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Anatomy > L37 Palm > Flashcards

L37 Palm Flashcards

(45 cards)

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1
Q

Abductor pollicis brevis

A

PA: Flexor retinaculum, scaphoid, trapezium

DA: Lateral side, base of proximal phalanx

Inn: Recurrent branch of median nerve

Action: Abduction CMC (MP), assists opposition

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2
Q

Opponens pollicis

A

PA: Flexor retinaculum, scaphoid,
trapezium

DA: Lateral side 1st metacarpal

Inn: Recurrent br. median nerve

Action: Opposition CMC

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3
Q

Flexor pollicis brevis (two heads)

A

PA: Flexor retinaculum, scaphoid,
trapezium

DA: Lateral side base of proximal
phalanx

Inn: Superficial head: Recurrent
br. median nerve
Deep head: Deep br. ulnar
nerve

Action: Flexion CMC (MP)

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4
Q

Adductor pollicis

A

PA: Transverse head: Shaft 3rd
metacarpal

Oblique head: Bases 2nd & 3rd metacarpals, carpal bones

DA: Medial side base of proximal
phalanx

Inn: Deep br. ulnar nerve

Action: Adduction CMC (MP)

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5
Q

Abductor digiti minimi

A

PA: Pisiform

DA: Medial side base proximal
phalanx

Inn: Deep branch ulnar nerve

Action: Abduction (MP)

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6
Q

Flexor digiti minimi

A

PA: Hook of hamate, flexor
retinaculum

DA: Medial side base proximal
phalanx

Inn: Deep branch ulnar nerve

Action: Flexion (MP)

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7
Q

Opponens digiti minimi

A

PA: Hook of hamate, flexor
retinaculum

DA: Medial border of 5th
metacarpal

Inn: Deep branch ulnar nerve

Action: Brings 5th digit into
opposition with
thumb

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8
Q

Palmar interossei (3)

A

PA: Palmar surfaces digits 2, 4, 5

DA: Bases of proximal phalanges
& lateral bands of extensor
expansion, digits 2, 4, 5

Inn: Deep branch ulnar nerve

Actions:
(1) Adduction digits 2, 4, 5
toward axis
(2) Assist lumbrical action

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9
Q

Dorsal interossei (4)

A

PA: Adjacent sides of two metacarpals

DA: Bases of proximal phalanges &
lateral bands of extensor expansion,
digits 2, 3, 4

Inn: Deep branch ulnar nerve

Actions:
(1) Abduction digits 2, 3, 4
away from axis
(2) Assist lumbrical action

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10
Q

What is a typical position for hand casts or splits?

A

Wrist neutral or with slight extension (resting position)

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11
Q

What are the 8 carpel bones?

A

Proximal row (lateral to medial):

  • scaphoid
  • lunate
  • triquestrum
  • pisiform

Distal row (lateral to medial):

  • trapezium
  • trapezoid
  • capitate
  • hamate
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12
Q

What bones make up the wrist joint?

A

radius, scaphoid, lunate, & triquetrum

not the ulna!

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13
Q

What is the area between metacarpals called and what is contained there?

A

web space, filled with muscles and other soft tissue

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14
Q

What is the significance of the palmar aponeurosis?

A
  1. Tendon of palmaris longus (PL)
  2. Continuous with fibrous tendon
    sheaths of long flexor tendons
  3. Fibrous septa dividing palm into
    compartments
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15
Q

What compartment is Palmer brevis in and what are its features (PA, DA etc)

A

Not in one of the 5 compartments!

PA: Medial side of palmar aponeurosis
DA: Skin on medial border of hand
Act: Wrinkles skin of hand, deepens
hollow of palm aiding in palmar
grip, protects ulnar a/n
Inn: Ulnar nerve

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16
Q

What is the palmar carpal ligament and what does it do?

A

(thickening of antebrachial
fascia, holds flexor tendons in
place across the wrist )

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17
Q

What is Dupuytren’s contracture?

A

Progressive, shortening, thickening,
and fibrosis of the palmar fascia
& aponeurosis (cause unknown)

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18
Q

What are the 5 compartments of the palm?

A
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19
Q

What is in the central compartment?

Study These Flashcards
A
  1. Superficial palmar arch & brs
  2. Median nerve & brs
  3. Long flexor tendons (FDS & FDP)
  4. Lumbricals
    (5. Midpalmar space: deep to flexor tendons)
20
Q

Lumbricals:

What are their positions relative to the different joints?

Study These Flashcards
A

PA: Tendons of flexor digitorum profundus
DA: Lateral bands of extensor
expansion digits 2-5
Inn: 1 & 2 (lateral): Median n
3 & 4 (medial): Deep br. ulnar n
Actions: MP flexion, PIP & DIP extension

MP joints: Lumbricals are located
anterior to the axis of motion, results in flexion

PIP & DIP joints: Lateral bands are
located posterior to the axis
of motion, results in extension

21
Q

What is the importance of lumbricals (and interossei)

Study These Flashcards
A

Flexion of MP jts coupled with Extension of PIP/DIP jts.

Prevents hand from only being able to do full flexion or extension.

22
Q

What’s in the thenar compartment?

What are the key concepts?

Study These Flashcards
A

Contents:

  1. Recurrent n (br. median n)
  2. Thenar muscles
    (3. Thenar space or cleft)

Key concepts:
1. Associated with pollex
(thumb, pollicis)
2. Mm innervated by recurrent
br. of median nerve (with one
exception)

23
Q

What are the thenar muscles?

Study These Flashcards
A
  1. Abductor pollicis brevis
  2. Opponens pollicis
  3. Flexor pollicis brevis (2 heads)
24
Q

Abductor pollicis brevis

Study These Flashcards
A

PA: Flexor retinaculum, scaphoid, trapezium
DA: Lateral side, base of proximal phalanx
Inn: Recurrent br. median nerve
Action: Abduction CMC (MP) (assists opposition)

25
Opponens pollicis
PA: Flexor retinaculum, scaphoid, trapezium DA: Lateral side 1st metacarpal Inn: Recurrent br. median nerve Action: Opposition CMC
26
Flexor pollicis brevis (2 heads)
* *PA**: Flexor retinaculum, scaphoid, trapezium * *DA**: Lateral side base of proximal phalanx * *Inn: Superficial head:** Recurrent br. median nerve * *Deep head:** Deep br. ulnar nerve * *Action**: Flexion CMC (MP)
27
Which digits have continuations of synovial portions of flexor tendon sheaths (bursa)? What are the implications?
Digits 1 (ulnar bursa) and 5 (radial bursa) have continuous sheaths that allows infection to spread from the digit to the forearm.
28
What's in the adductor compartment?
**Adductor pollicis**: Transverse head Oblique head **PA: Transverse head**: Shaft 3rd metacarpal **Oblique head**: Bases 2nd & 3rd metacarpals, carpal bones **DA**: Medial side base of proximal phalanx **Inn**: Deep br. ulnar nerve **Action**: Adduction CMC (MP)
29
What's in the hypothenar compartment? Key concepts?
_Key concepts_: 1. Associated with digit 5 (digiti minimi) 2. Mm innervated by deep branch of ulnar n. _Contents_: Hypothenar muscles (3) 1. Abductor digiti minimi 2. Flexor digiti minimi 3. Opponens digit minimi
30
**Hypothenar muscles**: (info) Abductor digiti minimi: Flexor digiti minimi: Opponens digiti minimi:
_Abductor digiti minimi_: PA: Pisiform DA: Medial side base proximal phalanx Inn: Deep branch ulnar nerve Action: Abduction (MP) _Flexor digiti minimi_: PA: Hook of hamate, flexor retinaculum DA: Medial side base proximal phalanx Inn: Deep branch ulnar nerve Action: Flexion (MP) _Opponens digiti minimi_: PA: Hook of hamate, flexor retinaculum DA: Medial border of 5th metacarpal Inn: Deep branch ulnar nerve Action: Brings 5th digit into opposition with thumb
31
What are the contents and key concepts of the interosseous compartment?
_Key concepts_: Mm innervated by deep branch of ulnar n. _Contents:_ 1. Palmar interossei (unipennate) 2. Dorsal interossei (bipennate)
32
Palmar Interossei (PADs)
**PA**: Palmar surfaces digits 2, 4, 5 **DA**: Bases of proximal phalanges & lateral bands of extensor expansion, digits 2, 4, 5 **Inn**: Deep branch ulnar nerve **Actions**: (1) Adduction digits 2, 4, 5 toward axis (2) Assist lumbrical action
33
Dorsal Interossei (DABs)
**PA**: Adjacent sides of two metacarpals **DA**: Bases of proximal phalanges & lateral bands of extensor expansion, digits 2, 3, 4 **Inn**: Deep branch ulnar nerve **Actions**: (1) Abduction digits 2, 3, 4 away from axis (2) Assist lumbrical action
34
How do DABs, PADs and Lumbricals work together?
1. All three mm are located anterior to the flexion/extension axis of the MP joint: Flex at MP joints 2. All three mm are incorporated into the lateral band portion of the extensor expansion. 3. The lateral bands are located posterior to the flexion/extension axes of the PIP & DIP joints: Extension at PIP & DIP joints
35
What makes up the deep palmar arch? What does it give rise to?
The deep palmar arch is an anastomose of the radial artery and the deep branch of the ulnar artery, located near the bases of metacarpals. It gives rise to the palmar metacarpal arteries (anastomose with superficial palmar arch near MC heads)
36
What makes up the superficial palmar arch? What are the branches of the superficial palmar arch?
The superficial primary arch is the main continuation of ulnar artery (primary role) and is completed by a branch of the radial artery. It is the primary artery supply to digits 2-5 It gives rise to the common palmar digital aa which give rise to proper palmar digital aa (sides of adj. digits)
37
What are the palmar side veins of the hand?
Parallels arterial pattern: Superficial & deep venous palmar arches Drain into: Deep veins of forearm (ulnar & radial vv)
38
What are the dorsal side veins of the hand?
Dorsal venous network drains into: Superficial veins: Cephalic & Basilic vv. (dorsal digital vv most distal)
39
What is contained in the carpal tunnel? What ligament defines the carpal tunnel?
9 tendons (from FDS, FDF, FPL) and the median n. The flexor retinaculum (transverse carpal ligament)
40
Median n in hand: location, branches, etc
passes through carpal tunnel to enter palm then branches into: 1. **Recurrent branch**: motor to **thenar muscles** except for deep head of flexor pollicis brevis 2. **Common palmar digital nn**: in metacarpal area (innervates lateral 2 lumbricals) then branch into **proper palmar digital nn** (follows artery naming) Proper digital nn supply sensory innervation to to adjacent sides to lateral 3 & 1/2 digits (4th is half deep branch of ulnar n)
41
What is the sensory innervation on the palmar surface?
blue = Ulnar n yellow = median n pink = radial n purple and green? not sure
42
What is the dorsal sensory innervation of the hand?
blue = ulnar n pink = radial n yellow = median n
43
What are some important actions of the median n in the thumb? (from Walters' chart)
_Unique: Pronation_: (pronators teres & quadratus) _Flexion digits 2 & 3_ FD superficialis: PIP FD profundus: DIP _Flexion digit 1_ FP longus: IP _Lumbrical Actions_ Lumbricals 1 & 2 to digits 2 & 3 _Opposition (thumb)_ Opponens pollicis
44
Ulnar n and the hand: Where do you test sensory innervation of the ulnar n?
Enters palm under palmar carpal ligament but above the transverse carpal ligament (guyon's tunnel). Then splits into superficial and deep branches. 1. **Deep Branch:** (motor, described later) 2. **Superficial Branch:** _Motor branch_: palmaris brevis _Sensory branch_: 2a. (Proper) palmar digital n to medial side of digit 5 2b. Common palmar digital nerve 2b1. (Proper) palmar digital nerves to digit 4 & 5 Associated with (proper) digital aa Sensory distribution of the ulnar n is tested in the pinky
45
What does the ulnar nerve supply?
1. Hypothenar muscles (3) 4. Medial 2 lumbricals (digits 4 & 5) 5. Palmar interossei 6. Dorsal interossei

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