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Y1S2Anatomy > Anatomy of the wrist joint and palm of the hand > Flashcards

Anatomy of the wrist joint and palm of the hand Flashcards

1
Q

What are the carpal bones and how are they arranged?

A
  • They are the bones between the radius and ulna and the metacarpals
  • 8 Bones arranged in two rows

1) Proximal row:
- Scaphoid
- Lunate
- Triquetrum
- Pisiform

2) Distal row
- Trapezium
- Trapezoid
- Capitate
- Hamate

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2
Q

What is the largest carpal bone?

A

capitate

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3
Q

What type of joint is the wrist joint?

A

Synovial, ellipsoid and biaxial

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4
Q

What are the articulations found in the wrist?

A

1) Distal surface of the radius with the scaphoid and lunate

2) The articular disc (triangular fibrocartilage) separates the head of the ulna from the triquetral bone, the disc firmly binds the lower ends of the ulna and radius together

  • FYI the articulating disc is attached to the styloid process of the ulna and the distal end of the radius from the other side
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5
Q

What are the movements of the wrist?

A

1) Flexion (flexor carpi radialis and flexor carpi ulnaris)

2) Extension (extensor carpi ulnar and extensor carpi radialis)

3) Abduction (flexor and extensor carpi ulnaris)

4) Adduction (flexor carpi radialis)

  • Articulates with the proximal row of carpal bones
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6
Q

What are the different joints found in the hand?

A

1) Wrist joints
2) Midcarpal joints
3) Carpometacarpal joints
4) Metacarpophalangeal joints
5) Interphalangeal joints (Proximal and distal)

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7
Q

Describe the midcarpal joints

A

1) Plane joint

2) Lies between the two rows of carpal bones

3) Allows gliding motion and assists with wrist motions

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8
Q

Describe the carpometacarpal joints

A

1) In the thumb it is a synovial saddle, on the other fingers it is a synovial plane joint (providing more free movement to the thumb)

2) Between the distal row of the carpal and the proximal row of metacarpal bones

3) Provides more of a stability than mobility

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9
Q

Describe the metacarpophalangeal joint

A

1) Knuckle joints

2) synovial ellipsoid/condyloid (condyloid in some resources) joint

3) Between the metacarpals and the base of the proximal phalanges

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10
Q

What are the movements of the metacarpophalangeal joint?

A

1) Flexion
2) Extension
3) Abduction
4) Adduction

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11
Q

Describe the interphalangeal joints

A

1) Synovial hinge

2) Between the phalangeal bone

3) Distal and proximal

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12
Q

What are the ligaments of the wrist joint?

A

1) Anterior radiocarpal ligaments

2) Posterior radio-carpal ligaments

3) Radial collateral ligaments (from radial to scaphoid and trapezium bone)

4) Ulnar collateral ligament (from ulna to pisiform and triquetrum bone)

5) Intercarpal ligaments (connects all carpal ligaments)

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13
Q

What are some of the clinical injuries of the wrist joint?

A

1) Colle’s fracture

2) Fracture of the scaphoid

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14
Q

Describe colle’s fracture

A

1) Fracture of the distal end of the radius

2) Due to the pulling of the muscles in the extensor side, the distal segments will overlap causing a dinner fork deformity of the hand

3) Dinner fork deformity

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15
Q

Describe the fracture of the scaphoid, and what is the commonest complication?

A

1) It is a common site for fracture because its middle part is thinner than its ends

2) A major complication that arises with this bone is that the blood supply of this bone comes from the radial artery from the distal to the proximal end so when a fracture occurs the proximal segment will become necrotic or malunion, it could be further complicated if the patient is diabetic or immunocompromised

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16
Q

What is the carpal tunnel?

A
  • C-shaped structures enclosed by the flexor retinaculum from the palmar side
  • carpal tunnel will form an osseofibrous tunnel that is tight and surrounded by bones and tough ligaments restricting any expansion
  • Problem arises when the intra-carpal tunnel pressure increases compromising structures like the arteries and veins
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17
Q

What are the structures that pass through the carpal tunnel?

A

1) Flexor pollicis longus

2) The four flexor digitorum superficialis

3) The four flexor digitorum profundus

4) Median nerve

5) Tendon of flexor carpi radialis (has a special compartment)

6) Flexor synovial sheaths (ulnar & radial bursa)

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18
Q

What is the carpal tunnel syndrome?

A
  • It happens a lot in types, musicians, manual workers, etc
  • When the median nerve that passes through the tunnel gets compressed
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19
Q

What is the flexor retinaculum?

A

It is a strong band that bridges over the carpal groove turning it into a carpal tunnel

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20
Q

What are the attachment sites of the flexor retinaculum?

A

1) Medially: pisiform and the hook of the hamate

2) Laterally: Splits to be attached to the scaphoid “superficially” and the trapezium “deeply” This will make a special tunnel for the flexor carpi radialis muscle

so the tendon of flexor carpi radialis muscle passes through the retinaculum while all other tendons pass via the carpal tunnel

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21
Q

What structures pass superficial to the wrist from medial to lateral?

A

1) Lateral to the pisiform, ulnar nerve followed by the ulnar artery

2) Lateral to the ulnar artery is the palmar cutaneous branch of the ulna

3) Tendon of palmaris longus

4) Palmar cutaneous branch of the median nerve

5) Superficial branch of radial artery

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22
Q

What is the flexor synovial sheaths?

A
  • They start a bit more proximal to the flexor retinaculum, extending under the carpal tunnel
  • Radial bursa, A separate synovial flexor synovial sheath for the flexor pollicis longus
  • Ulnar bursa extends in the middle of the hand and the pinky finger
  • each finger has its own synovial sheath
  • This is important, especially during the spread of an infection (finger prick injuries)
  • It is found between the tendon and the sheath helping in the sliding motion of the tendon
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23
Q

What are the cutaneous innervation of the hand?

A
  • Our hands are supplied by three nerves (radial, ulnar, and median)

1) Median nerve:
- Supplies the lateral 2/3 of the palm the lateral 3.5 fingers reflecting the back of the hand and supplying half of the 2, 3, & 4 fingers and their nail beds

  • The medial aspect of the dorsum is supplied by the palmar cutaneous branch, while the fingers from the dorsum and the palmar are supplied by the Digital cutaneous branches

2) Ulnar nerve:
- Medial third of the hand
- Medial 1.5 fingers (half of the fourth and the whole fifth finger)
- Medial 1/3 of the dorsum of the hand
- Medial 1.5 of the fingers in the dorsum of the hand

3) Radial nerve:
- Supplies the lateral 2/3 of the dorsum of the hand
- Lateral 3.5 fingers of the dorsum (thumb, 2, 3, and half of fourth) but without the nail bed

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24
Q

Does the palmar cutaneous branch of the median nerve get compressed in case of carpal tunnel syndrome?

A

NO, as it is superficial

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25
Q

What is an eminence?

A

They are swellings found on the hand (Hypothenar eminence “under the pinky” & thenar eminence “under the thumb”), which are made by muscles

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26
Q

What supports the central part of the hand?

A

Palmar aponeurosis helps us in proper gripping which is a continuation of the palmaris longus tendon

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27
Q

What is the fibrous sheath of the flexor tendon?

A
  • Dense plates of fibrous tissue that arches over the flexor tendons of the phalanges
  • Attached to the margins of the phalanges and the palmar IP joints
  • Its distal end is attached to the distal end of the phalanx
  • It runs in a osteofibrous canal that is lined by a synovial sheath
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28
Q

What is meant by intrinsic muscles of the hand? and how many are there?

A

It means that these muscles originate and inserts into the hand, and they are 19

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28
Q

How many layers of muscles do we have in the hand?

A

4

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28
Q

What are the muscles of the first layer of the hand?

A

1) Flexor digiti minimi brevis

2) Abductor digiti minimi

3) Flexor pollicis brevis

4) Abductor pollicis brevis

  • Action (abduction and flexion)
29
Q

What are the muscles of the second layer of the hand?

A
  • Below the first layer

1) Opponens pollicis

2) Opponens digiti minimi

3) Adductor pollicis (originates from the metacarpal of the thumb and inserts into the medial side of the fingers)

(function opposition of thumb and pinky “which is 3 movements flexion, abduction and medial rotation”, and adduction of the thumb)

30
Q

What are the muscles of the third layer of the hand?

A

1st, 2nd, 3rd & 4th lumbricals

origin (lateral aspect of the flexor digitorum profundus tendons)

insertion (dorsal expansion of the extensor tendon)

1st & 2nd are unipennate innervated by the median nerve

3rd and 4th are bipennate “originates from both sides of the profunda tendon” innervated by the ulnar nerve

  • Action, when it contracts it will cause flexion of the metacarpophalangeal and at the same time cause extension of the finger due to it being inserted into the extensor expansion giving us the writing position
31
Q

Why do we not give children in 3-4 years pencils?

A

As their lumbricals are weak and still not developed and we do not want to damage it

32
Q

What are the muscles of the 4th layer of the hand?

A
  • 8 muscles in the metacarpal bones
  • 4 palmar interossei that lie between the metacarpal bones (originates from the metacarpals and inserts into the proximal phalanx)
  • 4 dorsal interossei (originates from the adjoining sides of 2 metacarpals and inserts into the proximal phalanx)
  • Middle finger lacks the palmar interossei and has two dorsal interossei
  • Action: palmar adduction, dorsal abduction
33
Q

What is the origin of the abductor pollicis brevis?

A

Flexor retinaculum & scaphoid + crest of trapezium

34
Q

Where does the abductor pollicis brevis insert?

A

Lat. side of the base of the proximal phalanx of thumb

35
Q

What is the action of the abductor pollicis brevis?

A

1) Abduction

2) Medial rotation of the thumb

36
Q

What is the origin of the flexor pollicis brevis muscle?

A

Flexor retinaculum & crest of trapezium

37
Q

Where does the flexor pollicis brevis insert?

A

Lat. side of the base of the proximal phalanx of thumb

38
Q

What is the action of flexor pollicis brevis?

A

1) Flexion of thumb

2) Medial rotation of the thumb

39
Q

What is the origin of opponens pollicis?

A

Flexor retinaculum & crest of trapezium

40
Q

Where does the opponens pollicis insert?

A

Lat. border & palmar surface of 1st metacarpal

41
Q

What is the action of opponens pollicis?

A

1) Flexion of the thumb

2) Medial rotation of the thumb to touch the tip of other fingers

42
Q

What is the origin of abductor digiti minimi?

A

Pisiform & piso-hamate lig. & flexor retinaculum

43
Q

Where does the abductor digiti minimi insert?

A

The medial side of the base of the proximal phalanx of little finger

44
Q

What is the action of the abductor digiti minimi?

A

Abducts the little finger

45
Q

What is the origin of the flexor digiti minimi brevis?

A

Hook of hamate & flexor retinaculum

46
Q

Where do the flexor digiti minimi brevis inserts?

A

Med. side of base of proximal phalanx of little finger

47
Q

What is the action of flexor digiti minimi brevis?

A

Flexes the little finger to deepen the hollow of the hand

48
Q

What is the origin of opponens digiti minimi?

A

Hook of hamate & flexor retinaculum

49
Q

Where do the opponens digiti minimi inserts?

A

Med. margin & palmar surface of shaft of 5th metacarpal

50
Q

What is the action of the opponens digiti minimi?

A

Laterally rotates the pinky & flexes the little finger

51
Q

What is the origin of the adductor pollicis muscle?

A

Oblique head from capitate & base of 2nd & 3rd metacarpals, & Transverse head from palmar surface of 3rd metacarpal

52
Q

Where do adductor pollicis muscle inserts?

A

The medial side of the base of the proximal phalanx of the thumb

53
Q

What is the action of the adductor pollicis muscle?

A

Adducts the thumb

54
Q

What is the origin of the 4 lumbrical muscles?

A

1) 1st & 2nd from the lat. margin of the lat. tendons of flexor digiti profundus

2) 3rd & 4th by two heads from the adjacent margins of the med. 3 tendons

55
Q

Where do the 4 lumbricles insert?

A

They join the extensor expansion

56
Q

What is the action of the 4 lumbricles?

A

1) Flexion of the metacarpal joints

2) Extension of the interphalangeal joints

57
Q

What is the origin of the 4 palmar interossei muscles?

A

A single head from the 2nd, 4th & 5th metacarpals

58
Q

Where do the 4 palmar interossei muscle inserts?

A

In the extensor expansion

59
Q

What is the action of the 4 palmar interossei muscle?

A

1) Adducts the fingers towards the 3rd finger

2) Flexion of the MCP joint

3) Extension of the interphalangeal joint

60
Q

What is the origin of the 4 dorsal interossei muscles?

A

By the two heads of the adjacent metacarpal bones

61
Q

Where do the 4 dorsal interossei muscles insert?

A

1) 1st into the lateral side of the index finger

2) 2nd & 3rd to the side of the middle finger

3) 4th into the medial side of the ring finger

62
Q

What is the action of the dorsal interossei?

A

1) Abduction

2) MCP joint flexion

3) Extension of the IP joint

63
Q

What is the innervation of the muscles of the hand?

A

All of the are supplied by the ulnar nerve (15 muscles) except 5 are supplied by the median nerve

64
Q

Which muscles of the hand are supplied by the median nerve?

A

3 thenar muscles

1st & 2nd lumbricals

The median nerve enters deep in the retinaculum but its superficial branch supplies the palm while the nerve itself supplies the digits

65
Q

What is meant by ape hand?

A

It is a lesion to the median nerve leading to the atrophy of the thenar muscles and the patient would not be able to perform the opposition movement

66
Q

What are the sites of ulnar nerve injury?

A

1) Elbow

2) Wrist

67
Q

What will happen if the ulnar nerve is injured?

A

the ulnar nerve enters the hand superficial to the retinaculum and lateral to the pisiform, any compression that happens to it will lead to the paralysis of the 15 muscles it supplies

  • Causes partial claw hand deformity
  • We perform the card test as the most important muscles that are supplied by the ulnar nerve are the abductors and adductors of the hand
68
Q

Describe the arterial blood supply of the hand

A
  • The hand is supplied by two arteries radial and ulnar, each dividing into a superficial and a deep branch
  • They will join together forming 2 arches:
    1) Deep palmar arch
  • Princeps pollicis artery (thumb)
  • Radial artery of index finger (2nd finger)

2) Superficial palmar arch will give:

  • common palmar digital arteries (supplies the fourth and fifth finger)
  • Proper palmar digital arteries (supplies the 2nd and 3rd fingers)
69
Q

Describe the superficial palmar arch

A
  • Formed mainly by the ulnar artery
  • Superficial to the long flexor tendon deep to the palmar aponeurosis
  • On the lateral side of the hand the arch is completed by anastomosing with the superficial branch of the radial artery
70
Q

Describe the deep palmar arch

A
  • Formed mainly by the radial artery
  • Penetrates the origin of the thenar muscles, then it passes between the two heads of the adductor pollicis, running in the deep plane of the palm (across the bases of the metacarpal bones, from lateral to medial) to anastomose with the deep branch of the ulnar artery.
71
Q

Describe the venous drainage of the hand

A

we have two main veins, which start from the hand;

  • It starts as the dorsal venous arch and then branches into two veins:

1) Cephalic from the lateral “radial” side

2) Basilic from the medial “ulnar” side

Y1S2Anatomy (18 decks)

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