Musculoskeletal anatomy Flashcards
(237 cards)
1
Q
What does the shoulder girdle joint contain?
A
Sternoclavicular and acromioclavicular
2
Q
What is the function of the clavicle?
A
Assists shoulder movement and transmits force from upper limb to thorax
3
Q
what are the 5 main branches of the brachial plexus?
A
Axillary
Radial
Musculocutaneous
Ulnar
Median
4
Q
Which muscles does the axillary nerve innervate?
A
Deltoid muscle
Teres minor
5
Q
Which muscles does the radial nerve innervate?
A
Extensor muscles of the arm and forearm
6
Q
What are causes of radial nerve injuries in the axilla?
A
Crutch palsy
Saturday night’s palsy/ sleep palsy
7
Q
What are the motor effects of radial nerve injury in the axilla?
A
1.Paralysis of triceps ad anconeus –> loss of extension of elbow (however elbow can be extended by gravity)
2.Paralysis of brachioradialis and supintor –> weakness of supination but it is not lost since biceps can supinate
3.Paralysis of long extensors of wrist ad fingers causing wrist and finger drop
8
Q
Which nerve injury causes wrist drop?
A
Radial nerve
9
Q
What can cause a lesion of axillary nerve?
A
Fracture of surgical neck or shoulder dislocation
10
Q
Which nerve causes a flat shoulder?
A
Axillary nerve lesion
11
Q
What does axillary nerve injury lead to?
A
Paralysis of deltoid & teres minor –> flat shoulder and inability to abduct arm from 15 degrees to 90 degress
Loss of sensation over lower 1/2 of deltoid
Sensation over upper 1/2 of deltoid is normal as it is supplied by lateral supraclavicular nerves C 3,4
12
Q
What is the cause of median nerve injury at the elbow?
A
Supracondylar fracture
13
Q
What is the motor effect of median nerve injury?
A
Pronation (2 pronators lost)
Wrist flexion –> weak + ulnar deviation
Finger flexion –> ask patient to make fist –> can’t flex inndex and middle —> benediction (lateral 1/2 FDP paralysis but medial 1/2 of FDP intact)
Thumb flesion –> loss of FBL + Brevs
Paralysis of thenar eminence muscles –> flat thenar emeninace
lost thumb opposition
14
Q
How do you test for lost thumb opposition?
A
Counting test
15
Q
Which nerve injury causes Ape hand deformity?
A
Median nerve injury
16
Q
What are the causes of ulnar nerve lesions?
A
Stab wound
Entrapment (ulnar tunnel)
17
Q
What is the effect of lesion of ulnar nerve at wrist?
A
1.Paralysis of all interossei & med. 2 lumbricals –>Partail claw hand (lateral 2 lumbricals), loss of fingers abduction and adduction
2.Anesthesia in media 1/2 fingers (Palmar surface)
18
Q
What is the test for loss of fingers abduction?
A
Paper test
19
Q
How do you test Adductor pollicis?
A
Forment’s test
20
Q
What are the causes of lesions of ulnar nerve at elbow?
A
Fracture medial epicondyle
21
Q
What are the effects of lesion on ulnar nerve at elbow?
A
Previous effect at wrist +
Wrist flexion –> weak + radial deviation (FCU)
Clawing –> less apparent (ulnar paradox as medial 1/2 FDP is paralyzed)
Anasthesia on medial 1/3 of hand and medial 1/2 fingers
22
Q
What does the ulnar nerve supply?
A
Lower anterior/ flexor compartments of the forearm and hand: some flexors (ulnar side) and most hand muscles (mid hand and little finger) (hypothenar)
23
Q
What causes of upper trunk lesion- C5,6 (Erb’s paralysis)?
A
Difficult child birth
24
Q
What is the motor effect of Erb’s paralysis?
A
Arm is adducted and medially rotated, forearm is extended and pronated and wrist is flexed
25
What deformity happens in Erb's paralysis?
waiter's tip
26
Where does the sensory loss occur in Erb's paralysis?
Lateral side of arm and forearm and hand
27
What is the lower brachial plexus injury called?
Klumpke's palsy
28
What is the beginning of the axillary vein?
As continuation of the basilic vein at the lower border of teres major
29
How does the axillary vein end?
At the outer border of the 1st rib by forming the subclavian vein
30
Where does the axillary vein run?
Rund medial to the axillary artery
31
What are the tributes of the axillary vein?
a. Trbutaries corresponding to the branches of axillary artery
b.Cephslic vein at its upper part
C.The two venae comitantes of the brachial artery (brachial veins)
32
What is the begining of axillary artery?
As the continuation of subclavian artery at outer border of first rib
33
What is the end of the axillary artery?
At the lower border of teres major by becoming brachial artery
34
What is the course of the axillary artery?
Divided b the pectoralis minor into 3 parts
1st part:above PM
2nd part:behind or deep to PM
3rd part: below PM
35
What are the branches of the axillary artery?
First part: One branch --> superior thoracic artery
Second part: Two branches
1.Thoraco-acromial artery: short trunk that divides into
a.acromial branch
b.pectoral branch
c.clavicular branch
d.deltoid branch
2.Lateral thoracic artery to thoracic wall (in females it is enlarged and supplies the breast)
Third part has 3 branches:
1.subscapular artery:
Largest branch of axillary artery follows lateral border of scapula till inferior angle accompanies thoracodorsal nerve around scapula
Gives circumflex scapular artery around scapula
2.Anterior circumfles humeral artery passes anterior to surgical neck of humerus and anastomoses with posterior circumflex humeral artery
3.Posterior circumflex humeral artery it accompanies axillary nerve and anastomoses with anterior circumflex forming a circular anastomosis around surgical neck
36
What is the anastomosis around scapula?
Anastomosis between 1st part of subclavian artery and 3rd part of axillary artery
37
What is the value of the anastomis around scapla?
It carries adequate blood to upper limb when there is an occlusion between the 2 arteries
38
What is the site of anastomosis around scapula?
On the fossae of scapula, deep to the muscles
39
What is the function of arterial anastomosis around shoulder?
Joint movement leads to temporary occlusion of blood vessels anastomosis provides alternativ routes for blood to upper limb
40
What are the arteries sharing in anastomosis around scapula?
From the 1st part of subclavian artery:
1.Dorsal scapular (deep branch of transverse cervical artery)
2.Suprascapular artery
From the 3rd part of axillary artery:
1.Subscapular artery
2.Circumflex scapular artery
41
What is the main stabilizer of the the sternoclavicular joint?
Costo-clavicular ligament
42
What type of joint is the sternoclavicular joint?
Synovial joint
43
What type of joint is the synovial plane?
Acromioclavicular joint: Articulation between acromion of scapula & clavicle
Type of joint: Synovial plane
44
What is the function of the upper fibers of the trapezius?
Elevate the scapula
45
What is the function of the lower fibers of the trapezius?
Depress the scapula
46
What is the function of the middle fibers of the trapezius?
Retract the scapula
47
Which fibers are used to raise limb above the head?
Upper and lower fibers of the trapezius
48
What happens as a result of an injury to the accessory nerve?
Paralysis of the trapezius muscle = a drop shoulder with rotation of the scapula towards the midline and restricted abduction of the arm is caused
49
Which muscle helps you scratch your back?
Latissimus dorsi
50
What actions do the latissimus dorsi commit?
Adduction
Extension
Medial rotation
51
Which muscle is responsible for climbing or elevating the trunk?
Latissimus dorsi
52
Which muscles are responsible for protraction and retraction of scapula?
Serratus anterior & pectoralis minor
Middle fibers of trapezius and rhomboidus muscles
53
What is responsible for upward rotation and downward rotation of scapula?
Upper and lower fibers of trpezius & lower 5 digitations of serratus anterior
54
What is deep to pectoralis major?
1.Pectoralis minor
2.Subclavis muscle
4.Clavipectoral fascia (between 2&3)
55
which muscles draws the trunk upward as in climbing & swimming?
Pectoralis major and latissimus dorsi
56
what is the origin and insertion of serratus anterior muscle?
Arise from the upper 8 ribs and insert into the scapula
57
what is the nerve spply of serratus anterior ?
Long thoracic nerve (C5,6,7 from the roots of the brachial plexus)
58
What causes winged scapula?
Injury of the nerve to serratus anterior occurs during operaton for carcinoma of the breast
59
what are the 6 muscles connecting the scapula with the humerus?
1.Deltoid
2.Supraspinatus
3.Infraspinatus
4.Teres minor
5.Teres ajor
6.Subscapularis (seen from front of the scapula)
60
What are the muscles of the anterior fascial compartment?
Biceps brachii
coracobrachialis
Bravhialis
61
What is the blood supply of the anterior fascial compartent?
Brachial artery
62
What is the nerve supply to the anterior fascial compartment?
Musculocutaneous nerve
63
What are the structures found in the anterior fascial compartment?
Median nerve
Ulnar nerve
Basilic vein
64
Where is the long head of the biceps brachii found?
In the lateral side
65
what is the insertion of the biceps brachii?
Inserted by tendon and aponeurosis
66
What is the action of the biceps bracjii?
Flexion shoulder and elbow
Supination of forearm
67
What are the roots of biceps tendon reflex?
root value: C5, 6
mainly C6
68
What is the function of the coracobrachialis?
Flexion and adduction of arm
69
What is the action of the brachialis?
Flexion of elbow
70
What is the anterior compartment innervation?
Musculocuaneous nerve
71
What is the origin and root value of musculocutaneous nerve?
Lateral cord, C5, 6, 7
72
What are the branches of the musculocutaneous nerve?
1.Muscular (muscles of the front of arm, flexor compartment)
2.Cutaneous (lateral cutaneous nerve of foream)
73
What does the injury of musculocutaneous nerve cause?
Weakness of arm flexion and sensory loss along the lateral forearm
74
What is the begning and ending of the brachial artery?
Begining: As continuation of axillary artery
End: At the neck of radius by dividing into radial and ulnar artery
75
What are the branches of the brachial artery?
1.profunda brachii a.
2.Sup. Ulnar collateral
3.INf. ulnar collateral
4.Musular branches
5.Nutrient artery
76
What is the front medial epicondyle anastomosis?
anterior branch of inferior ulnar collateral artery (brachial artery)
Anterior ulnar recurrent artery (ulnar artery)
77
What is the anastomosis of the back of the medial epicondyle?
1. superior ulnar collateral
2. posterior branch of inferior ulnar collateral (brachial artery)
3. posterior ulnar recurrent artery (ulnar artery)
78
What are the front lateral epicondyle anastomosis?
1. Radial collateral arerty (profunda)
2.Radial recurrent artery (radial artery)
79
What is the back anastomosis of the lateral epicondyle?
1.Posterior desceding branch (profunda brachii artery)
2.Posterior interosseous resurrent artery (arises from posterior interosseous artery)
80
What are the superficial contents of the cubital fossa?
Basilic
cephalic
median
cubital
81
What are the deeper contents of the cubtal fossa?
Biceps brachii
Brachial artery
venae comitantes
Median nerve
82
What are the contents of the cubital fossa from medial to lateral?
1.Median nerve
2.Brachial artery
3.Tendon of biceps brachii
4.Radial nerve
83
What can a supracondylar fracture of humerus cause?
1.The broken bone can push on the artery and nerve
2.The broken bone can spike the brachialis muscle
84
What are the root value of triceps tendon reflex?
Root value: C6, 7
Mainly c7
85
What are the contents of the posterior compartment of the arm?
muscles: the 3 heads of the triceps muscle
Nerve supply to muscle: Radial nerve
Blood supply: Profunda bracii and ulnar collateral arteries
86
What is the origin of each head of the triceps brachii?
Long head : scapula
Lateral head: Humerus
Medial head: Humerus
87
What is the insertion of the triceps brachii?
Inserted in olecranon process of ulna
88
What supplies the triceps brachii?
Radial nerve
89
What is the function of the triceps brachii?
Extend elbow against resistance
90
What is the origin and root value of the radial nerve?
Posterior cord (C5, 6, 7, 8, T1)
91
What are the branches of the radial nerve?
1.Musscular to the 3 heads of tri & anconeus
2.Posterior cutaneous of arm
2.Lower lateral cutaneous arm
4.Posterior cutaneous of forarm
5. Muscular to brachialis, brachioradialis ad ext. carpi rad
6. 2 terminal branches (superficial radial & posterior interossssseous)
92
What is the motor effect of radal nerve injury in the arm?
1.Injury of radial nerve above the elbow --> leads to wrist drop and fingers drop due to paralysos of all extensors of the wrsit and fingers (this will affect the powerful grip)
2.Impairs the the extension of the elbow against resistance due to affection of the triceps
93
What is the sensory effect of the radial nerve injury in the arm ?
1.Patch of sensory loss over the lower half of deltoid
2.A small area of complete loss of sensation on the dorsum of the hand between 1st and 2nd metacarpal bones
3.Parasthesia over the posterior surface of arm, forearm, lower part of the lateraal side of the arm
94
Where does ulnar nerve compression occur?
Medial epicondyle
Between two heads of flexor carpi ulnaris muscle
95
What is the origin of the pronator teres?
Humeral head: Common flexor origin (CFO)
Ulnar head: from the coronoid process of ulna
96
What is the insertion of the pronator teres?
Lateral surface of the shaft of radius
97
what is the origin and insertion of the flexor carpi radialis ?
Origin: CFO
Insertion: Into the bases of the 2nd and 3rd metacarpal bone
98
What is the origin and insertion of the palmaris longus?
Origin: CFO
Insertion:
1. distal part of flexor retinaculum
2.Apex od palmar aponeurosis
99
What is the origin and insertion of the flexor carpi ulnaris?
Origin: CFO and posterior border of ulna
Insertion: into the pisiform bone. the tendon is then prolonged to the hook of hamate and base of 5th metacarpal bone
100
What is the origin and insertion of flexor digitorum superficialis?
Origin:
1.CFO
2.Coronoid process of ulna
3.Anterior oblique line radius
Insertion:
By 4 tendons for the medial 4 fingers to be inserted into the sides of the shaft of the middle phalanx
101
what is the deep muscles of the forearm?
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
102
What is the common nerve supply of the deep muscles of the forearm?
The anterior interosseous branch of median nerve except medial half of flexor digitorum profundus which is uspplied by ulnar nerve
103
What is the origin of flecor digitorum profundus?
Situated on the ulnar side of the forearn abd arises from:
1.Upper 3/4 of anterior and medial surfaces of shaft of ulnar
2.Medial half of anterior surface of interosseous membrane
104
What is the insertion of the flexor digiitorum profundus?
By 4 tendons for the medial 4 fingers passes between the two slips of the corresponding tendon of FDS to be insrted into base of the terminal phalanx
105
What is the origin of the flexor pollicis longus muscle?
SItuated on the radial side of the forearm and arises from:
1.Upper two thirds of anterior surface of the shaft of radius
2.Interosseoous membrane
106
What is the insertion of the flexor pollicis longus muscle?
By a tendon which passes below the flexor retinaculum to be inserted into the distal phalanx of the thumb
107
What is the origin of the pronator quadratus?
From the lower quarter of the shaft of ulna
108
What is the insertion of the pronator quadratus?
Into the lower quarter of the shaft of radius
109
What are the bones of the hand
Scarpal
Lunate
Triquertum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
110
What is the type of joint of the wrist joint?
Ellipsoid synovial joint
111
What are the muscles responsible for abduction?
Flexor carpi radialis
Extensor carpi radialis longu and brevis
112
What muscles are responsible for adduction?
Flexor carpi ulnaris
Extensor carpi ulnaris
113
What muscles are producing extension?
Extensor carpi radialis longu & brevis
Extensor carpi ulnaris
Extensor digitorum
Extensor digit minimi
Extensor indicis
Extensor pollicis longus
114
What muscles are responsible for flexion?
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Flexor pollicis longus
Flexor digitorum superficialis
Flexor digitorum profundus
115
Which has a larger range in the wrist and why? Abduction or adduction?
Adduction
Because the styloid process of radius is lower than the styloid process of ulna
116
What are the superior articulating surface of the wrist joint?
Inferior surface of distal end of radius
Inferior surface of articular cartilage
117
What is the inferior articulating surface of the wrist joint?
Poximal surface of scaphoid, lunate and triquetral bones
118
What seperates the radiocarpal joint from the carpal bones?
triangular articular disc
119
Which part of the wrist is most effected by a blow?
Scaphoid bone
120
Why is the proximal part of the scaphoid most likely to be necrosed?
It receives blood supply distally
121
What are the posterior ligaments of the wrist?
Posterior radiocarpal ligament
122
What are the anterior ligaments of the wrist?
Ulnar collateral ligament (runs from ulna to the triquetrum and pisiform)
Palmar radiocarpal ligament
Radial collateral ligament (Runs from the radius to the scaphoid and trapezium)
123
What are the superficial forearm muscles from lateral to medial?
1.Pronator teres
2.flexor carpi radialis
3.palmaris longus
4.Flexor digitorum superficialis
5.Flexor carpi ulnaris
124
What is the origin and insertion of pronator teres?
Origin:
Superficial head: common flexor origin
Deep (ulnar) head: Coronoid flexor of ulna
INsertion: middle of lateral surface of radius
125
What is the action of pronator teres?
Pronation of forearm
Helps in flexion of elbow joint
126
Where does pronation of forearm take place?
In radioulnar joint
127
What is the origin and insertion of flexor carpi radialis?
Origin: common flexor origin
Insertion: Metacarpal bone
128
What is the origin and insertion of flexor carpi radialis?
Origin: common flexor origin
Insertion: Metacarpal bone
129
What is the action of the flexor carpi radialis?
Flexion of wrist
WIth extensor carpi radialis longus & brevis --> adduct the hand
130
What is the origin of the palmaris longus?
Common flexor origin
131
What is the insertion of the palmaris longus?
Apex of palmar aponeurosis
132
What is the nerve supply of the palmaris longus?
Median nerve
133
What is the action the palmaris longus?
Helps in flexion of wrist
134
What is the origin of the flexor digitorum superficialis?
Origin by 2 heads:
Humeroulnar head
Radial head
135
What is the insertion of the flexor digitorum superficialis?
By 4 tendons for the medial 4 fingers
136
What are the actions of the flexor digitorum superficialis?
Flexion of proximal interphalangeal & metacarpophalangeal joints of the medial 4 fingers
137
What is the origin of the flexor carpi ulnaris?
Humeral head :CFO
Ulnar head
138
What is the insertion of the flexor carpi ulnaris?
5th metacarpal
139
What is the action of the flexor carpi ulnaris?
flexion of wrist joint
adducts hand with extensor carpi ulnaris
140
What are the superficial muscles of the forearm?
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis
Flexor carpi ulnaris
141
What is the origin of the flecor pollicis longus?
Anterior surface of radius
142
What is the insertion of the flexor pollicis longus?
Terminal phalanx of thumb
143
What is the origin and insertion of flexor digitorum profundus?
Origin: Anterior surface of shaft of ulna
Insertion: 4 tendons --> terminal phalanges of medial 4 fingers
144
What is the action of the flexor digitorum profundus?
1.Flexion of distal phalanges of medial 4 fingers
2.Helps in flexion of middle & proximal phalanges of medial 4 fingers
3.Helps in flexion of wrist
145
What is the origin of the pronator quadratus?
Anterior surface of ulna
146
What is the insertion of the pronator quadratus?
Anterior surface of radius
147
What are the deep muscles of front of forearm?
Flexor pollicis longus
Flexor digitorum profundus
Pronator quadratus
148
What nerve supplies most superficial muscles of forearms and what is the exception?
Median nerve
Exception: Flexor carpi ulnaris by ulnar nerve
149
Which nerve supplies all deep muscles of the forearm what is the exception?
Anterior interosseous nerve
Exception: medial 1/2 of flexor digitorum profundus by ulnar nerve
150
What is the beginning of the radial artery?
One of 2 terminal branches of brachial artery at level of neck of radius in cubital fossa
151
What is the end of the radial artery?
Continues as deep palmar arch
152
Where can you feel the radial pulse?
Lateral to the tendon of flexor carpi radialis
153
What is the beginning of the ulnar artery?
Opposite neck of radius
Larger terminal branch of brachial artery
154
What is the end of ulnar artery?
Divides into 2 terminal branches; superficial and deep
155
What are the roots of the median nerve?
Root value: C5, 6, 7, 8, T1
It arises by two roots: lateral root from lateral cord and medial root from medial cord
156
What does the anterior interosseous nerve supply?
The lateral 1/2 of the flexor digitorum profundus, flexor policis longus and pronator quadratus
157
Where does the palmar cutaneous branch from and what does it supply?
Arises above the flexor retinaculum and supplies the lateral 2/3 of the palm
158
What causes carpal tunnel syndrome?
Compression of the median nerve within the carpal tunnel
159
What are the clinical features of carpal tunnel syndrome?
Numbness, tingling and pain in the distribution of the median nerve
160
What can carpal tunnel syndrome lead to?
Atrophy of the thenar muscles
161
What is tinel's sign?
Tapping the nerve in the carpal tunnel to elicit pain in median nerve distribution
162
What are the root values of the ulnar nerve?
Root value: C7, 8, T1
arises from the medial cord of the brachial plexus
163
What is the pathway of the ulnar nerve in the forearm?
Passes behind medial epicondyle. it enters the forearm by passing between the two heads of the flexor carpi ulnaris
Near the wrist, the ulnar nerve become superficial and pass superficial to the flexor retinaculum
164
what are the branches of the ulnar verve?
2 Muscular branches: to flexor carpi ulnaris and medial 1/2 of the flexor digitorum profundus
2 cutaneous branches: supply medial 1/3 of the palm of the hand & medial 1/3 of the dorsum of the hand and dorsum of the medial one and half fingers
165
What are the characteristics of colles' fracture?
Silver fork deformity with dorsal and proximal displacement of distal fragment.
166
What is the difference between the colles and smiths fracture?
Colles fracture: Distal fracture of the radius i the forearm with dorsal (posterior) displacement of the wrist and hand
Smiths fracture: The distal fracture fragment is displaced ventrally, as opposed to colles' fracture which the fragment is displaced dorsally
167
What is the action of the anconeus?
Assists in extension of the elbow
168
What is the origin, insertion and action of brachioradialis?
Origin: from lateral suraondylar ridge
Insertion: Into the base of the styloid process of radius
Action: flex the elbow in mid prone position
169
What is the origin, insertion and action?
Origin: From lateral supracondylar ridge
Insertion: Into second metacarpal bone
Action: Extends and abducts the hand at the wrist joint
170
What is the origin, insertion and action of the extensor carpi radialis brevis?
Origin: from the common extensor origin
Insertion: Into base of the third metacarpal bone
Action: Extends and abducts the hand at the wrist joint
171
What is the origin, insertion and action of the extensor digitorum?
Origin: from the common extensor origin
Insertion: Through extensor expansion
Action: EXtends the MP and IP joints of the medial four fingers
172
What is the origin, insertion and action of extensor digit minimi?
Origin: from the common extensor origin
Insertion: its tendon joins the extensor expansion of the little finger
Action: Extends all the joints of the little finger
173
What is the origin, insertion and action of extensor carpi ulnaris?
Origin: from the common extensor origin
Insertion: into the 5th metacarpal bone
Action: Extends and adducts the hand at the wrist joint
174
what is the tennis elbow or lateral epicondylitis?
Is a painful condition of the elbow caused by overuse.
It is an inflammation of the tendons that join the forearm muscles on the outside of the elbow.
This leads to pain and tenderness on the outside of the elbow.
175
What is the origin, insertion and action of the supinator?
Origin: by 2 heads
Insertion: into lateral surface of radius
Action: Suppinated the extended arm
176
What is the origin, insertion and action of abductor pollicis longus?
Origin: From the postrior surface of radius & ulna
Insertion: into first metacaral bone of the thumb
Action: Abducts and extends the thumb at the carpometacarpal joint
177
What is the origin, insertion and action of the extensor pollicis brevis?
Origin: from the posterior surface of radius
Insertion: Into base of proximal phalanx of the thumb
Action: Extends the proximal phalanx of the thumb
178
What is the orgin, insertion and action of extensor pollicic longus?
Origin: From the posterior surface of ulna
Insertion: into base of distal phalanx of the thumb
Action: EXtends the distal phalanx of the thumb
179
What is the origin, insertion and action of extensor indicis?
Origin: From the posterior surface of ulna
Insertion: into the extensor expansion of the index
Action: Extends the joints of the index finger
180
What is the nerve supply of the extensor group?
Anconeus, brachioradialis and extensor carpi radialis longus ---> supplied by radial nerve
Remaining muscles ----> posterior interosseous nerve of the radial nerve
181
What do the deep branches of the radial nerve perforate?
Pronator teres
Flexor carpi radialis
Pronator quadratus
Flexor carpi ulnaris
Supinator
182
Where does the posterior interosseous nerve arise from and what is its course?
Arise from the radial nerve in the frot of the lateral epicondyle of humerus as the deep terminal branch of the radial nerve.
It passes deep to the extensor retinaculum (in the 4th compartment) to the back of the carpus
183
what id the deep fascia of palm of the hand?
1.Palmar aponeurosis
2.Flexor retinaculum
3.Fibrous flexor sheath of the fingers
184
Define the flexor retinaculum of wrist
It is a thickened strong deep fascia in front of the carpus and converts its anterior concavity into the carpal tunnel
185
What is the function of the flexor retinaculum?
Prevents displacement of long flexor tendons during contraction
186
What are structures passing superficial in the carpal tunnel from medial to lateral?
Tendon of palmaris longus
Ulnar nerve
Ulnar vessels
Palmar cutaneous branch of ulnar nerve, median nerve
187
What are the structures passing deep in the carpal tunnel?
Median nerve
Tendons of
1.fl. digit. superficialis
2.fl. digit. profndus
3.flexor pollicis longus
4.flexor carpi radialis
Common synovial sheath of tendons
188
What is fibrous flexor sheaths?
these are dense plates of fibrous tissue which arch across the flexor tendons in the fingers
189
What is the definition of the synovial sheaths of flexor tendons?
These are tubular sacs which surround the terminal parts of the tendons before its insertion
190
What is the function of the synovial sheath of flexor tendons?
To provide a sort of lubrication for it
191
What is the palmar aponeurosis?
This is thick and strong fibrous sheet that covers the middle part of the palm
192
What is the ulnar bursa?
A common synovial sheath for the 8 tendons of flexor digitorum superficialis and profundus
193
What is the radial bursa?
It surrounds tendon of flexor pollicis longus
194
What is dupuytren contacture of the hand?
A deformity in the hand which the medial part of the palmar aponeurosis undergoes fibrosis producing progressive shortening and flexion of the littke and ring fingers
195
What is the pulp space?
The space which lies over the palmar surface of the terminal (distal) phalanx, it is divided into seperate loculi that contain subcutaneous fat
Its infection is very painful due to accumulation of pus in narrow space under tension
196
What are the boundries of the snuff box?
Medial: extensor pollicis longus
Lateral: Abductor pollicis longus
Extensor pollicis brevis
Floor: scaphoid
trapezium
197
What is the position of the anatomical snuff box?
It is a hollow on the lateral part of the wrist
198
What is the extensor retinaculum and its site?
Definition ---> it is fibrous hand
Site ----> extend obliquely across the back of wrist
199
What are the lateral group short muscles of thumb?
3 thenar muscles
Adductor pollicis deep to them
200
What are the medial group sort muscles of the little finger?
3 hypothenar muscles
Palmaris brevis superficial to them
201
What is the central palm muscles?
4 Lumbricals
4 palmar interossei
4 dorsal interossei
202
What are lateral group muscles?
3 Thenar muscles from the thenar eminence
1.Abductor pollicis brevis
2.Flexor pollicis brevis
3.Opponens pollicis
Adductor pollicis deep to them
203
What is the nerve supply of the 3 thenar muscles?
Lateral terminal branch of median nerve
204
What is the action of the abductor pollicis brevis?
Abducts the thumb
205
What is the flexor pollicis brevis action?
Flexes the thumb
206
What is the opponens pollicis action?
Opposition of thumb
207
What is the adductor pollicis action?
Adducts the thumb
208
What are the medial group muscles?
3 Hypthenar muscles
1.Abductor digit minimi
2.Flexor digiti minimi
3.OPonens digiti minimi
1 palmaris brevis superficial to them
209
What is the origin, insertion and action of the palmaris brevis?
(Superficial to hypothenar muscle)
Origin: From palmar aponeurosis & flexor retinaculum
Insertion: skin to the medial border of the hand
Action : Deepen the hollow of the palm to improve grip of the palm during holding a rounded object
210
What is the nerve supply of the hypothenar muscles and palmaris brevis?
Ulnar nerve
211
What is the action of the abductor digiti minimi?
Abducts the little finger
212
What is action of the flexor digiti minimi?
Flexes the little finger
213
What is the action of the opponens digit minimi?
Pulls the 5th metacarpal bone forwards & rotates it laterally to deepen the hallow of the palm during gripping
214
What are the central palm muscles?
4 Lumbricals
4 palmar interossei
4 Dorsal interossei
215
What are the lumbrical muscles?
4 Small muscles arranged 1st-4th from lateral to medial with no bony attachments
216
What is the origin of the lumbrical muscles?
Tendons of flexor digitorum profundus
217
What type of muscles are 1st & 2nd lumbricals and what are they supplied by?
Are unipennate
supplied by median nerve
218
What type of muscles are 3rd and 4th lumbricals and what are they supplied by?
Are bipennate
supplied by deep branch of ulnar nerve
219
What is the insertion of the lumbrical muscles?
Extensor expansion of the corresponding finger (medial 4 fingers)
220
What is the action of the lumbrical muscles?
Together with interossei put the fingers in writing position
(flex M-P joints, extend I-P joints through the extensor expansions of the medial 4 fingers)
221
What is the nerve supply of the interossei?
Ulnar nerve after deep terminal branch
222
What is the action of palmar interossei?
Adduct the fingers towards the axis of the middle finger (PAD)
223
What is the action of the dorsal interossei?
Abduct the fingers from the axis of the middle finger (Dab)
224
What is the action of the limbricals and all interossei?
Flex M-P joints & extend I-P joints --> put the fingers in writing position?
225
Which muscles are responsible for pincer's action?
Lumbricals and all interossei
226
What is the course of the median nerve in the hand?
Passes deep to the flexor retinaculum through the carpal tunnel, it ends by dividing into medial & lateral divisions
227
What does the median nerve supply?
a.Motor fibers to 5 muscles: 3 muscles of thenar eminence + 1st & 2nd lumbricals (L1 & L2)
b.Sensory fibers to the skin of the palmar surface of the lateral 3 1/2 fingers and the dorsum of their terminal & middle pl
228
What is the course of the ulnar nerve?
It enters the palm, superficial to the flexor retinaculu
it ends by dividing into superficial & deep terminal branches
229
What is the most important nerve in the hand?
Ulnar nerve
230
What does the ulnar nerve supply in the hand?
a. motor fibers to 15 muscles: 1 by superficial branch & 14 by deep branch
b. Sensory fibers to the skin of the palmar surface of the medial 1 1/2 fingers and the dorsum of their terminal & middle phalanges
231
What do motor fibers in the ulnar nerve supply?
Motor fibers to 15 muscles:
1 by superficial branch palmaris brevis
14 by deep branch
adductor pollicis
hypothenar eminence
medial 2 lumbricals (l3 & l4)
all interosseii (palar & dorsal)
232
What do the sensory fibers of the ulnar nerve supply?
The skin of the palmar surface of the medial 1 1/2 fingers and the dorsum of their terminal & middle phalanges
233
What are the nerves of palm of the hand?
Median nerve
Ulnar nerve
Radial nerve
234
What is the superficial palmar arch?
It is the termination of the ulnar artery and is completed by the superficial palmar branch of the radial artery
235
What is the deep palmar arch?
The termination of the radial artery and is completed by the deep branch of the ulnar artery
236
What is a ganglion cyst?
A mucous-filed synovial cyst
237
What causes a ganglion cyst?
Trauma
mucoid degeneration
synovial herniation
(arises from a joint or tendon sheath, no true epithelial lining)
