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SHB > 9.27.16 Hand > Flashcards

9.27.16 Hand Flashcards

1
Q

What are the carpal bones in the proximal row?

A

Scaphoid, Lunate, Triquetrum, Pisiform

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2
Q

What are the carpal bones in the distal row?

A

Hamate, Capitate, Trapezoid, Trapezium

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3
Q

What is the boat-shaped carpal bone?

A

Scaphoid

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4
Q

What is the most frequently fractured carpal bone?

A

Scaphoid

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5
Q

The scaphoid has a tubercle for attachment of the ___.

A

Flexor retinaculum

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6
Q

What is the crescent-shaped carpal bone?

A

Lunate

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7
Q

What is the most frequently dislocated carpal bone?

A

Lunate

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8
Q

What is the pyramidal-shaped carpal bone?

A

Triquetrum

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9
Q

The triquetrum has an oval articular facet on the palmar surface for the ___ bone.

A

Pisiform

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10
Q

What is the small, pea-shaped carpal bone?

A

Pisiform

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11
Q

The pisiform is a sesamoid bone within the tendon of the ___.

A

Flexor carpi ulnaris

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12
Q

What carpal bone has a hook-like process from the palmar surface?

A

Hamate

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13
Q

What is the largest carpal bone and the first to ossify?

A

Capitate

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14
Q

What is the wedge-shaped carpal bone?

A

Trapezoid

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15
Q

The trapezium has a saddle-shaped facet for the ___ and a tubercle for the attachment of the ___.

A

First metacarpal; flexor retinaculum

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16
Q

What is the keystone of the carpal tunnel?

A

Capitate

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17
Q

Which two carpal bones articulate with the radius?

A

Scaphoid and lunate

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18
Q

What are the metacarpals?

A

5 bones of the intermediate portion fo the hand numbered from lateral (thumb) to medial

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19
Q

Metacarpals are numbered 1-5 from ___ to ___.

A

Lateral; medial

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20
Q

What are the 3 common characteristics of the metacarpals?

A
  1. Base articulates with the carpal bones
  2. Linear shaft
  3. Rounded head
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21
Q

What are the phalanges?

A

The bones of the fingers

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22
Q

How many phalanages are there? Describe the components.

A
  • 14 bones
  • 2 in thumb (proximal and distal)
  • 3 in digits 2-5 (proximal, middle, distal)
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23
Q

Each bone of the phalanges has a ___ (proximally), ___, and ___ (distally).

A

Base; shaft; head

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24
Q

What is the dermatome of C6, C7, and C8 in the arm and hand regions?

A

C6: lateral arm, forearm, thumb
C7: back of arm, back of forearm, 2nd and 3rd digits
C8: medial arm, forearm, hypothenar

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25
Q

The deep palmar fascia is continuous proximally with the ___ fascia and at the borders of the palm with the fascia on the ___ of the hand.

A

Antebrachial dorsum

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26
Q

The deep palmar fascia is thin over the thenar and hypothenar eminences, but thick in the palm, where it forms the ___.

A

Palmar aponeurosis

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27
Q

The deep palmar fascia continues distally on the fingers by helping to form the fibrous ___.

A

Digital sheaths

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28
Q

What is the palmar aponeurosis?

A

Strong, heavy, dense, well-defined triangle layer of the deep fascia in the middle of the palm that covers the long tendons of the digital muscles as they pass through the hand and the arteries and nerves destined for the fingers

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29
Q

What is the clinical manifestation of Dupuytren’s Contracture?

A

Manifests as progressive fibrosus, which produces abnormal bands of fibrous tissue that extend from the aponeurosis to the bases of the phalanges, pulling one or more digits into marked flexion at the metacarpophalangeal joints so they can not be straightened.

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30
Q

What are synovial sheaths?

A

Space filled with fluid to allow free movement of tendons into hands and fingers

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31
Q

What are the posterior and anterior boundaries of the carpal tunnel?

A

Posterior: carpal bones
Anterior: flexor retinaculum

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32
Q

What are the 10 structures that pass through the carpal tunnel?

A

Flexor digitorum superficialis (4 tendons)
Flexor digitorum profundus (4 tendons)
Flexor pollicis longus (1 tendon)
median nerve

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33
Q

Carpal tunnel syndrome results from any lesion that will ___ the size of the carpal tunnel.

A

Decrease

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34
Q

What are three possible causes of carpal tunnel syndrome?

A
  1. Fluid retention
  2. Infection
  3. Excessive exercise
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35
Q

The ___ nerve is the softest structure in the carpal tunnel and is the most affected by an increase in pressure.

A

Median

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36
Q

Because the median nerve innervates the ___ muscles, these muscles begin to waste.

A

Thenar

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37
Q

What are the intrinsic hand muscles of the thenar compartment?

A
  1. Opponens pollicis
  2. Abductor pollicis brevis
  3. Flexor pollicis brevis
    (OAF)
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38
Q

What is the origin and insertion of opponens pollicis?

A

Origin: flexor retinaculum and tubercle of trapezium
Insertion: Lateral side of 1st metacarpal

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39
Q

What innervates opponens pollicis?

A

Median nerve (recurrent branch)

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40
Q

What is the function of opponens pollicis?

A

Draws 1st metacarpal forward and rotates it medially

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41
Q

What supplies opponens pollicis?

A

Superficial palmar branch of radial artery

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42
Q

What is the origin and insertion of abductor pollicis brevis

A

Origin: flexor retinaculum, tubercles of scaphoid and trapezium
Insertion: lateral side of base of proximal phalanx of thumb

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43
Q

What innervates abductor pollicis brevis?

A

Median nerve (recurrent branch)

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44
Q

What is the function of abductor pollicis brevis?

A

Abducts thumb

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45
Q

What supplies abductor pollicis brevis?

A

Superficial palmar branch of radial artery

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46
Q

What is the origin and insertion of flexor pollicis brevis?

A

Origin: Flexor retinaculum and tubercle of trapezium
Insertion: Lateral side of base of proximal phalanx of thumb

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47
Q

What innervates flexor pollicis brevis?

A

Median nerve (recurrent branch)

48
Q

What is the function of flexor pollicis brevis?

A

Flexes proximal phalanx of thumb

49
Q

What supplies flexor pollicis brevis?

A

Superficial palmar branch of radial artery

50
Q

What are the intrinsic hand muscles of the hypothenar compartment?

A
  1. Opponens digiti minimi
  2. Abductor digiti minimi
  3. Flexor digiti minimi brevis
51
Q

What is the origin and insertion of opponens digiti minimi?

A

Origin: flexor retinaculum and hook of hamate bone
Insertion: palmar surface of 5th metacarpal

52
Q

What innervates opponens digiti minimi?

A

Ulnar nerve (deep branch)

53
Q

What is the function of opponens digiti minimi?

A

Draws 5th metacarpal anteriorly and rotates it to face thumb

54
Q

What supplies opponens digit minimi?

A

Deep palmar branch of ulnar artery

55
Q

What is the origin and insertion of abductor digiti minimi?

A

Origin: Pisiform bone and tendon of flexor carpi ulnaris
Insertion: Medial side of base of proximal phalanx of little finger (5th digit)

56
Q

What innervates abductor digit minimi?

A

Ulnar nerve (deep branch)

57
Q

What is the function of abductor digiti minimi?

A

Abducts little finger

58
Q

What supplies abductor digiti minimi?

A

Deep palmar branch of ulnar artery

59
Q

What is the origin and insertion of flexor digiti minimi brevis?

A

Origin: flexor retinaculum and hook of hamate bone
Insertion: medial side of base of proximal phalanx of little finger

60
Q

What innervates flexor digiti minimi brevis?

A

Ulnar nerve (deep branch)

61
Q

What is the function of flexor digiti minimi brevis?

A

Flexes proximal phalanx of little finger

62
Q

What supplies flexor digiti minimi brevis?

A

Deep palmar branch of ulnar artery

63
Q

What is the origin and insertion of lumbrical 1st and 2nd?

A

Origin: lateral two tendons of flexor digitorum profundus
Insertion: lateral side of extensor expansion of digits 2 and 3

64
Q

What innervates lumbrical, 1st and 2nd?

A

Median nerve (digital branches)

65
Q

What is the function of lumbrical, 1st and 2nd?

A

Extend digits at interphalangeal joints, flex metacarpophalngeal joints

66
Q

What supplies lumbrical, 1st and 2nd?

A

Superficial and deep palmar arches

67
Q

What is the origin and insertion of lumbrical, 3rd and 4th?

A

Origin: medial three tendons of flexor digitorum profundus
Insertion: lateral sides of extensor expansion of digits 4 and 5

68
Q

What innervates lumbrical, 3rd and 4th?

A

Ulnar nerve (deep branch)

69
Q

What is the function of lumbrical, 3rd and 4th?

A

Extends digits at interphalangeal joints, flex metacarpophalangeal joints

70
Q

What supplies lumbrical, 3rd and 4th?

A

Superficial and deep palmar arches

71
Q

The lumbricals will help extend a ___ finger due to the insertion on the ___ expansion. What does this allow?

A

Flexed; extensor; pinching on the pulp of the fingers (not the tips)

72
Q

What is the extensor expansion hood?

A

Common “hood” which aids in extension of fingers; receives extensor digitorum, interossei, and lumbrical tendons

73
Q

What is the origin and insertion of the dorsal interosseous muscles?

A

Origin: adjacent sides of two metacarpal bones
Insertion: base of proximal phalanges, extensor expansion of digits 2-4

74
Q

What innervates the dorsal interosseous muscles?

A

Ulnar nerve (deep branch)

75
Q

What is the function of the dorsal interosseous muscles?

A

Abducts digits from the axial line of the hand (3rd joint); flexes digits at metacarpophalangeal joint and extend interphalangeal joints

76
Q

What supplies the dorsal interosseous muscles?

A

Deep palmar arch

77
Q

The dorsal interossei are ___ muscles.

A

Bipennate (two heads)

78
Q

The palmar interossei are ___ muscles.

A

Unipennate (one head)

79
Q

What is the origin and insertion of palmar interosseous muscles?

A

Origin: sides of metacarpals 2,4, and 5
Insertion: bases of proximal phalanx and extensor expansion of digits 2, 4, and 5

80
Q

What innervates the palmar interosseous muscles?

A

Ulnar nerve (deep branch)

81
Q

What is the function of the palmar interosseous muscles?

A

Adducts digits toward axial line of hand (3rd digit); flexes digits at metacarpophalangeal joint and extends interphalangeal joints

82
Q

What supplies the palmar interosseous muscles?

A

Deep palmar arch

83
Q

What is the origin and insertion of adductor pollicis?

A

Origin of oblique head: bases of 2nd and 3rd metacarpals and capitate and adjacent bones
Origin of transverse head: anterior surface of 3rd metacarpal
Insertion: medial side of base of proximal phalanx of thumb

84
Q

What innervates adductor pollicis?

A

Ulnar nerve (deep branch)

85
Q

What is the function of adductor pollicis?

A

Adducts thumb

86
Q

What supplies adductor pollicis?

A

Deep palmar arch

87
Q

Describe the path of the radial artery to the hand.

A

The radial artery continues around the lateral carpal bones (dorsally) and extends across the floor of the snuff box, then pierces the 1st dorsal interosseous muscle to enter the palmar areas of the hand.

88
Q

The radial artery gives of ___ artery to supply the medial side of the thumb and the ___ artery to supply the lateral side of the 2nd digit.

A

Princeps pollicis; radialis indicis

89
Q

The radial artery continues through the palm as the ___, which eventually will anastamose with the deep branch of the ___ artery.

A

Deep palmar arch; ulnar

90
Q

The superficial palmar branch comes off the radial artery before it wraps around the lateral carpals, then passes through the ___ muscles to anastamose with the superficial palmar arch of the ___ artery.

A

Thenar; ulnar

91
Q

Describe the path of the ulnar artery to the hand.

A

The ulnar artery enters the hand via the canal of Guyon with the ulnar nerve.

92
Q

The superficial branch of the ulnar artery becomes the ___, which traverses across the palm, giving off the common palmar digital arteries.

A

Superficial palmar arch

93
Q

The superficial palmar arch anastamoses with the superficial palmar branch of the ___ artery.

A

Radial

94
Q

The deep branch of the ulnar artery passes between the ___ and the ___, and anastomoses with the deep palmar arch (radial artery).

A

Abductor digiti minimi; flexor digiti minimi

95
Q

Describe broadly what the nerves of the hand innervate.

A

Median: 1/2 LOAF + cutaneous
Ulnar: all other muscles + cutaneous
Radial: cutaneous only to back of hand

96
Q

Describe the path of the median nerve to the hand.

A

The median nerve enters the hand under the flexor retinaculum through the carpal tunnel

97
Q

The recurrent (thenar) branch of the median nerve first branches ___ to the flexor retinaculum. It then enters the ___ and innervates 1/2 LOAF - what does this stand for?

A

Distal; thenar eminence; 1st and 2nd Lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis

98
Q

The median nerve will become the common palmar digital nerves and then the proper palmar digital nerves. What do these do?

A

Provides cutaneous sensation to the palmar aspect of the lateral 3 1/2 fingers and the dorsal aspect of the same fingers distally (in the area of the nail bed)

99
Q

The ulnar nerve enters the hand via ___.

A

Canal of Guyon (ulnar canal)

100
Q

What are the branches of the ulnar nerve in the hand?

A

Palmar cutaneous branch, dorsal cutaneous branch, superficial branch, deep branch

101
Q

The palmar cutaneous branch of the ulnar nerve runs to the ___ side of the palm.

A

Medial

102
Q

The dorsal cutaneous branch of the ulnar nerve passes under the ___ tendon and extends distally across the dorsum of the hand, including dorsal surfaces of the medial 1 1;2 digits.

A

FCU

103
Q

The superficial branch of the ulnar nerve becomes what two sets of nerves?

A

Common palmar digital nerves and proper palmar digital nerves

104
Q

The deep branch of the ulnar nerve passes between AbdDM and FDMB tendons, passes deep to the flexor tendons along the path of the deep palmar arch, and innervates what muscles?

A 
Palmaris brevis
Hypothenar muscles (OAF)
3rd and 4th Lumbricals
Dorsal Interossei
Palmar Interossei
Adductor Pollicis
105
Q

The superficial branch of the radial enters the dorsum of the hand by passing over the ___.

A

Anatomical snuff box

106
Q

The radial nerve continues as ___ to the dorsal aspect of the lateral hand, including cutaneous sensation to the dorsal aspect of the lateral 2 1/2 digits proximal to the DIP joint.

A

Dorsal digital nerves

107
Q

Does the radial nerve have any motor branches in the hand?

A

No

108
Q

What causes the claw hand (ulnar claw)?

A

Ulnar nerve palsy, usually at the wrist

109
Q

Claw hand leads to weakness of most of the ___ muscles of the hand, especially in the ___.

A

Intrinsic; lumbricals

110
Q

Claw hand occurs beccause of unopposed activity of the ___.

A

Extensor digitorum muscle

111
Q

Unopposed activity of the extensor digitorum muscle leads to hyperextension of the 4th and 5th metacarpophalangeal joints and flexion of the PIPs and DIPs. You will also lose ability to spread the finers due to loss of ___.

A

Interossei

112
Q

What causes ape hand?

A

Median nerve palsy

113
Q

Ape hand includes wasting of the ___ muscles and the inability to oppose the ___.

A

Thenar; thumb

114
Q

What causes the hand of benediction?

A

Median nerve palsy

115
Q

The hand of benediction deformity is seen while trying to make a ___.

A

Fist

116
Q

What causes hand of benediction?

A

Prolonged compression of injury of the median nerve at the level of the elbow or upper arm.

117
Q

What causes wrist drop?

A

Palsy of the radial nerve

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