Exam 2- Upper Limb Flashcards Preview

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Flashcards in Exam 2- Upper Limb Deck (70):
1

The Hand Consists of...

Carpals, Metacarpals, Phalanges, Muscles, Fascia, Tendons, and Nerves and Vessels.

2

Flexor Creases

Mark Joints, Attachment points to deep fascia

3

PAD and DAB

Palmar ADducts and Dorsal ABducts

4

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.

5

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.

6

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.

7

Lumbricals

Originate from gaps in the profundus and insert with the lateral cord from the extensor hood.

8

Flexor Retinaculum

Forms the Carpal Tunnel

9

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

10

Ulnar Bursa

The synovial sheath containing the long flexor tendons

11

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

12

Spaces in the Hand

Midpalmar Space (Pinky side and between middle and index) and Thenar Space (Thumb side and some index)

13

OAF

Opponens, Abductor, and Flexor
Thenar- Pollicis- Innervated by Recurrent Median Nerve
Hypothenar- Digiti Mini- Innervated by Deep Branch of Ulnar

14

Radial Nerve

Innervates posterior side of arm, forearm, and hand

15

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

16

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

17

Arteries for the Lumbricals

Superficial Palmar Arch, Common Palmar Digital Arteries, Deep Palmar Arch, and Dorsal Digital Artery

18

Laceration of the Hypothenar Eminence

Weakness in pinky during opposition and tingling in 4th and 5th and medial palm.
Ulnar Nerve is damaged

19

Blood Supply to the Hand

There is a very vast blood supply to the hand

20

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.

21

Lymphatics of the Hand

They all drain into one lymph node in the cubital fossa causing tenderness on the medial side

22

Infection of the Hand

Swells dorsally
Potential spaces may become infected and pus accumulates (hypothenar, thenar, adductor) or spead (midpalmar to proximal forearm)

23

Radial Nerve Injury effect on Hand

Wrist Drop (due to extensor paralysis) anesthesia on hand is limited to dorsum

24

Ulnar Nerve Injury effect on Hand

Compression at Ulnar Canal (Guyon tunnel) by pisohamate ligament (Handlebar Neuropathy)

25

Carpal Tunnel Syndrome

Caused by compression of the median nerve in the carpal tunnel
Manifests as weakness and wasting of thenar muscles, and loss of opposition of the thumb. Anesthesia of over 3.5 digtis thumb side
Causes a depression the appearat base of thumb.
Treated by cutting the flexor retinaculum

26

Position of Rest

Where all of the joints have the least amount of tension
This comes from Muscle Tone

27

Sternoclavicular Joint (SC Joint)

Attaches appendicular to axial
Ball and socket between the Sternum and Clavicle
Articular Disc serves two functions: Shock Absorption and prevents Medial Displacement
Very difficult to dislocate.
The ligaments are the Anterior and Posterior sternoclavicular ligaments reinforcing the joint capsule, the interclavicular ligament, and the costoclavicular ligament anchoring the clavicle.

28

Acromioclavicular Joint (AC Joint)

Clavicle and Scapula
This is the least likely to be dislocated
Main articulation that suspends upper extremity from trunk
Functions: Allows scapula additional ROM and forces to transmit from upper extremity to clavicle
Separated Shoulder is AC Joint
Has 4 Ligaments: Acromioclavicular, Coracoacromial, and Coracoclavicular- Trapezoid and Conoid (These last two cause the shoulder separation)

29

Glenohumeral Joint

Main Shoulder Joint from the Humerus and Glenoid Fossa
Greatest ROM in the body at the cost of stability
Dislocated Shoulder is Glenohumeral Joint (and this is the most dislocated joint)
Inferior Ligament is the one most likely to fail
SIT are the main muscles for reinforcement
Has 3 Ligaments: Coracohumeral, Transverse Humeral, and lots of Capsular Ligaments (main source of stability) (split into superior, middle, and inferior)
Scapulothoracic Articulation begins rotation when the humerus is abducted 30 degrees
Scapulohumeral Rhythm- 2:1 ratio of humerus movementto scapula movement

30

Elbow Joint

3 Articulations and 2 Joints
Gliding Joint (Capitulum and Radius)- Functional Hinge
Proximal Radioulnar Joint- Pivot Joint
Trochlea and Ulna- Typical Hinge Motion
Joint Capsule surrounds all 3 articulations
Main ligaments: Radial (Lateral) Collateral Ligament, Ulnar (Medial) Collateral Ligament (breaks down into Anterior, Posterior, and Oblique Bands), and Anular (Lateral) Ligament (holds radial head in ulnar notch)

31

Proximal and Distal Radioulnar Joints

Pronation and Supination
Proximal- Proximal radial notch is the pivot
Distal- Ulnar notch of the radius is the pivot point
Interosseus membrane runs between- Tightens when radius is pushed proximally and in supination and loose in pronation
Pronate- Palm Down
Supinate- Palm Up

32

Wrist (Radiocarpal) Joint (RC Joint)

Ulnar has nothing to do with it
Lunate and Scaphoid articulate with the radius
Reinforced by palmar, dorsal, radial collateral, and ulnar collateral ligaments
Permits flexion/extension, and adduction/abduction

33

Intercarpal (Midcarpal) Joints

Between proximal and distal rows of the carpis (excluding pisiform)
Responsible for most flexion of the hand
3 articulations: Lateral (radial) part, Central (ball and socket), and Ulnar part
Scaphoid, Lunate, and Triquetrum are the most frequently fractured

34

Carpometacarpal Joints (CM Joints)

They are plane articulations
The thumb CM Joint is freely movable, saddle articulation
No motion for digits 2 and 3, Limited for 4, and more mobile for 5

35

Metacarpophalangeal Joint (MP)

The base for all of the fingers
Can flex/extend and adduct/abduct.
Some opposition occurs at digit 5

36

Interphalangeal Joint (IP)
DIP/PIP

IP is technically only the thumb
Movements are flexion and extension
Synovial Joint capsule reinforced by collateral ligatments
Distal Interphalangeal Joint
Proximal Interphalangeal Joint

37

Power Grip

The most energy "expensive" hand action
Medial, Ulnar, Radial, and maybe Musculocutaneous Nerves all effect this

38

Actions of the Hand

Power Grip- Forcing digits against the palm around an object with opposing force from the thumb
Hook Grip- Carrying a briefcase/bag with handle. Mainly the long digit flexors
Precision Grip- fine control from intrinsic hand muscles like holding a pencil
Pinching- Compression between thumb and index finger

39

De Quervain's Tenosynovitis

Inflammation, swelling, and irritation in tendons from thumb to wrist
Painful to turn wrist, grasp, and make a fist
Can cause pain in the forearm
Involves Extensor Pollicis Brevis and Abductor Pollicis Longus Tendons

40

Lateral Epicondylitis

"Tennis Elbow"
Overuse syndrome of the common extensor tendon
Gradual Symptoms develop
Involves Extensor Carpi Radialis Brevis, Extensor Carpi Ulnaris, and Extensor Digitorum

41

Medial Epicondylitis

"Golfer's Elbow"
Overuse syndrome of the common flexor tendon
Involves Pronator Teres, Flexor Carpi Radialis, Palmaris Longus, Flexor Digitorum Superficialis, and Flexor Carpi Ulnaris

42

Pronator Teres Syndrome

Compression of the Median Nerve that runs between the 2 heads of the Pronator Teres
Tingling or nukbness in the palm, thumb, and fingers (minus pinky)

43

Frozen Shoulder

Pain and stiffness in the shoulder joint resulting in a loss in ROM

44

Erb-Duchenne

Injury to the superior brachial plexus
Results in "waiters tip" position because C5-C6 innervates flexors of the arm and a primary supinator of the arm and C7-C8 innervate extensors

45

Musculocutaneous Nerve

Mixed Nerve (Motor and Sensory Nerves)
As it courses distally it becomes primarily cutaneous

46

Median Nerve

If the Brachial Plexus is injured at all, the median nerve will always be affected

47

Posterior Cord

The posterior cord is about the same size as the other two put together

48

Flexor Carpi Ulnaris

Tendon guides Ulnar nerve and artery

49

Palmaris Longus

Missing in 14% of people
To test, oppose thumb and pinky and flex wrist in order to palpate
Inserted in distal half of flexor retinaculum

50

Flexor Digitorum Superficialis

Piano Playing Muscle

51

Hand of Benediction

Median Nerve is injured at the Elbow
Can't flex digits 1-3

52

Ulnar Claw

Ulnar Canal Syndrome
Causes "clawing" of the 4th and 5th fingers (hyperextension at the metacarpophalangeal joint with flexion at the PIP)
Their ability to flex is unaffected

53

Handlebar Neuropathy

Riding a bike and puts pressure on the hooks of their hamates, which compresses their ulnar nerves
Results in sensory loss on the medial side of the hand, and weakness of the intrinsic hand muscles

54

Off-Shoot Nerves of the Brachial Plexus
Dorsal Scapular
Long Thoracic
Suprascapular
Nerve to Subclavius
Lateral Pectoral Nerve
Upper Subscapular Nerve
Middle Subscapular Nerve (Thoracodorsal Nerve)
Lower Subscapular Nerve
Medial Pectoral Nerve
Medial Cutaneous Nerve to Arm
Medial Cutaneous Nerve to Forearm
Axillary
Musculocutaneous
Median
Radial
Ulnar

-Dorsal Scapular- Rhomboids and Levator Scapulae
-Long Thoracic- Serratus Anterior
-Suprascapular- Supraspinatus and Infraspinatus
-Nerve to Subclavius- Subclavius
-Lateral Pectoral Nerve- Pectoralis Major
-Upper Subscapular Nerve- Subscapularis
-Middle Subscapular Nerve (Thoracodorsal Nerve)- Latissimus Dorsi
-Lower Subscapular Nerve- Subscapularis and Teres Major muscles
-Medial Pectoral Nerve- Pectoralis Major and Minor
-Medial Cutaneous Nerve to Arm- Skin of the Arm
-Medial Cutaneous Nerve to Forearm- Skin of Forearm
-Axillary- Teres Minor and Deltoid
-Musculocutaneous- Biceps Brachii, Coracobrachial, and Brachialis
-Median- 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
-Radial- Innervates the triceps brachii, and the extensor muscles in the posterior compartment of the forearm
-Ulnar- Innervates the muscles of the hand (apart from the thenar muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor digitorum profundus

55

Klumpke Palsy

A lower brachial plexus injury results from excessive abduction of the arm (e.g person catching a branch as they fall from a tree)
Nerves affected: Ulna and Median nerves.
Muscles paralyzed: All the small muscles of the hand
Sensory functions: Loss of sensation along medial side of arm.
The metacarpophalangeal joints are hyperextended, and the interphalangeal joints are flexed. This gives the hand a clawed appearance.

56

Know the Pathway of the Arteries

SEE PICTURE

57

Radial Groove

Radial Nerve and Deep Branch of Brachial Artery course through it together.

58

Snuff Box

Radial Artery and Radial Nerve in snuff box floor
Ulnar (medial) border: Tendon of the extensor pollicis longus.
Radial (lateral) border: Tendons of the abductor pollicis longus and extensor pollicis brevis.
Proximal border: Styloid process of the radius.
Floor: scaphoid and trapezium.

59

Quadrangular Space

Axillary and Posterior Circumflex Humeral Artery course through it

60

Know the Palmar Arches and the arteries that contribute to it. Also be able to label a picture of it (Arches, Common Palmer Digital Artery, Proper Palmer Digital Artery, Artery and the Deep Branch of Ulnar Artery, and Princeps Pollicis Artery)

STUDY PICTURE
Pages 435 and 453 of Atlas
Page 781 of Moore

61

Nerve and Artery Together

Ulnar Nerve runs with the Superior Ulnar Collateral Artery

62

Nursemaid's Elbow

Also known as Babysitter's Elbow
Nursemaid's elbow is a common injury of early childhood. It is sometimes referred to as "pulled elbow" because it occurs when a child's elbow is pulled and partially dislocates. The medical term for the injury is "radial head subluxation."
Nursemaid's elbow occurs when there is a partial separation of the radiocapitellar joint. Because a young child's ligaments are not fully formed, even a mild force on the joint may cause it to shift, or partially dislocate.
The annular ligament surrounds the radius and may be particularly loose in some young children, which may lead to nursemaid's elbow recurring over and over again.

63

General Drainage of Lymph of Upper Limb

Right side drains to the Lymphatic Duct
Everything else drains into the Thoracic Duct

64

Scaphoid

The most frequently fractured carpal bone

65

Extensor Retinaculum

Function?

66

General Digit Formula for Fingers

Order of length in most people
Digits 3,4,2,5,1 is in men.
In women, 2 may be the same length as 4. THere are also times tat it's longer.

67

General Digit Formula for Fingers

Order of length in most people
Digits 3,4,2,5,1 is in men.
In women, 2 may be the same length as 4. THere are also times tat it's longer.

68

Flexor Retinaculum and Extensor Retinaculum

Prevents Bowstringing of the Flexor Muscles and Extensor Muscles

69

Branches of Radial Nerve

Once the deep branch of the radial nerve leaves/pierces the supination, it becomes the posterior interosseus

70

Most superficial Muscles/Tendons in the Wrist

Flexor Carpi Ulnaris, FLexor Carpi Radialis, and Palmaris Longus