Forearm and hand* Flashcards
Which vein does the median cubital vein join?
The basilic vein
What are the three main veins that drain blood from the arm?
Basilic, brachial and cephalic
What are the five main veins that drain the forearm?
The cephalic, radial, median antebrachial, basilic and ulnar veins
What are the main contents of the cubital fossa?
Radial nerve, biceps tendon, brachial artery, median nerve (Really need beer to be at my nicest)
Where do the brachial veins lie in relation to the brachial artery?
medial
Which muscles mark the borders of the cubital fossa?
Brachioradialis (laterally), pronator teres (medially), transverse line between epicondyles of the humerus (superior)
What are the attachments of brachioradialis?
O: Lateral supracondylar ridge of the humerus
I: Styloid process of the radius
What is the innervation to brachioradialis?
Radial nerve (C5-6)
What is the action of brachioradialis?
Forearm flexion
Which nerve pierces the supinator muscle?
The deep branch of the radial nerve
What is the deep branch of the radial nerve called when it pierces the supinator muscle?
Posterior interosseous nerve
What are the attachments of the flexor retinaculum?
Pisiform and hook of hamate to scaphoid and trapezium
What is Guyon’s canal?
A separate part of the carpal tunnel that transmits the ulnar vessels and nerves
Which tendons do not pass through the carpal tunnel into the hand?
Flexor carpi radialis - it travels through a separate part. Palmaris longus - passes superficial to the carpal tunnel
What are the four muscles that make up the superficial layer of the anterior forearm?
Palmaris longus, flexor carpi ulnaris, flexor carpi radialis, pronator teres
What is the common origin of most of the flexor muscles of the forearm?
The medial epicondyle of the humerus
What are the attachments of pronator teres?
O: Medial supracondylar ridge of humerus, coranoid process of ulna
I: Lateral surface of radius
Which nerve innervates the flexor compartment of the forearm?
The median nerve
What are the attachments of flexor carpi radialis?
O: medial epicondyle of the humerus
I: Bases of metacarpals 2-3
What are the attachments of palmaris longus?
O: Medial epicondyle of the humerus
I: Flexor retinaculum, palmar aponeurosis
Which nerve passes between the heads of pronator teres?
The median nerve
What are the attachments of flexor carpi ulnaris?
O: Medial epicondyle of the humerus, olecranon of ulna
I: Pisiform, hamate, base of metacarpal 5
What are the attachments of flexor digitorum superficialis?
O: Medial epicondyle of the humerus, coranoid process of ulna, anterior border of radius
I: Sides of middle phalanges of digits 2-5
What are the actions of flexor digitorum superficialis?
Metacarpophalangeal and PIP joint flexion
What are the attachments of flexor digitorum profundus?
O: proximal half of anterior surface of ulna, interosseous membrane
I: palmar surface of distal phalanges of digits 2-5
What is the innervation to flexor digitorum profundus?
Medial half: Ulnar nerve
Lateral half: Median nerve
What is the innervation to the flexor compartment of the forearm?
Median nerve, except medial half of flexor digitorum profundus and flexor carpi ulnaris (ulnar nerve)
What are the attachments of flexor pollicis longus?
O: Anterior surface of radius and interosseous membrane
I: palmar surface of distal phalanx of thumb
What are the attachments of pronator quadratus?
O: Distal anterior surface of ulna
I: Distal anterior surface of radius
The anterior interosseous nerve is a branch of which nerve?
The median nerve
Which artery contributes most of the superficial palmar arch?
The ulnar artery
Which artery contributes most to the deep palmar arch
The radial artery
What artery does the interosseous arteries come from?
The ulnar artery
How many phalanges are there in the thumb?
2
Which carpal bones articulate with the radial bone?
Scaphoid, lunate and part of triquetrum
Which carpal bones articulate with the ulna?
None of the carpal bones articulate with the ulna
What is the function of the palmar aponeurosis?
Gives firm attachment to the skin to improve grip, protects underlying neurovasculature
What is dupuytren’s contracture?
Thickening and contraction of the ulnar side of the aponeurosis
What is the name for where the tendons of flexor digitorum profundus pass through the split tendons of flexor digitorum superficialis?
Campers chiasm
What are the attachments of the palmar aponeurosis?
O: Palmaris longus tendon, palmaris brevis
I: The distal sheath of each finger (not thumb), skin
What are the attachments of palmaris brevis?
O: Palmar aponeurosis, flexor retinaculum
I: Dermis of hypothenar region
What is the function of palmaris brevis?
To tighten the palmar aponeurosis
What is the innervation to palmaris brevis?
Superficial branch of ulnar nerve (C8, T1)
What does the recurrent branch of the median nerve innervate?
The muscles of the thenar eminence
What causes the ape hand deformity?
Damage to the recurrent motor branch of the median nerve
Where does the ulnar artery bifurcate?
Distal and lateral to the pisiform bone
Which artery provides the majority of blood supply to the superficial palmar arch?
The ulnar artery
Which artery provides the majority of the blood supply to the deep palmar arch?
The radial artery
What is the name of the arteries that come off the superficial palmar arch to supply the digits?
The common palmar digital arteries
Which bones does the flexor retinaculum attach to?
Medially: pisiform and hook of hamate
Laterally: Scaphoid tubercle and crest of trapezium
Which structures pass through the carpal tunnel?
4 tendons of flexor digitorum superficialis, 4 tendons of flexor digitorum profundus, median nerve, flexor pollicis longus tendon
Which tendon passes through a separate part of the carpal tunnel?
Flexor carpi radialis
Which structures pass through the wrist superficially to the flexor retinaculum?
Ulnar nerve, ulnar artery, palmaris longus tendon
Where is Guyon’s canal?
Between the pisiform and the hook of hamate
Name the muscles of the thenar eminence?
Abductor pollicis brevis, adductor pollicis, flexor pollicis brevis and opponens pollicis
What is the action of abductor pollicis brevis?
Abduction of the carpo-metacarpal joint of the thumb
What are the attachments of abductor pollicis brevis?
O: Tubercles of scaphoid and trapezium bones, flexor retinaculum
I: Lateral aspect of base of proximal phalanx of thumb
What is the innervation to abductor pollicis brevis?
The recurrent branch of the median nerve (C8, T1)
What is the action of adductor pollicis?
Adduction of the carpometacarpal joint of the thumb
What are the attachments of adductor pollicis?
O: Transverse head: Palmar base of metacarpal bone 3. Oblique head: Capitate bone, palmar bases of metacarpal bones 2&3
I: Medial base of proximal phalanx of thumb
What is the innervation to adductor pollicis?
Deep branch of ulnar nerve (C8, T1)
What is the action of flexor pollicis brevis?
Flexion of the carpametacarpal and metacarpophalangeal joints of the thumb
What are the attachments of flexor pollicis brevis?
O: Superficial head: Flexor retinaculum, trapezium. Deep head: trapezoid, capitate
I: Lateral aspect of base of proximal phalanx of the thumb
What is the innervation to flexor pollicis brevis?
Superficial head: Recurrent branch of median nerve (C8, T1)
Deep head: Deep branch of ulnar nerve (C8, T1)
What are the attachments of opponens pollicis?
O: Tubercle of trapezium bone, flexor retinaculum
I: Radial border of metacarpal of the thumb
What is the innervation to opponens pollicis?
Recurrent branch of the median nerve (C8, T1)
What is the action of abductor digit minimi?
Abduction and flexion of metacarpophalangeal joint, extension of interphalangeal joints of the pinkie
What are the attachments of abductor digiti minimi?
O: Pisiform bone
I: Ulnar side of base of proximal phalanx, extensor expansion
What is the innervation to the hypothenar eminence?
Deep branch of the ulnar nerve (C8, T1)
What are the muscles of the hypothenar eminence?
Abductor digit minimi, flexor digiti mínimo brevis , opponens digiti minimi
What is the action of flexor digiti minimi?
Flexion of the metacarpophalangeal joint of the pinkie
What are the attachments of flexor digiti minimi?
O: Hook of hamate, flexor retinaculum
I: Base of proximal phalanx of pinkie
What are the attachments of opponens digiti minimi?
O: Hook of hamate, flexor retinaculum
I: Ulnar aspect of the 5th metacarpal
What are the attachments of the lumbrical muscles?
O: Tendons of flexor digitorum profundus
I: Extensor expansion of hand
What is the action of the lumbricals?
Flexion of the metacarpophalangeal joints, extension of the interphalangeal joints
What is the innervation of the lumbricals?
1+2 - Median nerve (C8, T1)
3+4 - Ulnar nerve (C8, T1)
Which of the lumbricals are unipennate and which are bipennate?
1+2 - Unipennate
3+4 - Bipennate
How many palmar interossei are there?
Three
What is the action of the palmar interossei?
Adduction (PAD)
Flexion of the metacarpophalangeal joints, extension of the interphalangeal joints
What is the innervation to the palmar interossei?
deep branch of Ulnar nerve (C8, T1)
What are the attachments of the palmar interossei?
O: Ulnar side of metacarpal bone 2, radial side of metacarpal bones 4+5
I: Ulnar base of proximal phalanx/extensor expansion of digit 2, radial base of proximal phalanges/extensor expansions of digits 4+5
Are the palmar interossei unipennate or bipennate?
Unipennate
What is the pathway of the palmary digital nerves?
They come off the medial or ulnar nerve and run along the medial and lateral sides of each digit
Where is the olecranon?
The pointy part of your elbow, the superior aspect of the ulna
What are the attachments of the extensor retinaculum?
Laterally: Radius
Medially: Styloid process of ulna, triquetrum, pisiform
What are the actions of brachioradialis?
Flexion of the forearm at the elbow (when semi-pronated)
What are the attachments of brachioradialis?
O: Lateral supracondylar ridge
I: Styloid process of radius
What is the innervation to brachioradialis?
Radial nerve (C5,6)
What are the actions of anconeus?
Assists in forearm extension and stabilization of the elbow joint
What are the attachments of anconeus?
O: Lateral epicondylar ridge
I: Lateral surface of olecranon
What is the innervation to anconeus?
Radial nerve (C7,8)
What are the five superficial muscles of the posterior forearm?
Extensor carpi radialis longus, brevis.
Extensor digitorum.
Extensor digiti minimi.
Extensor carpi ulnaris.
Which two structures are likely to be injured following a scaphoid fracture?
Radial artery, superficial branch of the radial nerve
Which nerve is directly responsible for the innervation of the lateral aspect of flexor digitorum profundus?
anterior interosseous nerve - branch of the median
What type of joint is the wrist joint?
A condyloid, synovial joint
Which one of the carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris?
Pisiform
Pronation and supination involve the movements of which bones?
The radius over the ulna
Where is the clavipectoral fascia?
under the clavicular portion of pectoralis major. It protects both the axillary vessels and nodes.
What are the attachments of extensor carpi radialis longus?
O: Lateral supracondylar ridge of humerus
I: posterior aspect of base of metacarpal bone 2
What is the innervation to extensor carpi radialis longus?
Radial nerve (C5-C8)
What are the attachments of extensor carpi radialis brevis?
O: Lateral aspect of humerus
I: Posterior base of metacarpal bone 3
What are the attachments of extensor digitorum?
O: Lateral epicondyle of humerus
I: Extensor expansions of digits 2-5
What is the innervation to extensor digitorum?
Posterior interosseous nerve (C7, C8)
What is the innervation to extensor carpi radialis brevis?
Radial nerve C5, C6
What are the attachments of extensor digiti minimi?
O: Lateral epicondyle of humerus
I: Extensor expansion of digit 5
What is the innervation to extensor digiti minimi?
Posterior interosseous nerve (C7, C8)
What are the attachments to extensor carpi ulnaris?
O: lateral epicondyle of humerus, posterior border of ulna
I: base of metacarpal bone 5
What is the innervation to extensor carpi ulnaris?
Posterior interosseous nerve (C7, C8)
What are the attachments of supinator?
O: Lateral epicondyle of humerus, annular ligament, supinator crest of ulna
I: Proximal 1/3rd of radius
What is the innervation to supinator?
Posterior interosseous nerve from radial nerve (C7, C8)
What are the attachments of extensor indicis?
O: Posterior surface of distal 1/3rd of ulna and interosseous membrane
I: Extensor expansion of index finger
What is the action of extensor indicis?
Weak hand extension, index finger extension at metacarpophalangeal and interphalangeal joints
What is the innervation to extensor indicis?
Posterior interosseous nerve (C7, C8)
What are the contents of the anatomical snuff box?
CARTs - Cephalic vein, (radial) Artery, Radial nerve (superficial branch), Tendons of extensor carpi radialis longus and brevis
What makes up the floor of the anatomical snuffbox?
Scaphoid and trapezium
What makes up the medial border of the anatomical snuffbox?
Extensor pollicis longus tendon
What makes up the lateral border of the anatomical snuffbox?
Extensor pollicis brevis, abductor pollicis longus
What are the attachments of abductor pollicis longus?
O: Posterior surface of proximal half of radius, ulna and interosseus membrane
I: Base of metacarpal bone 1
What is the innervation to abductor pollicis longus?
Posterior interosseous nerve (C7, 8)
What are the attachments of extensor pollicis longus?
O: Posterior surface of middle third of ulna and interosseous membrane
I: Posterior aspect of base of distal phalanx of thumb
What is the innervation to extensor pollicis longus and brevis?
Posterior interosseous nerve (C7, 8)
What are the attachments to extensor pollicis brevis?
O: Posterior surface of distal third of radius
I: Posterior aspect of base of proximal phalanx of thumb
What do the the dorsal digital arteries come off?
The dorsal metacarpal arteries
Where do the dorsal metacarpal arteries lie?
Along the grooves between the dorsal interossei
