The hand (B)

Question 1

What are the two types of pulley that hold the tendons down to the bone?

Answer 1

Annular and Cruciform

Question 2

Describe the posterior tendinous anatomy of the hand.

Answer 2

You get the extensor retinaculum followed by synovial tendon sheaths and intertendinous bands
At the end of the long extensors there are extensor expansions

Question 3

Which muscles attach to the extensor expansions?

Answer 3

Lumbricals and some interossei

Question 4

What are the two fibrous capsules found at the wrist joint?

Answer 4

Radio-carpal joint

Distal radio-ulnar joint

Question 5

Which two ligaments are found on the radial and ulnar sides of the wrist?

Answer 5

Radial Collateral Ligament

Ulnar Collateral Ligament

Question 6

Which muscles are important for the following wrist movements:

Flexion
Extension
radial deviation
ulnar deviation

Answer 6

Flexion:
Flexor carpi radialis
Flexor carpi ulnaris
(and the long flexors of the thumb and fingers + palmaris longus and abductor pollicis longus)

Extension:
Extensor carpi radialis longus 
Extensor carpi radialis brevis 
Extensor carpi ulnaris 
(and long extensors of the thumb and fingers)

Radial Deviation:
Flexor carpi radialis 
Extensor carpi radialis longus 
Extensor carpi radialis brevis 
Abductor pollicis longus 

Ulnar Deviation:
Flexor carpi ulnaris
Extensor carpi ulnaris

Question 7

What is the name given to the joint between the two rows of carpal bones?

Answer 7

Midcarpal joint

Question 8

Which carpal bone does the thumb metacarpal articulate with?

Answer 8

Trapezium

Question 9

What movements are the metacarpophalangeal joints capable of?

Answer 9

Flexion and extension

Abduction and adduction

Question 10

What ligament prevents hyperextension of the interphalangeal joints?

Answer 10

Palmar plates (AKA volar plates)

Question 11

Which ligaments prevent abduction and adduction of the interphalangeal joints?

Answer 11

Collateral ligaments

Question 12

What are the two main arteries of the hand and what do they divide into?

Answer 12

Ulnar Artery:

• found beside the flexor carpi ulnaris
• Interosseous arteries of the forearm (ulnar gives off common interosseous artery in forearm)
• main contributor of Superficial palmar arch (and a small contribution to deep palmar arch via its deep palmar branch)
• palmar digital arteries (from superficial palmar arch)

Radial Artery:

• under brachioradialis and beside flexor carpi radialis in the wrist
• Found in the anatomical snuff box
• main contributor of Deep palmar arch and small contribution to superficial palmar arch via its superficial palmar branch
• Palmar metacarpal arteries (from the deep palmar arch)

NB palmar metacarpal arteries and palmar digital arteries anastomose

Question 13

What are the anterior and posterior interosseous arteries a branch of?

Answer 13

Ulnar Artery

Question 14

What is the arch on the dorsal side of the hand called?

Answer 14

Dorsal carpal arch - source is from both radial and ulnar arteries: anastomosis

Question 15

What arteries come off the palmar arches?

What arteries come off the dorsal carpal arch?

Answer 15

Superficial palmar arches gives off Common palmar digital arteries which then give off the Proper palmar digital arteries. The deep palmar arch gives off the palmar metacarpal arteries which join/anastomose with the common palmar digital arteries before it gives off the proper palmar digital arteries

Dorsal carpal arch itself arises from both radial and ulnar artery anastomosis. It first gives off dorsal metacarpal arteries which then becomes the dorsal digital arteries

Question 16

Where do you find anastomoses in the hand?

Answer 16

Between the dorsal and palmar digital arteries

The arches and plexuses are also places of anastomoses between the radial and ulnar arteries

Question 17

What are the two main superficial veins of the arm?

Answer 17

Cephalic and Basilic

Question 18

What happens to the basilic and cephalic veins as they pass into the ARM?

Answer 18

The basilic vein dives deep to form the axillary artery (by joining with the brachial vein venae comitantes of brachial artery)
The cephalic artery joins the axillary artery higher up

Question 19

At what point does the axillary vein become the subclavian vein?

Answer 19

As it passes over the first rib

Question 20

What pattern do the deep veins from the hand follow?

Answer 20

They pass in the opposite direction to the arteries

Question 21

What vein links the cephalic and basilic vein in the cubital fossa?

Answer 21

Median cubital vein

Question 22

Which spinal nerves contribute to the:

Answer 22

Ulnar Nerve : C8-T1
Median Nerve: C6-T1
Radial Nerve: C5-T1

Question 23

What is the main motor nerve of the hand?

Answer 23

Ulnar nerve

Question 24

What is the radial nerve responsible for in the hand?

Answer 24

Sensory innervation of the lateral half of the dorsum of the hand

Question 25

What type of nerve are the digital nerves?

Answer 25

They are purely sensory because the motor innervation to the muscles controlling the fingers happens more proximally

Question 26

What are the contents of the carpal tunnel?

Answer 26

4 tendons of flexor digitorum superficialis 4 tendons of flexor digitorum profundus Flexor pollicis longus tendon Median nerve

Question 27

Where does the median nerve lie relative to the forearm muscles at the wrist?

Answer 27

In between FDP and FDS | Deep to PL

Question 28

What intrinsic hand muscles does the median nerve provide motor supply to?

Answer 28

``` LOAF Lumbricals (1 and 2) Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis ```

Question 29

What does the median nerve provide sensory supply to?

Answer 29

``` Palmar surface of thumb Index finger Middle finger Half of the ring finger Some of the dorsal surface of those digits ```

Question 30

Describe the position of the ulnar nerve at the wrist.

Answer 30

It lies by flexor carpi ulnaris | It runs over the flexor retinaculum, lateral to the pisiform

Question 31

What are the two branches of the ulnar nerve in the hand and what are their roles?

Answer 31

Superficial branch sensory to: Little finger and medial half of right finger ``` Deep branch motor to: Hypothenar muscles Adductor pollicis Lumbricals 3 and 4 All the interossei (In other words: all the muscles except LOAF) ```

Question 32

The radial nerve divides into two branches just above the elbow. What are the two branches of the radial nerve?

Answer 32

Superficial radial nerve (sensory) | Posterior interosseous nerve (motor)

Question 33

Which part of the hand does the radial nerve supply sensory innervation to?

Answer 33

Dorsum of the hand (mainly thumb, index finger and middle finger)

Question 34

What sensory branches does the median nerve give off before passing under the flexor retinaculum?

Answer 34

Palmar cutaneous branch | Dorsal branch

Question 35

What branches do the superficial radial nerve and dorsal branch of the ulnar nerve split into?

Answer 35

Dorsal digital nerves/branches

Question 36

What are the bony attachments of the carpal tunnel that forms a gutter?

Answer 36

Scaphoid Trapezium Pisiform Hamate

Question 37

What is the roof of the carpal tunnel?

Answer 37

Flexor retinaculum

Question 38

Through which canal do the ulnar nerve and artery pass through?

Answer 38

Guyon’s Canal

Question 39

What are the three different types of grip and which muscles are involved in each type?

Answer 39

Power Grip: Long flexors of the fingers and thumb Intrinsic muscles of the palm Extensors of the wrist joint Precision Grip: The wrist and fingers are held rigidly by the long flexors and extensors The intrinsic muscles of the hand carry out the fine movements needed Hook Grip: Consumes little energy Mainly involves long flexors of the digits (e.g. carrying shopping bag or briefcase)

Question 40

What wrist movement do you need to achieve full flexion of the fingers and why?

Answer 40

The flexors have to be slightly longer than need be to allow the wrist and fingers to fully extend This means that to get full flexion you need to extend the wrist to shorten the flexors so that they can fully flex This is why you can more easily take something from someone’s grip if you flex the wrist to loosen the grip