Anatomy of hand

Question 1

Palmar branch of both the median and ulnar Travels Superficial to the ______ _________ this portion of the median nerve usually remains functioning during carpal tunnel syndrome

Answer 1

flexor retinaculum

Question 2

The radial nerve: superficial branch to dorsal aspect of the

Answer 2

proximal 3 ½ lateral fingers (to about middle phalanges)

Question 3

The median nerve supplies the

Answer 3

proper palmar digital nerves to distal 3 ½ lateral fingers

Question 4

The ulnar nerve supplies the

Answer 4

Dorsal branch of the ulnar nerve: emerges from under the flexor carpi ulnaris tendon, on the medial aspect of the distal forearm, and winds around the wrist to provide cutaneous innervation to the dorsal aspect of the 1½ medial fingers

Question 5

Recall that the cephalic vein originates from the lateral aspect and the ______ from the medial aspect of the dorsal venous arch

Answer 5

basilic

Question 6

Median cubital vein joins the _______ vein to the basilic vein in the superficial fascia of the cubital fossa.

Answer 6

cephalic

Question 7

lymphatics: Lateral side: empty into the __________ which then drain to the apical nodes of the axilla

Answer 7

infraclavicular nodes

Question 8

lymphatics: Medial side of the hand and forearm can drain directly into the

Answer 8

lateral group of axillary nodes or to the cubital (supratrochlear) nodes before draining in the lateral group of nodes.

Question 9

Dupuytren’s Contracture

Answer 9

Is a localized thickening and contracture of the palmar aponeurosis. •A condition in which the medial part of the palmar aponeurosis undergoes progressive shortening •It commonly starts near the root of the ring finger and draws that finger into the palm, flexing it at the metacarpophalangeal joint. •Later, the condition involves the little finger in the same manner. •In long standing cases, the pull on the fibrous sheaths of these fingers (little and ring) results in flexion deformity of the proximal interphalangeal joints . •The distal interphalangeal joints are not involved and are actually extended by the pressure of the fingers against the palm. •Surgical division of the shortened part of the aponeurosis is done to straighten the bent fingers

Question 10

Attachments of Flexor retinaculum

Answer 10

Medially: hook of the hamate & pisiform bones, but volar carpal ligament encloses ulnar nerve and vessels. Laterally: to scaphoid & trapezium, but splits to enclose tendon of flexor carpi radialis tendon

Question 11

Structures passing superficial to Flexor retinaculum:

Answer 11

Ulnar nerve & vessels, palmaris longus tendon, palmar cutaneous branch of median and ulnar nerves, superficial palmar branch of radial artery

Question 12

Structures passing deep to Flexor retinaculum:

Answer 12

Median nerve, tendons of flexor digitorum superficialis and profundus with ulnar bursa, tendon of flexor pollicis longus with radial bursa.

Question 13

Extrinsic muscles are responsible for _____ movements of hand

Answer 13

crude

Question 14

intrinsic muscles control ____ movements of hand

Answer 14

fine

Question 15

Intrinsic Muscles of the Hand

Answer 15

-Thenar (thumb) -Hypothenar (little finger) muscles -Interossei muscles (four dorsally and three anteriorly) originating between the metacarpal bones -Lumbrical muscles arising from the deep flexor (and are special because they have no bony origin) to insert on the dorsal extensor hood mechanism.

Question 16

Thenar Eminence (Intrinsic Muscles of the Hand)

Answer 16

• Abductor pollicis brevis - Flexor pollicis brevis - Opponens pollicis brevis All these muscles act on the thumb. They are all supplied by the median nerve

Question 17

Hypothenar Eminence (Intrinsic Muscles of the Hand)

Answer 17

• Abductor digiti minimi - Flexor digiti minimi - Opponens digiti minimi All act on little finger They are supplied by ulnar nerve

Question 18

Lumbricals (Intrinsic Muscles of the Hand)

Answer 18

• Each lumbrical tendon inserts on the lateral side of the corresponding extensor (dorsal digital) expansion (on the dorsal aspect of the MCP joint). • First 2 lumbricals have one head whereas the 3rd and the 4th have 2 heads •Flex the MP joints and extend the IP joints. •1st and the 2nd are supplied by the median nerve, 3rd and 4th are supplied by the ulnar nerve.

Question 19

Dorsal Interossei (Intrinsic Muscles of the Hand)

Answer 19

• bipennate - 4 dorsal and are numbered from lateral to medial side - Abduct the index, middle and ring fingers ( DAB), also flex the MP joints and extend the IP joints of these 3 fingers. - Innervated by ulnar nerve.

Question 20

Palmar Interossei (Intrinsic Muscles of the Hand)

Answer 20

• unipennate - Are 4 (sometimes 3), numbered from lateral to medial side. -Adduct the index, ring and little fingers (PAD), also flex the MCP joints and extend the IP joints of these 3 fingers. - Innervated by ulnar nerve.

Question 21

Superficial palmar arch: Formed by (Palmar Arches Deep & Superficial)

Answer 21

superficial branches of ulnar (2/3 rd ) and radial arteries (1/3 rd)

Question 22

Deep arch: Formed by (Palmar Arches Deep & Superficial)

Answer 22

deep branches of radial (2/3rd and ulnar arteries (1/3 rd)

Question 23

The superficial arch is very superficial, just deep to the __________ (Palmar Arches Deep & Superficial)

Answer 23

palmar aponeurosis.

Question 24

Laceration of palm can cause severe bleeding. -Bleeding can be controlled by clamping (Palmar Arches Deep & Superficial)

Answer 24

the brachial artery against humerus, not by compressing the radial or ulnar or both arteries (because of connection between palmar & dorsal arches)

Question 25

Ulnar artery passes (superficial/deep) to the flexor retinaculum, (medial/lateral) to the ulnar nerve and pisiform (Superficial Palmar Arch)

Answer 25

superficial lateral

Question 26

Radial artery swings from the anterior aspect of the wrist to the lateral side and then posterior aspect of the hand by passing beneath the tendons of ______________ and \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 26

abductor pollicis longus and extensor pollicis muscles (both longus and brevis)

Question 27

Divides between the two heads of the first dorsal interosseous muscle to pass between the ________ and ________ heads of the adductor pollicis muscle.

Answer 27

transverse and oblique

Question 28

Fascial spaces of the hand

Answer 28

Palmar spaces: 1) Superficial palmar spaces 2) Deep palmar spaces (divides into: Mid palmar space and Thenar space) 3) Pulp spaces

Question 29

Deep Palmar Arch: deep to the _______ tendons but anterior to the metacarpal bones and \_\_\_\_\_\_

Answer 29

long flexor tendons interosseous muscles

Question 30

Mid-palmar space Superficial Boundaries:

Answer 30

Palmar aponeurosis Superficial palmar arch Flexor tendons of medial 3 fingers

Question 31

Mid-palmar space deep Boundaries:

Answer 31

Fascia covering 3rd & 4th interosseus space

Question 32

Mid-palmar space medial Boundaries:

Answer 32

Medial palmar septum

Question 33

Mid-palmar space lateral Boundaries:

Answer 33

Mid palmar septum

Question 34

Mid-palmar space proximal Boundaries:

Answer 34

distal margin of the flexor retinaculum

Question 35

Mid-palmar space distal Boundaries:

Answer 35

Distal palmar crease & continues with 3 rd & 4 th web space

Question 36

Mid-palmar space distal Boundaries:

Answer 36

Distal palmar crease & continues with 3rd & 4th web space

Question 37

Thenar space Superficial boundaries:

Answer 37

Palmar aponeurosis Superficial palmar arch Flexor tendons index finger

Question 38

Thenar space deep boundaries:

Answer 38

Fascia covering adductor pollicis muscle

Question 39

Thenar space medial boundaries:

Answer 39

Mid palmar septum

Question 40

Thenar space lateral boundaries:

Answer 40

Lateral palmar septum

Question 41

Thenar space proximal boundaries:

Answer 41

distal margin of the flexor retinaculum

Question 42

Thenar space distal boundaries:

Answer 42

Distal palmar crease & continues with 1st web space

Question 43

Incision for draining the abscess if Pus in the mid palmar space

Answer 43

drain 3rd or 4th web space

Question 44

Incision for draining the abscess if Pus in the thenar space

Answer 44

drain 1st web space along the radial side of index finger.

Question 45

Digital Pulp Spaces is the space between

Answer 45

skin & distal phalanx of each finger

Question 46

Digital Pulp Spaces is the space between

Answer 46

skin & distal phalanx of each finger

Question 47

Digital Pulp Spaces is Traversed by

Answer 47

fibrous septa & contain fat & blood vessels

Question 48

Infection of the pulp space is known as

Answer 48

WHITLOW/FELON which is associated with severe throbbing pain

Question 49

Infection of the pulp space is drained by (lateral/medial) incision.

Answer 49

lateral incision.

Question 50

If Infection of the pulp space is neglected, it leads to _______________ of the distal 4/5th of distal phalanx (proximal 1/5 th remains unaffected).

Answer 50

“avascular necrosis”

Question 51

Median Nerve Passes between the __________ and \_\_\_\_\_\_\_\_\_\_, deep to the palmaris tendon

Answer 51

flexor digitorum superficialis and the flexor carpi radialis

Question 52

Median Nerve Passes under the \_\_\_\_\_\_\_\_

Answer 52

flexor retinaculum

Question 53

Median Nerve divides into 2:

Answer 53

Common palmar digital nerves

Question 54

Two common palmar digital branches dividing into

Answer 54

proper palmar digital nerves

Question 55

Innervation to 1st and 2nd lumbrical

Answer 55

Median Nerve

Question 56

Injury of median nerve at different levels cause different syndromes: At the wrist:

Answer 56

Injury by compression at the carpal tunnel causes carpal tunnel syndrome

Question 57

Injury of median nerve at different levels cause different syndromes: In the hand,

Answer 57

thenar muscles are paralyzed and will atrophy over time.

Question 58

Ulnar Nerve is Superficial to the \_\_\_\_\_\_\_\_but runs distally in a groove between the pisiform and the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 58

flexor retinaculum hook of the hamate (tunnel of Guyon)

Question 59

Ulnar Nerve In the palm, it divides into a _________ branch and a ______ branch

Answer 59

superficial and deep

Question 60

Superficial branch of ulnar nerve: (innervations)

Answer 60

motor to a small muscle, the palmaris brevis, and cutaneous to the medial aspect of the medial 1 ½ fingers

Question 61

Deep branch of ulnar nerve: to the (innervations)

Answer 61

3 hypothenar muscles, all dorsal and palmar interossei muscles, the 2 most medial lumbrical muscles and the adductor pollicis

Question 62

Injury to Ulnar Nerve In the tunnel of Guyon:

Answer 62

lose the cutaneous innervation to the palmar aspect of their medial 1 ½ fingers and ability to contract all the intrinsic muscles of the hand, except for the 5 muscles innervated by the median nerve Flexor and extensor extrinsic muscles will be unopposed and the fingers will take the very characteristic position of the “clawed • All interossei are paralyzed: the MCP joint present in an extended position with both PIP and DIP joints in flexion • Only 2 medial lumbrical muscles are paralyzed: contribute to this position but note that the extension at the MCP and flexion at both the DIP and PIP of the index or ring and middle fingers will be less dramatic. Why? • Adductor pollicis brevis is non

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