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Y2 CONTROL & MOVEMENT > A4 - Wrist & Hand > Flashcards

A4 - Wrist & Hand Flashcards

1
Q

What are the 3 bones that make up the hand?

A
  1. carpal bones 2. metacarpals 3. phalanges
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2
Q

Label the movements of the fingers and the bones of the hand

A
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3
Q

Which bones make up the proximal row of carpal bones?

A

From radial side to ulnar:

  1. scaphoid
  2. lunate
  3. triquetral
  4. pisiform
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4
Q

Which carpal bones make up the distal row?

A

From ulnar side to radial:

  1. hamate
  2. capitate
  3. trapezoid
  4. trapezium
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5
Q

Which of the carpal bones articulate with the radius to form the radiocarpal (wrist) joint?

A
  1. scaphoid
  2. lunate
  3. part of the triquetral
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6
Q

Which of the carpal bones is most commonly fractured?

What can happen in later life if this fracture is missed?

A

scaphoid bone

if a fracture of the scaphoid is missed, the part of the scaphoid that interacts with the radius dies

this leads to painful arthritis in later life

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7
Q

Label the carpal bones

A
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8
Q

What are the 4 joints within the hand?

A
  1. metacarpophalangeal joints
  2. proximal interphalangeal joints
  3. distal interphalangeal joints
  4. the carpometacarpal joint
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9
Q

What bones are involved in a ‘boxer’s fracture’?

A

this is a break of the 5th metacarpal bones

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10
Q

Which bones are involved in forming the carpometacarpal joint?

A

the trapezium and the first metacarpal

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11
Q

Label the joints of the hand

A
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12
Q

What are the following movements of the thumb?

A
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13
Q

What are the 2 types of nodes associated with osteoarthritis?

Which joints do they affect?

A

Herberden’s nodes affect the distal interphalangeal joints

Bouchard’s nodes affect the proximal interphalangeal joints

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14
Q

What are the following nodes associated with osteoarthritis?

A
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15
Q

What are the 3 main deformities of the hand associated with rheumatoid arthritis?

A
  1. Boutonniere deformity of the thumb
  2. ulnar deviation of metacarpophalangeal joints
  3. swan-neck deformity of the fingers
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16
Q

How does the Boutonniere deformity affect the joints in the hand?

A

the proximal interphalangeal joint is permanently bent towards the palm

the distal interphalangeal joint is bent away from the palm

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17
Q

How does the swan neck deformity affect the joints in the hand?

A

It causes distal interphalangeal joint to be bent towards the palm

the proximal interphalangeal joint is bent away from the palm

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18
Q

What is the carpal tunnel?

A

a space on the anterior aspect of the wrsit

the long flexor tendons of the forearm and the median nerve pass through it

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19
Q

What forms the roof, floor and sides of the carpal tunnel?

A

Roof:

transverse carpal ligament (this is the flexor retinaculum)

Floor and sides:

carpal bones

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20
Q

What are the 4 main structures that run through the carpal tunnel?

A
  1. median nerve
  2. 4 tendons of flexor digitorum profundus
  3. 4 tendons of flexor digitorum superficialis
  4. tendon of flexor pollicis longus
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21
Q

What structure is implicated in carpal tunnel syndrome?

A

the median nerve becomes compressed within the carpal tunnel

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22
Q

Label the components of the carpal tunnel

A
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23
Q

What are the 2 main functions of the palmar aponeurosis?

A
  1. it protects the underlying tendons
  2. it gives firm attachment to the skin of the palm to improve the grip
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24
Q

What is the apex of the triangular palmar aponeurosis continuous with?

A

the palmaris longus tendon

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25
Q

What is the difference between intrinsic and extrinsic muscles/

A

Intrinsic muscles have both their origin and insertion within the hand

Extrinsic muscles insert, via long tendons, onto the bones in the hand but their origin lies outside of the hand

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26
Q

How can the intrinsic muscles of the palm be divided into 5 groups?

A
  1. thenar eminence
  2. hypothenar eminence
  3. adductor pollicis
  4. lumbrical muscles
  5. palmar interossei
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27
Q

What is the innervation of the intrinsic muscles of the hand?

A

deep branch of the ulnar nerve

except the 3 thenar and 2 lateral lumbricals - median nerve

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28
Q

What are the 3 muscles of the thenar eminence?

A
  1. opponens pollicis
  2. abductor pollicis brevis
  3. flexor pollicis brevis
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29
Q

What is the innervation of the 3 thenar muscles?

A

the recurrent branch of the median nerve (C8, T1)

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30
Q

What is the action of opponens pollicis?

A

it medially rotates the thumb

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31
Q

What is the action of abductor pollicis brevis?

A

it abducts the thumb at the metacarpophalangeal joint

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32
Q

What is the role of flexor pollicis brevis?

A

it flexes the thumb at the metacarpophalangeal joint

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33
Q

Label the 3 thenar muscles

A
34
Q

What is the innervation of adductor pollicis?

What is its function?

A

It allows for adduction of the thumb

It is innervated by the deep branch of the ulnar nerve (C8, T1)

35
Q

Which muscle is shown in the diagram?

A
36
Q

What are the 3 hypothenar muscles?

A
  1. opponens digiti minimi
  2. abductor digiti minimi
  3. flexor digiti minimi brevis
37
Q

What is the action of opponens digiti minimi?

A

it laterally rotates metacarpal V

38
Q

What is the action of abductor digiti minimi?

A

it abducts the little finger at the metacarpophalangeal joint

39
Q

What is the action of flexor digiti minimi brevis?

A

It flexes the little finger at the metacarpophalangeal joint

40
Q

What is the innervation of the hypothenar muscles?

A

deep branch of the ulnar nerve (C8, T1)

41
Q

Label the three hypothenar muscles

A
42
Q

From which tendon do the lumbrical muscles arise?

A

from the tendons of flexor digitorum profundus in the hand (FDP)

43
Q

What is the role of the lumbrical muscles?

Where do they insert?

A

they insert onto the extensor expansions

they are important for fine precision movements of the fingers

they flex the metacarpophalangeal joints whilst extending the interphalangeal joints

44
Q

What are the innervations of the lumbrical muscles?

A

Medial lumbricals (3rd & 4th):

deep branch of the ulnar nerve

Lateral lumbricals (1st & 2nd):
digital branches of the median nerve

45
Q

Label the lumbrical muscles

A
46
Q

Where are the interossei found?

Where do they insert?

A

There are 4 dorsal and 3 palmar interossei

They lie between the metacarpal bones

They insert onto the extensor expansion

47
Q

What is the function of the palmar interossei?

A

PAD -PAlmar ADduct

the palmar interossei are involved with adduction of the fingers

48
Q

What is the function of the dorsal interossei?

A

DAB - Dorsal ABduct

dorsal interossei are involved with abduction of the fingers

49
Q

What function is performed by both the palmar and dorsal interossei?

A

they both contribute to extension at the interphalangeal joints of the fingers

50
Q

What is significant about movement of the middle finger during abduction/adduction of the fingers?

A

the middle finger moves very little

a line drawn along the plane of the middle finger is the axial line of the hand

abduction and adduction occur about the axial line of the hand

51
Q
A
52
Q

Which direction do the tendons of the palmar interossei travel?

What happens when they contract?

A

the tendons diverge away from the middle finger

when they contract, the 2nd, 4th and 5th digits are pulled towards the middle finger (adduction)

53
Q

Where are the locations of the palmar interosseus muscles?

How many of them are there?

A

There are 3 palmar interossei - the middle finger (3rd) does not have one

54
Q

Which direction do the tendons of the dorsal interossei travel?

What action is acheived when they contract?

A

the tendons converge towards the middle finger

when they contract, they pull digits 2 and 4 away from the middle finger (abduction)

abductor digiti minimi abducts digit 5

55
Q

How many dorsal interossei are attached to the middle finger?

How does this affect its motion?

A

2 dorsal interossei are attached to the middle finger

This allows it to be moved independently from side to side

56
Q

What are the insertions of the dorsal interossei?

Where are they positioned?

A

Insertion into base of proximal phalanges and dorsal hood

57
Q

Where are extensor expansions (hoods) found in the hand?

A

they cover the dorsum and sides of the distal metacarpal bones and proximal phalanges

58
Q

What intrinsic muscles are found in the dorsum of the hand?

A

there is only one set of intrinsic muscles in the dorsum of the hand

these are the dorsal interossei

59
Q

Which muscles insert onto the extensor expansion?

What movement is possible as a result of this?

A

the interossei and the lumbrical muscles

this allows for:

flexion at the metacarpophalangeal joints &

extension and the interphalangeal joints

to occur simultaneously

60
Q

What technique can be used to make the superficial veins of the hand more visible?

A

using a tourniquet around the arm or forearm restricts venous return and distends the superficial veins

61
Q

Which veins form the dorsal venous network?

Which vein runs through the anatomical snuffbox?

A

the cephalic and basilic veins form the dorsal venous network

the cephalic vein runs through the anatomical snuffbox

62
Q

Which arteries supply the hand?

A

the radial and ulnar arteries

63
Q

Which digits are supplied mainly by the radial artery?

A

thumb and lateral side of the index finger

64
Q

Which digits are supplied mainly by the ulnar artery?

A

medial side of the index finger and the remaining digits

65
Q

What forms the superficial and deep arches in the hand?

A

superficial arch:

formed from terminal part of ulnar artery with input from radial artery

deep arch:

formed from terminal part of radial artery with input from ulnar artery

66
Q

What do the superficial and deep palmar arches give rise to?

A

digital arteries

67
Q

What is significant about anastomoses between the ulnar and radial arteries?

A

this ensures that, if one of the arteries is blocked, the hand will still be perfused

68
Q

Label the arteries and blood supply of the hand

A
69
Q

When may Allen’s test be used in clinic?

A

it is used to assess the adequacy of blood flow within both the ulnar and radial arteries

this is performed before the arteries are accessed for arterial blood samples

70
Q

Label the steps being shown in Allen’s test

A
71
Q

What is Raynaud’s Syndrome?

A

a condition in which spasms of the arteries cause episodes of reduced blood flow

the small arteries in the extremities are sensitive to even the slightest changes in temperature, the cold and stress

72
Q

Which nerves supply the skin of the hand?

A
  1. ulnar nerve
  2. radial nerve
  3. median nerve
73
Q

Which area of the palm is supplied by the ulnar nerve?

A

it supplies sensory innervation to the skin over the ulnar 1 ½ digits and the adjacent part of the palm

74
Q

Which area of the dorsum is supplied by the ulnar nerve?

A

it supplies sensory innervation to the skin over the ulnar 2 digits

except the lateral half of the skin over the distal phalanx of the 4th finger

75
Q

Which structures does the ulnar nerve supply motor innervation to?

A
  1. hypothenar eminence muscles
  2. medial two lumbricals
  3. 7 interossei
  4. adductor pollicis
76
Q
A
77
Q

Which areas of the palm are supplied by the median nerve?

A

it supplies sensory innervation to the skin over the lateral 3 ½ digits

and the adjacent part of the palm of the hand

78
Q

Which parts of the dorsum of the hand are supplied by the median nerve?

A

it supplies sensory innervation to the skin over the distal phalanges of the lateral 3 ½ digits

79
Q

Which structures does the median nerve supply motor innervation to?

A
  1. thenar eminence muscles
  2. lateral two lumbricals
80
Q

label the median nerve and the structures that it supplies

A
81
Q

Which part of the hand is supplied by the radial nerve?

A

it supplies sensory innervation over the remaining part of the palm

and over the dorsum of the lateral 3 digits as far as the interphalangeal joint of the thumb and the distal interphalangeal joints of the 2nd and 3rd fingers

82
Q
A

Y2 CONTROL & MOVEMENT (69 decks)

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