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Flashcards in Functional Hand Anatomy Deck (76)
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1

List muscles innervated by the median nerve in order of innervation 

PT, FCR, PL, FDS, FDP D3

AIN: FPL, FDP D2, PQ

Recurrent br: OP, APB, FPB (supericial head)

Lumbricals 1, 2

2

Describe course of median nerve

BP: roots C5-T1, br of lateral cord from anterior division of upper/middle trunk + br of medial cord from anterior division of lower trunk

ARM:

  • Lateral to Brachial artery, between brachialis and biceps
  • cross over coracobrachialis and run medial to brachial artery
  • *Ligament of Struthers forms tunnel to enter forearm between supracondylar process and medial epicondyle  

FOREARM

  • deep to *Lacertus FIbrosis*  and bicipital aponeurosis
  • between *2heads of PT*
  • AIN runs between FDP, FPL and deep to PQ with AIA  (ulnar source)
    • FPL, FDP D2, PQ
  • Median proper runs b/w FDS and FDP
    • ​PT, FCR, PL, FDS, FDP
  • Palmar cut br  5cm proximal to wrist crease b/w FCr PL

WRIST

  • Recurrent motor br 50% distal to TCL, 30% wihtin CT, 20% pierce TCL
  • APB, FPBs, OP
  • Lumbrical 1,2
  • Sensory D1,2,3.5

 

3

List muscles innervated by radial nerve

Triceps (long, lateral, medial heads), BR, ECRL

Anconeus, Supinator

PIN: +/-ECRB, EDC, EDM, ECU, APL, EPB, EPL, EIP

4

Describe course of radial nerve

BP: roots C5-T1, posterior cord

ARM:

  • triangular interval (triceps long/lateral heads and teres major)
    • posterior to brachial artery, medial to humerus, along long head of triceps
  • Radial groove with deep brachial artery 
  • PCN antebrachial
  • Triceps long/lateral/medial, BR, ECRL, ECRB, anconeus, Brachialis (medial only) 
  • LIMS 10cm above lateral epicondyle w radial collateral artery
  • Radial Tunnel (Lat ECRB, ECRL, BR, Medial biceps brachialis, Floor Radiocapitellar joint, Roof BR)

ELBOW:

  • Deep branch and superficial br 4cm above supinator
  • SBRN run under BR radial to radial artery, emerge between BR and ECRL 9cm before styloid, superficial to EPB,APL,extensor retinaculum. 
  • Deep br pierce supinator and wrap around radius neck to go to Posterior ocmpartment 
    • Arcade of frohse = proximal edge of supinator
    • PIN as exiting supinator
    • +/- ECRB, EDC, EDM, ECU,APL, EPB, EPL, EIP
    • PIN & PIA run together deep to 4th compartment

 

 

5

What are the surface landmarks for identifying the A1 pulleys for each digit

  • Distal palmar crease -> D4, D5 A1 pulley
  • Proximal palmar crease ->D2
  • Midway between 2 above - > D3
  • MCP crease -> thumb

6

What is kaplan's line

  • Line drawn parallel to proximal palmar crease begining in first web space and coursing through hook of hamate
  • at line perpendicular to radial border of D3 and kaplan = recurrent motor br of median n
  • at line perpendicular to ulnar border of D4 and kaplan = common ulnar digital n

7

Where are cleland and grayson ligaments relative to NV bundle and what is there function?

  • Cleland - dorsal to NV. Fx to retain integument in position
  • Grayson - volar to NV. Fx to prevent bowstringing of NV bundle with movement

8

Name the potential spaces in the hand

  • Deep
    • Thenar
    • Hypothenar
    • Midpalm
  • Superficial
    • Dorsal sub-aponeurotic
    • Dorsl subcutaneous
    • Interdigital web (collar button)
  • Extend into Forearm
    • Parona's space
    • Radial bursa
    • Ulnar bursa
  • Palmar space

9

What are theories of carpal alignment trasnlating to function (3)

  • Classic
    • 2 rows 
      • proximal radiocarpal row = S, L, Tq, (+Ps)
      • Mid carpal row = Tz, Tm, C, H
  • Navarro
    • 3 longitudinal colums
      • central - flex-extend = C, L, H
      • radial - trasnfers load of thumb = Tz Tm S
      • Ulnar - prono-sup.= Tq
  • Lichtman
    • oval ring concept made of 4 elements
      • S, L, Tq and the distal row

10

How do you determine if a carpal height is normal?

  • Carpal height = 1/2 length of D3 MC
  • Carpal height = 1.5 x Capitate height

11

What are normal angles of relation to the lunate ? (b/w S-L, R-L, C-L)

  • R-L <15'
  • C-L <15'
  • S-L 30-60

12

What are the ligaments of the wrist

  • Extrinsics - span radiocarpal and midcarpal
    • Volar
      • RSC (radioscaphocapitate)
      • long and short RL
      • UL
      • UTq
    • Dorsal
      • DRC (Dorsal radiocarpal - to Tq)
  • Intrinsics - b/w carpal bones
    • S-L, L-Tq, T-T, T-C, C-H
    • DIC (dorsal intercarpal - S-Tz - Tq)

13

What is the TFCC, what does it consist of, and its fx

Triangular fibrocartilage complex

  • origin:  sigmoid fossa & lunate fossa of distal radius
  • insertion - ulnar styloid
  • fx; primary stabilizer of the DRUJ

Consists of:

  • triangular fibrocartilage
  • ulnar meniscus homologue
  • dorsal and volar radioulnar ligaments
  • UL and UT interosseous ligaments
  • ECU tendon sheath

14

Define the boundaries and contents of the carpal tunnel

  • Roof: TCL
  • Floor: volar radiocarpal ligaments
  • Radial; Trapezium and scaphoid tubercle
  • Ulnar; Pisiform and hook of hamate

Contents

  • 4FDP 4FDS tendons
  • FPL
  • median nerve

15

Define the boudaries and contents of Guyons canal

  • Roof: Volar carpal ligament and Pisohamate lig,
  • Floor/Radial wall: Hook or hamate and TCL insertion
  • Ulnar wall: Pisiform and PHlig insertion

Contents

Ulnar nerve and artery (nerve is ulnar)

16

List the extensor compartments

  1. APL, EPB
  2. ECRL, ECRB
  3. EPL
  4. EDC, EIP
  5. EDM
  6. ECU

17

What is the important stabilizer of the first CMC joint?

Saddle joint - biconcave b/w Tm and 1st MC

Allows for 3planes of motion (flex-ext, abd-add, pron-sup

Volar oblique (beak)ligament is primary stbailizer

APL insertion on dorsal base of MC is 2' stabilizer

18

What tendons insert on the dorsal base of D2,3,4,5?

  • D2- ECRL
  • D3- ECRB
  • D4- none
  • D5- ECU

19

Name and describe the stabilizers of the MCP jts

  • Volar plate - Accessory CL and CL
    • areolar tissue prximal to allow for shrinkage w flexion
  • Condyloid shape of MC head with narrow dorsal and wide volar shape - non-spherical
  • DTMC - attaches to VP - lumbricals are volar and IO are dorsal to DTMC

20

What is unique about the volar plate of the MCPjt of the thumb

  • contains two sesamoid bones
  • Radial sesamoid- insertion of FPB +/- APB
  • Ulnar sesamoid - insertion of adductor pollicis

21

What is the difference between the proper and accessory collateral ligaments

  • proper CL originate on BONE (lateral condyle of MC) and the accessory originate on ligament  (the Proper CL)
  • Both CLs insert on volar plate, only Proper Cl insert on bone (PP)
  • Function: Proper CL are tight in flexion and stabilize power grip
  • Function: Accessory are tight in extension

22

How do IP joints differ from MCP joints

  • IPs are hinge joints, MCPs are condyloid joints
  • VP prevents hyperextension in IPs

23

Where are the annular and cruciate pulleys located

  • 5 annular pulleys
    • A1,3,5 overlie MCP PIP DIP jts and insert on volap plate and bone
    • A2,4 lie in between
  • 3 cruciate pulleys
    • lie b/w A2-3, 3-4, 4-5 - at location of trasnverse digital arteries

24

WHat is the vascular supply ot the tendons

  • Segmental
    • Arises from vincula (condensation of mesotenon), bony insertions, paratenon
    • each tendon has 2 vincula - VB and VL
    • the VBS and VBP insert just proxial to FDS and FDP insertions
    • VLP (at PIP jt), VLS (at base PP)

25

What abnormalities  in extensor tendons can be expected?

  • EDC multiple slips to D4, D5
  • Absent EDC to D5
  •  

26

What is the fx of the sagittal bands

  • maintains EDC tendon centralized over MCP
  • Origin: VP and DTMC
  • Insertion: EDC

27

What is fx of Lateral bands

  • flexion MCP, extension IPs
  • Formed by Lumbrical + IO radially and just IO ulnarly

28

What is the function of the trasnverse retinacular ligament  and where are they located

  • Origin:  flexor sheath of PP

  • Insertion: conjoined tendons of lateral band,

  • Course: Runs lateral to PIP joint & superficial to collaterals

  • Function: Prevents excessive dorsal translation of lateral bands w PIPJ extension, facilitates volar translation of lateral bands w flxn

  • attenuation leads to dorsal translation of lateral bands —> swan neck

  • contracture leads to volar translocation —> boutonierre

 

  • (KI I CHANGED THIS, REVIEW YOURSELF AS WELL)

  • origin: deep belly of IO
  • insert: extensor hood, distal to and parallel w sagittal bands
  • Fx: insertion of IO to PP to facilitate MCP j flexion
  • ***Transverse bands Tighten in intrinsic tightness

29

What is the function of the oblique retinacular ligament and where are they located

  • Originates on volar PP / FTS
  • inserts after oblique course on terminal tendon
  • fxn: Coordinated PIP & DIP flexion and extension
    • (as DIP flexes, ORL tightens causing flexion of PIP; as PIP extends, ORL tightens causing extension of DIP; passive flexion of PIP relaxes ORL and allows DIP flxn)
  • contracture causes volar displacement of lateral bands (boutonierre)

  • becomes lax in swan neck

  • test: extend the PIP joint  (tightens the ligament) and note resistance to passive DIP flexion (relative to when the PIP is flexed)

  •  

30

What is the fx, origin, insertion of the lumbricals 

  • Fx- PIP jt extension
  • Origin - FDP tendon
  • Insertion
    • form RADIAL lateral band =>PIP extension
    • form Oblique fibers of extensor hood =>MCP flexion