Forearm, Wrist, and Hand I Flashcards
The wrist joint exists between the distal surface of the radius and the three most lateral carpal bones of the proximal row which are called what?
scaphoid, lunate, triquetrum
The elbow is a hinge joint, allowing what type of movement and in what plane?
flexion/extension in sagittal plane
The interosseous membrane between the radius and ulna forms a ___ joint, binding the bones together and allowing pronation and supination
syndesmotic
In regards to the distal radioulnar joint, there is a strong ______ ____ that binds the two bones together and when injured, is a common source of wrist pain.
articular
The wrist (radoiocarpal) is a condyloid joint that allows what type of movements in what plane?
flexion/extension in sagittal plane; abduction/adduction in frontal plane
In regards to the wrist joint, an articular disc is located in the gap between the distal end of the ___ and the ___ and ___
ulna; lunate; triquetrum
A fibrous capsule is attached to the distal radius and ulna and the proximal row of carpal bones. It is thickened anteriorly and posteriorly by ____ ligaments and medially and laterally by ____ and ___ _____ ligaments
radiocarpal; ulnar; radial collateral
Each carpal bone makes a ____ joint with any other carpal joint that it abuts
synovial
Injury of the ____ ligaments is a common source of chronic wrist pain
interosseus
In regards to the carpometacarpal (CMC) joints, the motion is _____, except the 1st is very ____ and 5th has some play
minimal; mobile
The thumb is oriented at ___ degrees in anatomical position and ____ degrees at rest
45; 90
Flexion/extension of the thumb is across the ____
palm
note: occurs in oblique plane
In regards to the CMP joint, ____ moves the thumb away from the palm, while ___ moves the thumb towards the palm
abduction; adduction
note: occurs in flex/extend plane
The heads of the metacarpals ___-___ are prevented from separating by ligaments, especially the deep transverse metacarpal ligament
2-5
Metacarpophalangeal (MP) joints allow abduction only when ____, as ligaments tighten when MP joint is ___
extended; flexed
The thumb’s MCP joint’s ability to abduct/adduct is very restricted, thus most abduction/adduction is from the ___ joint
CMC
When referring to gamekeeper’s thumb or skier’s thumb injuries, what ligament is torn?
ulnar collateral
note: sometimes the ligament is displaced by the adductor policies aponeurosis (stener lesion)
Proximal (PIP) and Distal Interphalangeal (DIP) joints are structurally ___ joints, but restrictive ulnar/radial collateral ligaments create a functional pure ___ joint
condyloid; hinge
The thumb IP joint ____/_____ parallel to the CMC joint motion
flex/extends
Anterior forearm muscles primarily perform ___ of the forearm while posterior forearm muscles primarily perform ___ of the forearm
pronation; supination
The ___ ____ ligament is the most superficial at the wrist and is continuous with the extensor retinaculum
palmar carpal
The ___ _____ is deep to the palmar carpal ligament and attaches to the tubercles on the scaphoid and trapezium laterally and to the hook of the hamate and pisiform medially creating a fibro-osseus tunnel between the retinaculum and the intermediate carpal bones, a ___ ___
flexor retinaculum; carpal tunnel
the ______ ______ spans the dorsum of the wrist region and helps form the six separate tunnels through which pass the extensor and abductor tendons
extensor retinaculum
Nerves, superficial veins, and lymphatics cross the wrist ____ to the deep fascia
superficial
True or false, the ante brachial fascia continues into the hand where it encases the hand and the digits
true
The thinner compartment contains muscles that move the ____
thumb
note: adductor pollicis compartment is often recognized as a separate space deep to the thinner compartment. The deep fascia here is relatively thin
The hypothenar compartment contains muscles that move the ____
pinky
This compartment is located between thinner and hypothenar compartments, deep to the thickened deep fascia, the palmar aponeurosis. It contains the flexor tendons and their synovial sheaths, the lumbricals and the superficial palmar arch
central
In regards to the superficial layer of posterior muscles of the forearm, the muscles arise proximally from the supracondylar line or from the lateral epicondyle of the humerus forming a ___ ___ tendon
common extensor
This muscle arises from the supracondylar line of the humerus, passes anterior to the elbow joint and inserts on the radius. It aids in elbow flexion
brachioradialis
This muscle arises from the supracondylar line and inserts on the base of the 2nd metacarpal. It extends and abducts the wrist.
Extensor carpi radialis longus
This muscle arises form the common extensor tendon and inserts on the extensor hood. It extends all joints of the fingers (2-5) and the wrist.
extensor digitorum
This muscle arises form the common extensor tendon and inserts on the base of the 3rd metacarpal. Extends and abducts the wrist
extensor carpi radialis brevis
The intertendinous connections of extensor digitorum link adjacent tendons proximal to the MP joint resulting in what?
inability to fully isolate extension of digits 2-5 when extensor digitorum is the sole mover
the extensor expansion (hood) is the flattening/widenting of the ___ ____ tendons on the posterior surface of digits 2-5 as they pass the ___ joint
extensor digitorum; MP
This muscle arises in common with the extensor digitorum but has its own separate tendon to the little finger, inserting into hood. Extends all joints of 5th digit
extensor digiti minimi
This muscle arises from common extensor tendon and ulna and inserts on the base of the 5th metacarpal. Extends and adducts the wrist
extensor carpi ulnaris
What is “tennis elbow”?
lateral epicondylitis - wrist stabilization while forcefully extending the elbow
This muscle arises from the lateral epicondyle of the humerus and the proximal ulna, wraps around the upper part of the radius and inserts on it. The deep branch of the radial nerve passes deep to this muscle. It supinates.
supinator
This muscle arises from the lower part of the ulna and its tendon joining the extensor digitorum tendon, goes to the index finger (digit 2). Extends all joints of 2nd digit.
extensor indicis
This muscle arises form the interosseous membrane and bones of the forearm and inserts on the base of the 1st metacarpal. Abducts and helps extend CMC joint of thumb
abductor pollicis longus
This muscle arises from the interosseous membrane and ulna, its tendon curves around the dorsal tubercle of the radius and inserts on the base of the distal phalanx of the thumb. Extends all joints of the thumb.
extensor pollicis longus
This muscle arises from the interests membrane and radius and inserts on the base of the proximal phalanx of the thumb. Extends CMC and MP joints of the thumb
extensor pollicis brevis
What forms the anatomical snuff box and what is found inside?
the tendons of the extensor pollicis braves and longus; the radial artery passes along the floor of this box which is formed by the scaphoid bone
This is a group of 4 muscles on the dorsal hand that arise by 2 heads adjacent from metacarpal bases and shafts, and insert on extensor expansions
dorsal interossei
Each dorsal interossei ____ its respective finger away from the 3rd finger at the MP joint; aids ____ in flexion of MP and extension of IP
abducts; lumbricals
In regards to the superficial layer of anterior forearm muscles, they arise proximally from the ___ epicondyle of the humerus by fused ___ ___ tendon
medial; common flexor
This muscle arises by 2 heads (humeral/ulnar) and inserts into the radius, just distal to the supinator. The median nerve passes between the two heads of this muscle. Pronates the forearm/hand
pronator teres
This muscle abducts the ulna during pronation to keep the hand spinning on one central axis rather than allowing to just turn over around a distal ulnar axis
anconeus
This muscle arises from common tendon and inserts on the base of the second metacarpal. Fees and abducts the wrist.
flexor carpi radialis
This muscle is not alway present. It arises from the common tendon and inserts on the palmar aponeurosis. Flexes wrist
palmaris longus
This muscle arise by 2 heads and inserts on the pisiform, then continues via the pisohamate and pisometacarpal ligaments. The ulnar nerve passes between the two heads of this muscle. Flexes and adducts the wrist
flexor carpi ulnaris
This muscle arises from common flexor tendon and the bones of the forearm and splits to insert on the middle phalanges of the fingers 2-5. The median nerve courses on its deep surface. Flexes wrist and flexes MP and PIP joints of digits 2-5
flexor digitorum superficialis
This muscle arises from the ulna and the interosseous membrane and inserts on the distal phalanges of fingers 2-5. It flexes all joints of digits 2-5 and the wrist
flexor digitorum profundus
This muscle arises from the radius and the interosseous membrane and inserts on the distal phalanx of the thumb. Flexes all joints of the thumb
flexor pollicis longus
This muscle is located on the distal part of the forearm, its fibers coursing transversely, originated from the ulna and inserting on the lateral aspect of the radius. Pronates.
pronator quadratus
This small, often indistinct muscle arises form the medial side of the palmar aponeurosis and inserts into the skin on the medial part of the palm helping to form creases when gripping
palmaris brevis
What muscles form the thenar eminence?
abductor pollicis brevis, opponens pollicis and the flexor pollicis
This muscle arises from trapezium to insert on radial side of the base of the proximal phalanx. Abducts thumb at CMC joint
abductor pollicis brevis
This muscle arises from trapezium to insert on base of the proximal phalanx. Flexes thumb at MP and CMC joints
flexor pollicis brevis
This muscle arises from the trapezium to insert on the radial side of the first metacarpal. Abduct, flex, and medially rotates thumb at CMC joint
opponens pollicis
This muscle has 2 heads: transverse head from 3rd metacarpal, oblique head from bases of metacarpals 1-2; both heads insert into the ulnar side of the base of the proximal phalanx. Adducts thumb at CMC joint and aids in flexion of the CMC and MP joints
adductor pollicis
What 3 muscles make up the hypothenar eminence?
abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
This muscle arises from the pisiform to insert on the medial side of the base of the proximal phalanx. Abducts MP joint of 5th digit
abductor digiti minimi
This muscle arises from the hook of hamate to the medial side of the base of the proximal phalanx. Flexes MP joint of 5th digit
flexor digiti minimi
This muscle arises from the hook of hamate to the body of metacarpal 5. Laterally rotates and helps flex the CMC joint very slightly, bringing 5th digit toward the mid palm for opposition
opponens digit minimi
This is a group of 4 worm-like muscles. Each arise from the tendons of the flexor digitorum profundus from the radial side for the first 2 lumbricals and from adjacent tendons for the last 2 lumbircals and insert into the extensor hood. Flex MP joint and exerted IP joint
lumbricals
note: “keyboarding” muscles
This is a group of 3 deep, slender muscles. All insert on the extensor hood of the same digit from which they arise. Each adducts its respective finger toward the 3rd finger at the MP joint; aids lumbricals in flexion of MP and extension of IP
palmar interossei
2nd adducts ->
In regards to the forearm, which two muscles are innervated by deep radial nerve? which 3 muscles are innervated by radial nerve?
deep radial: ECRB, supinator
radial: anconeus, brachioradialis, ECRL
In regards to the anterior forearm, which two muscles are innervated by the ulnar nerve?
FCU and half of FDP; everything else is innervated by median nerve
Palmaris brevis is innervated by what?
superficial ulnar nerve
dorsal interossei, palmar interossei, adductor pollicis, and lumbricals 3-4 are all innervated by what?
deep ulnar nerve
lumbricals 1-2 are innervated by what?
digital median nerve
the thenar muscles are all innervated by what?
recurrent median nerve
All of the hypothenar muscles are innervated by what?
deep ulnar nerve
Injury of the main radial nerve causes what?
“wrist drop” - no wrist extension, no finger/thumb extension
As the deep branch of the radial nerve emerges from the supinator, it changes its name to ___ ___ nerve, which innervates the rest of the posterior forearm musculature
posterior interosseus
Injury to the radial nerve at the distal arm effects cutaneous sensation and muscular function how?
cutaneous sensation: lost beyond level of lesion
muscular function: all posterior forearm actions lost
Injury to the deep branch of the radial nerve between the elbow and supinator effects cutaneous sensation and muscular function how?
cutaneous sensation: normal
muscular function: weak wrist extension, unable to extend fingers and thumb
Injury to the posterior interosseus nerve distal to supinator effects cutaneous sensation and muscular function how?
cutaneous sensation: normal
muscular function: good wrist extension, unable to extend fingers and thumb
Injury to the superficial branch of radial nerve between elbow and distal forearm, deep to brachioradialis effects cutaneous sensation and muscular function how?
cutaneous sensation: lost beyond level of lesion
muscular function: all good
True or false? no muscles of the hand are innervated from the dorsal perspective
true
The ___ nerve innervates the thinner muscles via the ___ branch and the 1st and 2nd lumbricals by the ___ branch
median; recurrent; digital
Distal to the pisiform, the ulnar nerve divides into deep and superficial branches. The superficial branch innervates ____ ____ and is also cutaneous. The deep branch innervates what?
palmaris brevis; the remaining musculature
The ulnar nerve courses posterior to the elbow joint via the ___ ____, a fiber-osseus channel bound by the humeral medial epicondyle and the ulnar olecranon process
cubital tunnel
The ulnar nerve enters the anterior compartment of the forearm between the 2 heads of the ___ ___ ___ which it also innervates along with ___ ____ ___
flexor carpi ulnaris; flexor digitorum profundus
The ulnar nerve provides a ___ ___ branch in the distal forearm which eventually supplies the dorsal of the medial hand and the dorsal of the 5th and medial 1/2 of the 4th digits
dorsal cutaneous
The ulnar nerve bifurcates near/within ___ canal to form the superficial and deep branches
guyon’s
The ___ branch of the ulnar nerve pierces the hypothenar eminence to then arch laterally through the deep palm on the anterior surfaces of interpose muscles, then ending in the adductor pollicis
deep
Chronic compression at Guyon’s canal yields ___ ____, which has an impact on ulnar innervated hand muscles and palmar cutaneous distribution, but not dorsal cutaneous distribution. The dorsal cutaneous branch of the ulnar nerve branches before guyon’s canal. A more proximal compression will elicit both ____ and ___ cutaneous loss
handlebar palsy; palmar; dorsal
The median nerve enters the anterior compartment of the forearm between the 2 heads of the ____ ____
pronator teres
The median nerve gives a superficial palmar branch prior to reaching the ____ ____ to feed the palm
carpal tunnel
The median nerves divides into common palmar digital nerves after exiting the carpal tunnel, following the deep surface of the palmar aponeurosis, innervating the ___-___ lumbricals
1-2
Each common palmar digital nerve from the median nerve divides into ____ palmar digital branches which pass along the sides of the digits 1 to lateral half of 4
proper
The median nerve gives a ____ branch just distal to the carpal tunnel, which swings back over the FPB, then pierces between FPB and APB to access OP
recurrent
The radial nerve courses anterior to the ___ joint, deep to the ____, where it bifurcates into its superficial and deep branches
elbow; brachioradialis
The ___ branch of the radial nerve courses deep to the brachioradialis with the radial artery. In the distal forearm, it sweeps laterally and posteriorly to gain access to the dorsal of the hand
superficial
The deep branch of the radial nerve passes deep between the heads of the supinator to become the ___ ____ nerve
posterior interosseus
In the cubital fossa, near the neck of the radius, the brachial artery divides into the ___ and ___ arteries to distribute to the entire forearm and hand
radial; ulnar
The radial artery courses distally deep to the ____
brachioradialis
The radial artery gives a superficial palmar branch in the distal forearm which continues anteriorly through the ___ ___ to contribute to the ____ ____ ___
thenar eminence; superficial palmar arch
___ ___ artery feeds the thumb
princeps pollicis
___ ____ arch is the continuation of the radial artery.
deep palmar
The deep palmar arch gives rise to 3 ____ ____ arteries which feed into 3 common palmar digital arteries
palmar metcarpal
Scaphoid bone is fed by a ___ branch of radial artery; the proximal half of scaphoid can die due to a fracture
recurrent
The ulnar artery gives rise to a ____ ___ artery deep to the pronator teres
common interosseus
the ulnar artery becomes the supericial ___ ___ which provides 3 common and proper palmar digital arteries
palmar arch
Match the arterial supply to the compartment
posterior forearm:
anterior forearm:
hand:
posterior forearm: radial, radial recurrent, deep brachial artery, posterior interosseus
anterior forearm: ulnar, ulnar recurrent, anterior interosseus
hand: numerous branches of ulnar and radial arteries, including dorsal carpal branches
The correct order of structures in the wrist from medial to lateral is: tendon of flexor carpi ulnas, ulnar nerve, ulnar artery, palmaris longs tendon, median nerve, flexor carpi radialis, radial artery. True or false?
true
True or false? the tendon of the flexor carpi radials and the tendon of flexor carpi ulnaris run within the carpal tunnel
false; separate fibrous tunnels deep to the palmar carpal ligament
The ___ nerve is found deep to the flexor retinaculum within the carpal tunnel
median
The ___ artery runs through the floor of the anatomical snuff box
radial
What are the contents of the carpal tunnel
tendons of the flexor digitorum superficial, flexor digitorum profundus, flexor pollicis longus and the median nerve
One continuous synovial sheath encases all the flexor digitorum tendons forming the ___ bursa, which is continuous with the synovial sheath to the flexor tendons of the fifth digit
ulnar
The tendon of the flexor pollicis longus lies laterally in a separate synovial sheath that forms the ___ bursa which is continuous into the first digit
radial
There are three separate synovial sheaths for the distal parts of the tendons of fingers __, ___, and ___
2,3,4
Stenosing tenosynovitis (trigger finger) - caliber of opening for tendon to pass through the sheath is reduced and tendon has a ___ ___
swollen nodule
What are the boundaries of the cubital fossa?
proximal: line connecting humeral epicondyles
lateral: brachioradialis
medial: pronator teres
floor: brachialis and supinator
roof: skin, deep fascia, bicipital aponeurosis
Give the contents of the cubital fossa from lateral to medial
deep branch of radial nerve, radial recurrent artery, tendon of biceps brachia, brachial artery, median nerve, anterior ulnar recurrent artery
