Exam 2- Upper Limb Flashcards
(70 cards)
The Hand Consists of…
Carpals, Metacarpals, Phalanges, Muscles, Fascia, Tendons, and Nerves and Vessels.
Flexor Creases
Mark Joints, Attachment points to deep fascia
PAD and DAB
Palmar ADducts and Dorsal ABducts
4 Layers of the Palm
1: Fascia (Palmar Aponeurosis, Flexor Retinacula, and Septa)
2: The short muscles of the thumb and digit 5 (for position adjustmaents and fine movement) and short muscles of the hand
3: The long flexor tendons (power for grip)
4. Adductor of the thumb and deep muscles.
Dupuytren Contraction
Disease with Palmar Fascia
Results in progressive shortening, thickening, and fibrosis of the palmar fascia and aponeurosis
This pulls the 4th and 5th fingers into partial flexion.
Treatment usually involves surgical exision of all fibrotic parts of the palmar fascia to free fingers.
Annular and Cruciform Parts
This is what ligaments are composed of
They prevent bowstringing
Run around the synovial sheath which is around the flexor digitorum superficialis and profundus
Annular is larger and runs more proximal.
Lumbricals
Originate from gaps in the profundus and insert with the lateral cord from the extensor hood.
Flexor Retinaculum
Forms the Carpal Tunnel
Tendons that pass through the carpal tunnel
Flexor Digitorum Superficialis Tendons Flexor Digitorum Profundus Tendons Flexor Pollicis Longus Tendon Flexor Carpi Radialis Tendon Median Nerve
Ulnar Bursa
The synovial sheath containing the long flexor tendons
Midpalmar Space
This space is continuous with the anterior compartment of the arm through the carpal tunnel
This is clinically significant because the spaces of the hand may become infected and consequently become distended with pus
Spaces in the Hand
Midpalmar Space (Pinky side and between middle and index) and Thenar Space (Thumb side and some index)
OAF
Opponens, Abductor, and Flexor
Thenar- Pollicis- Innervated by Recurrent Median Nerve
Hypothenar- Digiti Mini- Innervated by Deep Branch of Ulnar
Radial Nerve
Innervates posterior side of arm, forearm, and hand
Median Nerve
Innervates most of the anterior forearm and 5 muscles of the hands
Innervates most of the flexor muscles in the forearm, the thenar muscles, and the two lateral lumbrical muscles that move the index and middle fingers
Ulnar affects flexor carpi ulnaris and medial half of flexor digitorum profundus… Median is the rest
Ulnar Nerve
Innervates a little of the anterior forearm and most of the hands (especially palmar)
Only forearm muscles it innervates are Flexor Carpi Ulnaris and Flexor Digitorum Profundis
Arteries for the Lumbricals
Superficial Palmar Arch, Common Palmar Digital Arteries, Deep Palmar Arch, and Dorsal Digital Artery
Laceration of the Hypothenar Eminence
Weakness in pinky during opposition and tingling in 4th and 5th and medial palm.
Ulnar Nerve is damaged
Blood Supply to the Hand
There is a very vast blood supply to the hand
Arteries Contributing to the Superficial Palmar Arch and Deep Palmar Arch
Be able to label the arches, the common palmer digital artery, the proper palmer digital, artery and the deep branch of ulnar artery and princeps pollicis artery
Superficial Palmar Arch is a direct continuation of Ulnar Artery (some radial)
Deep Palmar Arch is a direct continuation of Radial Artery (some ulnar)
Page 781 of Moore
Radial Artery splits into Deep Palmar Arch and Princeps Pollicis.
Lymphatics of the Hand
They all drain into one lymph node in the cubital fossa causing tenderness on the medial side
Infection of the Hand
Swells dorsally
Potential spaces may become infected and pus accumulates (hypothenar, thenar, adductor) or spead (midpalmar to proximal forearm)
Radial Nerve Injury effect on Hand
Wrist Drop (due to extensor paralysis) anesthesia on hand is limited to dorsum
Ulnar Nerve Injury effect on Hand
Compression at Ulnar Canal (Guyon tunnel) by pisohamate ligament (Handlebar Neuropathy)