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Musculoskeletal System > Clinical Anatomy Of The Wrist And Hand > Flashcards

Clinical Anatomy Of The Wrist And Hand Flashcards

1
Q

Explain in detail, the basics of the wrist joint

A

Synovial joint between the distal end of the radius and ulna with the carpal bones

- Radius articulate with scaphoid and lunate
- Radioulnar disc articulates with the lunate and triquetrum

Intercarpal joints

  • synovial joints shared a single capsule
  • limited movements but contributes to the positioning of the hand in flexion, extension, abduction and flexion
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2
Q

What is the function of the wrist joint?

A

Allows movement of the hand around two axes
-flexion and extension

-Abduction (lateral deviation) and adduction (medial deviation)

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3
Q

What are the bones of the wrist?

A

Proximal row- lateral to medial

  1. Scaphoid
  2. Lunate
  3. Triquetrum
  4. Pisiform(pea shaped)

Distal row- lateral to medial

  1. Trapezium
  2. Trapezoid
  3. Capitat: articulate with the base metacarpal III
  4. Hamate- hook on Palmer surface
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4
Q

Summarize joints and bones of the hand

A

1st carpometacarpal(CMC) joint between trapezium and base of thumb -saddle joint which permits flexion, extension, abduction, adduction, and opposition of the thumb

2nd to 5th carpomatcarpal (CMC) joints only permits limited gliding movements

Metacarpopharyngeal (MCP)- joints permits flexion, extension, abduction and adduction of digits

Interpharyngeal(IP) joints permits flexion and extension

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5
Q

What is the anatomical snuff box?

A

A triangular depression formed on the poster lateral side of the wrist

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6
Q

What are the borders and contents of the anatomical snuff box?

A

Lateral border

  • abductor pollicus longus
  • extensor pollicis brevis

Medial border:
-extensor pollicis longus

Roof:

  • Superficial branch of the radial nerve
  • cephalic vein

Floor:

  • Scaphoid and trapezium
  • distal ends of the tendons of ECRL & ECRB

Contents: radial artery

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7
Q

What are the clinical consequences of delaying treatment if anatomical snuff box falling on his outstretched hand?

A

Nonunion, avascular necrosis of proximal portion

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8
Q

Explain boxers fracture

A

Impaction fracture of the neck fifth metacarpal (sometimes can involve fourth metacarpal )

  • Usually commipunicated
  • Usually because of a direct blow with a clenched fist against a solid surface
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9
Q

What is Colle’s fracture?

A

Fracture of the distal radius with posterior displacement of the distal

Dinner fork deformity

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10
Q

What is Smith’s fracture?

A

Garden spade deformity

Fracture of the distal radius with anterior displacement of the distal fragment

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11
Q

What is the scaphoid fracture?

A

Usually around the Neck. MaY lead to avascular necrosid of the proximal fragment

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12
Q

What is carpal tunnel ?

A

The carpal tunnel is formed anteriorly at the wrist

Floor: deep arch formed by the carpal bones

Roof: flexor retinaculum

Contents: the tendons of FDS, FDP FPL, & the median nerve

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13
Q

Describe Guyon’s Canal

A

Roof: palmar canal ligament

Floor: flexor retinaculum and hypothenar muscles

Contents: ulnar nerve artery and vein

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14
Q

What are the compartments of the hand?

A

Midpalmar (central)- contains long flexor tendons, lumbricals, palmar arches

Thenar eminence- contains FPL tendon and three thumb muscles. Recurrent median nerve

Hypothenar eminence- Contains three little finger muscles and deep motor branch of the ulnar nerve

Four interosseous spaces- palmar and dorsal interosseous muscles. Deep motor division of the ulnar nerve

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15
Q

Explain Dupuytren’s Contracture

A
  • Flexion contracture of the hand
  • Thickening and contraction of the palmar aponeurosis
  • nodule formation
  • unable to extend fingers
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16
Q

How can Dupuytren’s contracture be treated?

A
  • Needle aponeurotomy is a minimally invasive technique where the cords are weakened through the insertion and manipulation of a small needle. Once weakened, the offending cords may be snapped by simply pulling the finger(s) straight
  • Surgical- cutting out thickened and contracted bands in palmar aponeurosis
17
Q

What are the tendon sheaths of the hand?

A
  • Fibrous digital tendon sheaths
  • Synovial sheaths
  • Radial bursa
  • Ulnar bursa

Clinical correlate: trigger finger (stenosing tnsynovitis)

18
Q

What are the fibrous digital tendon sheaths ?

A

Dense connective tissue surrounding tendons of FDP, FDS, & FPL muscles

Hold tendons to the phalanges and prevent bowing

19
Q

What are the synovial sheaths of the hands?

A

Within the fibrous sheath the tendon has a synovial sheath directly surrounding it

20
Q

What is the radial bursa?

A

Synovial sheath surrounding the tendon of FPL continuing through to carpal tunnel

21
Q

What is th Ulnar bursa

A

Common flexor sheath

Synovial sheath surrounding the tendons of FDP &. FDS of 5th digit continuing through the midpalmar space and into the carpal tunnel

22
Q

What is trigger finger(stenosing tenosynovitis)?

A
  • fibrosis and tightening of the fibrous digital sheath of the flexor tendons at the level of the metacarpophalangeal (MCP) joint
  • Inflammation and nodule formation of the flexor tendons

-Triggering of the affected finger is due to tendons requiring excessive force to fully extend or flex
(Clinical correlate: inflammation of synovial sheaths)

23
Q

What are extensor sheaths

A

Tendons of extensor digitorum and extensor pollicus longus expand over the proximal phalanx, makes a “hood” which then divides into a central band and 2 lateral bands

Serves as an attachment for:

  • lumbricals
  • dorsal interossei
  • palmar interossei
  • due to attachment, these muscles also extend at the interphalangeal joint
24
Q

List the intrinsic muscles of the hand

A

Hypothenar group-deep branch of the ulnar nerve
1. Flexor digiti minimi

  1. Abductor digiti minimi
  2. Opponents digiti minimi

Lumbricals

Thenar group: recurrent branch of the median nerve
1. Flexor pollicis brevis

  1. Abductor pollicis brevis

Oppnens pollicis

25
Q

What are the functions of the dorsal interosseous ?

A

Abduction of digits

Extension of digits

Deep branch of the ulnar nerve

One part inserts inti dorsal hood, another part inserts into base of proximal pharynx

26
Q

What is the function of the palmar interosseous?

A

Adduction

Extension of digits

Deep branch of the ulnar nerve

Inserts into dorsal expansion

27
Q

What is the function of the adductor pollicis?

A
  • Adducts the thumb

- deep branch of the ulnar nerve

28
Q

What is the blood supply of the superficial palmar arch?

A

Mainly from ulnar artery

29
Q

What is the blood supply of the deep palmar arch?

A

Mainly from radial artery

Come back fir clinical correlate- Allen test

30
Q

Briefly describe veinous drainage of the hand

A

Superficial veins:
-On the dorsum of the hand, the dorsal venous network coalesces on the medial side of the wrist to form the basilic vein and on the lateral side of the wrist to form the cephalic vein

Deep vein:
Superficial and deep venous palmar arches accompany arterial Palmer arches in the hand

Drain into the paired radial and ulnar veins

31
Q

Summarize general lymphatic drainage of the upper limb

A

Can be divided into deep & superficial

Follows the same path of veinous drainage of the upper limb

All lymphatics drain to the axillary nodes

Superficial drainages veins within the skin and superficial fascia

  • medial hand, forearm and arm
    • Lymphatic fluid will go to lateral (humeral) axillary nodes then to central axillary nodes, then finally to Apical axillary nodes

Lateral hand, forearm and arm
-lymphatic fluid will go directly to the Apical axillary nodes

All lymph then pass from Apical to Subclavian trunk to lymphatic /thoracic duct

32
Q

Discuss deep drainage of the upper limb

A

Deep drainage: veins within the compartments

-Lymohatic fluid from the compartments of hand, forearm, and arm will go to lateral (humeral) nodes, then to central then finally to Apical

All lymph then pass from Apical to Subclavian trunk to lymphatic/thoracic duct

Musculoskeletal System (41 decks)

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