9.27.16 Hand Flashcards
1
Q
What are the carpal bones in the proximal row?
A
Scaphoid, Lunate, Triquetrum, Pisiform
2
Q
What are the carpal bones in the distal row?
A
Hamate, Capitate, Trapezoid, Trapezium
3
Q
What is the boat-shaped carpal bone?
A
Scaphoid
4
Q
What is the most frequently fractured carpal bone?
A
Scaphoid
5
Q
The scaphoid has a tubercle for attachment of the ___.
A
Flexor retinaculum
6
Q
What is the crescent-shaped carpal bone?
A
Lunate
7
Q
What is the most frequently dislocated carpal bone?
A
Lunate
8
Q
What is the pyramidal-shaped carpal bone?
A
Triquetrum
9
Q
The triquetrum has an oval articular facet on the palmar surface for the ___ bone.
A
Pisiform
10
Q
What is the small, pea-shaped carpal bone?
A
Pisiform
11
Q
The pisiform is a sesamoid bone within the tendon of the ___.
A
Flexor carpi ulnaris
12
Q
What carpal bone has a hook-like process from the palmar surface?
A
Hamate
13
Q
What is the largest carpal bone and the first to ossify?
A
Capitate
14
Q
What is the wedge-shaped carpal bone?
A
Trapezoid
15
Q
The trapezium has a saddle-shaped facet for the ___ and a tubercle for the attachment of the ___.
A
First metacarpal; flexor retinaculum
16
Q
What is the keystone of the carpal tunnel?
A
Capitate
17
Q
Which two carpal bones articulate with the radius?
A
Scaphoid and lunate
18
Q
What are the metacarpals?
A
5 bones of the intermediate portion fo the hand numbered from lateral (thumb) to medial
19
Q
Metacarpals are numbered 1-5 from ___ to ___.
A
Lateral; medial
20
Q
What are the 3 common characteristics of the metacarpals?
A
- Base articulates with the carpal bones
- Linear shaft
- Rounded head
21
Q
What are the phalanges?
A
The bones of the fingers
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)
23
Q
Each bone of the phalanges has a ___ (proximally), ___, and ___ (distally).
A
Base; shaft; head
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
25
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.
Antebrachial dorsum
26
The deep palmar fascia is thin over the thenar and hypothenar eminences, but thick in the palm, where it forms the ___.
Palmar aponeurosis
27
The deep palmar fascia continues distally on the fingers by helping to form the fibrous ___.
Digital sheaths
28
What is the palmar aponeurosis?
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
29
What is the clinical manifestation of Dupuytren's Contracture?
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.
30
What are synovial sheaths?
Space filled with fluid to allow free movement of tendons into hands and fingers
31
What are the posterior and anterior boundaries of the carpal tunnel?
Posterior: carpal bones
Anterior: flexor retinaculum
32
What are the 10 structures that pass through the carpal tunnel?
Flexor digitorum superficialis (4 tendons)
Flexor digitorum profundus (4 tendons)
Flexor pollicis longus (1 tendon)
median nerve
33
Carpal tunnel syndrome results from any lesion that will ___ the size of the carpal tunnel.
Decrease
34
What are three possible causes of carpal tunnel syndrome?
1. Fluid retention
2. Infection
3. Excessive exercise
35
The ___ nerve is the softest structure in the carpal tunnel and is the most affected by an increase in pressure.
Median
36
Because the median nerve innervates the ___ muscles, these muscles begin to waste.
Thenar
37
What are the intrinsic hand muscles of the thenar compartment?
1. Opponens pollicis
2. Abductor pollicis brevis
3. Flexor pollicis brevis
(OAF)
38
What is the origin and insertion of opponens pollicis?
Origin: flexor retinaculum and tubercle of trapezium
Insertion: Lateral side of 1st metacarpal
39
What innervates opponens pollicis?
Median nerve (recurrent branch)
40
What is the function of opponens pollicis?
Draws 1st metacarpal forward and rotates it medially
41
What supplies opponens pollicis?
Superficial palmar branch of radial artery
42
What is the origin and insertion of abductor pollicis brevis
Origin: flexor retinaculum, tubercles of scaphoid and trapezium
Insertion: lateral side of base of proximal phalanx of thumb
43
What innervates abductor pollicis brevis?
Median nerve (recurrent branch)
44
What is the function of abductor pollicis brevis?
Abducts thumb
45
What supplies abductor pollicis brevis?
Superficial palmar branch of radial artery
46
What is the origin and insertion of flexor pollicis brevis?
Origin: Flexor retinaculum and tubercle of trapezium
Insertion: Lateral side of base of proximal phalanx of thumb
47
What innervates flexor pollicis brevis?
Median nerve (recurrent branch)
48
What is the function of flexor pollicis brevis?
Flexes proximal phalanx of thumb
49
What supplies flexor pollicis brevis?
Superficial palmar branch of radial artery
50
What are the intrinsic hand muscles of the hypothenar compartment?
1. Opponens digiti minimi
2. Abductor digiti minimi
3. Flexor digiti minimi brevis
51
What is the origin and insertion of opponens digiti minimi?
Origin: flexor retinaculum and hook of hamate bone
Insertion: palmar surface of 5th metacarpal
52
What innervates opponens digiti minimi?
Ulnar nerve (deep branch)
53
What is the function of opponens digiti minimi?
Draws 5th metacarpal anteriorly and rotates it to face thumb
54
What supplies opponens digit minimi?
Deep palmar branch of ulnar artery
55
What is the origin and insertion of abductor digiti minimi?
Origin: Pisiform bone and tendon of flexor carpi ulnaris
Insertion: Medial side of base of proximal phalanx of little finger (5th digit)
56
What innervates abductor digit minimi?
Ulnar nerve (deep branch)
57
What is the function of abductor digiti minimi?
Abducts little finger
58
What supplies abductor digiti minimi?
Deep palmar branch of ulnar artery
59
What is the origin and insertion of flexor digiti minimi brevis?
Origin: flexor retinaculum and hook of hamate bone
Insertion: medial side of base of proximal phalanx of little finger
60
What innervates flexor digiti minimi brevis?
Ulnar nerve (deep branch)
61
What is the function of flexor digiti minimi brevis?
Flexes proximal phalanx of little finger
62
What supplies flexor digiti minimi brevis?
Deep palmar branch of ulnar artery
63
What is the origin and insertion of lumbrical 1st and 2nd?
Origin: lateral two tendons of flexor digitorum profundus
Insertion: lateral side of extensor expansion of digits 2 and 3
64
What innervates lumbrical, 1st and 2nd?
Median nerve (digital branches)
65
What is the function of lumbrical, 1st and 2nd?
Extend digits at interphalangeal joints, flex metacarpophalngeal joints
66
What supplies lumbrical, 1st and 2nd?
Superficial and deep palmar arches
67
What is the origin and insertion of lumbrical, 3rd and 4th?
Origin: medial three tendons of flexor digitorum profundus
Insertion: lateral sides of extensor expansion of digits 4 and 5
68
What innervates lumbrical, 3rd and 4th?
Ulnar nerve (deep branch)
69
What is the function of lumbrical, 3rd and 4th?
Extends digits at interphalangeal joints, flex metacarpophalangeal joints
70
What supplies lumbrical, 3rd and 4th?
Superficial and deep palmar arches
71
The lumbricals will help extend a ___ finger due to the insertion on the ___ expansion. What does this allow?
Flexed; extensor; pinching on the pulp of the fingers (not the tips)
72
What is the extensor expansion hood?
Common "hood" which aids in extension of fingers; receives extensor digitorum, interossei, and lumbrical tendons
73
What is the origin and insertion of the dorsal interosseous muscles?
Origin: adjacent sides of two metacarpal bones
Insertion: base of proximal phalanges, extensor expansion of digits 2-4
74
What innervates the dorsal interosseous muscles?
Ulnar nerve (deep branch)
75
What is the function of the dorsal interosseous muscles?
Abducts digits from the axial line of the hand (3rd joint); flexes digits at metacarpophalangeal joint and extend interphalangeal joints
76
What supplies the dorsal interosseous muscles?
Deep palmar arch
77
The dorsal interossei are ___ muscles.
Bipennate (two heads)
78
The palmar interossei are ___ muscles.
Unipennate (one head)
79
What is the origin and insertion of palmar interosseous muscles?
Origin: sides of metacarpals 2,4, and 5
Insertion: bases of proximal phalanx and extensor expansion of digits 2, 4, and 5
80
What innervates the palmar interosseous muscles?
Ulnar nerve (deep branch)
81
What is the function of the palmar interosseous muscles?
Adducts digits toward axial line of hand (3rd digit); flexes digits at metacarpophalangeal joint and extends interphalangeal joints
82
What supplies the palmar interosseous muscles?
Deep palmar arch
83
What is the origin and insertion of adductor pollicis?
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
What innervates adductor pollicis?
Ulnar nerve (deep branch)
85
What is the function of adductor pollicis?
Adducts thumb
86
What supplies adductor pollicis?
Deep palmar arch
87
Describe the path of the radial artery to the hand.
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
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.
Princeps pollicis; radialis indicis
89
The radial artery continues through the palm as the ___, which eventually will anastamose with the deep branch of the ___ artery.
Deep palmar arch; ulnar
90
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.
Thenar; ulnar
91
Describe the path of the ulnar artery to the hand.
The ulnar artery enters the hand via the canal of Guyon with the ulnar nerve.
92
The superficial branch of the ulnar artery becomes the ___, which traverses across the palm, giving off the common palmar digital arteries.
Superficial palmar arch
93
The superficial palmar arch anastamoses with the superficial palmar branch of the ___ artery.
Radial
94
The deep branch of the ulnar artery passes between the ___ and the ___, and anastomoses with the deep palmar arch (radial artery).
Abductor digiti minimi; flexor digiti minimi
95
Describe broadly what the nerves of the hand innervate.
Median: 1/2 LOAF + cutaneous
Ulnar: all other muscles + cutaneous
Radial: cutaneous only to back of hand
96
Describe the path of the median nerve to the hand.
The median nerve enters the hand under the flexor retinaculum through the carpal tunnel
97
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?
Distal; thenar eminence; 1st and 2nd Lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
98
The median nerve will become the common palmar digital nerves and then the proper palmar digital nerves. What do these do?
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
The ulnar nerve enters the hand via ___.
Canal of Guyon (ulnar canal)
100
What are the branches of the ulnar nerve in the hand?
Palmar cutaneous branch, dorsal cutaneous branch, superficial branch, deep branch
101
The palmar cutaneous branch of the ulnar nerve runs to the ___ side of the palm.
Medial
102
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.
FCU
103
The superficial branch of the ulnar nerve becomes what two sets of nerves?
Common palmar digital nerves and proper palmar digital nerves
104
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?
```
Palmaris brevis
Hypothenar muscles (OAF)
3rd and 4th Lumbricals
Dorsal Interossei
Palmar Interossei
Adductor Pollicis
```
105
The superficial branch of the radial enters the dorsum of the hand by passing over the ___.
Anatomical snuff box
106
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.
Dorsal digital nerves
107
Does the radial nerve have any motor branches in the hand?
No
108
What causes the claw hand (ulnar claw)?
Ulnar nerve palsy, usually at the wrist
109
Claw hand leads to weakness of most of the ___ muscles of the hand, especially in the ___.
Intrinsic; lumbricals
110
Claw hand occurs beccause of unopposed activity of the ___.
Extensor digitorum muscle
111
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 ___.
Interossei
112
What causes ape hand?
Median nerve palsy
113
Ape hand includes wasting of the ___ muscles and the inability to oppose the ___.
Thenar; thumb
114
What causes the hand of benediction?
Median nerve palsy
115
The hand of benediction deformity is seen while trying to make a ___.
Fist
116
What causes hand of benediction?
Prolonged compression of injury of the median nerve at the level of the elbow or upper arm.
117
What causes wrist drop?
Palsy of the radial nerve
