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hand Flashcards

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1
Q

what are the main types of grip *

A

power grip

precision grip

hook grip

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2
Q

describe power grip *

A

the fingers are flexed around the object with opposing power from the thumb eg grasping a rod

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3
Q

muscles involved in the power grip *

A

long flexors of the finger and thumb

the intrinsic muscles of the palm

the extensors of the wrist joint - to give more power to the long flexors (posterior hand muscles are involved)

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4
Q

describe the precision grip *

A

the object is gripped between the tips of the fingers and the thumb

eg unbuttoning a shirt

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5
Q

muscles involved in the precision grip *

A

teh wrist and fingers are held rigidly by the long flexors and extensors

the intrinsic muscles of the hand carry out the dine movements needed

forearm control of the wrist - dont wnat the wrist to get floppy

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6
Q

describe the hook grip *

A

consumes little energy

eg carrying shopping bag

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7
Q

muscles involved in the hook grip *

A

mainly involves long flexors of the digits

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8
Q

summarise teh facia of the palm *

A

it is anatomically continuous with the fascia of the forearm

the palmar fascia is the fascia of hand that lies in the palm - dense

there are specialisations (condensations) of the palmar fascia that form the palmar aporneurosis and the fibrous digital sheaths

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9
Q

describe the palmar aporneurosis *

A

it overlies the long flexor tendons of the hand

the proximal end is continuous with the flexor retinaculum and the palmaris longus tendon

the distal end of the aporneurosis is continuous with teh fibrous digital sheaths

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10
Q

describe the fibrous digital sheaths *

A

they contain the flexor tendons and their synovial sheaths which wrap round the tendons and bones

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11
Q

describe the extensions of fascia called septa *

A

they extend from teh palmar aporneurosis to the boens of the hand - separating the space between the aporneurosis and bones into compartments

separate vessels and muscles and tendons running from wrist

a medial septum goes to the little finger metacarpal

a lateral septum goes to the middle finger metacarpal

these septi divide the space into a

  • hypothenar compartment
  • central compartment
  • thenar compartment
  • adductor compartment

deep to the thenar compartment is the adductor compartment which contains the adductor pollicus muscle

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12
Q

what are the bones of the wrist and hand *

A

the radius

ulnar

carpus (carpal bones)

  • proximal row: sphenoid, lunate, triquetrum, pisiform
  • distal row: trapexium, trapezoid, capitate, hamate

the metacarpal bones

the phalanges

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13
Q

what muscular compartments are involved in the hand region *

A

anterior compartment of the forearm - superficial and deep

posterior compartment of the forearm

posterior compartment of the forearm

intrinsic muscles of the hand

  • thenar compartment muscles
  • adductor comaprtment
  • hypothenar compartment
  • interossei and lumbricals
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14
Q

what are the muscles of the superficial anterior compartment of the forearm *

A

pronator teres

flexor carpi radialis

palmaris longis

flexor carpi ulnaris

flexor digitorum superficialis

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15
Q

what are the muscles of the deep anterior compartment of teh forearm *

A

flexor digitorum profundis

flexor pollicus longus

pronator quadratus

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16
Q

what are the muscles of the extensor compartment of the forearm *

A

muscles that move the wrist joint

  • Extensor carpi radialis longus (ECRL)
  • Extensor carpi radialis brevis (ECRB)
  • Extensor carpi ulnaris (ECU)

muscles that move the digits

  • Extensor digitorum (ED)
  • Extensor indicis (EI)
  • Extensor digit minimi (EDM)

muscles that move the the thumb

  • Abductor pollicis longus (APL)
  • Extensor pollicis brevis (EPB)
  • Extensor pollicis longus (EPL)

other muscles

  • Brachioradialis
  • Supinator
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17
Q

what are the intrinsic muscles of the hand *

A

thenar muscles

  • abductor pollicus brevis
  • flexor pollicus brevis
  • opponens pollicus

adductor muscle - single muscle

  • adductor pollicus

hypothenar muscle

  • abductor digiti minimi
  • flexor digiti minimi
  • opponens digiti minimi

interossei and lumbricals

  • lumbricals
  • palmer interossei (3)
  • dorsal interossei (4)

other

  • palmaris brevis
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18
Q

functions of the interossei and lumbricals *

A

lumbricals - flex the MCJ’s, extend the IPJ’s

palmar interossei - adduct the digits (PAD)

dorsal interossei - abduct the digits (DAB)

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19
Q

describe the anterior tendinous anatomy of teh hand *

A

teh fibrous digital sheaths extend from the level of teh metacarpal head to the base of teh distal phalanx in each digit

with the underlying bone the sheaths form the osseo-fibrous tunnels

the long flexor tendons and their synovial sheaths run in these tunnels

part of the digital sheaths form condensations called pulleys - allow for more function of the long flexor tendons

these are the annular and cruciform pulleys

after passing the wrist joint the flexor digitorum profundus and flexor digitorum superficialis pass in the carpal tunnel beneath the flexor retinaculum and enter a common tendinous sheath

the tendons pass to their respective digits in a digital synovial sheath (sheath is wrapped around the tendon forming a double layer, rather tahn the tendon being in the sheath), which is in its own fibrous digital sheath (synovial sheath prevents friction)

the digital synovial sheaths of the index, middle and ring fingers are separate from the common synovial sheath, those of the little finger and thumb are continuous with the common sheath

at the proximal base of the phalanx - the tendon of teh FDS splits around the FDP

the FDS attaches to the anterior surface of the middle phalanx and teh FDP attaches to the distal phalanx (FDS doesnt go as far)

the tendon of the flexor pollicus longus has its own synovial sheath at the flexor retinaculum - this runs to the distal phalanx of the thumb

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20
Q

describe the posterior tendinous anatomy of the hand *

A

all the extensor tendons are held to the dorsum of the wrist by the extensor retinaculum (not as tough as the flexor retinaculum)

there are synovial tendon sheaths that surround the tendons fascilitating free movement of the tendons - some sheaths are connected some are individual

the long extensor tendons to the digits are joined by intertendinous bands - they prevent free movement of 1 extensor tendon independantly of the others

at the metacarpals the long extensor tendons flatten to form extensor expansions - they form a hood on the back of the digit. they are intrically involved in the movement of the digits

the lumbrcals and interossei attach to the expansions

the extensor digitorum extends the metacarpo-pharyngeal joint and the interphalangeal joint. it extends the wrist joint after maximal extension of the digits

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21
Q

what are the joints in the hand *

A

distal radio-ulnar joint

wrist joint

intercarpal joint

carpo-metacarpal and inter-metacarpal joints

metacarpo-phalangeal joints

interphalangeal joints

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22
Q

what movements do the midcarpal (joint between prox and distal carpal row) and carpo-metacarpal joints allow *

A

flexion and extension

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23
Q

what are the series of intercarpal joints *

A

joints between the prox row

joints between the distal row

joints between the prox and distal row - midcarpal joint

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24
Q

what type of joint are the intercarpal joints and what is the movement *

A

plane synovial

gliding - augmenting the flexion and radial deviation of the wrist joint

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25
describe the carpometacarpal joints \*
the CMC joint of thumb is between the trapezium and the thumb metacarpal - synovial joint of saddle variety allows thuim to move in different direction CMC of digits are between trapezoid, capitate, hamate and metacarpals - they are synovial elipsoid CMC of index and middle finger is rigid CMC of ring finger is less CMC of little is very mobile
26
clinical importance of the carpometacarpal joint of the thumb \*
becomes osteoarthritic
27
describe the intermetacarpal joints \*
plane synovial joints between the metacarpals at their bases
28
describe the movements at the carpometacarpal and intermtacarpal joints \*
flexion and extension radial deviation and ulnar deviationn circumduction
29
describe the metacarpophalangeal joints \*
condylar synovial joints between metacarpal heads and prox phalanges
30
what movements do the metacarpophalangeal joints allow \*
flexion and extension abduction and adduction together - circumduction
31
describe the interphalangeal joints\*
hinge synovial joints there is a proximal IP and distal IP joint in thumb only 1 IP joint
32
movements of the interphalangeal joints \*
flexion and extension only
33
describe the ligaments holding teh metacarpophalangeal and interphalangeal joints together \*
they include collateral ligaments both ulnar and radial ulnar collataral ligament of thumb is frequently injured skiing connection between phalanxes is not very strong - not good fit between bone therefore ligaments hold bone in place but only allow flexion and extensioon of IPJ
34
what is the volar plate \*
it is on the anterior surface of the prox IP joint it is a dense condensation of fibrous tissue formed by collateral ligaments frequently damaged
35
what are the muscles that move the thumb \*
abduction * abductor pollicus longus * abductor pollicus brevis adduction * adductor pollicus * first doral interosseous extension * extensor pollicus longus * extensor pollicus brevis * abductor pollicus longus flexion * flexor pollicus longus * flexor pollicus brevis opposition * opponens pollicus (works at carpo-metacarpal joint) * occurs at the metacarpo-phalangeal joint and involves abduction, flexion, and adduction at the metacarpo-phalangeal joint
36
describe the arterial supply of the hand \*
hand supplied by the radial and ulnar arteries in the hand there are extensive anastomoses between the ulnar and radial arteries ulnar artery runs in anterior comp of forearm - passes on ulnar side of palmar surface of wrist. artery is lateral to ulnar nerve which is lateral to flexor carpi ulnaris. the artery supplies medial muscles of the forearm - branches into the common then posterior and anterior interosseous artery. enter hand passing over the flexor retinaculum lateral to pisiform through semi-rigid ulnar (Guyon's) canal with teh ulnar nerve. It divides just below this into * superficial palmar arch (recieves branch from superficial palmar branch of radial artery) * gives off 3 common palmar digital arteries - they divide into palmar digital arteries * the deep palmar branch of ulnar artery --- radial artery passes down lateral aspect of forearm under brachioradialis muscle and beside FCR at wrist. it crosses floor of anatomical snuff box and enters palm of hand between the 2 heads of the 1st dorsal interosseous muscle, then passes between the 2 heads of the adductor pollicus muscle. it anastomoses with deep palmar branch of ulnar artery to form deep palmar arch deep palmar arch gives origin to palmar metacarpal arteries arteries also form dorsal carpal arch
37
where is the radial artery palpable
at the wrist lies superficially on palmar aspect of radial side of wrist
38
describe the venous drainge of the hand \*
deep and superficial arterial arches have corresponding palmar venous arches - deep drainage dorsal digital veins drain into dorsal venous arch (superficial system) on dorsum of hand arch gives rise to cephalic and basilic vein laterally and medially most drainage is through the superficial system
39
what are the 3 main nerves to the hand \*
median nerve c6-t1 ulnar nerve c8-t1 radial nerve c5-t1
40
what nerves contribute to sensory supply of the hand \*
ulnar median radial they do so in the digits through digital nerves
41
effect of division of one of the digital nerves
anaesthesia in part of the digit
42
describe the path of the median nerve \*
supply anterior compartment of the hand and forearm descends through anterior comp of arm - no branches in cubital fossa it lies medial to brachial artery (can be damaged by supracondylar fractures of humerus or dislocations) passes between the heads of the pronator teres at wrist lies superficially between the tendons of FDS and FDP and deep to palmaris longus enters the carpel tunnel - here it is accompanied by 9 flexor tendons (FDP FDS FPL) passes under the flexor retinaculum the recurrent branch of median nerve leaves main trunk in carpel tunnel and supplies the 3 thenar muscles
43
what does the median nerve supply\*
in forearm * pronator teres * FDS * lateral protion of FDP * FCR * pronator quadratus * palmaris longus after passing under the flexor retinaculum * the 3 thenar muscles - abductor pollicus brevis, flexor pollicus brevis and opponens pollicus * the lateral (2 and 3) lumbricals sensory * palmar surface of thumb * index and middle finger * lateral half of ring finger * some dorsal supply (main nerve to the anterior compartment of the forearm, some supply to intrinsic hand muscles)
44
describe the path of the ulnar nerve \*
initially descends in the anterior compartment of the arm more distally enters the posterior comp - lies superficially posterior to medial epicondyle no branches in arm enters anterior comp of forearm between heads of flexor carpi ulnaris and descends on medial side of forearm proximal to wrist it gives off 2 branches - palmar cutaneous branch, dorsal cutaneous branch at wrist lies anteriorly - between FCU (medially) and ulnar artery (laterally) then passes into hand passes over the flexor retinaculum in ulnar canal with ulnar artery, lateral to the pisiform bone it divides distal to the flexor retinaculum to superfical and deep braches
45
what does the ulnar nerve supply \*
in forearm * FCU * medial portion of FDP palmar cutaneous branch supplies medial palm of hand dorsal cutaneous branch supplies medial half of dorsum of hand, including little and ring fingers superficial branch of ulnar nerve - sensory to palmar surface of little finger and medial sode of ring finger deep branch of ulnar nerve - motor to * hypothenar muscles (abductor digiti minimi, flexor digiti minimi, and opponens digiti minimi) * abductor pollicis * the medial (fourth and fifth) lumbricals * all interossei it controls most of muscles involved in fine movements of the hands
46
describe the path of the radial nerve \*
lies on the humerus in the radial groove superior to elbow divides into superficial radial nerve (sensory) and deep radial nerve (motor) superficial branch is cutaneous - sensory to lateral 2/3 of dorsum of hand, dorsum of thumb and proximal portions of dorsal of index and middle fingers posterior interosseous nerve is continuation of deep radial nerve as it passes between heads of the supinator supplies all extensor parts of forearm and arm doesnt supply any muscles in hand
47
what does the carpal tunnel contain \*
median nerve FPL tendon 4 tendons of FDP 4 tendons of FDS
48
what is the carpal tunnel made from \*
base - bony arch of teh carpal bones roof- flexor retinaculum (called transverse carpal ligament) bony attachments - palpable * scaphoid, trapezoid, (laterally) * pisiform, hamate (medially)
49
what is carpal tunnel syndrome \*
compression of the median nerve in the carpal tunnel causes tingling, loss of sensation and pain in the hand
50
what are the names and numbers of digits, would you use names or numbers clinically
thumb index finger middle ring little 1-\>5 never numbers - dont want people to count in emergancy, have to do it quickly
51
what carpel bones articulate in wrist joint \*
proximal row with forearm bones pisiform not involved - it is a sesamoid bone
52
how are the carpal bones involved in forming the carpal tunnel \*
there are prominences medially and laterally formed by hook of hamate, pisiform (that sits anterior to the triquetum) tubercule of scaphoid and tubercle of trapezium the form the bony attachments for the flexor retinaculum
53
what is clinically significant about the compartments of the hand
way the infection might travel
54
describe the thenar and hypothenar eminences \*
they are the prominant parts on the thumb and little finger side of the hand - made by the muscles
55
what does it mean if a muscle is called carpi
acts across the wrist but doesnt go into digits
56
what does it mean if muscle is called digitorum
acts on medial digits 2-5
57
how can anterior comnpartment forearm muscles act on teh hand \*
they attach across elbow joints and go across wrist and to digits
58
what are the intrinsic muscles of the hand involved in \*
precise movements - small movements
59
what are the movements of the thumb \*
abduction adduction extension flexion opposition
60
what are the muscles involved in moving the thumb \*
abduction * APL APB adduction * adductor pollicus * 1st dorsal interosseous extension * EPL EPB * APL flexion * FPL FPB opposition * opponens pollicus
61
muscles in the thenar compartment \*
opponens pollicis abductor pollicus brevis flexor pollicus brevis
62
muscles in the hypothenar compartment \*
abductor digiti minimi flexor brevis digiti minimi opponens digitu minimi
63
what supplies the thenar muscles \*
median nerve - except for the adductor pollicis
64
describe teh adductor pollicis \*
broad attachment on the middle metacarple fan shape - fibres converge and insert on prox phalanx of thumb
65
describe the location of the lumbricals \*
tehy attach top the tendons of the flexor digitorum profundus distal attachment - converge to form tendon round to anterior of digit insterts into connective tissue taht forms hood over digit - this is the extensor expansion
66
descrieb the arrangement of the dorsal interossei \*
prox attachment between bones tendons attach towards axial line (ie middle fingers) for dorsal interossei tendons attach away from axial line for palmar interossei DAB - dorsal abduct PAD - palmer adduct (pull digits to axial line)
67
describe the tendinous anatomy of the digits anteriorly \*
have annular and cruciate parts tough ligamentosu structures wrap around the tendons' synovial sheath there are thicked palmar ligaments (plates) at joints they ligaments pull the digit close to the tendon, so that tendon is held to the bone
68
describe the tendinous anatomy of the digits posteriorly \*
extensor expansion over MPJ to there is a tendinous hood over the proximal IPJ FDS attaches to base of middle phalanx FDP - go to deep phalanx piercing FPS lumbrical pulls the extensor expansion - flex teh MPJ and straighten the IPJ
69
describe the digital nerves \*
purely sensory - no muscles in digits often damaged - can cause disability, if cant feel things cant function properly
70
what is the innervation of the intrinsic muscles of the hand \*
median supplies the thenar and lateral 2 lumbricals ulnar supplies all otehr intrinsic hand muscles
71
describe teh palmar cutaneous branch of the median nerve \*
branches before teh carpal tunnel gives sensation to the arm
72
illustarte the pattern of innervation to the palmer surface of teh hand &
ulnar - digital branch to little and 1/2 ring finger
73
illustrate the pattern of innervation of innervation in the posterior of the hand \*
superficial branch of radial nerve supplies the lateral aspect of the dorsal of the hand - sensory dorsal branch of ulnar supplies the medial aspect of the palm
74
illustrate teh areas of cutaneous innervation of the hand &
75
describe the extensor digitorum tendon\*
tendon expands over MCP - making the extensor expansion lumbricles attach to the extensor expansion the tendon carries on distally and then narrows out again it allows complete extension of the digits
76
what is guyon's canal \*
ulnar nerve passes through - not affected as often as the carpal tunnel
77
78
identify teh location of the thenar and hypothenar muscles and lumbricles \*
-
79
identify on the metacarpals the body (shaft) base (proximally) and head (distally) \*
80
identify in the phalanges the body (shaft) base (proximally) and head (distally) \*
81
where does secondary ossification of the metacarpals develop
the growth centres of the 4 fingers is at their heads growth centre of the thumb is at base
82
where does secondary ossification occur in the phalanges
teh centres are at the bases
83
surface mark the cephalic, basilic and cubital veins \*
mark them if can see if not, illustrate where they would be - make sure median cubital is going down laterally to demonstrate superficial veins - apply pressure around middle of arm by encircling with hands = venous congestion and distention distal to the compression
84
identify and palpate head of ulnar
little finger side of wrist
85
identify ulnar and radial styloid process \*
wither side of teh wrist
86
identify the prox (and middle if present) and distal wrist crease and what do they indicate \*
prox/middle - marks radio-carpal joint line distal wrist crease - prox extent of the flexor retinaculum
87
identify teh dorsal venous arch
on dorsal of hand
88
identify the long extensor tendons
extend the wrist against resistance
89
palpate thenar and hypothenar eminance
by thumb and little finger
90
identify prox, distal palmar skin creases adn radial longitudinal crease
distal - mark position of metacarpophalangeal joints radial longitudinal - partly encircles the thenar eminence
91
identify the digital creases on the palmar surface of fingers - prox, middle and distal
92
palpate the pisiform, tubercle of scaphoid, hook of hamate, ridge of trapezium
pisiform - distal end of FCU tendon scaphoid - fully extend the wrist and it is along the line of FCR hook of hamate - palpate deep to hypothenar muscles, 1cm distal and lateral to the pisiform trapezium - palpate deep to middle of root of thenar muscles, distal to scaphoid
93
identify head of metacarpals and palpate
knuckes
94
identify radial styloid
in anatomical snuff box
95
identify scaphoid
in anatomical snuff box
96
identify the tubercle of teh base of the thumb metacarpal
in the snuff box
97
identify head of ulnar on dorsum of wrist
flex wrist to see
98
identify dorsal radial tubercle
EPL tendon of extended thumb leads towards the tubercle
99
identify the superficial palmar arch and deep palmar arch `
superficial - main artery is ulnar, distal limit of teh arch is at the level of the distal border of teh fully extened thumb just prox to prox palmar crease deep - main artery is radial, teh arch lies 1cm proc to superficial arch at distal edge of the flexor retinaculum
100
what is allen's test
a visual test for teh relative contribution of radial and ulnar arteries to the hand subject asked to raise hand and make clenched fist examiner compresses both radial and ulnar arteries, when fist is released palmar skin appears pale examiner releases either one of the arteries and notes the tie for colour return to the hand fastest artery is the dominant
101
would you use the dominant artery to take bloos
no - arteries go into vasospasm when needle in them so collapse for a while, so take from least dominant so dominant can maintain blood supply to the hand meanwhile
102
assess integrity of flexor pollicis longus
nerve - median examiner holds prox phalanx of thumb whilst distal phalanx is flexed against resistance - the muscle/tendon is deep for palpation
103
assess integrity of the extensor pollicus longus
radial nerve thumb extended against resistance at interphalangeal joint tendon visible at medial border of snuff box and medial to dorsal tubercle of radius
104
assess integrity of flexor digitorum profundus
ulnar and median nerves examiner holds prox IP joint in extended position, while distal IP joint is flexed against resistance
105
assess integrity of FDS
median nerve each digit assessed individually non-test fingers are held in full extension by examiner while prox IP joint of test finger is flexed against resistance
106
assess integrity of extensor digitorum
radial nerve forearm is pronated and the digits extend at MCP joints examiner applies resistance on prox phalanges tendons become visible and palpable on dorsum of hand muscle belly is palpable on forearm
107
assess integrity of dorsal interossei
ulnar nerve examiner holds adjacent extended and adducted fingers of subject between thumb and index finger while subject attempts to abduct them
108
assess integrity of palmer interossei
ulnar nerve subject holds slip of paper between adjacent fingers taht are extended and adducted the subject is asked to close the fingers tightly on the paper while the examiner attempts to withdraw it
109
movement of flexor digitalis superficialis \*
flex fingers powerfully median nerve
110
muscle that only flexes the last phalanx
flexor digitalis profundus ulnar and mendian
111
how many hypothenar muscles are there and innervation
3 ulnar
112
nerve supply of the intrinsic muscles of the hand \*
adductor pollicus - ulnar thenar - median hypothenar - ulnar
113
muscles that move the digits \*
extension - radial nerve * extensor digitorum * extensor indicis * extensor digit minimi hypothenar muscles - innervation ulnar nerve - lateral to medial, extensor flexor oponens digiti minimi lumbricals interosseus muscles flexion * FDP - median nerve to index and middle fingers, ulnar to ring and little * FDS - median nerve
114
what is mallet finger \*
when the end of the finger bends in towards the palm because there is damage to the extensor digitorum tendon
115
explain the spread of infection in tendinous sheaths \*
in flexor tendinous sheaths it is a sergical emergancy because they are closed compartments, this is not true in extensor sheaths in flexor infection can lead to necrosis
116
what is the blood supply of the digits \*
radial - thumb and lateral side of index ulnar- medial side of index and other digits

anatomy of the limbs (14 decks)

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