in cubital fossa
- wrist:between brachioradialis and FCR
- snuff box
Through 1st dorsal interosseous
- princeps pollicis A
- deep palmar arch
153
Ulnar A course in hand
```
Branch from brachial A in cubital fosssa
wrist:lateral to FCU
Guyon's tunnel:
-superficial palmar arch
-deep palmar arch
```
154
Adductor compartment
Deep to central and thenar compartments
-Transverse head (3rd mid MC//base of prox thumb)
-oblique head (capitate//base of prox thumb)
Innervated by deep Ulnar N
155
Innervation of adductor compartment
Deep Ulnar N
- lumbricals 3,4
- palmar/dorsal interossei
- adductor pollicis
156
Intermetacarpal compartment
3 palmar interossei (all flex MCP and extend PIP/DIP)
- bring digits (index, ring, little) towards middle finger
- 1st: ulnar add; 2nd:radial add; 3rd: rad add
4 dorsal interossei (all flex MCP, and extend PIP/DIP)
- 1st/2nd:radial abd
- 3rd/4th: ulnar abd
157
Lumbricals: strength in MCP position
Flexed MCP:
- weak MCP flexor (due to small CSA despite mech advantage)
- strong IP extensor (more active in IP extension when MCP=extended)
Extended MCP:
- weak MCP flexor (due to small CSA despite mech advantage
- strong IP extensor
158
Interossei: strength at MCP joint position
| abduction always stronger than adduction
Flexed MCP:
- strong MCP flex
- strong IP ext
- weak MCP add/abd
Extended MCP:
- weak MCP flex
- weak IP ext
- strong MCP add/abd
159
cutaneous innervation of hand
Median N
- palmar branch= palm (radial half)
- digital branch= D1,2,3, half of 4
Ulnar N
- dorsal branch=dorsal medial
- superficial branch = palmar medial; D5, half of 4
Superficial Radial Branch=posterolateral hand
160
Arches of hand
- dynamic
- supported by intrinsic musculature
- 3 Arches:
- prox transverse (CMC)
- distal transverse (MCP)
- longitudinal: wrist-->fingers
