Flashcards in The Hand Deck (38):
What structures does the palmar fascia form?
- palmar carpal ligament
- flexor retinaculum
- palmar aponeurosis
- fibrous digital sheaths
What is Dupuytren's contracture?
pathological thickening and contracture of the superficial layer (longitudinal bands) of the palmar aponeurosis
What characteristic of the palmar aponerosis lends to its strength?
it bilaminar nature
- superficial layer is longitudinally oriented while the fibers of the deep layer are transversely oriented.
Specialized deep fascia anchored to the margins of the phalanges forming a fibro-osseous canal for the passage of the digital flexor tendons. (prevent bowstringing of the digital flexor tendons)
fibrous digital sheaths
What is present between the fibrous sheath and its accompanying tendon?
synovial digital sheath
While each digit possesses its own synovial sheath, which two are more robust extending to the flexor retinaculum?
- radial bursa (bursa of the flexor pollicis longus tendon)
- ulnar bursa (common flexor bursa)
What are the four compartments of the hand?
thenar, central, hypothenar, adductor-interosseous
what is the main supplier of the superficial palmar arch?
Where is the superficial palmar arch?
located w/n central compartment between the palmar aponeurosis and the long digital flexor tendons
- largest and more distal arch
What is the main supplier of the deep palmar arch?
Where is the deep palmar arch?
located w/in the adductor-interosseous compartment on the surface of the metacarpal bones deep to the long flexor tendons and the adductor pollicis muscles
What forms the different compartments of the hand?
connective tissue septa extending from the palmar aponeurosis to the shafts of the metacarpal delineating 3 compartments (thenar, central, and hypothenar). A deeper transverse fascial plane delineates the adductor-interosseous compartment.
what exists between the opposing fascias of the central and adductor-interosseous compartments which allows greater movement?
deep palmer space or cleft - further divided into lateral palmer space (thenar) and medial palmer space by extension of the palmar aponeurosis to the shaft of 3rd metacarpal
What muscles are present in the thenar compartment?
intrinsic - abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
extrinsic - tendon of flexor pollicis longus and accompanying synovial sheath (radial bursa)
`What nerves are present in the thenar compartment?
branches of the median nerve
what arterial branches are present in the thenar compartment?
what bones are present in the thenar compartment?
What muscles are present in the hypothenar compartment?
inrinsic - abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
what nerves are present in the hypothenar compartment?
branches of the ulnar nerve
What arteries are present in the hypothenar compartment?
branches of ulnar artery
what bones are present in the hypothenar compartment?
What sits in the central compartment of the hand?
structures that lie beneath the palmar aponeurosis
- superficial palmar arch and branches
- branches of the median and ulnar nerves
- tendons and synovial linings (ulnar bursa) of long digital flexors
What sits in the adductor-interosseous compartment?
- deep palmer arterial arch and its branches
- adductor pollicis
- palmer and dorsal interossei deep branch of the ulnar nerve
- metacarpals 2, 3, 4
What branch of the radial artery courses through the thenar musculature and passes superficial to the long digital flexor tendons to anastomose with the ulnar artery?
superficial palmar branch
What branch of the radial artery arises in the vicinity of the anatomical snuff box and course deep to the extensor tendons to form the dorsal carpal arch by anastomosing with the dorsal carpal branch of the ulnar artery?
dorsal carpal branch
What branches pring from the dorsal carpal arch?
3 dorsal metacarpal arteries - course on the dorsal surface of the dorsal interosseous muscles and will divid to form two dorsal digital arteries which course distally along the adjacent sides of the contiguous digits
What branch arises from the radial artery to supply the thumb?
What branch arises from the radial artery to supply the index finger?
What branches form from the deep palmar arterial arch?
palmar metacarpal arteries - arise from convexity of deep arch and course distally in the 2nd, 3rd, and 4th metacarpal intervals. at webs of fingers individual anastomose with common palmar digital branches of the superficial palmar arterial arch
What branch from the ulnar artery anastomosis with the radial artery to form the deep palmer arch?
deep palmer branch a.
What branches form from the superficial palmar arterial arch?
common palmar digital arteries - course distally on surface of long digital flexor tendons and at webs of fingers anastomoses with the palmar metacarpal arteries of the deep arch
what are formed by the division of the short arterial trunks formed by the union of the palmar metacarpal, common palmar digital, and distal perforating arteries and course distally toward the fiber tips on adjacent sides of contiguous fingers?
proper digital arteries (each finger receives 4)
What branch from the median nerve innervates the muscles of the thenar compartment?
recurrent or motor branch n.
what branch of the median n (3 in number) supplies the cutaneous innervation to the thumb and 2nd, 3rd, and radial side of 4th digit (includes skin on dorsum of digits)
common palmar digital nerves
what branches of the medan nerve proximal to the flexor retinaculum and descends superficial to the flexor retinaculum innervates the central area o the palm?
palmar cutaneous branches
What two branches does the ulnar nerve divide into a the base of the hypothenar eminence w/in the hand?
superficial branch - provides common and proper digital branches to the 5th and ulnar side of the 4th digit
deep branch - follows course of the deep palmer branch of the ulnar artery to lie superficial and proximal to the deep palmar arterial arch; innervates hypothenar msucles, lumbricals 3 & 4, all interossei and adductor pollicis muscles.
What branches of the ulnar nerve supply cutaneous innervation to the hand?
cutaneous palmer branch - arise in forearm and descends lateral to the ulnar artery where it enters the central palm
dorsal cutaneous branch - arise proximal to the wrist passes dorsally in the area of he ulnar styloid process and divides into three dorsal digital nerves, (innervates skin on medial dorsum of hand and portion of the the ulnar side of the 4th digit and entire 5th)