ANATOMY OF THE HAND Flashcards
What is the carpal tunnel?
- narrow passageway on anterior portion of the wrist
- provides access to palm for tendons and the median nerve
The carpal tunnel is a narrow passageway on anterior portion of the wrist that provides access to palm for tendons and the median nerve. What tendons of which 2 flexor muscles does this allow access to?
1 - flexor digitorum profundus and extensor digitorum
2 - flexor digitorum profundus and flexor digitorum superficialis
3 - flexor digitorum profundus and extensor carpi ulnaris
4 - flexor digitorum profundus and flexor carpi radialis
2 - flexor digitorum profundus and flexor digitorum superficialis
The carpal tunnel is a narrow passageway on anterior portion of the wrist that provides access to palm for tendons and the median nerve. What are the 4 bones that line the base of the carpal tunnel. This can be remembered by the second half of the mnemonic for the carpal bone, That They Cant Handle?
- That = Trapezium
- They = Trapezoid
- Cant - Capitate
- Handle = Hamate with hook of hamate
What are the 3 basic groups of bones in the hands?
1 - carpals
2 - metacarpals
3 - phalanges (digits) (thumb is digit 1)
Label the carpal bones of the hand below:
Trapezium Trapezoid Capitate Hamate Scaphoid Lunate Triquetrum Pisiform
1 - Scaphoid 2 - Lunate 3 - Triquetrum 4 - Pisiform 5 - Trapezium 6 - Trapezoid 7 - Capitate 8 - Hamate
Using the mnemonic below, what are the 8 carpal bones of the hand?
Some Lovers Try Positions That They Can’t Handle
1 - Some – Scaphoid 2 - Lovers – Lunate 3 - Try – Triquetrum 4 - Positions – Pisiform 5 - That – Trapezium 6 - They – Trapezoid 7 - Can’t – Capitate 8 - Handle – Hamate
What 4 carpal bones are included in the proximal row? (Closest bones to the radius and ulna)
1 - Scaphoid
2 - Lunate
3 - Triquetrum
4 - Pisiform
What 4 carpal bones are included in the distal row?
1 - Trapezium (remember trapeZIUM sounds like thumb)
2 - Trapezoid
3 - Capitate
4 - Hamate
Which carpal bone is most commonly injured?
- scaphoid
- largest bone in proximal row and articulates with the radius
Which 4 bones make up the base of the carpal tunnel? The mnemonic below may help:
That
They
Cant
Handle
1 - Tipping = trapezium
2 - Trains = trapezoid
3 - Can = capitate
4 - Hurt = hamate
The roof of the carpal tunnel is formed by what fibrous band?
- flexor retinaculum
There are 2 muscles, each of which have 4 tendons that pass through the carpal tunnel at the wrist. Which 2 muscles are these?
1 - flexor digitorum profundus and flexor digitorum superficialis
2 - flexor carpis ulnaris and flexor digitorum superficialis
3 - flexor digitorum profundus and pronator teres minor
4 - flexor carpis ulnaris and flexor policies longus
1 - flexor digitorum profundus and flexor digitorum superficialis
Which tendon for the thumb passes through the carpal tunnel?
1 - abductor pollicis brevis
2 - flexor pollicis longus
3 - flexor pollicis brevis
4 - extensor pollicis longus
2 - flexor pollicis longus
- remember it runs with the FDP and FDS in anterior compartment
Which nerve passes through the carpal tunnel?
1 - median nerve
2 - ulnar nerve
3 - radial nerve
4 - axillary nerve
1 - median nerve
There are 5 joints if the hand. Label them using the labels below:
Interphalangeal Wrist Metacarpophalangeal Carpal (midcarpal) Carpometacarpal
1 - Wrist
2 - Carpal (midcarpal)
3 - Carpometacarpal (carpal to metacarpal)
4 - Metacarpophalangeal (metacarpal to phalanges)
5 - Interphalangeal (between phalangeal joints)
What type of joint is the wrist?
- synovial joint (diarthroses = freely moveable)
- specifically a condyloid joint
What bones articulate to form the wrist joint?
- radius with lunate and scaphoid
The ulnar bone does not form part of the wrist joint, instead it connects to a fibrocartilaginous ligament, called the articular disc, which then comes into contact with which 2 carpal bones?
1 - lunate and trapezoid
2 - lunate and saphoid
3 - triquetrum and lunate
4 - triquetrum and hamate
3 - triquetrum and lunate
The wrist allows 4 movements, what are they?
- flexion and extension
- adduction and abduction
Clinically adduction and abduction are not really used. What terms are used instead?
- adduction = ulnar deviation (move towards the ulnar bone)
- abduction = radial deviation (move towards the radial bone)
Which 2 forearm muscles facilitate wrist abduction (radial deviation)?
1 - Flexor carpi radialis and flexor carpi ulnaris
2 - Flexor carpi ulnaris and carpi radialis longus and brevis
3 - Flexor carpi radialis and Extensor carpi radialis longus and brevis
4 - Extensor carpi radialis longus and brevis
3 - Flexor carpi radialis and Extensor carpi radialis longus and brevis
Which 2 forearm muscles facilitate wrist adduction (ulnar deviation)?
1 - Flexor carpi radialis and flexor carpi ulnaris
2 - Flexor carpi ulnaris and extensor carpi ulnaris
3 - Flexor carpi radialis and Extensor carpi radialis longus and brevis
4 - Extensor carpi radialis longus and brevis
2 - Flexor carpi ulnaris and extensor carpi ulnaris
Which 3 muscles of the forearm facilitate flexion at the wrist?
1 - Flexor carpi radialis
2 - Flexor carpi ulnaris
3 - Palmaris Longus
Which 2 muscles of the forearm facilitate extension at the wrist?
1 - Extensor carpi radialis longus and brevis
2 - Extensor carpi ulnaris
Carpal joints are those between the carpal bones of the hand. What type of joint are these?
- synovial plane joints
- biaxial movements (amphiarthroses)
What bones make up the carpometacarpal joints?
- carpal and metacarpals
What type of joints are carpometacarpal joints, and what is the one exception to this?
- digits 2-5 are synovial plane joints
- digit 1 (thumb) is a saddle joint
What carpal bone meets the digit I (the thumb) forming a saddle joint?
- trapzIUM as it sounds like thumb
What movements are possible at the saddle joint of the thumb?
- flexion/extension
- adduction/abduction
- rotation
- circumduction
What joint and what movements are possible at the metacarpophalangeal joints?
- synovial condylar joint
- Flexion / Extension
- Abduction / Adduction
- Circumduction
- Limited rotation
What joins the metacarpophalangeal joints and ensures limited range alone, essentially they tend to move together?
- collateral ligaments
What type of joint and what movements are possible at the interphalangeal joints, both proximal and distal interphalangeal?
- PIPs = proximal interphalangeal joint
- DIPs = distal interphalangeal joint
- synovial hinge joint
- flexion/extension
The palmaris longus is a long flexor superficial muscle of the anterior forearm. This has an origin at the medial epicondyle of the humerus, then inserts into what in the hand?
- forms Palmar Aponeurosis
The palmaris longus is a long flexor superficial muscle of the anterior forearm. This has an origin at the medial epicondyle of the humerus, then inserts into the hand forming the Palmar Aponeurosis. What is the Palmar Aponeurosis?
- a thick fascia connecting to the skin
- provides a semirigid barrier between the palmar skin and the important underlying neurovascular and tendon structures
Which muscles and which compartment do the muscles that flex the interphalangeal joints (proximal and distal) sit in?
- Flexor Digitorum Superficialis (FDS) superficial tendons
- Flexor Digitorum Profundus (FDP) deep tendons
- both sit in the anterior compartment of the forearm
There are 2 muscles that sit in the anterior compartment of the forearm that flex the interphalangeal joints (proximal and distal) as below:
- Flexor Digitorum Superficialis (FDS) superficial tendons
- Flexor Digitorum Profundus (FDP) deep tendons
- both sit in the anterior compartment of the forearm
Which nerve innervates these, also the same nerve that passes through the carpal tunnel?
- median nerve all
- ulnar nerve innervates FDS medial head, ulnar nerve innervate 1/2 of digit 4 (medial side) and all of digit 5
The hands have multiple fibrous sheaths. What is the purpose of these sheaths?
- stop tendons from bolstering out
- allows smooth movement of the fingers
Each finger has fibrous arches and cruciate ligaments that are anchoring them to the bones. What is the purpose of these?
- ensure fingers are held together
There are 2 muscles that sit in the anterior compartment of the forearm that flex the interphalangeal joints (proximal and distal) as below:
- Flexor Digitorum Superficialis (FDS) superficial tendons
- Flexor Digitorum Profundus (FDP) deep tendons
- both sit in the anterior compartment of the forearm
Which parts of the fingers do the FDS and FDP actually help move?
- FDP = distal phalanx - remember deep goes to distal
- FDS = middle phalanx
There are 2 muscles that sit in the anterior compartment of the forearm that flex the interphalangeal joints (proximal and distal) as below:
- Flexor Digitorum Superficialis (FDS) superficial tendons act on middle phalanx
- Flexor Digitorum Profundus (FDP) deep tendons act on distal phalanx
- both sit in the anterior compartment of the forearm
As the FDP is further along the finger than the FDS, what is formed allowing the FDP tendons to reach the distal phalanx?
- campers chiasm is formed
- FDP passes through the FDS
Which muscle flexes the metacarpophalangeal joint (MCPJ) and the interphalangeal joints (IPJ) of the thumb?
- MCPJ = Flexor Pollicis Brevis
- IPJ = Flexor Pollicis Longus
Which muscle of the posterior forearm is responsible for extending the digits of the fingers at both the metacarpophalangeal and interphalangeal joints (proximal and distal) joints?
- extensor digitorum
- through a hood mechanism
The extensor digitorum located in the posterior forearm is responsible for extending the digits of the fingers at both the metacarpophalangeal and interphalangeal joints (proximal and distal) joints. However, there is an accessory extensor of the index finger and the little finger. located in the posterior compartment of the forearm. What are these muscles called?
- little finger = extensor digiti minimi
- index finger = extensor indices
Which muscle in the hand has no bony attachment?
- lumbrical
- attach to FDP and extensor hood
The lumbricals have no bony attachment. Instead they attach to the tendons of the FDP and extensor hood. What joints and movements do the lumbricals facilitate?
- flexion at the metacarpophalangeal joint
- extension at the PIP and DIP joints
The anatomical snuffbox is a location close to the thumb that is important for ensuring tendons and muscles do not bow out of the hand. There are 3 tendons that mark the border of the snuff box. Using the labels below, label the image:
extensor pollicis longus
abductor pollicis longus
extensor pollicis brevis
1 - extensor pollicis longus
2 - extensor pollicis brevis
3 - abductor pollicis longus
The anatomical snuffbox is a location close to the thumb that is important for ensuring tendons and muscles do not bow out of the hand. There are 3 tendons that mark the border of the snuff box as we can see in the image below. What are the 3 main components that pass through the snuff box?
1 - ulnar artery, superficial branch of radial nerve, cephalic vein
2 - radial artery, superficial branch of ulnar nerve, cephalic vein
3 - radial artery, superficial branch of ulnar nerve, basilic vein
4 - radial artery, superficial branch of radial nerve, cephalic vein
4 - radial artery, superficial branch of radial nerve, cephalic vein
Which 2 muscles extend the metacarpophalangeal (MCPJ) and interphalangeal (IPJ) joints of the thumb?
1 - Extensor Pollicis Brevis (EPB) and Extensor Pollicis Longus (EPL)
2 - Extensor Pollicis Brevis (EPB) and Flexor Pollicis Longus (FPL)
3 - Flexor Pollicis Brevis (FPB) and Flexor Pollicis Longus (FPL)
4 - Flexor Pollicis Brevis (FPB) and Extensor Pollicis Longus (EPL)
1 - Extensor Pollicis Brevis (EPB) and Extensor Pollicis Longus (EPL)
Which 2 muscles abduct the thumb?
1 - Abductor Pollicis Longus (APL)
2 - Abductor Pollicis Brevis (APB)
Which 2 nerve root innervates the intrinsic muscles of the hands?
- deep branch of ulnar nerve which is supplied by T1 and a little of C8
- median nerve innervates the thenar muscles
Which 3 muscles make up the hypothenar muscles?
1 - flexor digiti minimi, opponens digiti minimi, adductor digiti minimi
2 - flexor digiti, opponens digiti longus, abductor digiti minimi
3 - extensor digiti minimi, opponens digiti minimi, adductor digiti minimi
4 - flexor digiti minimi, opponens digiti minimi, abductor digiti minimi
4 - flexor digiti minimi, opponens digiti minimi, abductor digiti minimi
Which 3 muscles make up the thenar muscles?
1 - Abductor Pollicis Brevis, Opponens Pollicis, Flexor Pollicis Brevis
2 - Adductor Pollicis Brevis, Opponens Pollicis, Flexor Pollicis Longus
3 - Abductor Pollicis Brevis, Flexor Pollicis Brevis, Flexor Pollicis Longus
4 - Adductor Pollicis Brevis, Opponens Pollicis, Flexor Pollicis Longus
1 - Abductor Pollicis Brevis, Opponens Pollicis, Flexor Pollicis Brevis
The palmer brevis muscle is located on the palm of the hand close to the little finger. Most of the intrinsic muscles of the hand are innervated by the deep branch of ulnar nerve, however, the palmer brevis is one exception to this. Which nerve innervates this muscle?
1 - median nerve
2 - superficial branch of ulnar nerve
3 - radial nerve
4 - axillary nerve
2 - superficial branch of ulnar nerve
The palmer brevis muscle is located on the palm of the hand close to the little finger. Most of the intrinsic muscles of the hand are innervated by the deep branch of ulnar nerve, however, the palmer brevis is one exception to this and is innervated by the superficial ulnar nerve. What is the origin and insertion of this muscle?
1 - origin = palmer aponeurosis, insertion = skin of medial hand
2 - origin = scaphoid bone, insertion = skin of medial hand
3 - origin = pisiform bone, insertion = skin of medial hand
4 - origin = flexor retinaculum, insertion = skin of medial hand
1 - origin = palmer aponeurosis, insertion = skin of medial hand
The palmer brevis muscle is located on the palm of the hand close to the little finger. Most of the intrinsic muscles of the hand are innervated by the deep branch of ulnar nerve, however, the palmer brevis is one exception to this and is innervated by the superficial ulnar nerve. What is function of this muscle?
- tightens palmer aponeurosis when contracted
- means grip becomes tighter as well
What are the interossei muscles?
- intrinsic muscles of the hand located between the metacarpals
- set of dorsal and a set of palmer interossei
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. How many palmer interossei are there?
1 - 1
2 - 2
3 - 3
4 - 4
3 - 3
- origin = lateral and medial surfaces of the metacarpals
- insertion = extensor hood and proximal phalanx of each finger
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. There are 3 palmer interossei. Where are these 3 muscles located?
1 - between digits 1, 2 and 3
2 - between digits 2 and 3, 3 and 4 and 4 and 5
3 - between digits 1 and 2 and 4 and 5
4 - between digits 1 and 2 and 3 and 4
2 - between digits 2 and 3, 3 and 4 and 4 and 5
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. There are 3 palmer interossei located between digits 2 and 3, 3 and 4 and 4 and 5 as below. What are the origin and insertions of these muscles?
1 - origin = metacarpals, insertion = lateral proximal phalanx
2 - origin = carpal bones, insertion = lateral proximal phalanx
3 - origin = metacarpals, insertion = distal proximal phalanx
4 - origin = carpal, insertion = lateral distal phalanx
1 - origin = metacarpals, insertion = lateral proximal phalanx
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. There are 3 palmer interossei located between digits 2 and 3, 3 and 4 and 4 and 5 as below. What nerve innervates these intrinsic muscles?
1 - radial nerve C7-C8
2 - ulnar nerve C8-T1
3 - median nerve C8-T1
4 - deep branch of the ulnar nerve C8-T1
4 - deep branch of the ulnar nerve C8-T1
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. There are 3 palmer interossei located between digits 2 and 3, 3 and 4 and 4 and 5. Using the menmonic PAD, what action do these muscles facilitate?
- adduction
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. These muscles originate and insert as below, and are innervated by the deep ulnar nerve.
- origin = lateral and medial surfaces of the metacarpals
- insertion = extensor hood and proximal phalanx of each finger
There are 2 groups of these muscles, what are the 2 groups?
- dorsal interossei muscles
- palmer interossei muscles
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. How many dorsal interossei muscles are there?
1 - 2
2 - 3
3 - 4
4 - 5
3 - 4
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. There are 4 dorsal interossei muscles. Where are they located?
- between all digits
- not on the lateral borders of the minimi or the pollicis
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. There are 4 dorsal interossei muscles. What nerve innervates these intrinsic muscles?
1 - radial nerve C7-C8
2 - ulnar nerve C8-T1
3 - median nerve C8-T1
4 - deep branch of the ulnar nerve C8-T1
4 - deep branch of the ulnar nerve C8-T1
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. These muscles originate and insert as below, and are innervated by the deep ulnar nerve.
- origin = lateral and medial surfaces of the metacarpals
- insertion = extensor hood and proximal phalanx of each finger
There are 2 groups of these muscles, the dorsal and palmer interossei muscles. The mnemonic DAB helps remember the movement here, what does DAB stand for?
- D = Dorsal
- AB = ABduct
- NOTE - not thumb or little finger
The interossei muscles are the intrinsic muscles of the hand located between the metacarpals. These muscles originate and insert as below, and are innervated by the deep ulnar nerve.
- origin = lateral and medial surfaces of the metacarpals
- insertion = extensor hood and proximal phalanx of each finger
There are 2 groups of these muscles, the dorsal and palmer interossei muscles. The mnemonic PAD helps remember the movement here, what does PAD stand for?
- P = Palmer
- AD = ADduction
The lumbricals are deep muscles of the hand that flex the metacarpophalangeal joints and extend the interphalangeal joints (PIP and DIP). There are 4 of these muscles, and are the only muscle in the hand that does not attach to a bone. What are these muscles attached to?
- flexor digitorum profundus (FDP)
- extensor hood
The thumb is able to adduct independently from the other digits, and it has 2 heads. What is this muscle called and which nerve innervates this?
- Adductor (adduction) Pollicis (means thumb)
- deep branch of ulnar nerve
The thumb is able to adduct independently from the other digits, and it has 2 heads. What is the origin and insertion of adductor pollicis muscle?
1 - origin = capitate and metacarpal bone 3, insertion = medial proximal phalanx
2 - origin = hamate and metacarpal bone 2, insertion = medial proximal phalanx
3 - origin = capitate and metacarpal bone 2, insertion = medial proximal phalanx
4 - origin = hamate and metacarpal bone 3, insertion = medial proximal phalanx
1 - origin = capitate and metacarpal bone 3, insertion = medial proximal phalanx
The little finger and thumb are unique from the other digits in that they have 3 separate muscles and are called the hypothenar muscles. Label the 3 muscles of the thumb using the labels below:
Abductor Pollicis Brevis
Opponens Pollicis
Flexor Pollicis Brevis
1 = Flexor Pollicis Brevis 2 = Abductor Pollicis Brevis 3 = Opponens Pollicis
The thumb and title finger are unique from the other digits in that they have 3 separate muscles. The 3 muscles of the thumb can be seen below and are called the thenar muscles. What is this group of muscles called and which nerve innervates this group of muscles?
Abductor Pollicis Brevis
Opponens Pollicis
Flexor Pollicis Brevis
- thenar muscles
- innervated by deep branch of the median nerve
The little finger and thumb are unique from the other digits in that they have 3 separate muscles. Label the 3 muscles of the little finger using the labels below:
Abductor Digiti Minimi
Flexor Digiti Minimi
Opponens Digiti Minimi
1 = Flexor Digiti Minimi 2 = Abductor Digiti Minimi 3 = Opponens Digiti Minimi
The little finger and thumb are unique from the other digits in that they have 3 separate muscles. The 3 muscles of the little finger can be seen below.
Abductor Digiti Minimi
Flexor Digiti Minimi
Opponens Digiti Minimi
What is this group of muscles called?
- Hypothenar Muscles
What are the 2 arteries supplying the hand?
- ulnar artery forms the superficial palmer arch
- radial artery forms deep palmer arch
The 2 main arteries supplying the hand are the ulnar and radial arteries. What do each of the supply in the hand?
- ulnar = little finger, ring, middle & medial half of index
- radial = thumb and lateral half of index
The blood that drains from the hand can drain via either the superficial or deep veins. What are the 2 superficial veins that the blood of the hand drains into, the same 2 that are present in the forearm?
1 - basalic vein
2 - cephalic vein
Other than the basilic and cephalic vein that drain blood from the hand, what are the other veins in the hand named after?
- accompanying arteries
Label the nerve roots on the image for the dermatome, keeping in mind the dermatome is where a single nerve root innervates a specific part of the skin:
C3 C4 C5 C6 C7 C8 T1 T2
1 = C3 2 = C4 3 = C5 4 = C6 5 = C7 6 = C8 7 = T1 8 = T2
What are the 4 mains nerves of the hand?
1 = median 2 = ulnar 3 = radial 4 = superficial cutaneous
