Anatomie 3 (membre supérieur) Flashcards by Compte Partagé

Retaining ligaments of fingers and position

Grayson: Volar and transverse, palmar to neurovasc bundle (brevents bowstringing during flexion)

Cleland: dorsal, passes from junction of periosteum and flexor tendon sheath to skin

Transverse retinacular ligament: radial and ulnar to PIP, superficial to collateral ligaments, prevents dorsal displacement of lateral bands

Oblique retinacular ligament (Of Landsmeer): from volar P2 to dorsal P3, coordinates PIP and DIP joint motion

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Deep fascial spaces of hand

Midpalmar space
Thenar space
Hypothenar space
Interdigital web space
Parona’s space (at wrist)

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Extensor compart of wrist

1: APL, EPB
2: ECRL, ECRB
3: EPL
4: EDC and EIP
5: EDM
6: ECU

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Position of EPL in at the level of the extensor retinaculum

Ulnar to Listers tubercule

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Position of EIP and EDM relative to EDC

Both ulnar to EDC

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Name of connections between EDC tendons

Juncturae tendinum

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Extensor zones

1: DIP
2: P2
3: PIP
4: P1
5: MCP
6: MC
7: wrist
8: distal 1/3 forearm
9: proximal 2/3 forearm

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Thumb extensor zones

1: over IP
2: over P1
3: over MCP
4: over MC
5: over carpal bones

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Flexor tendon zones

Zone 1: distal to FDS insertion
Zone 2: distal to A1
Zone 3: distal to carpal tunnel
Zone 4: above carpal tunnel
Zone 5: proximal to carpal tunnel

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Zones of thumb flexor tendon

Zone T1: Distal to IP joint
Zone T2: distal to A1 pulley
T3: Over thenar eminence
T4: Carpal tunnel
T5: Proximal to carpal tunnel

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Thumb pulleys

A1 and A2 over MCP and IP
Oblique pulley is between both/P1 (most important to prevent bowstringing) run proximal ulnar to distal radial

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Which is the most important pulley in the thumb

Oblique pulley

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Name the two pathway of tendon healing and identify which one causes adhesions

Intrinsic pathway (proliferation of tenocytes)
Extrinsic pathway (invasion of cells from tendon sheath)(adhesions)

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Anomalous interconnections in forearm

Martin-Gruber anastomosis
Riche Cannieu anastomosis

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Describ Martin-Gruber anastomosis
Prevalence
Relevance clinically

Motor fiber connection between medial to ulnar nerve in forearm

Affects 10-25% population

Can cause preserved ulnar nerve motor function in the hand after high ulnar injury

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Describ RicHe-Cannieu anastomosis

Relevance clinically

Motor fiber connection from ulnar to median nerve in Hand

Common

Can result in preserved thenar motor function after median nerve injury

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Describe Marinacci anastomoses

Rare anomalous intercommunication from the ulnar nerve to the median nerve in the forearm

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What are the dominant arteries for each finger

D1: UDA
D2: UDA
D3: UDA
D4: RDA
D5: RDA

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Define Vincula

Fold of mesotenon in tendon sheath that anchors tendon to bone and contains receive direct blood supply from transverse digital arteries

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Name and identify the location of the three volar communicating branch of the digital arteries and the associated vinculum

Proximal transverse palmar arch, proximal to PIP, gives vineculum longum profundus and vineculum brevis superficialis

Middle transverse palmar arch, proximal to DIP, gives vineculum brevis profondus

Distal transverse palmar arch at the level of the lanula

There is also a vinculum longus superficialis proximal P1 from direct branch of proper digital artery

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Name a specialized neuromyoarterial receptor in fingertip and its clinical application

Glomus body

Functions to control blood pressure and thermoregulation

Can give rise to painful glomus body tumor

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Structure comprise dans la perionychium (4)

Nail fold
Nail plate
Nail bed
Hyponychium

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Define Hyponychium

Junction sterile matrix of nail bed and skin beneath distal nail margin

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Define paronychium

skin on each side of the nail/lateral nail fold

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Define eponychium

Skin proximal to nail that covers nail fold

Why is the lanula white

due to persistance of nail cell nuclei in the germinal matrix

Difference between germinal and sterile matrix and specific localisation of each

Germinal: proximal to lanula, distal to extensor tendon, reponsible for 90% of nail production Sterile: nail bed distal to lanula, responsible for nail plate adherence, secondary site of nail production

3 location of nail growth

1) germinal matrix 2) sterile matrix 3) dorsal roof of nail fold

How/through which machanism does the germinal matrix produce the nail

gradient parakeratosis

Rate of nail growth and time to grow a complete nail

Rate: 3-4mm/month 100 days

4 conditions that increase speed of nail growth

Longer digit Summer months Young person Nail bitters

2 components of nail fold

1) ventral floor: germinal matrix 2) dorsal roof: host cells that cause nail shine

quel % de la population a une arcade palmaire superficielle provenant seulement de l'artère ulnaire

39%

quel % de la population a une arcade palmaire superficielle parfaitement communicante radiale-ulnaire

35%

quel % de la population a une arcade palmaire superficielle provenant de l'artère ulnaire + médiane + radiale

quel % de la population n'a pas de communication entre art radiale et ulnaire au niveau de l'arcade palmaire superficielle (vascularisation des doigts séparément, PAS d'arcade proprement dite)

16%

quel % de la population a les 3 artères (R + U + M) qui vascularise les doigts séparément SANS communication en arcade palmaire superficielle

quel % de la population a: -communication radio-ulnaire typique de l'arcade palmaire profonde

35%

Différence des muscles bellies of FDS and FDP

FDP: common muscle belly (except D2 which is separated) FDS: individual muscle belly

Arrangement of flexor tendons in carpal tunnel

FDS: D3 and D4 at superficial to D2 and D5 FDP is deep

Innervation of FDP tendon

D2 and D3: AIN D4 and D5: Ulnar nerve

Configeration, origin, insertion, innervation and action of lumbricals

D2 and D3: unipennate, origin from radial side FDP, insert extensor expansion hood (radial lateral band), median nerve D4 and D5: bipennate, origin from radial and ulnar side FDP, insert extensor expansion hood (radial lateral band), ulnar nerve Action: main extensor of IP, weak flexor of MCP

Name structure of extensor hood

Proximal: sagital bands, lateral bands Central slip Distal: oblique retinacular ligament, triangular ligament

Accessory head of FPL name, origin and associated complication

Gantzer muscle Origin: medial epicondyle and coronoid process of ulna AIN compressive neuropathy

Explain location or annular and cruciate pulleys

A1: MCP A2: P1 C1: proximal to PIP A3: PIP C2: distal to PIP A4: P2 C3: proximal to DIP A5: DIP

Most important pulleys and why

A2 and A4 pulleys Prevents bowstringing the most

What makes up the A0 pulley (2)

Transverse fibers of palmar aponeurosis Vertical septa of Legeu and Juvara

3 structure the makes a tendon

Endotenon (inner) Epitenon (outer) Paratenon (most outer)

2 mechanism for tendon vascular supply, which is dominant

1: Direct vascular supply 2. Synovial diffusion (dominant)

What are the 3 source of direct vascular supply to tendon, and localisation relative to the tendon

Myotendinous junction (proximal tendon) Osteotendinous junction (distal tendon) Connective tissues (mid tendon)

3 connective tissue structures that vascularise the tendon

Paratenon Mesotenon Vincula

% of population that does not have D5 FDS

7-20%

Name and describe the variant connection between hand flexor tendons and its incidence

Linburg-Comstock variant Between FPL muscle belly/tendon and FDP D2 8-35% of population

Palmar interossei, # of units, bi vs unipennate, insertion, action, innervation

3 units unipennate Inserts on lateral bands Adducts, flex MCP, extend IP Ulnar nerve

Dorsal interossei, # of units, bi vs unipennate, insertion, action, innervation

4 units bipennate Inserts on lateral bands Abducts, flex MCP, extend IP Ulnar nerve

Sagital bands: origin and insertion and function (2)

Origin from intermetacarpal plate and insert on dorsal hood above MCP Prevent lateral subluxation of extensor tendons, prevents MCP joint hyperextension

Name 3 anomalous extensor muscle and their implication

Extensor carpi radialis intermedius (can be used in tendon transfer) Extension medii proprius Independent extensor of middle finger (can be used for sagital bands injuries) Extensor digitorus, brevis manus, often between 2nd and 3rd metacarpal

Structure of nerve from outside to inside (6)

Mesoneurium (loose areolar tissue) Epineurium--> recouvre nerf principal Perineurium --> recouvre fascicule Endoneurium--> recouvre axones

Blood supply of nerves (3)

Vasa nervorum Extrinsic vessels Capillary plexus

À quoi sert un nœud de Ranvier?

- Gap junctions de Cellules de Schwann - Conduction saltatoire - Plus rapide

Nommer les structures innervées par le AIN

FDP D2D3 FPL PQ articulation radiocarp et radioulnaire

Définir la ligne de Kaplan

Ligne reliant le 1er webspace et le crochet de l'hamatum

Quelles structures anatomiques retrouve-t-on a/n de la ligne de Kaplan

-Arcade palamaire profonde -Rebord distal du ligament transverse du carpe - branche récurrente n. médian

Comment repérer anatomiquement la branche récurrente du nerf médian

Jonction entre la ligne de kaplan et une ligne suivant l'axe du bord radial du majeur

Comment localiser anatomiquement l'arcade palmaire superficielle

Tout juste proximal à une ligne reliant le distal et proximal transverse palmar crease

2 muscles responsables de la rotation externe de l'épaule

Infraépineux Teres minor

4 muscles responsables de la rotation interne de l'épaule

Teres major Subscapularis Latissimus dorsi Pectoralis major

Principal muscle responsable de stabiliser la scapula

Serratus antérieur

Quel nerf innerve: serratus antérieur

long thoracique

Quel nerf innerve: muscle rhomboid major et minor

scapulaire dorsal

Quel nerf innerve: muscle supra et infra épineux

suprascapulaire

Quel nerf innerve: muscle subscapularis

upper subscapular lower subscapular

Quel nerf innerve: muscle teres major

Lower subscapular

Quel nerf innerve: latissimus dorsi

thoracodorsal

Quel nerf innerve: pec major et minor

pectoral médial pectoral latéral

Quel nerf innerve: muscle deltoide

axillaire

Quel nerf innerve: muscle teres minor

axillaire

3 muscles innervés par le n. musculocutané

Coracobrachialis Biceps brachial Brachialis