Forearm, Wrist and Hand (+ UE Blood Supply) Flashcards
arterial supply to the upper extremity
brachial artery and brachial profunda
at level of the elbow = radial artery and ulnar artery
where does it turn from axillary artery to brachial artery
at the inferior border of the teres major –> axillary–> brachial artery
brachial profunda artery
deep artery of the arm is a major branch from the brachial artery
what does the brachial artery divide into
radial (lateral side) and ulnar (medial side) artery
major branches of the ulnar artery
anterior interosseous artery
posterior interosseous artery
ulnar supply into the hand
superficial palmar arch
radial artery into the hand
deep palmar arch
makes sense that it is deep because the radial artery is supplying the posterior aspect of the arm
cephalic vein drainage
superficial to the metacarpals - lateral side
dorsal venous network in hand
drains the superficial and deep venous palmar arches
median cubital vein
communication between the basilic and cephalic veins in the cubital fossa
cephalic vein ends?
termination of the axillary vein
more proximal - when it becomes subclavian basically
basiclic vein ends when?
origin of the axillary vein - inferior border of the teres major - when the axillary starts going towards the heart
T/F the ulna is articulating with the carpel bones
FALSE - just the radius is because it widens out in the distal hand
mnemonic for carpel bones and the orientation
STARTS AT THE THUMB Proximal row = lateral to medial Second Row (Distal) = medial to lateral "So long to pinky" "Here comes the thumb"
How do you know you’re looking at the dorsal hand?
cannot see the pisiform bone
name proximal bone in carpels
so long to pinky Scaphoid Lunate Triquetrum Pisiform
name distal carpel bones
Here comes the thumb Hamate Capitate Trapezoid Trapezium
radiocarpel articulation
type
function
between the distal radius and the proximal row of the carpels
condyloid
wrist flexion and extension
wrist abduction and adduction
midcarpal
articulation
type
function
between the proximal and distal row of carpel bones
PLANE SYNOVIAL JOINT
gliding motions between the carpels
distal radioulnar joint
pivot synovial joint
pronation and supination
- ulnar not moving
ulnar deviation aka
ADduction
radial deviation
ABduction
distal radius fractures
aka
Colle’s Fracture - FRACTURE OF THE DISTAL RADIUS
‘FOOSH’
70% of these fractures occur in post-menopausal woman
usually a fall from an outstretched arm
DORSAL DISPLACEMENT OF DISTAL FRAGMENT
stabalizing ligaments in the hand
extensor retinaculum
flexor retinaculum
extensor retinaculum
posterior stabalizing ligament in the carpels
flexor retinaculum
anterior stablizing ligament in the carpel
THIS IS ARCHED IN THE CARPEL REGION
also called the transverse carpal ligament
function of the retinaculum in hands
stabalize the tendons going into the hand
can feel the muscles in forearms move when you wingle your fingers - muscle bellies in arm then tendons into hand
carpel tunnel
formed by the flexor retinaculum or the transverse carpel ligament
versus the extensor retinaculum is right up against the bones of the carpels
extensors
Attachment
Action
Innervation
muscles acting on the wrists
Attachment - lateral epicondyle of humerus to base of metacarpels
Action - wrist extension
Innervation
- radial nerve
lateral epicondylitis
repeated forceful flexion and extension of the wrist may strain the attachment at the lateral epicondyle of the - producing inflammation at the periosteum - irritating at the elbow joint (tennis elbow?)
flexors
Attachment
Action
Innervation
Attachment - medial epicondyle of the humerus to the base of the metacarpals
Action - wrist flexion
Innervation - median + ulnar nerve
Palmaris Longus
Attachment
Action
Innervation
Attachment - medial epicondyle of the humerus to the fascia in the palm of the hand
Action - tense the fascia in the palm of the hand and known to weakly flex the wrist (as it has a similar attachement with the wrist flexors)
Innervation- median nerve
may be absent in 10-15% of the population because known to bring out the claws in animals
non-manipulative prehension patterns
cylindrical grip
hook grip
spherical grip
EXTRINSIC MUSCLES INVOLVED IN THE MOVEMENT (from muscles in the forearm)
cylindrical grip
holding onto something like a cylinder - beer can?
a non-manipulative prehension pattern
hook grip
a non- manipulative prehension pattern
dont need to useyour thumb - using the other digits
spherical grip
a non-manipulative prehension pattern
where your thumb comes across more
holding a ball
manipulative prehension patterns
using INTRINISC HAND MUSCLES - FINE MOTOR MOVEMENTS
palmar pinch **
lateral pinch
tip-to-tip pinch
palmar pinch
a manipulative prehension pattern
distal phaylnx of 2 and 3 with the thumb
- pad to pad between first (thumb) digit and second digit
lateral pinch
manipulative prehension pattern where the thumb (1st digit is being used) with the SIDE OF THE PROXIMAL PHALYNX
example = holding a key
Tip-to-tip
manipulative prehension pattern
not as powerful but more fine tuned
tip of 1st - thumb with tip of second
distal of the phaylnx
articulations of digits and thumb
name with thumb in own group then usually digits 3-5 in another
carpometacarpal joints
location and action
distal of carpels with metacarpals
adduction and abduction at the thumb
flexion and extension with thumb
opposition with thumb
first IP joint?
what we call the thumb because no 3rd phalange so we have ONE interphalange joint
Metacarpophalangeal Joints
location and action
Between distal of metacarpels and the first phalange
Flexion and Extension AND ABduction and ADduction
aka MCP or MP joint
Proximal Interphalangeal Joints
action and location
between the distal proximal phalange and the second phalange
aka PIP
Action - flexion and extension
Distal Interphalangeal Joints
location and action
located at the distal part of the second phalange with the third distal phalange
Action - extension and flexion
opposition movement
bringing the thumb towards your pinky - using the CMC joint
extrinisic digit flexors
name and
action
innervation
flexor digatorum superficialis and flexor digitorum profundus
Action - Flex PIP
Flex DIIP = the digatorum profundus
innervation:
median and ulnar nerves
carpel tunnel syndrome
because the flexor retinaculum forms a tunnel on the anterior side - we have a lot of tendons/muscles/ and MEDIAN NERVE going through - if we have inflammed or irritated muscles or tendons this can COMPRESS THE MEDIAN NERVE and can then suffer from carpel tunnel syndrome
- because the carpal tunnel contains the extrinsic tendons of the digit flexors as well as the main branch of the MEDIAN NERVE
- likely will see ATROPHY of the thenar muscles - in the thumb - because supplied by the median
Digit Extensors
Name w/ action
innervation
Extensor Digitorum Communis - all 2-5 digits
Extensor indicis proprius - extensor for digit number 2
extensor digiti minimi - specific for the 5th digit
innervation - all by the radial nerve
flexor pollicis longus
extensor pollicis longus and brevis
abductor pollicis longus
all are EXTRINSIC TO THE THUMB
- flexion
- extension
- abduction
FORMING THE ANATOMICAL SNUFF BOX
pollicis refers to?
the thumb
Anatomical snuff box
formed by the extrinsic muscles of the thumb - extensor pollicis longus (on dorsal side)
extensor pollicis brevis on palmar side and abductor pollicis longus
GOING OVER THE DISTAL END OF THE RADIUS AND THE STYLOID PROCESS
base is formed by the scaphoid bone of the carpel at the base
thenar group of muscles
INTRINSIC TO THE HAND - on the thumb side and innervated by the median nerve
hypothenar group of muscles
INTRINSIC TO THE HAND - on the pinky side of the hand and innervated by the ulnar nerve
lumbricals
Attachment
Action *
Innervation
Attachment - flexor tendons in palm to dorsum of proximal phalanges
Action - flex at MP and extend at PIP and DIP joints
Innervation - median and ulnar nerve
these are INTRINSIC CENTRAL HAND MUSCLES
course of fibers of the lumbricals
cross on the ANTERIOR side of the MP joint
DORSAL AND PALMAR INTEROSSEI
attachment
action
innervation
THESE ARE CENTRAL INTRINISC HAND MUSCLES
Attachment - metacarpals to proximal phalanges
ALL ULNAR INNERVATION
‘PAD AND DAB’ mnemonic
Dorsal = ABduction - 4 muscles
Palmar = ADduction - 3 muscles
which nerves give Cutaneous Innervation to the Hand
Radial, Median and Ulnar nerves
radial innervation to hand
the rest of the back part of the hand
makes sense - as the radial nerve is doing a lot of the posterior aspect
ulnar innervation to hand
cutaneous innervation to the front and back of all of digit 5 and the half of the front and back of digit 4
hit funny bone? why we have tingling in out pinky a lot
median innervation in hand
the rest of the anterior part of the hand - palm
CUBITAL TUNNEL SYNDROME
- stretching and pressure on ulnar nerve
- ulnar nerve traveling under medial condyle - inner side of elbow - numbness or tingling in the RING AND SMALL FINGERS, pain in the forearm, and or weakness in the hand
causes of cubital tunnel syndrome
- pressure - nerve doesn’t have pad on it - causing numbness potentially
- keeping elbow bent for a long period of time
- ulnar nerve may not stay in place - move back and forth
pressure, stretching (bending too long), and anatomy
sustained grips and long awakawrd postures
contributing to the incidence of hand, wrist, and arm pain
T/F 40-70% of dental professionals experience chronic hand and wrist pain
True
dental professionals and hygienists experience four times the prevalence found in the general working public?
true - between 23-40% professionls and 75 % of hygienists
most common between 30-60 years of age
more common in female than male
exercise can decrease risk
prevention posture
between 60 degrees and 90 degrees
stay away from too much flexion and extension
neutral forearm position - keep forearms parallel to floor
difference between carpel tunnel and cubital tunnel syndrome
carpel = position of wrist and compression of the median nerve
cubital syndrome = position of the elbow - mainly in prolonged flexion and compression or irritation of the ulnar nerve
borders of the anatomical snuff box
proximal = styloid process of radius base = scaphoid bone of carpel
lateral = extensor pollicus brevis medial = extensor pollicis longus
De Quervain’s Tenosynovitis
chronic irritation of tendons connecting extrinsic muscles of the thumb
swelling of synovial, tendons, and sheath
pain and swelling at base of thumb
mostly in the extensor pollicis brevis and abdutor pollicus longus
‘wrist drop’
radial innervation is lost in the wrist because of loss of the innervatoin in a higher area of the arm
loss of a wrist extensor muscle