the hand Flashcards
hand organisation: describe the organisation, innervation, blood supply and function of the intrinsic muscles of the hand; digits: describe and demonstrate the movements of the fingers and thumb; describe the position, function and nerve supply of the muscles and tendons involved in these movements, differentiating between those in the forearm and those intrinsic to the hand (140 cards)
1
Q
what is the deep fascia of the palm of the hand called, and 2 features of skin of palm
A
palmar fascia (thicker skin with no hair follicles)
2
Q
what 2 specialisations of the palmar fascia form
A
palmar aponeurosis, fibrous digital sheaths
3
Q
location of palmar aponeurosis in relation to long flexor tendons
A
well-defined region of palmar fascia in hand, overlying long flexor tendons of hand
4
Q
proximal end of palmar aponeurosis
A
continuous with flexor retinaculum (transverse carpal ligament) and palmar longus tendon
5
Q
distal end of palmar aponeurosis
A
forms four bands which are continuous with the fibrous digital sheaths of each finger
6
Q
what are fibrous digital sheaths
A
tubes which contain flexor tendons and their synovial sheaths
7
Q
what is the space between the palmar aponeurosis and bones of the hand separated into compartments by
A
extensions of fascia called septa (medial and lateral)
8
Q
2 septa locations
A
medial septum (to little finger metacarpal) and lateral septum (to middle finger metacarpal)
9
Q
what are the 3 compartments created by septa
A
hypothenar (medial, little finger), central, thenar (lateral, thumb)
10
Q
what compartment is deep to the thenar compartment
A
adductor compartment
11
Q
what muscle is contained within the adductor compartment
A
adductor pollicis muscle
12
Q
5 bones/groups of bone in wrist and hand
A
radius, ulna (articulates via articular disc), carpals, metacarpals, phalanges
13
Q
what are the 8 carpals (from lateral to medial and proximal then distal row)
A
scaphoid, lunate, triquetrum, pisiform (only proximal carpal to not articulate proximally), trapezium, trapezoid, capitate, hamate
14
Q
3 groups of muscles in wrist and hand
A
anterior compartment of forearm (superficial and deep compartment muscles), posterior compartment of forearm muscles, intrinsic muscles of hand
15
Q
4 (compartment) muscles of intrinsic muscles of hand
A
thenar compartment muscles, adductor compatment muscles, hypothenar compartment muscles, interossei and lumbricals
16
Q
5 muscles of superficial anterior compartment of forearm
A
pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis
17
Q
3 muscles of deep anterior compartment of forearm
A
flexor digitorum profundus, flexor pollicis longus, pronator quadratus
18
Q
extensor compartment of forearm: 3 muscles that move wrist joint
A
extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris
19
Q
extensor compartment of forearm: 3 muscles that move digits
A
extensor digiti minimi, extensor indicis, extensor digitorum
20
Q
extensor compartment of forearm: 3 muscles that move thumb
A
extensor pollicis brevis, extensor pollicis longus, abductor pollicis longus
21
Q
2 other muscles of forearm
A
brachioradialis, supinator
22
Q
intrinsic muscles of hand: 3 thenar muscles
A
abductor pollicis brevis, flexor pollicis brevis, opponens policis
23
Q
intrinsic muscles of hand: adductor muscle, and attachments
A
adductor pollicis, with a broad attachment to middle metacarpal bone, and narrow attachment to base of proximal phalanx of thumb
24
Q
intrinsic muscles of hand: 3 hypothenar muscles
A
abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
25
intrinsic muscles of hand: where do 4 lumbricals flex and extend at
flex at metacarpals, extend at interphalangeal joints
26
intrinsic muscles of hand: 2 types of interossei, and how many of each
palmar interossei (3), dorsal interossei (4)
27
intrinsic muscles of hand: function of palmar interossei muscles (PAD)
adduct digits
28
intrinsic muscles of hand: function of dorsal interossei muscles (DAB)
abduct digits
29
anterior tendinous anatomy: proximal and distal attachments of fibrous digital sheaths
level of metacarpal head to base of distal phalanx
30
anterior tendinous anatomy: what do fibrous digital sheaths and underlying bone form
osseo-fibrous tunnels
31
anterior tendinous anatomy: what run through the osteo-fibrous tunnels
long flexor tendons and their synovial sheaths
32
anterior tendinous anatomy: what is the name of the condensations formed by parts of the fibrous digital sheath
pulleys
33
anterior tendinous anatomy: function of pulleys
allow more functional use of long flexor tendons
34
anterior tendinous anatomy: name of 2 pulleys
annular, cruciform
35
anterior tendinous anatomy: what 2 tendons pass deep to flexor retinaculum in carpal tunnel, after passing the wrist joint, to enter a common synovial sheath
tendons of flexor digitorum profundus and flexor digitorum superficialis
36
anterior tendinous anatomy: how do the tendons of flexor digitorum profundus and flexor digitorum superficialis pass to respective digits
via digital synovial sheath (lubricate and prevent friction), contained within fibrous digital sheath
37
anterior tendinous anatomy: what digits have continuous sheaths with the common synovial sheath
little finger and thumb
38
anterior tendinous anatomy: what happens to the flexor digitorum superficialis tendon at the base of the proximal phalanx
splits around flexor digitorum profundus
39
anterior tendinous anatomy: where does the flexor digitorum superficialis tendon attach
anterior surface of middle phalanx
40
anterior tendinous anatomy: where does the flexor digitorum profundus tendon attach
distal phalanx (hence pierces flexor digitorum superficialis)
41
anterior tendinous anatomy: where does flexor pollicis longus have its own synovial sheath at
flexor retinaculum
42
anterior tendinous anatomy: where does flexor pollicis longus run to
distal phalanx of thumb
43
posterior tendinous anatomy: what holds all the extensor tendons of the hand to the dorsum of the wrist region
extensor retinaculum (at wrist, not as tough as flexor retinaculum, holding tendons down)
44
posterior tendinous anatomy: what surround the tendons on the posterior side of the hand
synovial tendon sheaths
45
posterior tendinous anatomy: function of synovial tendon sheaths
facilitate free movement of tendons
46
posterior tendinous anatomy: what joins long extensor tendons to digits on dorsum of hand
inter-tendinous bands
47
posterior tendinous anatomy: function of inter-tendinous bands
prevent free movement of one extensor tendon independently of others
48
posterior tendinous anatomy: what do the long extensor tendons flatten to form at the level of the metacarpals
extensor expansions, forming a hood on back of digit
49
posterior tendinous anatomy: what muscles distally attach to the extensor expansions of long extensor tendons (not bone), and what are their proximal continuation or attachments from
lumbricals (4, with proximal continuation from flexor digitorum profundus muscle) and interossei (proximal attachment between adjacent metacarpals, arranged along axial line of hand)
50
posterior tendinous anatomy: function of extensor expansions
intricately involved in movements of digits
51
posterior tendinous anatomy: what 3 joints does the extensor digitorum extend
metacarpal and interphalangeal joints, some part in extending wrist joint after maximal extension of digits
52
posterior tendinous anatomy: what 2 digits have their own individual long extensors
index finger and little finger
53
6 joints of region
distal radio-ulnar joint, wrist joint, intercarpal joints, carpo-metacarpal and inter metacarpal joints, metacarpo-phalangeal joints, interphalangeal joints
54
distal radio-ulnar joint type
pivot-type synovial joint
55
function of distal radio-ulnar joint
allows radius to rotate around ulna
56
what ligament is within the distal radio-ulnar joint, and what is it
triangular ligament, which is a triangular fibrocartilage articular disc
57
muscles moving distal radio-ulnar joint
supinator, biceps, pronator quadratus, pronator teres
58
wrist joint type
elipsoid synovial joint
59
location of wrist joint
between distal radius and its associated triangular fibrocartilage articular disc, with the proximal row of the carpal bones (not pisiform)
60
6 strong ligaments stabilising wrist joint
ulnar collateral ligament, radial collateral ligament, palmar radio-carpal ligament, palmar ulnocarpal ligament, dorsal radio-carpal ligament, inter-carpal ligaments
61
3 movements of wrist
flexion/extension, radial deviation (abduction) and ulnar deviation (adducion), circumduction
62
what 2 other joints allow flexion in wrist region
midcarpal joints, carpo-metacarpal joints
63
5 muscles providing flexion at wrist joint
flexor carpi radialis, flexor carpi ulnaris, long flexors of thumb and fingers, palmaris longus, abductor pollicis longus
64
4 muscles providing extension at wrist joint
extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, long extensors of thumb and fingers
65
5 muscles providing radial deviation (abduction) at wrist joint
flexor carpi radialis, extenor carpi radialis longus, extensor carpi radialis brevis, abductor pollicis longus, extensor pollicis brevis
66
2 muscles providing ulnar deviation (adduction) at wrist joint
extensor carpi ulnaris, flexor carpi ulnaris
67
intercarpal joints type
synovial
68
3 sets of intercarpal joints
joints between proximal carpal bones, joints between distal carpal bones, joints between proximal and distal carpal bones (midcarpal joints)
69
main movement occuring at carpal joints
gliding, augmenting the movement occurring at the wrist joint itself (especially flexion and radial deviation of the wrist)
70
carpo-metacarpal joint of thumb type
synovial joint of saddle variety
71
carpo-metacarpal joint of thumb location
articulation between trapezium and thumb metacarpal
72
why is the carpo-metacarpal joint of thumb clinically important
often becomes osteoarthritic
73
other carpo-metacarpal joints type
synovial elipsoid joints
74
other carpo-metacarpal joint locations
between the trapezoid, capitate and hamate with the metacarpals of the digits
75
order of rigidity of other carpo-metacarpal joints
index and middle finger > ring finger > little finger
76
what joints are present between metacarpals at their bases
plane synovial intermetacarpal joints
77
3 movements occuring at carpo-metacarpal and intermetacarpal joints
flexion/extension, radial deviation (abduction) and ulnar deviation (adducion), circumduction
78
metacarpophalangeal joints type
condylar synovial joints
79
metacarpophalangeal joints location
between metacarpal heads and proximal phalanges (knuckles)
80
2 movements occuring at metacarpophalangeal joints
flexion/extension, abduction and adduction
81
interphalangeal joints type
hinge synovial joints
82
movement occuring at interphalangeal joints
flexion/extension
83
what ligaments hold metacarpophalangeal and interphalangeal joints together, and function
radial and ulnar collateral ligaments (prevent abduction and adduction)
84
what collateral ligament of the thumb is clinically important, and why
ulnar collateral ligament of thumb, as often injured in skiing by falling on the outstretched thumb
85
location of volar plate
anterior surface of the proximal interphalangeal joint
86
what is the volar plate
dense condensation of fibrous tissue formed by collateral ligaments at front of proximal interphalangeal joint, and is frequently damaged
87
5 movements of thumb
abduction, adduction, extension, flexion, opposition
88
2 muscles that allow abduction of thumb
abductor pollicis longus, abductor pollicis brevis
89
2 muscles that allow adduction of thumb
adductor pollicis, first dorsal interosseous
90
3 muscles that allow extension of thumb
extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus
91
2 muscles that allow flexion of thumb
flexor pollicis longus, flexor pollicis brevis
92
muscle allowing opposition of thumb, and location
opponens pollicis (working at carpo-metacarpal joint, underneath palmaris brevis)
93
where else does opposition of thumb occur at, and what does it involve
metacarpo-phalangeal joint, involving abduction, flexion and then adduction
94
2 arteries supplying blood to hand
ulnar, radial
95
where does ulnar artery run in forearm, and where does it pass in the wrist
anterior compartment of the forearm, passing on ulnar side of palmar surface of wrist
96
what lies medial to the ulnar artery at the wrist
flexor carpi ulnaris (more medial), ulnar nerve (less medial)
97
3 branches of ulnar artery in forearm
common interosseous, anterior interosseous, posterior interosseous (behind interosseous membrane)
98
what does the ulnar artery run over, lateral to and through to reach the hand
runs over flexor retinaculum, lateral to pisiform, and through semi-rigid ulnar (Guyon's) canal (with ulnar nerve)
99
2 branches of ulnar artery after reaching the hand
superficial palmar arch, deep palmar arch of ulnar artery
100
what else does the superficial palmar arch receive a contribution from
superficial palmar branch of the radial artery
101
what does the superficial palmar arch give off
3 common palmar digital arteries
102
what do the 3 common palmar digital arteries divide into
palmar digital arteries
103
where does radial artery run in forearm, and where does it lie in the wrist
lateral aspect of forearm, under cover of brachioradialis, and lies superficially on palmar aspect of radial side of wrist
104
how does the radial artery pass into the hand
crosses floor of anatomical snuff box, entering palm between two heads of first dorsal interosseous muscle, then passes between two heads of adductor pollicis muscle
105
what does the radial artery anastomose with to form the deep palmar arch
deep palmar branch of ulnar artery
106
what does the deep palmar arch give origin to
palmar metacarpal arteries
107
what do the superficial and deep palmar arterial arches have to drain them
palmar venous arches (deep drainage)
108
what do dorsal digital veins drain into
dorsal venous arch (superficial system), on dorsum of hand
109
what superficial veins does the dorsal venous arch give rise to laterally and medially; describe deep venous drainage of arm and forearm
cephalic vein laterally, basilic vein medially (join by median cubital veins); in forearm and arm, deep radial and ulnar veins exist, with drainage into venae comitantes and brachial veins
110
3 main nerves to hand
median, ulnar, radial
111
what does median nerve supply in forearm
main nerve of anterior compartment
112
what does ulnar nerve supply in forearm
contribution to medial muscles of anteiror compartment, but mostly pass into hand
113
what does radial nerve supply in forearm
posterior compartment
114
what nerves are purely sensory (muscles mainly in forearm and palmar region) and supply the digits
digital nerves
115
what does division of a digital nerve cause
anaesthesia in part of the digit
116
median nerve spinal cord levels
C6,7,8 T1
117
where does median nerve lie in wrist
superficially between tendons of flexor digitorum superficialis and flexor digitorum profundus, deep to palmaris longus
118
what accompanies the median nerve in carpal tunnel (except palmar cutaneous branch)
9 flexor tendons (flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus)
119
what does the median nerve pass under in the hand
flexor retinaculum
120
what 5 muscles is the median nerve motor supply of
3 thenar muscles, lateral (first and second) lumbricals
121
what are the 3 thenar muscles
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
122
how does the recurrent branch of the median nerve usually leave the main trunk
within carpal tunnel
123
what does the median nerve supply sensory supply to
palmar surface of thumb (palmar cutaneous branch), index and middle ringers, and lateral half of ring finger, as well as some of dorsal surface of these digits
124
ulnar nerve spinal cord levels
C8, T1
125
proximal to the wrist, what 2 branches does the ulnar nerve give off
palmar cutaneous branch, dorsal cutaneous branch
126
what does the palmar cutaneous branch supply
medial palm of hand
127
what does the dorsal cutaneous branch supply
medial half of dorsum of hand, including ring and little fingers
128
where does the ulnar nerve lie in the wrist
anteriorly, between the flexor carpi ulnaris medially and ulnar artery laterally (doesn't go through carpal tunnel)
129
where does the ulnar nerve pass beyond the wrist, before dividing
passes over flexor retinaculum in ulnar canal with ulnar artery, just lateral to pisiform bone
130
2 branches of ulnar nerve distal to flexor retinaculum
superficial branch, deep branch
131
what does the superficial branch of the ulnar nerve supply
sensory to palmar surface of little finger, and medial side of wring finger
132
what does the deep branch of ulnar nerve supply
motor to hypothenar muscles, adductor pollicis, medial (third and fourth) lumbricals, all interossei (hence controls most muscles involved in fine movements of hand)
133
what are the 3 hypothenar muscles
abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
134
radial nerve spinal cord levels
C5,6,7,8 T1
135
what are the 2 branches of the radial nerve after dividing superior to elbow
superficial radial nerve (sensory cutaneous), deep radial nerve (motor)
136
what does superficial branch of radial nerve supply sensory innervation to in hand
lateral two-thirds of the dorsum of the hand, dorsum of thumb, proximal portions of dorsal index and middle fingers
137
what is the direct continuation of the deep radial nerve, and where does this continuation occur
posterior interosseous nerve, as it passes between heads of supinator
138
what do the radial nerve and its continuations (deep radial
| nerve and posterior interosseous nerve) supply
all extensor compartment muscles of arm and forearm (doesn't supply any muscles in the hand)
139
structure of phalanges
base, shaft, head
140
how many phalanges in each digit
3, except thumb which has 2
