Elbow, Wrist, & Hand Flashcards
On the medial and lateral distal end of the humerus it flares out and this area is known as the medial and lateral _____ (also known as pillars). When you think of pillars you think of support and holding forces from collapsing.
condyles
At the end of the condyles are the medial and lateral ____.
epicondyles
The (distal/proximal) end of the humerus inclines anteriorly and that incline anteriorly is essential for full range of motion.
distal
On the anterior surface of the humerus, we have the ____ fossa which is on the medial side and we have the ____ fossa on the lateral side.
coronoid; radial
• On the anterior surface of the distal humerus we have the articular surfaces of the elbow and on the lateral side we have the _____ that looks kind of like a ball.
Capitellum
On the anterior surface of the distal humerus we have the articular surfaces of the elbow and on the medial side we have this hour glass shaped figure called the ____.
trochlea
The ___ fossa is on the posterior aspect of the distal humerus.
olecranon
There is a little groove next to the trochlea on the medial side called the _____ groove which is where the ulnar nerves run.
ulnar
The most proximal process on the ulna is the _____ process which has a pointy protrusion on the posterior aspect (the point of your elbow).
olecranon
From an anterior view/surface, the olecranon process makes up on one half of the ____ notch.
trochlear
On the most proximal end on the ulna there is a process called the ____ process which makes up the other half of the trochlear notch.
coronoid
The _____ notch is the semi-circle between the olecranon process and the coronoid process and this notch is where the distal humerus sits.
trochlear
The ____ sits in the trochlear notch.
trochlea
There is an important ridge running down the olecranon process and up the coronoid process. The ridge inside the _____ notch sits in the groove of the trochlea and that geometric congruity between the two bones facilitates motion in the (frontal/sagittal) plane.
trochlear; sagittal
The ____ notch is where the radius articulates on the forearm
radial
The proximal epiphysis of the radius has what is called the radial head and the entire surface of this radial head is covered in ____ cartilage which is hyaline cartilage.
articular
The neck of the radius is (smaller/larger) in circumference than the radial head itself.
smaller
There is a roughened area on the anteromedial side of the radius called the ____ tuberosity.
radial
The sharp ridge coming down the anterior surface of the radius is an attachment site to the ____ membrane.
interosseous
The ulnar tuberosity is an attachment for the ____ .
brachialis
There is a ridge running down both the ulna and the radius, it is an attachment point for the _____ membrane.
interosseous
The distal end of the radius flares out and the flare is more to the dorsal side and more to the lateral side. The flare creates half of the surface of the ____ joint and creates what is called a biconcave joint which is a synovial joint.
radiocarpal
On the cubital fossa, forming the superior part of the triangle is an imaginary line from the _____ to the ____ .
medial epicondyle to the lateral epicondyle
On the cubital fossa, running medially is the ______ muscle, running laterally is the _____ muscle.
pronator teres; brachioradialis
• Inside on the floor of the cubital fossa is the _____ muscle coming down to the forearm and attaching to the ulnar tuberosity and just lateral to it is the _____ muscle.
brachialis; supinator
What runs in the cubital fossa apart from the muscles discussed?
Blood vessels and nerves
When you flex the elbow all the way, the ____ ____ goes into the coronoid fossa, just like the radial head attaches laterally to the capitellum and it is going to go up and bump into the radial fossa.
coronoid process
The trochlea and the trochlear notch dictates motion of the ____ joint because it has that ridge and sits in a groove, locks it in place, makes it very stringent to a single plane.
elbow
There is a (soft/hard) end feel between the biceps brachii, the brachialis, and the forearm muscles.
soft
In extension of the elbow there is a (bony/soft) end feel because it is bone against bone.
bony
The elbow joint is a ____ joint.
synovial
The elbow joint capsule is pretty (large/small).
large
What joints makeup the elbow?
The ulnohumeral joint, radiohumeral joint, & the proximal radioulnar joint
The elbow joint capsule surrounds (all/half) of the joints that makeup the elbow
all
There is a (loose/tight) elbow joint capsule anteriorly and posteriorly.
loose
The loose elbow joint capsule anteriorly allows us to get to full (extension/flexion), the loose joint capsule posteriorly allows us to get to full (flexion/extension).
extension; flexion
The anterior elbow joint capsule will only be put on tension during full (extension/flexion). The posterior elbow joint capsule will be put on tension during full (flexion/extension).
extension; flexion
Medially and laterally the elbow joint capsule is under tension and it is reinforced medially and laterally by (ligaments/tendons)
ligaments
The elbow joint is pretty much a (hinge/saddle) joint and its’ goal is to keep it in the (frontal/sagittal) plane.
hinge; sagittal
The ____ joint is the only joint in the body where you have muscle fibers going over the joint capsule and is pretty much attached to the anterior capsule. This is important because when someone fractures or dislocates their elbow they are at very high risk for a flexion contracture of their elbow and we hypothesize that there must be something in relation to the brachialis muscle articulating with the anterior capsule.
elbow
How many flexors are in the anterior compartment of the arm?
3
How many extensors are in the posterior compartment of the arm?
2
The main extensor in the posterior compartment of the arm is the ____ and the other extensor is the ____ .
triceps brachii; anconeus
The ____ nerve innervates the posterior compartment of the arm
radial
The _____ nerve innervates the anterior compartment of the arm
musculocutaneous
Based on the triceps being on the posterior compartment of the arm you should automatically know that they are innervated by the _____ nerve
radial
Based on the brachialis being on the anterior compartment of the arm you should automatically know that they are innervated by the _____ nerve
musculocutaneous
The medial collateral ligament of the elbow is also known as the ___ collateral ligament.
ulnar
Pitchers end up with (ucl/lcl ) injuries more than any other athlete.
ucl
The ulnar collateral ligament is an important ligament for (stability/mobility) of the elbow.
stability
The ulnar collateral ligament of the elbow has how many bands? Name them.
3; The anterior band, posterior band, & a transverse band
The ulnar collateral ligament’s apex is on the (medial/lateral) epicondyle of the elbow.
medial
The anterior band of the ulnar collateral ligament runs to the ___ process
coronoid
The posterior band of the ulnar collateral ligament runs to the _____ process.
olecranon
The transverse band of the ulnar collateral ligament runs between the ____ process and the ____ process.
coronoid; olecranon
The ___ collateral ligament is interesting because most ligaments run from one bone to another while the ulnar collateral ligament runs from one part of a bone to another part of a bone.
ulnar
The ulnar collateral ligament is under tension throughout the range of motion, it is under greater tension in elbow (extension/flexion) than it is in elbow (flexion/extension).
extension; flexion
The (ulnar/radial) collateral ligament is an attachment site for the forearm flexor muscle mass.
ulnar
The innervation of the forearm in the ulnar collateral ligament area is the distal branches of the ____nerve or the ___ nerve.
median; ulnar
The lateral collateral ligament is also known as the ___ collateral ligament.
radial
The distal end of the lateral collateral ligament does not attach to a bone, it attaches to the ___ ligament.
annular
The lateral ulnar collateral ligament is attaching to the ___
ulna
The lateral collateral ligament is a complex composed of what two ligaments?
The lateral collateral ligament and the lateral ulnar collateral ligament
The (lateral/medial) collateral ligament is an attachment site for the lateral forearm muscles.
lateral
Out of all of the elbow joints, only one is in the elbow and that is the _____ joint.
proximal radioulnar
Between the radius and the ulna is the ____ membrane.
interosseous
The proximal radioulnar joint has the (concave/convex) radial notch making contact with the (convex/concave) radial head.
concave; convex
The ____ ligament goes around the radial head.
annular
The ___ ligament runs from the anterior surface of the radial notch all the way around to the posterior edge of the radial notch. It is not a complete circle, but it laps around the radius.
annular
There is a (larger/smaller) circumference of the annular ligament proximally than distally creating a funnel shape
larger
That funnel created by the larger circumference of the annular ligament proximally allows for the larger radial head to stay in position on the radial notch of the ulna because the radial head is too (big/small) to get down to the narrower part of the funnel.
big
The annular ligament (does not/does) attach to the radius.
does not
The annular ligament is made up of dense (regular/irregular) connective tissue.
regular
The radial notch is covered with ____ cartilage which is hyaline cartilage.
articular
The radial head is covered in _____ cartilage.
hyaline
The annular ligament is part ____cartilage and inside the annular ligament there is a ____ lining that the hyaline cartilage on the radial head rubs against which is there to prevent the hyaline cartilage from getting caught in the shearing of tissue on the ligament.
hyaline; synovial
The interosseous membrane between the ___ and ____ is there to support the orientation of the two bones together.
radius and ulna
The radial head sits in the ____ ligament against the radial notch of the ulna and it can’t move other than spinning in place.
annular
The concave surface of the ulnar ___ of the radius will go into pronation and supination and the distal radius will wrap around the ulna.
notch
What bony structure can help you to determine the anterior/posterior orientation of the hand?
The hamate
We have two rows of carpal bones each with ___ bones in them
four
Name the carpal bones in the proximal row of the wrist joint from radial to ulnar
Scaphoid, lunate, triquetrum, and the pisiform
Name the carpal bones in the distal row of the wrist joint from radial to ulnar
Trapezium, trapezoid, capitate, and the hamate
The most proximal region of the wrist joint are the two bumps on the (distal/proximal) end of the forearm on the radius and ulna. The rest of the wrist joint is carpal bones.
distal
How the wrist moves is based on the ____ ____ more so than it is the radius and ulna.
carpal bones
Each of the bones in the two rows of the wrist joint are bound together by (ligamentous/tendinous) attachments in each row.
ligamentous
The ligamentous attachments that bound the bones in the proximal and distal row of the wrist joints are called ______ ligaments.
interosseous
The term interosseous means (in-between/around) two bones and it is usually a ligament that is holding two together in a specific orientation.
in-between
The interosseous ligaments in the proximal and distal row of the wrist joints lead to us having defined joint spaces between the ___ and the ___ bone in between the proximal row and distal row.
radius and the carpal
These interosseous ligaments in the wrist joint hold the carpal bones in their proper orientation.
T or F?
True
Is the radius or ulna larger?
Radius
The (ulna/radius) never actually gets close to the carpal bones. The majority of contact is from the radius.
ulna
The radius from medial to lateral is (concave/convex). The radius from anterior to posterior is (concave/convex). This creates a biconcave joint at the radiocarpal joint.
concave; concave
The tissue that is between the ___ and the ___ bone forms a biconcave system.
ulna; carpal
The primary bone to bone contact with the radius at the radiocarpal joint is between what two bones of the wrist?
The scaphoid and lunate
What two bones of the wrist do not make contact with the radius?
The triquetrum and the pisiform
The abbreviation for TFCC is what?
Trinagular FibroCartilaginous Complex
The reason the TFCC is where it is because the (radius/ulna) is longer than the (ulna/radius) and the ulna needs something to fill the gap.
radius; ulna
How many parts does the TFCC have? Name them.
5; the intraarticular disk (the ulnar carpal disc), the ulnocarpal meniscus homologue, ulnar collateral ligament, extensor carpi ulnaris tendon sheath, & the styloid process of the ulna?
What two parts from the TFCC create a triangle?
The intraartiuclar disk and the ulnocarpal meniscus homologue
The intraarticular disk and part of the ulnocarpal meniscus homologue are attached between what two bones?
The radius and the ulna
The intraarticular disk from the TFCC runs between the distal styloid of the ___ and the medial edge of the ____ .
ulna; radius
The ulnocarpal meniscus homologue runs from the distal styloid process of the ulna and attaches to the triquetrum. It doesn’t attach right to the bottom, it attaches to the ___ collateral ligament and also the (extensor/flexor) carpi ulnaris muscle tendon sheath.
ulnocarpal; extensor
Around the TFCC there is a relationship or attachment to the ____ radioulnar ligament and the ___ radioulnar ligament. They are not apart of the TFCC but they run right around the edge.
palmar; dorsal
The ____ attaches the ulna to the radius and helps prevent separation of the ulna from the radius and also fills the gap between the ulna and the proximal carpal bones.
TFCC
(All/half) of the TFCC is a part of the radiocarpal joint
All
The distal surface of the proximal row of carpals joining with the proximal surface of the distal row of carpals creates the ____ joint.
midcarpal
The ______ joint is generally biconcave and biconvex.
midcarpal
The midcarpal joint from medial to lateral has a (concave/convex) surface on the distal surface of the proximal row of carpals and anterior to posterior they are (concave/convex) as well. On the proximal surface of the distal row they are (convex/concave).
concave; concave; convex
The ___ joint and the _____ joint act similarly in terms of general function of the wrist.
radiocarpal; midcarpal
The midcarpal joint and the radiocarpal joint are (synovial/fibrous) joints.
synovial
What osteokinematic motions can you perform at the midcarpal joint and the radiocarpal joint?
Flexion/extension, radial/ulnar deviation, & circumduction
Pronation/supination (does not/does) occur at the wrist, it (occurs/does not occur) at the forearm and elbow.
does; occurs
The wrist has (lots/minimal) of ligamentous support. The wrist has a network of dorsal and palmar ligaments.
lots
The palmar ligaments on the wrist are more extensive than the dorsal ligaments because they have (more/less) ligaments in that area.
more
There are medial/ulnar collateral ligaments and lateral/radial collateral ligaments at the wrist, just like in the hand and the elbow and they are going to resist motions accordingly.
T or F
True
The ulnar collateral ligament network of the wrist is going to resist (extension/flexion) of the wrist.
extension
The radial collateral ligament network of the wrist is going to resist (flexion/extension) of the wrist.
flexion
The carpometacarpal (CMC) joints are found more (distally/proximally) than the radiocarpal joints and the midcarpal joints.
distally
When talking about the carpometacarpal joints, for right now we are only talking about what digits?
2-5
The ______ joint is made up of the distal surface of the distal row of carpals and the proximal bases of the metacarpals.
carpometacarpal
The carpometacarpal joints are not concave or convex, they are (irregularly/perfectly) shaped and congruent.
irregularly
(Articular/thick) cartilage goes along each bone on the articular surfaces on the distal surface of the distal row of carpals and in between the proximal bases of the metacarpals. So what you see is articular surface to articular surface, metacarpal to distal carpal bone, the cartilage continues around and goes in between the proximal bases of the metacarpals. This allows for (movement/stability) between the congruent nature of the metacarpal bases.
Articular; movement
There is very (little to no/large) motion between the second and third metacarpal and there is very little motion between the 4th and 5th metacarpal.
little to no
When making a tight fist, the (ulnar/radial) side of your hand moves on the dorsal surface and goes in tighter when the radial side does not. So you get more motion at the carpometacarpal joints digits _and _than you do in _and _. Digits 2 and 3 are very (stable/loose) and 4 and 5 have a little bit more (motion/stability).
Ulnar; 4 and 5; 2 and 3; stable; motion
The motion that is occurring between metacarpals is ____ .
sliding
The motion that is occurring between the metacarpal and carpal bone is ____.
sliding
When bones are irregularly shaped and congruent there (won’t be/will be) a concave/convex rule.
won’t be
What is resisting the sliding movements in the wrist?
The dorsal and palmar ligamentous networks surrounding those joints.
Metacarpals _and _ play a huge role in the arch support of the hand and that is why they can’t move.
2 and 3
The first carpometacarpal (CMC) joint is the articular surface between the ___ and the base of the ____ metacarpal.
trapezium; first
The first carpometacarpal joint is a (saddle/fibrous) joint.
saddle
There is a (concavity/convexity) from anterior to posterior on the trapezium and a (convexity.concavity) from medial to lateral on the trapezium.
concavity; convexity
There is a (convexity/concavity) from anterior to posterior on the base of the first metacarpal and a (concavity/convexity) from medial to lateral on the base of the first metacarpal.
convexity; concavity
The trapezium at the thumb is rotated 90 degrees from the rest of the thumb (remember that when reviewing motions of the thumb, particularly the flexion/extension & adduction/abduction) so flexion/extension of the thumb occurs around in the ___plane and adduction/abduction of the thumb occurs in the ___ plane.
frontal; sagittal
(Adduction/flexion) of the thumb is bringing your thumb closer to your index finger.
Adduction
(Flexion/abduction) of the thumb is bringing your thumb in the direction of the pinky.
flexion
The articular surfaces and the ligaments around the first carpometacarpal joint are relatively (loose/tight) so it allows for a lot more motion than we see in the CMC joints 2-5.
loose
The trapezium at the thumb being rotated 90 degrees allows our thumb to be (mobile/static).
mobile
The ____ joint is the boxers knuckle, the one you punch with.
metacarpophalengeal
For all 5 metacarpophalangeal joint digits there is a rounded distal head of each metacarpal. It is more rounded (anterior to posterior/medial to lateral) and less rounded (medial to lateral/anterior to posterior).
anterior to posterior; medial to lateral
The anterior potion of the articular surface of the rounded distal head of the MCP joint extends further (anterior/posterior) than it does (posterior/anterior).
anterior; posterior
There is an (anterior/posterior) inclincation at the MCP joint that we don’t see (posteriorly/anteriorly).
anterior; posteriorly
The head of the metacarpal joins up with a biconcave face of the proximal ____.
phalynx
If you look at the proximal phalynx of all 5 digits, you will see it is concave (medial to lateral/anterior to posterior) and we can see anterior to posterior it is (convex/concave).
medial to lateral; convex
Flexion and extension of the MCP joint moves very (easily/difficulty) and it can also adduct and abduct.
easily
Adduction and abduction is relative to the __ finger for digits 2-5.
middle
The ulna is bigger (proximally/distally) and the radius is bigger (distally/proximally)
proximally; distally
The main feature of the proximal end of the ulna is the large curved articular surface called the ____ _____ and it articulates with the trochlea of the humerus
trochlear notch
The very proximal end of the ulna is called the ____ which is where the triceps tendon attaches
olecranon
The projection SLIGHTLY distal to the trochlear notch is the ____ _____
coronoid process
Distal to the coronoid process is this rough area called the ____ _____ which marks the insertion for the brachialis muscle
ulnar tuberosity
The small curved surface on the side of the trochlear notch is called the ____ _____ which is where the head of the radius articulates
radial notch
The ____ of the radius is just distal to the head of the radius
neck
The top of the head of the radius articulates with the ____ of the humerus
capitulum
Just distal to the neck of the radius is the ___ _____ which is the insertion for the biceps tendon
radial tuberosity
The forearm bones (radius & ulna) articulate with each other to form what joint?
The proximal radioulnar joint
What two ligaments hold the radial side of the elbow together, but also holds the rotating head of the radius in place against the ulna?
The radial collateral ligament and the anular ligament
The ____ ligament and the ____ ____ provide a perfectly fitting socket for the head of the radius to rotate in.
anular; radial notch
The elbow joint is held together by what two collateral ligaments?
The radial collateral ligament and the ulnar collateral ligament
The radial collateral ligament of the elbow arises from the (lateral/medial) epicondyle and fans out and becomes continuous with the anular ligament.
lateral
The (radial/ulnar) collateral ligament of the elbow and the anular ligament hold the humerus and the radial head securely together
radial
The ulnar collateral ligament arises from the (medial/lateral) epicondyle. It fans out in a triangle and is attached to the ulna all along the medial side of the trochlear notch.
medial
(Rotation/flexion) is coupled at the thumb in flexion/extension, abduction/adduction, and opposition and that occurs because the capsule is loose, the saddle joint concavity and convexity are shallow, and by the pull of the muscle.
rotation
The anterior portion of the metacarpophalangeal head projects (anteriorly/posteriorly), it isn’t perfectly round.
anteriorly
Rotation is possible at the MCP joints, (passive/active) rotation only.
passive
The dorsal aspect of the capsule at the MCP joint blends with the (extensor/flexor) tendon sheath.
extensor
The deep transverse metacarpal ligament is going to bind the heads of metacarpals _ to _.
2 to 5
What is another name for the palmar ligament?
Volar plate
The palmar ligament (volar plate) attaches to the capsule at the ___ joint.
MCP
The volar plate’s (distal/proximal) attachment is thick, strong, and firm, and the (proximal/distal) attachment is thin, wimpy, and weak.
distal; proximal
As the MCP joint moves into flexion the volar plate folds on itself (proximally/distally).
proximally
This idea of this wimpy thin proximal attachment allows for the volar plate to fold on itself as you (flex/extend) your finger. It also allows for the volar plate to move/slide proximally as you (flex/extend) your finger.
flex; flex
The volar plate is an attachment site/anchor for the (flexor/extensor) tendon sheath.
flexor
The collateral ligaments of the MCP joints have two parts: a true portion of the collateral ligament that runs from the ____ head to the base of the (proximal/distal) phalynx and an accessory portion of the collateral ligament that runs from the ____ bone to the ___ plate.
metacarpal; proximal; metacarpal; volar
The collateral ligaments of the MCP joint help (stabilize/promote mobility) the joint and the volar plate.
stabilize
The collateral ligaments play a role in (limiting/promoting) abduction & adduction of the MCP joint.
limiting
How much the collateral ligaments limit abduction & adduction of the MCP joint depends on how much flexion/extension the fingers are in. The (more/less) your fingers are flexed the more the collateral ligaments will limit abduction/adduction.
more
The reason the collateral ligaments of the MCP joint limit abduction/adduction more when your fingers are flexed is because the axis of rotation at this joint is eccentric in its location – it (is not/is) centered.
is not
As the metacarpal head moves from an extended position to a flexed position, the base of the proximal phalynx is getting further away from the proximal attachment of those collateral ligaments of the MCP Joint. So therefore, those collateral ligaments get put on tension as we go into (flexion/extension).
flexion
The articular surfaces of the phalangeal heads of the interphalangeal (IP) joint (proximal, middle, & distal) are all (the same/different).
the same
From side to side the interphalangeal joints are cylinder shaped, they have a central anteriorposterior groove, the base is (concave/convex) anterior to posterior and has an anterior to posterior ridge that goes into the groove of the head of the more (proximal/distal) phalynx which guides flexion/extension.
concave; proximal
The interphalangeal joint has a joint capsule and an associated ____ ligament.
palmar
The palmar ligament at the MCP & IP joint resists (extension/flexion)
extension
The MCP joint, proximal IP joint, & distal IP joint all have a ___ plate.
volar
The IP joints have a true and an accessory collateral ligament and the only difference between the collateral ligaments in this joint compared to the MCP joint is that the relative axis of rotation is (centered/not centered) in this joint and therefore the collateral ligaments are tight and under tension throughout the range of motion in flexion/extension.
centered
You can’t move your IP joints side to side, there is very little play there, so in that case the collateral ligaments are there to stabilize and resist medial and lateral forces to the IP joint and allow them to move strictly in the (sagittal/frontal) plane.
sagittal
The mobile wad (extensor carpi radialis brevis, extensor carpi radialis longus, & brachioradialis) of muscle is in the (posterior/anterior) compartment of the forearm
posterior
Extensors in the arm and forearm are innervated by the ____ nerve.
radial
Flexors of the forearm are innervated by what two nerves?
Median & ulnar nerves
When you flex your wrist, your fingers extend, and when you extend your wrist, your fingers flex. That is a balancing system that allows (active/passive) motion to occur and that is really important because if you have someone that loses innervation of the median and ulnar nerves and can’t flex their fingers actively, if they have extension you can make them extend their wrist and now they can grab something, not small things but large things.
passive
The extensor retinaculum is the thickening at the distal end of the (anterior/posterior) forearm and its fibers are going transversal across the forearm. ‘
posterior
Deep investing fascia of the forearm is called ___ fascia and you have to cut this away to get to the muscles of the forearm. That fascia is a membrane that surrounds the muscles and keeps the muscles in a specific size of the compartment.
antebrachial
Compartment syndromes create a closed (anterior and posterior/medial and lateral) compartment that if there is an injury in there and swelling occurs it could actually put so much compression on the muscle and their associated nerves and the nerves would die or the muscle would die so those are things we have to be careful of when we hear of compartment syndromes.
anterior and posterior
The extensor retinaculum is there and in place to hold the (ligaments/tendons) where they are supposed to be.
tendons
As the extensor retinaculum crosses from medial to lateral and lateral to medial it has septa attached to it and that septa divides the posterior compartment by attaching to the bones (the radius and the ulna) and creating _ individual compartments. This retinaculum is continuous with the deep fascia of the forearm but it is a reinforcement to that fascia to hold those tendons in those _ compartments.
6;6
How many tendons are in compartment 1 of the posterior compartment of the hand and what are the names of the tendon(s) in this compartment?
2; abductor pollicis longus and the extensor pollicis brevis tendon.
How many tendons are in compartment 2 of the posterior compartment of the hand and what are the names of the tendon(s) in this compartment?
2; extensor carpi radialis longus tendon and the extensor carpi radialis brevis tendon.
How many tendons are in compartment 3 of the posterior compartment of the hand and what are the names of the tendon(s) in this compartment?
1; extensor pollicis longus tendon.
How many tendons are in compartment 4 of the posterior compartment of the hand and what are the names of the tendon(s) in this compartment?
2; extensor indicis tendon and the extensor digitorum tendon.
How many tendons are in compartment 5 of the posterior compartment of the hand and what are the names of the tendon(s) in this compartment?
1; extensor digiti minimi tendon.
How many tendons are in compartment 6 of the posterior compartment of the hand and what are the names of the tendon(s) in this compartment?
1; extensor carpi ulnaris tendon.
The (inferior/posterior) compartments of the hand organize the different tendons to where they are going but also provide areas of angulation when needed to assist with length tension relationships.
posterior
What two ligaments are the flexor retinaculum made up of?
The palmar carpal ligament and the transverse carpal ligament
Out of the palmar carpal ligament and the transverse carpal ligament which is more superficial and proximal and which is more distal and deep?
Palmar carpal ligament - superficial and proximal
Transverse carpal ligament - deep and distal
The flexor retinaculum is on the (posterior/anterior) surface of the hand
anterior
The palmaris longus tendon forms the palmar ____ that goes through the hand
aponeurosis
The flexor retinaculum is continuous with the deep investing fascia of the forearm and has (transverse/straight) bands that are running across.
transverse
(Distally/proximally) there is a continuation of the flexor retinaculum as the transverse carpal ligament
Distally
The investing fascia in the hand has the thenar fascia covering the (thenar/hypothenar) muscles and the hypothenar fascia covering the (thenar/hypothenar) muscles.
thenar; hypothenar
The investing fascia in the hand is a continuation of the superficial portion (palmar carpal fascia) of the ____ retinaculum
flexor
As we pull the skin away we see the palmar ____ and if you have a palmaris longus, you will see the palmaris longus tendon
aponeurosis
The palmar aponeurosis keeps the skin firmly attached to the _____ .
metacarpals
The digital slips coming from fingers 2-5 and the superficial transverse metacarpal ligaments are all thickenings of the investing fascia and in this area the skin has a (weak/strong) firm attachment to that palmar ________ . So as you are pulling it up it is going to be hard to get off.
strong; aponeurosis
The hypothenar septum is on the (lateral/medial) side of the hand
medial
The thenar septum is on the (lateral/medial) side of the hand
lateral
Just anterior to the metacarpals there is the ____ interosseous fascia combined with this ___ interosseous fascia on the posterior aspect of the metacarpals creating a compartment that is more posterior on the hand
adductor; dorsal
The hypothenar septum attaches to the _ metacarpal.
5th
The thenar septum attaches to the _ metacarpal.
1st
The adductor interosseous fascia attaches to the _& _metacarpals.
1st & 5th
The dorsal interosseous fascia attaches to the ___ - ____ metacarpals
1st-5th
What is in the hypothenar compartment?
The three intrinsic muscles of the hypothenar compartment and the deep branch of the ulnar nerve.
The central compartment is a continuation of what?
The carpal tunnel
What is in the central compartment?
The flexor digitorum superficialis, flexor digitorum profundus, the median nerve, all of the synovial tendon sheaths and bursa that run with them, the superficial palmar arterial arch, and the lumbrical muscles of the hand.
What is in the adductor interosseous compartment?
All 7 interossei muscles, one intrinsic thumb muscle, the deep branch of the ulnar nerve, and the deep palmar arterial arch.
What is in the thenar compartment?
Three intrinsic thumb muscles, the recurrent branch of the median nerve, and the flexor pollicis longus.
How many tendons does the flexor digitorum superficialis have?
4
How many tendons does the flexor digitorum profundus have?
4
What runs in the carpal tunnel?
The 4 tendons of the flexor digitorum superficialis, the 4 tendons of the flexor digitorum profundus, the flexor pollicis longus, & the median nerve
The (ventral/dorsal) side of the MCP capsule blends in with the extensor hood
dorsal
The transverse carpal ligament (does not/does) cross the metacarpals
does not
In the carpal tunnel there are _ anchor points (bony prominences) that we are going to talk about. If we look at the hand and we start distally, on the distal carpal row we have the ___ ___ ___ ____ on the radial side, on the proximal row we have the ___ ___ ___ ____. If we go to the medial side we have the ___ ___ ___ ___ on the distal row and the ____ on the proximal row. Those are the anchor points for the most superficial border of the carpal tunnel.
4; tubercle of the trapezium; tubercle of the scaphoid; hook of the hamate; pisiform
The most distal edge of the carpal tunnel is going to be between the ____ and the ____. The most proximal portion of the carpal tunnel is going to be between the ___ and the ___.
hook of the hamate and the tubercle of the trapezium; pisiform and the tubercle of the scaphoid
The ____ carpal ligament from the flexor retinaculum runs between the four bony processes (anchor points) of the carpal tunnel.
transverse
Is the hamate bigger than the pisiform?
Yes
What runs in the carpal tunnel?
• The 4 tendons of the flexor digitorum superficialis, the 4 tendons of the flexor digitorum profundus, the flexor pollicis longus, the associated tendon sheaths of those muscles, and the median nerve
The flexor digitorum superficialis tendons sit (high/low) in the carpal tunnel, the flexor digitorum profundus tendons sit (anterior/posterior) in the carpal tunnel, and all of these tendons are (medial/lateral) in the carpal tunnel
high; posterior; medial
The flexor pollicis longus is more (medial/lateral) in the carpal tunnel
lateral
Somewhere anterior on the lateral half of the central is where you will find the ___ nerve in the carpal tunnel.
median
Fluid will be what colour in a T2 MRI?
white
Fluid will be what colour in a T1 MRI?
black
We don’t see as much carpal tunnel syndrome on today’s laptops because the keyboards are relatively flat and where you rest your wrists keeps the wrist somewhat in a neutral position. When you take your laptop and put it on an angle with your wrists fully (flexed/extended) and typing for 8 hours a day is how you will develop carpal tunnel.
extended
The flexor digitorum superficialis tendon attaches (shallower/deeper) than where the flexor digitorum profundus tendon attaches
deeper
How does the flexor digitorum superficialis tendon get deeper/behind the flexor digitorum profundus to reach its’ distal attachment site?
The flexor digitorum superficialis tendon splits to make this possible
What is the general function of the tendon sheaths?
To keep the tendons in place on the finger.
Tendon sheaths are present in (all/some) tendons that run through the fingers and the thumb on the palmar/flexor side.
all
There are 2 portions of the tendon sheath that we have to be aware of. There is a synovial tendon sheath which means there is a synovial capsule that has a ___ outer layer and a ___ inner layer.
fibrous; synovial
The synovial portion of the tendon sheath facilitates what?
Tendon movement
The fibrous portion of the tendon sheath anchors the tendon to the ____ and the ____
volar plate and the phalanx bone
The ____ portion of the tendon (synovial?) sheath has fibers that are reinforcing the fibrous portion of the synovial sheath and anchors them to the phalanxs and the joint.
fibrous
The fibrous portion of the tendon (synovial?) sheath is continuous with the _____ of the palmar aponeurosis
digital slips
Transverse fibers of the tendon sheath are also called ___ fibers
annular
Cross fibers of the tendon sheath are also called ___ fibers
cruciate
Transverse fibers (listed with an A) and cross fibers (listed with a C) reinforce the tendon sheath by anchoring the tendon sheath to the ___ of the joint capsule or to the ____.
volar plate; phalanges
The transverse fibers and cross fibers of the tendon sheath anchor to the volar plate (at/in-between) the joint line
at
The transverse fibers and cross fibers of the tendon sheath anchor to the phalanges (at/in-between) the joint line.
in-between
The transverse fiber and cross fiber reinforcements are critical for what?
normal tendon function and mobility to flex and extend our fingers
The synovial layer of the tendon sheath is attached to what?
The tendon
During motion, the fibrous and synovial layer of the tendon sheath slide relative to one another, so as you move your fingers those two layers slide (past/on) each other.
on
These tendon sheaths extend from just (distal/proximal) to the MCP joint (the distal end of the metacarpal) to the (distal/proximal) phalanx in all fingers except what two fingers?
proximal; distal; pinky finger and the thumb
The tendon sheath for the synovial layer of the flexor pollicis longus is continuous with what?
The radial bursae
The tendon sheath for the synovial layer of the flexor digitorum superficialis and the flexor digitorum profundus in the carpal tunnel and into the palm of the hand is known as what?
The ulnar bursae
The (radial/ulnar) bursae extends into the little finger, so the little finger tendon sheath is continuous with the (radial/ulnar) bursae.
ulnar; ulnar
In digits 2,3, & 4, their tendon sheaths are separate from the (radial/ulnar) bursae.
ulnar
The extensor aponeurosis runs from the _____ joint all the way to the distal _____.
MCP; phalanx
The ____ is the essence of digital function, understanding the ______ .. due to the static and dynamic forces that are applied to it, you will understand how we can use our hands for so many tasks.
extensor aponeurosis; extensor aponeurosis
The assumption is that the extensor aponeurosis is also included in the _____ (what finger?) as well as the other four fingers.
thumb
The extensor aponeurosis has several names: Name three.
Extensor hood, dorsal hood, & extensor mechanism
The extensor hood covers most of the (ventral/dorsal) surface (dorsum) of the four medial fingers.
dorsal
The lumbricals and interossei muscles of the hand attach to the ____ hood
extensor
Various (tendons/ligaments) contribute to the extensor hood
ligaments
The extensor hood consists of the transverse fiber shaped area of the (MCP/IP) with contributions from the lumbricals and interossei muscles of the hand, (extensor/flexor) digitorum, and the associated (ligaments/tendons).
MCP, extensor, ligaments
As the extensor hood crosses the (IP/MCP) joint the (extensor/flexor) digitorum expands on both sides into the extensor hood
MCP; extensor
The extensor hood as it crosses over the dorsum wraps around and attaches to the___ on the (MCP/IP) joint.
volar plate; MCP
When you extend your finger the volar plate moves (proximally/distally), which in attachment to the extensor hood it is the means by which the MCP joint extends through the pull of the (extensor/flexor) digitorum
distally; extensor
As the extensor digitorum pulls us towards extension the volar plate is coming like this and pushing up on the (proximal/distal) phalanx to help extend the finger at the ___ joint
proximal; MCP
If the volar plate is down on flexion, it is up on (flexion/extension)
extension
As the extensor digitorum tendon goes in here (extensor hood?) it is splitting into how many parts? Name them.
3; central band and two lateral bands on each side of the finger
There is a small part of one of the extensor digitorum tendons that splits and is a nonfunctional attachment (does not have a role, just an attachment) to the base of the proximal ___.
phalanx
The central band (one of the extensor digitorum tendons that splits) attaches to the base of the ___
middle phalanx
Splitting at the same time as the central band are two (lateral/central) bands (one of the extensor digitorum tendons that splits) (one on each side of the finger) that come off the extensor digitorum, go around the (proximal/distal) interphalangeal joint, crosses the (proximal/distal) interphalangeal joint, and attaching to the dorsal aspect of the base of the (proximal/distal) phalanx.
lateral; proximal; distal; distal
Volar is pertaining to the palm of the hand, so is volar anterior or posterior?
Anterior
The lumbricals and interossei muscles of the hand are on the volar side of the hand and they are coming up and attaching to the extensor hood and combining with the extensor digitorum to create the (lateral/central) band(s).
lateral
In summary, what three things create the extensor hood which splits into a central band and two lateral bands?
The extensor digitorum, lumbricals, and interossei muscles of the hand
The nonfunctional part of the extensor digitorum attaches to the base of the (proximal/distal) phalanx
proximal
The triangular membrane is over the (distal/middle) phalanx (not 100% if it is only over the middle phalanx or whether he was orienting us on a slide)
middle
The triangular membranes job is to keep the (lateral/central) bands from sliding (ventrally/dorsally) and hold the (central/lateral) bands more (dorsally/ventrally) as they are getting ready to cross the (proximal/distal) interpahalangeal joints
lateral; ventrally; lateral; dorsally; proximal
What is the name of the lumbricals and interossei muscles of the hand when they are together?
Intrinsic hand muscles
There is a ligament that is coming off the distal portion of the proximal phalanx crossing the proximal interphalangeal joint and running dorsally to join with the lateral band where they attach on the distal phalanx. And that attachment on the distal phalanx is called the ___ .
terminal tendon
Where do the lateral bands attach?
The terminal tendon
The oblique retinacular ligament (ORL) is also known as __ ligament
Landsmeer
The oblique retinacular ligament’s job is to keep the lateral band from sliding too far (ventrally/dorsally).
dorsally
The oblique retinacular ligament has a (proximal/distal) interphalangeal joint that is more ventral than dorsal
proximal
If tension is put on the oblique retinacular ligament it will limit (flexion/extension) of the proximal interphalangeal joints, but when it comes up dorsally and attaches to the terminal tendon at the distal interphalangeal joint it will limit (flexion/extension).
extension; flexion
The intrinsic muscles are (dorsal/ventral) to the MCP
ventral
The lateral bands are ventral at the (proximal/distal) interphalangeal joint
proximal
The lateral bands are dorsal at the (proximal/distal) interphalangeal joint
distal
When the intrinsic muscles contract they are going to (flex/extend) the MCP
flex
When the intrinsic muscles contract they are going to extend the (proximal and distal/middle) interphalangeal joint
proximal & distal
The lumbrical position is MCP (flexion/extension) and IP (flexion/extension)
flexion; extension
By keeping the bands where they are supposed to be, the extensor aponeurosis works (poorly/efficiently).
efficiently
In the whole extensor aponeurosis thing, the flexor digitorum superficialis is at the ___joint and the flexor digitorum profundus is at the __ joint
MCP; PIP
The lumbricals and interossei muscles of the hand form an S between the ___ and ___
MCP and PIP
The oblique retinacular ligaments forms an S between the ___ and ___ .
PIP and DIP
What muscles makeup the anatomical snuffbox?
Extensor pollicis longus, extensor pollicis brevis, & abductor pollicis longus
What muscles makeup the lateral border of the anatomical snuffbox?
Extensor pollicis brevis and abductor pollicis longus
What is the muscle that makes up the medial border of the anatomical snuffbox?
Extensor pollicis longus
