EXAM2_G13_Palmar Flashcards
ALLENS TEST
test patentcy of blood flow of radial and ulnar arteries
What supplies palm via deep palmar arch?
What is deep palmar arch in contact with (location)?
What are the thumb and index finger branches of this artery called respectively?
Radial Artery
contacts bases of metacarpals
PRINCEPS POLLICIS ARTERY (Thumb)
RADIALIS INDICIS ARTERY (Index finger)
What artery supplies via superficial palmar arch?
what is it deep to? superficial to? Lateral to?
Where does it travel through ?
Ulnar artery
deep to palmar aponeurosis, superficial to flexor aponeurosis and flexor tendons, lateral to ulnar nerve
Travels through GUYONS CANAL and terminates as superficial palmar arch and deep palmar branch
Compression of ulnar nerve through guyons canal is called what?
What symptoms?
ULNAR CANAL SYNDROME
Hyper-esthesia (diminished sensation of medial palm & pinky)
Paresis (weakness) of intrinsic hand muscles that are innervated by deep branch of ulnar nerve
Where is Ulnar nerve found?
deep to ? ermerges where? branches?
Where does it pass through
deep to FCU, medial to Ulnar artery
Emerges at wrist and gives palmar cutaneous branch
pass between palmar carpal ligament and flexor retinaculum and enters hand through Guyons Canal
What is guyons canal?
Tunnel between hook of hamate and pisiform
What does ulnar nerve divide into?
What innervations of each?
Deep branch (motor for hypothenar muscles, AdP, deep head of FPB, medial two lumbricals, all interossei)
Superficial branch (Motor to PB; common and proper palmar digital nerves that parallels arteries)
What provides cutaneous sensation of medial forearm and medial proximal palm?
Palmar Ulnar branch
What provides cutaneous sensation of lateral pinky and some palm around base of pinky?
Superficial branch of ulnar nerve
What provides cutaneous sensation of middle palm and up middle inner wrist?
Palmar Branch (median nerve derived proximal to wrist)
Where does palmar branch of median nerve enter the hand?
When enters hand what does it branch into?
What function?
Enters deep to flexor retinaculum then branches to become
-. Recurrent branch (MOTOR to THENAR) except deep head FPB
- Common palmar digital nerves
- Proper palmar digital nerves
Where do you test median nerve? Ulnar nerve?
Where can median be compressed? what symptoms
Median at tip of digit 2, ulnar at tip of pinky
Median can be compressed under flexor retinaculum and produces pain and paresthesias in cutaneous, can progress to motor problems too
LUMBRICALS- ONIA
O- TENDONS of FDP
I- Lateral bands of extensor expansions of digits 2,3,4,5
A- FLEX MCP joints, EXTENDS PIP/DIP joints
N- 1 &2 median, 3,4,5, deep ulnar
PALMAR INTEROSSEI (3)
O-Metacarpals of 2,4,5
I-base of proximal phalanx and extensor expansion of digits 2,4,5
-adducts 2,4,5 to axial line
DEEP BRANCH OF ULNAR
DORSAL INTEROSSEI (4)
O- adjacent sides of Metacarpals
I- base of proximal phalanx and extensor expansion of digits 2,3,4
A- abduction of digits 2,3,4 away from axial line- assists lumbricals (flex mcp, extend dip, pip)
N- Deep ulnar
Hypothenar muscles (3) OINA
AbDM- pisiform to prox phalanx of pinky
FDM- HookHam to proximal phalanx
ODM- HookHam to metacarpal (5th)
FPB
what bones does this one have?
TWO HEADS!
O- Flexor retinaculum & Trapezium
I- proximal phalanx base of thumb
superficial head- Recurrent b. median
Deep head- deep b. ulnar
Flex thumb
Has sesamoid bones and forms FPL tendon channel
OP
O-flexor retin, trapezium
I- 1st metacarpal
CMC joint opposition in thumb
Recurrent b. median
Central Compartment contents:
- tendons of long flexors related to FDS and FDP
- Lumbricals
- Superficial palmar arch and branches
- Median nerve and branches
- Midpalmar space
Hypothenar Compartment
3 muscles (AbDM,FDMb,ODM),
digit 5 digitiminimi,
deep branch of ulnar nerve
Interosseous compartment
Dorsal interosseous muscles (abduction of digits 234 away)
Palmar IM’s (adduction 2,4,5 toward axial line)
Innervated by Deep branch of ulnar nerve
Adductor compartment:
AP- deep branch of ulnar
What compartments affected by deep ulnar lesion?
Adductor compartment, Interosseous compartment, Hypothenar compartment
ALSO deep head of FPB
What compartment affected by median nerve lesion
Central comparment, Thenar compartment (if recurrent branch affected)
Thenar compartment
AbPB, FPB, OP- Recurrent branch of median (except deep head FPB is deep ulnar)
What is potential space called that is continuous w/ forearm via carpal tunnel and can spread infection from forearm to hand?
Midpalmar Space
What creates the tunnel over the concavity of the carpal bones? What are the structures in that tunnel?
Flexor retinaculum
- tendons of long flexor muscles (4 muscle tendons related to FDS, 4 related to FDP)
- Tendon of FPL
- MEDIAN NERVE
What 4 structures are superficial to the flexor retinaculum?
Tendon of FCR,PL, Ulnar Nerve, Ulnar Artery
TENOSYNOVITIS
inflammation of tendon and digital synovial sheaths
-can spread infection from digits 1 or 5 into the forearm via the Ulnar or Radial Bursa
What is Trigger finger called?
Digital tenovaginitis stenosans-
Fibrous digital sheath inflammation by repeated trauma
Narrows tendon tunnels
What covers the synovial tendon sheaths of digits?
Fibrous digital sheaths
creates osteofibrous tunnels that prevent bowstringing across joints
Ulnar bursa vs Radial Bursa
Ulnar- tendons of FDS & FDP within a common flexor sheath- continuous with digit 5
Radial bursa- FPL tendon in its own synovial sheath called radial bursa
What is Palmar aponeurosis disease?
what digits most affected?
DUPUYTREN CONTRACTURE
-progressive fibrosis and degeneration of palmar fascia and aponeurosis
Digits 4,5 most affected
Males>females
What are the two ligaments across the wrist superficial to deep?
Palmar carpal ligament
Flexor retinaculum
What is continuous with palmaris longus tendon and flexor retinaculum?
Palmar aponeurosis
holds skeleton in palm together
What are the ligaments across metacarpals called?
transverse metacarpal ligaments
What digit movements in Coronal plane?
Adduction/abduction of digits 2-5
Flexion/extension of thumb across palm
What digit movements in Sagittal plane?
Flexion/Extension of digits 2-5
AB/Adduction of thumb
Where are sesamoid bones found?
Pisiform in FCU, embedded in FPB tendon
