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1 MSK > anatomy of the forearms, cubital fossa and hands > Flashcards

anatomy of the forearms, cubital fossa and hands Flashcards

1
Q

what are the 2 parallel bones of the forearm?

A

the radius and ulna

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2
Q

what connects the 2 parallel bones of the forearm?

A

the interosseous membrane

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3
Q

which of the 2 bones of the forearm is the rotating one? which is the stabilising one?

A

ulna → stabilising

radius → pivoting

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4
Q

where does the radius and humorous articulate?

A

elbow joint

  • radial head
  • the capitulum of the humerus
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5
Q

where does the ulna and humorous articulate?

A

elbow joint

  • trochlear notch of ulna
  • trochlea of humerus
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6
Q

what movements happen at the elbow joint?

A

flexion and extension

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7
Q

where is the cubital fossa?

what shape is it?

A

triangular-shaped region anterior to the elbow joint

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8
Q

what are the borders of the cubital fossa?

A

superior - imaginary line between the epicondyles

lateral - brachioradialis muscle

medial - pronator teres muscle

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9
Q

what are the 3 key structures that cross vertically down through the cubital fossa?

A

TAN

  • tendon (biceps brachii)
  • artery (brachial)
  • nerve (median)
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10
Q

name the muscles of the SUPERFICIAL anterior forearm

A
  1. pronator teres
  2. flexor carpi radialis
  3. palmaris longus
  4. flexor carpi ulnaris
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11
Q

what is the action of the pronator teres?

A

it pronates the forearm

  • supinate is palms and forearm facing up holding (bowel of soup)
  • pronate is face down
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12
Q

what are the 2 actions of the flexor carpi radialis

A
  • flexes wrist

- lateral radial deviation (ie. abduction of hand and wrist)

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13
Q

palmaris longus - describe the shape and direction fo travel

A
  • middle, long, big muscle belly - inserts into palmar fascia
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14
Q

what is the action of thepalmaris longus?

A

weak flexor of the wrist

not always present (30% dont have)

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15
Q

what is the action of the flexor carpi ulnaris?

A
  • flexion

- medial ulnar deviation (ie. adduction of hand and wrist)

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16
Q

what nerves innervate the SUPERFICIAL muscles of the anterior forearm ?

A

median nerve -PT,FCR,PL

ulnar nerve - FCU

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17
Q

where do the SUPERFICIAL muscles of the anterior forearm originate from?

A

all originate from medial epicondyle

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18
Q

what is the muscle of the middle anterior forearm?

A

flexor digitorum superficialis

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19
Q

how many tendons does the flexor digitorum superficialishave?

where do they insert?

A
  • 4

- each tendon splits into 2 and these slips insert on either side of the the middle phalanx of digits 2-5

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20
Q

what is the action of the flexor digitorum superficialis(FDS) ?

A

flexes digits 2-5 at MCP joints
(Metacarpophalangeal)
and PIP joints (proximal interphalangeal)

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21
Q

what nerve innervates FDS?

A

median nerve

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22
Q

name the muscles of the DEEP anterior forearm

A
  1. Flexor digitorium profundus
  2. flexor pollicis longus
  3. Pronator quadratus
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23
Q

Flexor digitorum profundus

  • how many tendons arise from this muscle? where do these insert?
A

4 tendons
- travel into the hand
- onto digits 2-5
- pass through the slits in the FDS tendons
-to insert onto the palmar aspect of thedistalphalanx of digits 2-5.
(finger tip area)

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24
Q

what is the action of the Flexor digitorum profundus?

A
  • flexes digits 2-5

- distal interphalangeal joints (DIPS)

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25
Q

what nerve innervates FDP?

A

dual innervation
lateral half - median
medial half - ulnar

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26
Q

what is the action of the Flexor policies longus?

A

flexes the IP joint of the thumb

Interphalangealjoint

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27
Q

what is the insertion of the Flexor pollicis longus (FPL)?

A

inserts onto thedistal phalanxof the thumb.

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28
Q

describe the location and shape of the pronator quadratus muscle?

A

deepest forearm muscle

square shaped

lies over the distal ends of the radius and ulnar

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29
Q

what is the action of the Pronator quadratus?

A

pronates the distal radioulnar joint.

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30
Q

what are the radial and ulnar arteries terminal branches of?

A

subclavian → axillary → brachial → radial and ulnar arteries

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31
Q

where do the superficial and deep veins of the upper limb drain?

A

axillary vein

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32
Q

what are the superficial veins of the upper limb?

A
  • the cephalic vein
  • the basilic vein
  • the communicating median cubitalvein (connects the 2)
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33
Q

what are the deep veins of the upper limb?

A

radial and ulnar

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34
Q

what is the carpal tunnel?

A
  • narrow passageway at the wrist

- entrance to the palm

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35
Q

what are the borders of the carpal tunnel?

A

Floor and sides (=carpal arch)
- the carpal bones

roof
- theflexor retinaculum
(fibrous band that’s attached to carpal bones)

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36
Q

what structures pass through the carpal tunnel?

A
  • the 9 tendons of the anterior forearm

- the median nerve

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37
Q

what is carpal tunnel syndrome?

A

Compression of the median nerve
(very narrow)
weakness and atrophy of the muscles

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38
Q

what are the 8 carpal bones?

A

from lateral proximal row →

Scaphoid
Lunate
Triquatrum
Pisiform

Hamate
Capitate (central)
Trapezoid
Trapezium (thumb)

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39
Q

which carpal bones does the distal radius articulate with? what joint is this?

A
  • the scaphoid
  • the lunate
    = the radio carpal joint
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40
Q

what are the 3 sets of bones in the hand?

A

the carpals
the metacarpals
the phalanges

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41
Q

what is the singular of phalanges?

A

a phalanx

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42
Q

how are the metacarpals labelled?

A

numbered 1-5

1 = thumb 
5 = little finger
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43
Q

how many phalanges make up each digit?

A

digits 2-5 = a proximal, middle and distal phalanx (3)

digit 1 (thumb) = a proximal and distal phalanx (2)

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44
Q

what are the 3 different joint types in the hand?

A
  1. Carpometacarpal, CMC
  2. Metacarpophalangeal. MCP
  3. interphalangeal, IP
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45
Q

what are the interphalangeal joints of the thumb?

A

only 1 because only a proximal and distal phalanx

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46
Q

what are the interphalangeal joints of the digits 2-5?

A

PIP- proximal interphalangeal (between proximal and middle phalanges)

DIP- distal interphalangeal (between middle and distal phalanges)

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47
Q

what are the 3 grips the digits can make?

A

power grip (tight squeeze)

hook grip (eg. carrying bags)

precision grip (pads of thumb and index eg. pen holding)

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48
Q

what are the movements of the digits 2-5?

A

flexion (curl into fist)
extension (back to neural)

abduction (fingers apart)
adduction (fingers together)

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49
Q

what are the movements of digit 1?

A

flexion and extension

  • thumb across palm, think knife hand
  • thumb out to lateral side

abduction and adduction

  • thumb away from palm vertically
  • thumb back to in line with fingers

opposition
-across palm to touch little finger

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50
Q

what structure of the hand makes it so tough and protects the long flexor tendons, tendon sheaths and vessels in the central palm?

A

the palmar aponeurosis

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51
Q

where are the extrinsic and intrinsic muscles of the hand?

A

extrinsic - forearmand their tendons travel into the hand.

intrinsic -origins and insertions arewithinthe hand.

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52
Q

what 2 nerves innervate the intrinsic hand muscles?

A

ulnar and median

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53
Q

what are the 4 groups of intrinsic hand muscles?

A
  1. thenar eminence
  2. hypothenar eminence
  3. lumbricals
  4. interossei
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54
Q

where is the thenar eminence ?

A
  • fleshy mass on the palm of the hand

- at the base of the thumb.

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55
Q

what nerve innervates the muscles of the thenar eminence?

A

the recurrent branch of the median nerve (from carpal tunnel)

56
Q

what are the 3 muscles of the thenar eminence?

what actions do they all do?

A
  1. abductor pollicis brevis (abducts thumb)
  2. flexor pollicis brevis (flexion of thumb)
  3. opponens pollicis
    (opposes thumb)
57
Q

where do each of the muscles of the thenar eminence insert?

A

APB -onto lateral aspect of proximal phalanx of the thumb

FPB - onto Proximal phalanx

OP - onto 1st metacarpal (deepest)

58
Q

where is the hypothenar eminence ?

A

fleshy mass on the medial side of the palm of the hand, proximal to the little finger.

59
Q

what are the 3 muscles of the hypothenar eminence?

what actions do they all do?

A
  1. Flexor digiti minimi (flexes little finger)
  2. Abductor digit minimi (abducts)
  3. opponens digiti minimi (opposes)
60
Q

where do each of the muscles of the hypothenar eminence insert?

A

FDM - onto proximal phalanx of little finger

ADM - onto proximal phalanx

ODM - onto 5th metacarpal

61
Q

what nerve innervates the 3 muscles of the hypothenar eminence?

A

deep branch of ulnar

62
Q

how many lumbrical muscles are there in the hand?

A

one per finger

ie. digits 2-5

63
Q

where do the lumbrical muscles arise from?

A

the tendons of flexor digitorum profundus

64
Q

what side of the digits 2-5 do the lumbrical muscles travel along?

A

the lateral side

65
Q

where do the lumbrical muscles insert onto?

A

the dorsal aspects of digits 2-5

66
Q

what are the actions of the lumbrical muscles?

A

flex the MCP joints + extend IP joints

67
Q

what is the innervation of the lumbrical muscles?

A

same as FDP tendons

dual innervation

  • lateral half (digits 2,3) = median nerve
  • medial half (digits 4,5) = ulnar nerve
68
Q

where are the interossei muscles attached to?

A

lie between the metacarpals

69
Q

what/where are the 2 different groups of interossei muscles?

A

palmar - 3 muscles attached to palmar aspect of digits 2,4,5

dorsal - 4 muscles attached to dorsal aspect of digits 2-5

70
Q

what are the actions of the interossei muscles?

A
  • both groups aid extension at IP joints for digits 2-5
  • Palmar ADduct fingers
  • Dorsal ABduct fingers

PAD-DAB

71
Q

why is the intrinsic hand muscle adductor pollicis not in the thenar eminence?

A
  • it is located in the palm, below the eminence

- innervated by ulnar nerve (not median)

72
Q

where is the adductor pollicis attached?

A

to the 3rdmetacarpal and to the proximal phalanx of the thumb.

73
Q

what are the palmer arches?

A

where the radial and ulnar artereis anastomose deep in the palm

74
Q

what do the palmer arches give rise to?

A

metacarpal and digital arteries that supply the palm and digits.

75
Q

what are the 2 different palmer arches?

A

superficial and deep

76
Q

Cutaneous sensation of the hand is supplied by what 2 different types of nerves?

A
  • peripheral nerves

- dermatomes (spinal nerves)

77
Q

what is a dermatome?

A

a region of skin innervated by asingle spinal nerve

78
Q

what are the peripheral nerves the innervate the skin of the hand?

A

median
ulnar
radial

79
Q

where does the median nerve innervate on the hand?

A

palmar surface of the 3.5 lateral digits
+
dorsal distal phalanges of the 3.5 lateral digits (finger tips)

(thumb, index, middle, half of ring )

80
Q

where does the ulnar nerve innervate on the hand?

A
  • medial 1.5 digits on both palmar and dorsal aspects

half of ring finger, little finger

81
Q

where does the radial nerve innervate on the hand?

A
  • dorsal surface of lateral 3.5 digits as far as the DIP joint

(backs of fingers, but not tips)

82
Q

what are the symptoms of damage to median and ulnar nerves at wrist?

A

sensation to fingers impaired

83
Q

what plexus and spinal nerves innervates the upper limb?

A

the brachial plexus (C5-T1)

84
Q

where does C5 area correspond to?

A

upper lateral arm

regimental badge

85
Q

where does C6 area correspond to?

A

lateral forarm to thumb

86
Q

where does C7 area correspond to?

A

middle finger

87
Q

where does C8 area correspond to?

A

medial border of hand and medial forearm

88
Q

where does T1 area correspond to?

A

medial border of elbow

89
Q

how many layers of muscles are in the posterior forearm compartment?

A

2 layers - superficial and deep

90
Q

what are all the muscles in the posterior forearm compartment innervated by?

A

theradialnerve

91
Q

what are the 6 superficial muscles (lateral to medial) in the posterior forearm compartment?

A
  1. Brachioradialis
  2. extensor carpi radialis longus
  3. extensor carpi radialis brevis
  4. extensor digitorium
  5. extensor digit minimi
  6. extensor carpi ulnaris
92
Q

where do all 6 of the superficial muscles in the posterior forearm compartment originate from?

A

attached proximally to thelateral epicondyleof the humerus

ie. the common extensor origin

93
Q

where does the Brachioradialis muscle insert?

A

distal radius

94
Q

what is the action of the Brachioradialis?

A

weak flexor

95
Q

where do Extensor carpi radialis longus and Extensor carpi radialis brevis insert?

A

both on radial side

  • ECRL inserts onto 2nd metacarpal
  • ECRB inserts onto the 3rdmetacarpal
96
Q

what are the actions of Extensor carpi radialis longus and Extensor carpi radialis brevis?

A

they extend and abduct the wrist ( ie. radial deviation)

97
Q

where does Extensor digitorum insert onto?

A

inserts onto dorsal aspects of fingers (on extensor expansion)

98
Q

what is the action of Extensor digitorum ?

A

extends digits 2-5 via 4 tendons on dorsal aspect

99
Q

what is the action of Extensor digiti minimi?

A

extends the little finger via its insertion onto the dorsum of the little finger (on extensor expansion)

100
Q

where does Extensor carpi ulnaris insert into?

A
  • most medial of the superficial muscles.

- insertion onto the 5th metacarpal.

101
Q

what are the actions of the Extensor carpi ulnaris?

A

It extends and adducts the wrist (ie. ulnar deviation)

102
Q

what is the name of the band of tissue the tendons of the superficial muscles travel under at the wrist?
what is its role?

A

theextensor retinaculum

prevents the tendons from bowing when the wrist is extended.

103
Q

what are the 5 deep muscles of the posterior forearm compartment?
From lateral to medial they are

A
  1. supinator
  2. abductor pollicis longus
  3. extensor pollicis brevis
  4. Extensor pollicis longus
  5. extensor indicis
104
Q

where doe the deep muscles of the posterior forearm compartment originate from?

A
  • attach proximally to forearm bones + interosseous membrane.
  • EXCEPT for supinator
105
Q

where does the supinator originate from?

A
  • proximally to humorous

- wraps around upper radius bone

106
Q

what is the action of the supinator muscle?

A

supinates forearm and hand (face up)

107
Q

where does Abductor pollicis longus insert onto?

A

1st metacarpal (thumb)

so can abduct thumb

108
Q

what is the action and insertion of the Extensor pollicis brevis muscle?

A
  • extends thumb from MCP joint

- via its insertion on the proximal phalanx of the 1st digit

109
Q

what is the action and insertion of the Extensor pollicis longus muscle?

A
  • extends thumb from IP joint

- via its insertion on the distal phalanx of the 1st digit

110
Q

do the EPB and EPL muscle tendons lie superficially of deeply at the wrist?

A

the tendons of EPB and EPL lie superficially at the wrist as they wrap around the distal radius

111
Q

what is the action and insertion of the Extensor indicis muscle?

A
  • inserts onto dorsal aspect of index finger

- allowing independent extension of this digit.

112
Q

what is the extensor expansion?

where is it attached?

what is its role?

A
  • a fibrous structure that overlies dorsal aspect of the digits
  • attached from base of the proximal phalanges
  • fixes tenedons in place
113
Q

what are the 3 ‘slips’ of the extensor expansion ?

A

central slip → inserts on middle phalanx

2 marginal slips → converge on the distal phalanx.

114
Q

what 3 tendons are inserted onto the dorsal aspect of the extensor expansion?

A
  • ED - Extensor digitorum (superficial post)
  • EI - Extensor indicis (deep post)
  • EDM - Extensor digiti minimi (superficial post)
115
Q

what 2 groups of muscles are inserted onto the sides of the proximal parts of the extensor expansion?

A
  • lumbricals

- interossei

116
Q

where is the anatomical snuff box?

A
  • lateral aspect of the wrist,
  • at the base of the thumb,
  • seen when the thumb isextended.
117
Q

what shape is the anatomical snuff box?

A

triangular

118
Q

what are the boundaries of the anatomical snuff box?

A

the deep posterior muscles that move the thumb:

  • the EPL
  • the EPB
  • the APL
119
Q

what important structures run through he anatomical snuff box?

A
  • caphoid on the floor
  • radial artery
  • cephalic vein
  • superiorfial branch of radial nerve runs OVER it
120
Q

what artery supplies posterior Forearm

A

ulnar arteries

121
Q

what veins drain the posterior Forearm?

A

the deep veins

122
Q

what nerve innervates allthe muscles of the posterior forearm?

A

radial nerve

123
Q

what is a potential result of Proximal injuries to the radial nerve (e.g., in the arm)?

A

an inability to extend the wrist and fingers.

124
Q

what nerve innervates skin over:

  • the anatomical snuffbox
  • the skin over thedorsumof thelateral 3 1⁄2 digits as far as the DIP joint
A

the radial nerve (a superficial branch)

125
Q

what type of joint is the shoulder joint?

A

A synovialball and socketjoint

126
Q

what articulations form the shoulder joint?

A

articulation between:
- theglenoid fossaof the scapula
+
-theheadof the humerus.

127
Q

what features of the shoulder joint increase its range of mobility?

A
  • articulates are a poor fit

- joint capsule Is lax

128
Q

what features of the shoulder joint increase its stability?

A
  • ligaments reinforce the joint capsule
  • the rotator cuff
  • tendon of the long head of biceps
129
Q

what type of joint is the elbow joint?

A

A synovialhinge joint

130
Q

what articulations form the elbow joint?

A
  • trochlea of the humerus and thetrochlear notch of the ulna,
  • thecapitellumof the humerus and theradial head
131
Q

what type of joints are theproximal and distal radioulnar joints?

A

Synovial, pivot-type joints between the radius and ulna.

132
Q

what ligament holds the radial head in place whilst it rotates (to produce pronation and supination)?

A

Theanular ligamentof the radius is attached to the ulna and holds the radial head in place.

133
Q

what type of joint is the wrist joint?

A

a condyloid synovial joint

134
Q

what articulations form the wrist joint?

A

articulation of thedistal radiuswith thescaphoidandlunate.

reinforced by ligaments

135
Q

what type of joins are the carpal bone joints?

A

synovial joints, which are reinforced by ligaments.

136
Q

what type of joints are the hand joints?

A

synovial

metacarpophalangeal - condyloid
interphalangeal - hinge

137
Q

what joint is key for the movement of the thumb?

A

Thefirst carpometacarpal(CMC) joint that lies between thetrapeziumand the1st metacarpal (thumb)

saddle joint

1 MSK (4 decks)

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