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Anatomy > ANA Upper Limb 5 Hand, Carpal tunnel and wrist > Flashcards

ANA Upper Limb 5 Hand, Carpal tunnel and wrist Flashcards

1
Q

There are three groups of bones in the hand:

A
  1. the eight carpal bones are the bones of the wrist;
  2. the five metacarpals (I to V) are the bones of the metacarpus.
  3. the phalanges are the bones of the digits-the thumb has only two, the rest of the digits have three.
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2
Q

what forms much of the bony framework of the palm?

A

The carpal bones and metacarpals of the index, middle, ring, and little fingers (metacarpals II to V) tend to function as a unit and form much of the bony framework of the palm.

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3
Q

The function of the metacarpal bone of the thumb

A

The metacarpal bone of the thumb functions independently and has increased flexibility at the carpometacarpal joint to provide opposition of the thumb to the fingers.

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4
Q

Bones in the proximal row

A

the boat-shaped scaphoid;
the lunate, which has a ‘crescent shape’;
the three-sided triquetrum bone;
the pea-shaped pisiform

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5
Q

Location type and location of the pisiform bone

A

The pisiform is a sesamoid bone in the tendon of flexor carpi ulnaris and articulates with the anterior surface of the triquetrum.

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6
Q

Describe the scaphoid bone

A

The scaphoid has a prominent tubercle on its lateral palmar surface that is directed anteriorly.

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7
Q

Bones in the distal row

A
  1. the irregular four-sided trapezium bone;
  2. the four-sided trapezoid;
  3. the capitate, which has a head;
  4. the hamate, which has a hook.
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8
Q

Describe the articulation of the phalanges

A

The base of each proximal phalanx articulates with the head of the related metacarpal bone.
The head of each distal phalanx is non-articular and flattened into a crescent-shaped palmar tuberosity, which lies under the palmar pad at the end of the digit.

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9
Q

Describe the structure of a phalanx

A

the thumb has two-a proximal and a distal phalanx;
the rest of the digits have three-a proximal, a middle, and a distal phalanx.
Each phalanx has a base, a shaft (body), and distally, a head.

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10
Q

What is the wrist joint?

A

The wrist joint is a condyloid synovial joint between the distal end of the radius and the articular disc overlying the distal end of the ulna, and the scaphoid, lunate, and triquetrum.

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11
Q

Describe the articulation of the wrist joint

A

Together, the articular surfaces of the carpals form an oval shape with a convex contour, which articulates with the corresponding concave surface of the radius and articular disc.

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12
Q

Movements around the wrist joint

A

abduction, adduction, flexion, and extension.

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13
Q

Why can the hand can be adducted to a greater degree than it can be abducted?

A

Because the radial styloid process extends further distally than does the ulnar styloid process

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14
Q

Ligaments of the wrist and their function

A
  1. palmar radiocarpal
  2. palmar ulnocarpal
  3. dorsal radiocarpal ligaments.

In addition: radial and ulnar collateral ligaments of the wrist joint span the distance between the styloid processes of the radius and ulna and the adjacent carpal bones.

These ligaments reinforce the medial and lateral sides of the wrist joint and support them during flexion and extension.

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15
Q

Function of the carpal joints in movement

A

limited but contribute to the positioning of the hand in abduction, adduction, flexion, and, particularly, extension.

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16
Q

What are the carpal joints?

A

Is a synovial joint between the carpal bones which share a common articular cavity.

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17
Q

What joint imparts a wide range of mobility to the thumb?

A

The saddle joint, between metacarpal I and the trapezium, imparts a wide range of mobility to the thumb that is not a feature of the rest of the digits.

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18
Q

Movements at the carpometacarpal joint

A

flexion, extension, abduction, adduction, rotation, and circumduction.

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19
Q

Describe the degree of movement between metacarpals II to V?

A

The carpometacarpal joints between metacarpals II to V and the carpal bones are much less mobile than the carpometacarpal joint of the thumb, allowing only limited gliding movements.
Movement of the joints increases medially so metacarpal V slides to the greatest degree.

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20
Q

What are metacarpophalangeal joints?

A

The joints between the distal heads of the metacarpals and the proximal phalanges of the digits are condylar joint of synovial joint, which allow flexion, extension, abduction, adduction, circumduction, and limited rotation.

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21
Q

Ligaments of the metacarpophalangeal joints

A

The capsule of each joint is reinforced by the palmar ligament and by medial and lateral collateral ligaments.
In addition to the above ligaments, there is the deep transverse metacarpal ligaments.

The three deep transverse metacarpal ligaments are thick bands of connective tissue connecting the palmar ligaments of the metacarpophalangeal joints of the fingers to each other.
They are important because, by linking the heads of the metacarpal bones together, they restrict the movement of these bones relative to each other.
As a result, they help form a unified skeletal framework for the palm of the hand.

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22
Q

What are the INTERPHALANGEAL JOINTS OF HAND?

A

The interphalangeal joints of the hand are hinge joints that allow mainly flexion and extension.
They are reinforced by medial and lateral collateral ligaments and palmar ligaments.

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23
Q

Describe the carpal injury of a fracture across the waist of the scaphoid bone.

A

It is uncommon to see other injuries.
In approximately 10% of individuals, the scaphoid bone has a sole blood supply from the radial artery, which enters through the distal portion of the bone to supply the proximal portion.
When a fracture occurs across the waist of the scaphoid, the proximal portion therefore undergoes avascular necrosis.
It is impossible to predict which patients have this blood supply.

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24
Q

What is Avascular necrosis?

A

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years

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25
Q

What is the carpal tunnel?

A

The carpal tunnel is formed anteriorly at the wrist by a deep arch formed by the carpal bones and the flexor retinaculum .

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26
Q

How is the base of the carpal tunnel formed?

A

The base of the carpal arch is formed medially by the pisiform and the hook of the hamate and laterally by the tubercles of the scaphoid and trapezium.

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27
Q

What is the flexor retinaculum?

A

The flexor retinaculum is a thick connective tissue ligament that bridges the space between the medial and lateral sides of the base of the arch

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28
Q

What converts the carpal arch into the carpal tunnel?

A

The flexor retinaculum

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29
Q

Structures passing through the carpal tunnel

A
  1. The four tendons of the flexor digitorum profundus
  2. the four tendons of the flexor digitorum superficialis
  3. the tendon of the flexor pollicis longus
  4. median nerve.
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30
Q

Action of the synovial sheath in the carpal tunnel

A

•Free movement of the tendons in the carpal tunnel is facilitated by synovial sheaths, which surround the tendons.
•All the tendons of the flexor digitorum profundus and flexor digitorum superficialis are surrounded by a single synovial sheath; a separate sheath surrounds the tendon of the flexor pollicis longus.
•The median nerve lies anterior to the tendons in the carpal tunnel.

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31
Q

the ulnar artery, ulnar nerve, and tendon of palmaris longus pass into the hand, therefore do they pass through the carpal tunnel?

A

No. Although the ulnar artery, ulnar nerve, and tendon of palmaris longus pass into the hand, they do so anterior to the flexor retinaculum and do not pass through the carpal tunnel.

32
Q

The tendon of palmaris longus is surrounded by a synovial sheath. T/F

A

False

33
Q

What is carpal tunnel syndrome

A

Carpal tunnel syndrome is an entrapment syndrome caused by pressure on the median nerve within the carpal tunnel.
•This gives rise to loss of sensations and weakness of the muscles of the thenar eminence.

34
Q

Symptoms and treatment of carpal tunnel syndrome

A

Symptoms
1. Patients typically report pain and pins-and-needles in the distribution of the median nerve.

  1. Weakness and loss of muscle bulk of the thenar muscles may also occur.
  2. Gently tapping over the median nerve (in the region of the flexor retinaculum) readily produces these symptoms (Tinel’s sign).

Treatment
*Initial treatment is aimed at reducing the inflammation and removing any repetitive insults that produce the symptoms.
If this does not lead to improvement nerve conduction studies will be necessary to confirm nerve entrapment, which may require surgical decompression of the flexor retinaculum.

35
Q

What is is palmar aponeurosis?

A

The palmar aponeurosis is a triangular-shaped condensation of deep fascia that covers the palm and is anchored to the skin in distal regions.
•The apex of the triangle is continuous with the palmaris longus tendon, when present; otherwise, it is anchored to the flexor retinaculum.
•From this point, fibers radiate to extensions at the base of the digits that project into each of the index, middle, ring, and little fingers and, to a lesser extent, the thumb.

•Transverse fibers interconnect the more longitudinally arranged bundles that continue into the digits.

36
Q

What is the anatomical snuffbox?

A

The ‘anatomical snuffbox’ is a term given to the triangular depression formed on the posterolateral side of the wrist and metacarpal I by the extensor tendons passing into the thumb.

37
Q

Borders of anatomical snuffbox

A

The base of the triangle is at the wrist and the apex is directed into the thumb.
•The impression is most apparent when the thumb is extended

●the lateral border is formed by the tendons of the abductor pollicis longus and extensor pollicis brevis;

●the medial border is formed by the tendon of the extensor pollicis longus;

●the floor of the impression is formed by the scaphoid and trapezium, and distal ends of the tendons of the extensor carpi radialis longus and extensor carpi radialis brevis.

38
Q

Structures passing through the anatomical snuffbox

A
  1. The radial artery
  2. terminal parts of the superficial branch of the radial nerve
  3. cephalic vein
39
Q

What are the intrinsic muscles of the hand?

A
  1. adductor pollicis
  2. interossei
  3. thenar
  4. hypothenar
  5. palmaris brevis
  6. lumbrical muscles
40
Q

Difference between intrinsic and extrinsic muscles of the hand

A

The extrinsic: originate in the forearm, insert in the hand, and function in forcefully gripping (‘power grip’) with the hand

Intrinsic: occur entirely in the hand and mainly execute precision movements (‘precision grip’) with the fingers and thumb.

41
Q

Origin of Palmaris brevis

A

Palmar aponeurosis and flexor retinaculum

42
Q

Insertion of Palmaris brevis

A

Dermis of skin on the medial margin of the hand

43
Q

Innervation of Palmaris brevis

A

Superficial branch of the ulnar nerve [C8,T1]

44
Q

Action of Palmaris brevis

A

Improves grip

45
Q

Origin of Dorsal interossei (four muscles)

A

Adjacent sides of metacarpals

46
Q

Insertion of the Dorsal interossei (four muscles)

A

Extensor hood and base of proximal phalanges of index, middle, and ring fingers

47
Q

Innervation of the Dorsal interossei (four muscles)

A

Deep branch of ulnar nerve [C8,T1]

48
Q

Action of the Dorsal interossei (four muscles)

A

Abduction of index, middle, and ring fingers at the metacarpophalangeal joints

49
Q

Origin of Palmar interossei (four muscles)

A

Sides of metacarpals

50
Q

Insertion of Palmar interossei (four muscles)

A

Extensor hoods of the thumb, index, ring, and little fingers and the proximal phalanx of the thumb

51
Q

Innervation of Palmar interossei (four muscles)

A

Deep branch of ulnar nerve [C8,T1]

52
Q

Action of Palmar interossei (four muscles)

A

Adduction of the thumb, index, ring, and little fingers at the metacarpophalangeal joints

53
Q

Origin of Adductor pollicis

A

Transverse head- metacarpal III;

oblique head-capitate and bases of metacarpals II and III

54
Q

Insertion of Adductor pollicis

A

Base of proximal phalanx and extensor hood of thumb

55
Q

Innervation of Adductor pollicis

A

Deep branch of ulnar nerve [C8,T1]

56
Q

Action of Adductor pollicis

A

Adducts thumb

57
Q

Origin of Lumbricals (four muscles)

A

Tendons of flexor digitorum profundus

58
Q

Insertion of Lumbricals (four muscles)

A

Extensor hoods of index, ring, middle, and little fingers

59
Q

Innervation of Lumbricals (four muscles)

A

Medial two by the deep branch of the ulnar nerve; lateral two by digital branches of the median nerve

60
Q

Action of Lumbricals (four muscles)

A

Flex metacarpophalangeal joints while extending interphalangeal joints

61
Q

What are the thenar muscles of the hand?

A
  1. Opponens pollicis
  2. Abductor pollicis brevis
  3. Flexor pollicis brevis
62
Q

Origin of Opponens pollicis

A

Tubercle of trapezium and flexor retinaculum

63
Q

Insertion of Opponens pollicis

A

Lateral margin and adjacent palmar surface of metacarpal I

64
Q

Innervation of Opponens pollicis

A

Recurrent branch of median nerve [C8,T1]

65
Q

Action of Opponens pollicis

A

Medially rotates thumb

66
Q

Origin of Abductor pollicis brevis

A

Tubercles of scaphoid and trapezium and adjacent flexor

67
Q

Insertion of Abductor pollicis brevis

A

Proximal phalanx and extensor hood of thumb

68
Q

Innervation of Abductor pollicis brevis

A

Recurrent branch of median nerve [C8,T1]

69
Q

Action of Abductor pollicis brevis

A

Abducts thumb at metacarpophalangeal joint

70
Q

Origin of Flexor pollicis brevis

A

Tubercle of the trapezium and flexor retinaculum

71
Q

Insertion of Flexor pollicis brevis

A

Proximal phalanx of the thumb

72
Q

Innervation of Flexor pollicis brevis

A

Recurrent branch of median nerve [C8,T1]

73
Q

Action of Flexor pollicis brevis

A

flexes the thumb at the metacarpophalangeal joint, as well as flexion and medial rotation of the 1st metacarpal bone at the carpometacarpal joint.

74
Q

What are the 3 thenar muscles?

A
  1. Opponens pollicis
  2. Abductor pollicis brevis
  3. Flexor pollicis brevis
75
Q

What are the 3 hypothenar muscles?

A
  1. Opponens digiti minimi
  2. Abductor digiti minimi
  3. Flexor digiti minimi brevis
76
Q

Action of Dorsal interossei and Palmar interossei

A

PAD DAB
PAD - Palmar Adducts
DAB - Dorsal Abducts

77
Q

Action of the 4 lumbrical muscles

A

Flex metacarpophalangeal joints while extending interphalangeal joints

Anatomy (17 decks)

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