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Anatomy Unit I > GA8: Palmar Aspect of the Hand > Flashcards

GA8: Palmar Aspect of the Hand Flashcards

1
Q

Describe the Proximal Row (from lateral to medial) of the carpus

A

a. Scaphoid: with tubercle
b. Lunate
c. Triquetrum (triquetral)
d. Pisiform: a sesamoid bone that articulates only

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2
Q

Describe the Distal Row (from lateral to medial) of the carpus

A

a. Trapezium: with tubercle
b. Trapezoid
c. Capitate
d. Hamate: with hook

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3
Q

What is the carpal groove?

A

deep groove formed by palmar concavity of the carpus.

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4
Q

Define the Flexor retinaculum and its lateral and medial attachments

A

(transverse carpal ligament): fibrous specialization of
antebrachial fascia that bridges the carpal groove.
a. Medial attachments: pisiform and hook of the hamate.
b. Lateral attachments: tubercles of the scaphoid and trapezium.

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5
Q

What is the Carpal tunnel

A

osseofibrous tunnel formed by the carpal bones and the flexor
retinaculum.
a. Connects the anterior compartment of the forearm and the palm.
c. The tendon of the flexor carpi radialis m.
enters the hand through a separate
compartment in the lateral wall of the carpal
tunnel.

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6
Q

What are the contents of the Carpal tunnel proper

A 
1) Tendons of flexor digitorum superficialis, 
flexor digitorum profundus, and flexor 
pollicis longus mm. 
2) Synovial tendon sheaths (see below) 
3) Median n.
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7
Q

Describe the metacarpus

A

five metacarpal bones numbered I–V from lateral to medial.
1. Each has a base (proximal), shaft, and head (distal).
2. Metacarpal bases articulate with the distal row of carpals and—excepting MC I,
which articulates only with the trapezium—each other.
3. Metacarpal heads articulate with the bases of the proximal phalanges.

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8
Q

Describe the layout of the Digits

A

numbered I–V from lateral to medial.
1. Digits II–V each consist of three phalanges (singl. phalanx)—proximal,
intermediate (middle), and distal. Digit I (thumb) possesses only two phalanges—
proximal and distal.
2. Distal phalanges are marked by tuberosities that support the digital pads.

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9
Q

Carpometacarpal (CM) joints

A

between distal carpal row and metacarpal bases.

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10
Q

Metacarpophalangeal (MP) joints

A

between metacarpal heads and proximal

phalangeal bases.

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11
Q

Proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints:

A 
between 
the heads (proximal) and bases (distal) of adjacent phalanges. Note: the thumb has 
only one interphalangeal joint.
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12
Q

Thenar eminence:

A

lateral fleshy mass formed by intrinsic muscles of Digit I.

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13
Q

Hypothenar eminence:

A

medial fleshy mass formed by intrinsic muscles of

Digit V.

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14
Q

Palmar Fascias:

A

The deep palmar fascia is continuous with the deep fascia of the
forearm (antebrachial fascia). It is relatively thin over the thenar and hypothenar
eminences but thickened over the central palm and digits.

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15
Q

Define the Palmar aponeurosis and its’ structure

A

the thick triangular fascia of the central palm.
a. Its apex is continuous proximally with the flexor retinaculum and tendon of
palmaris longus.
b. Longitudinal digital bands: distal extensions of the palmar aponeurosis that
blend with the fibrous digital sheaths of Digits II–V.
c. Medial and lateral intermuscular septa: extend deeply from the medial and
lateral borders of the palmar aponeurosis and define three main palmar
compartments: central, thenar, and hypothenar.

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16
Q

Describe Fibrous digital sheaths and what they attach to & are continuos with:

A

specializations of the deep fascia.
a. Attach along the medial and lateral palmar
margins of the phalanges, forming osseofibrous
tunnels enclosing the long flexor tendons and
digital synovial sheaths (see below).
b. The fibrous sheaths of Digits II–V are continuous
proximally with the longitudinal digital bands of
the palmar aponeurosis.

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17
Q

Dupuytren’s contracture.

A

Fibrosis and shortening of the longitudinal digital bands creates traction on the fibrous digital sheaths and a flexure deformity of the digits (usually IV–V)

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18
Q

Describe mvmts of Digits II–V (fingers)

A

a. Flexion/Extension: sagittal plane at DIP, PIP, and MP joints.
b. Abduction/Adduction: coronal plane at MP joints.
1) Abduction: movement away from the reference axis (Digit III).
2) Adduction: movement toward the reference axis (Digit III).
c. Medial/lateral rotation: transverse planes normal to digital axes.
1) IP joints are strictly biaxial; MP joints II-V permit limited
rotation.
2) Rotation of the digits occurs when cupping the palm to grasp a round object (ball); contributes to opposition of the 5th digit.

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19
Q

Describe mvmts of Digit I

A

(thumb)
The 1st CM joint and the palmar surface of the thumb
are rotated medially relative to Digits II–V. Movements of the thumb
occur at right angles to those of the other digits.
a. Flexion/Extension: coronal plane, at the IP, MP, and CM joints.
The 1st CM joint contributes significantly to thumb flexion.
b. Abduction/Adduction: sagittal plane, primarily at the CM joint.
1) Abduction: movement anteriorly away from the plane of the
palm.
2) Adduction: movement posteriorly toward the plane of the palm.
c. Opposition/Reposition

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20
Q

Describe opposition & reposition of the thumb

A

1) Opposition: compound movement involving flexion and abduction of the
thumb accompanied by medial rotation of metacarpal I; allows thumb tip to
contact, i.e., oppose, the tips of the other digits.
2) Reposition: return of the thumb to the neutral position.

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21
Q

List the extrinsic muscles of the palm

A

a. Flexor digitorum superficialis m.
b. Flexor digitorum profundus m.
c. Flexor pollicis longus m.

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22
Q

Flexor digitorum superficialis m.
I:
A:
N:

A

Insertion: 4 separate tendons to Digits II–V
Split to insert on the bases of the intermediate phalanges
Action: Flexes the PIP and MP joints; assists elbow/wrist flexion
Innervation: Median n.

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23
Q

Flexor digitorum profundus m.
I:
A:
N:

A

Insertion: 4 separate tendons to Digits II–V
Pass through the FDS tendons to insert on distal phalanx bases
Action: Flexes the DIP, PIP, and MP joints; assists wrist flexion
Innervation: Median n. (Digits II–III) and ulnar n. (Digits IV–V)

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24
Q

Flexor pollicis longus m.
I:
A:
N:

A

Insertion: Base of the distal phalanx of Digit I
Action: Flexes the IP, MP, and CM joints; assists wrist flexion
Innervation: Median n.

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25
Q

List the Synovial tendon sheaths

A

a. Common flexor synovial sheath or ulnar bursa
b. Synovial sheath of flexor pollicis longus or radial bursa:
c. Digital synovial sheaths: envelop long flexor tendons

(see GA6)

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26
Q

Describe the Common flexor synovial sheath or ulnar bursa & where it begins & continues to

A

common sheath enveloping
tendons of the flexor digitorum superficialis and flexor digitorum profundus mm.
1) Begins proximal to the flexor retinaculum.
2) Continuous distally with the digital synovial sheath of Digit V.

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27
Q

Describe the Synovial sheath of flexor pollicis longus or radial bursa & where it begins & continues to

A

lateral to the
common synovial flexor sheath, with which it frequently communicates.
1) Begins proximal to the flexor retinaculum.
2) Continuous distally with the digital synovial sheath of the thumb.

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28
Q

Describe the Digital synovial sheaths & where it begins & continues to

A

envelop long flexor tendons within the digits.
1) The synovial sheaths of Digits II–IV terminate proximally at the metacarpal
midshaft.
2) The synovial sheaths of Digits I and V are continuous with the radial and
ulnar bursae, respectively.

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29
Q

What can bacterial tenosynovitis can result from

A

Penetrating injuries of the fingers or palm can result in bacterial
infections within the synovial tendon sheaths

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30
Q

Infections arising in
_________ can spread rapidly into the neighboring bursa and proximally into the forearm.
Infections originating in _________ are typically contained
within the affected digit.

A

a. Digits I or V (radial or ulnar bursa)

b. Digits II–IV

31
Q

List the intrinsic muscles of the hand

A

→5 muscles innervated by median n.; all remaining by ulnar n.

  a. Abductor pollicis brevis m. 
  b. Flexor pollicis brevis m. 
  c. Opponens pollicis m.

(Thenar muscles)

32
Q

List the thenar muscles

A

a. Abductor pollicis brevis m.
b. Flexor pollicis brevis m.
c. Opponens pollicis m.

33
Q

What is the insertion and primary action(s) of the Abductor pollicis brevis m.

A

Insertion: Base of the proximal phalanx of the thumb

Primary Action: Abducts the thumb

34
Q

What is the insertion and primary action(s) of the Flexor pollicis brevis m.

A

Insertion: Base of the proximal phalanx of the thumb

Primary Action: Flexes the CM and MP joints of the thumb

35
Q

What is the insertion and primary action(s) of the Opponens pollicis m.

A

Insertion: Lateral shaft of the 1st metacarpal

Primary Action: Opposes the thumb

36
Q

definition of Hypothenar muscles

A

intrinsic muscles of Digit V, which form the hypothenar
eminence. All share a common origin from the flexor retinaculum and its
attachments, and all are innervated by the deep branch of the ulnar n.

37
Q

List the Hypothenar muscles

A

a. Abductor digiti minimi m.
b. Flexor digiti minimi (brevis) m.
c. Opponens digiti minimi m.

38
Q

What is the insertion and primary action(s) of the Abductor digiti minimi m.

A

Insertion: Base of the proximal phalanx of Digit V

Primary Action: Abducts Digit V

39
Q

What is the insertion and primary action(s) of the Flexor digiti minimi (brevis) m.

A

Insertion: Base of the proximal phalanx of Digit V

Primary Action: Flexes the MP joint of Digit V

40
Q

What is the insertion and primary action(s) of the Opponens digiti minimi m.

A

Insertion: Shaft of Metacarpal V

Primary Action: Opposes Digit V

41
Q

Some lovers try positions that they cant handle

A

carpal boes……

42
Q

List the Intrinsic muscles of central compartment—

A

Inntervated Mostly by deep branch of ulnar n.

a. Adductor pollicis m.
b. Palmar interosseous muscles (3)
c. Dorsal interosseous muscles (4)
d. Lumbricals (4)

Abduction of Digits II–III; adduction of digits IV–V

43
Q

Adductor pollicis m
O:
I:
A:

A

Origin: Transverse Head from Metacarpal III
Oblique Head from capitate and bases of Metacarpals II–III
Insertion: Medial base of the proximal phalanx of the thumb
Action: Adducts and flexes the thumb

44
Q

Palmar interosseous muscles (3)
O:
I:
A:

A

Origin: Shafts of Metacarpals II, IV, and V
Insertion: Extensor expansions of Digits II, IV, V
Actions: Adduction; flexion of MP joints; extension of PIP and DIP joints

45
Q

Dorsal interosseous muscles (4)
O:
I:
A:

A

Origin: Bipennate muscles originating from adjacent metacarpal shafts
Insertion: Base of proximal phalanx and extensor expansion of Digits II–IV
Action: Abduction; flexion of MP joints; extension of PIP and DIP joints.

46
Q

Lumbricals (4)
O:
I:
A:

A

Origin: Tendons of flexor digitorum profundus m.
Insertion: Lateral side of the extensor expansions of Digits II–V
Innervation: 1–2 by median n., 3–4 by deep branch of ulnar n.
Action: Flexion of MP joints; extension of PIP and DIP joints
Abduction of Digits II–III; adduction of digits IV–V

47
Q 
Mnemonics for actions of the interossei are PAD and DAB—
Palmar ADduct and Dorsal ABduct. By virtue of their relationships to the MP joints and 
insertions on the extensor expansions, the interossei and lumbricals all act to flex the MP 
joints and extend the IP joints (King Tut action). The lumbricals perform this action most 
effectively. With lumbrical paralysis, inadequately opposed extrinsic flexors draw the 
affected digit(s) into a flexed position (claw hand deformity).
A

…….

48
Q

List the nerves of the palm:

A

Median n. & Branches: Palmar cutaneous branch, Recurrent branch of the median n., & Common palmar digital nn.

49
Q

Describe the Median n.

A

motor supply to five intrinsic muscles of the hand; cutaneous innervation to
the lateral palm and lateral 3½ digits.
1. Enters the palm through the carpal tunnel, deep to the flexor retinaculum and
anterior to the long flexor tendons.
2. Branches : Palmar cutaneous branch & Recurrent branch of the median n. & Common palmar digital nn.

50
Q

Describe the Palmar cutaneous branch:

A

arises just proximal to the carpal tunnel and passes

superficial to the flexor retinaculum to supply the lateral palm.

51
Q

Describe the Recurrent branch of the median n.:

A

arises deep to the flexor retinaculum and

courses proximolaterally to supply the three thenar muscles.

52
Q

Superficial lacerations over the thenar eminence may sever the ________ causing weakened thumb flexion and abduction and loss of opposition.
Subsequent atrophy of the thenar muscles results in an______ deformity.

A

a. recurrent median n.

b. ape thumb

53
Q

Describe the Common palmar digital nn. branch

A

1) Small branches give motor innervation to lumbricals 1–2.
2) Proper palmar digital nn.: terminal branches that give cutaneous
innervation to the palmar surfaces and nail beds of the lateral 3½ digits.

54
Q

Compression of the ______within the rigid carpal tunnel can cause
numbness and/or tingling in the lateral 3½ digits and weakness of thumb movements.

A

a. median n.

55
Q

Edema associated with pregnancy and inflammation of the synovial tendon sheaths due to
repetitive flexion/extension of the wrist and fingers (as with typing) are common causes of
___________

A

carpal tunnel syndrome.

56
Q

Define the ulnar n. and its course

A

motor innervation to most intrinsic hand muscles and cutaneous innervation to
the palmar and dorsal aspects of the medial hand and medial 1½ digits.
1. Course
a. Crosses the wrist in a bony groove lateral to the pisiform and medial to the hook
of the hamate and superficial to the flexor retinaculum.
b. Fibrous connective tissue creates a small osseofibrous tunnel, ulnar (Guyon’s)
canal, for the ulnar nerve.

57
Q

List the branches of the Ulnar n.

A

a. Palmar cutaneous branch
b. Dorsal cutaneous branch
c. Superficial branch
d. Deep branch:

58
Q

Because of the distribution of the proper digital branches of the
median and ulnar nn., effective local anesthesia of a digit (digit block) requires injection of
anesthetic solution along both _____________ of the digit base.

A

medial and lateral sides

59
Q

What does the Palmar cutaneous branch of the ulnar n. supply?

A

supplies skin of the medial palm.

60
Q

What does the Dorsal cutaneous branch of the ulnar n. supply?

A

1) Supplies skin of the medial side of the dorsal aspect of the hand.
2) Gives dorsal digital branches to the medial 1½ digits.

61
Q

What does the Superficial branch of the ulnar n. supply?

A

1) Supplies the palmaris brevis m. Page 7 of 8
Text © Michelle Singleton 2014
2) Common and proper palmar digital nn.: to the palmar surfaces and nail
beds of the medial 1½ digits.

62
Q

What does the Deep branch of the ulnar n. supply?

A

passes through the hypothenar muscle mass to reach the deep
palmar space; gives muscular branches to hypothenar muscles, lumbricals 3–4,
the interossei, and adductor pollicis m.

63
Q

3 muscles of the thenar eminicence and the 1st and 2nd lumbricles!!!

A

……..

64
Q

The ulnar nerve is subject to compression as it passes through the
_________. Pressure against the base of the extended palm, as when typing or riding a
bicycle, can cause numbness and tingling of the medial 1½ digits and weakness of intrinsic
hand muscles called _________.

A

a. ulnar canal

b. (cyclist’s palsy)

65
Q

Severing the ulnar n. at the wrist produces what two results?

A
  1. a flexion
    deformity of Digits IV–V (hand of benediction)
  2. and wasting of the intrinsic muscles (simian
    hand) .
66
Q

Palmar interosseii ….

A

PAD - Palmer adduct; unipennate

67
Q

Dorsal interossii side

A

DAB - Dorsal ABducts; bipennate..

68
Q

List the arteries of the palm

A
  1. Ulnar a.
  2. Radial a.
  3. Palmar arterial arches: Superficial arterial arch & Deep palmar arterial arch
69
Q

Describe the Ulnar artery of the palm

A
  1. Accompanies the ulnar nerve through Guyon’s canal then curves laterally across the
    palm to form the superficial palmar arterial arch.
  2. Deep palmar branch: courses with the deep branch of the ulnar n. and unites with
    the radial artery to complete the deep palmar arterial arch.
70
Q

Describe the Radial artery of the palm

A
  1. Gives a superficial palmar branch, which typically penetrates the thenar muscle
    mass and anastomoses with the ulnar a. to complete the superficial palmar arch.
  2. Winds dorsally across the floor of the anatomical snuffbox and passes between the
    heads of the 1st
    dorsal interosseous muscle to reach the central compartment.
  3. Gives large branches to the first two digits (princeps pollicis and radialis indicis aa.).
  4. Curves medially deep to the adductor pollicis m. (oblique head) to form the deep
    palmar arterial arch.
71
Q

Describe the Superficial palmar arterial arch, where it lies, and what it gives rise to

A

formed primarily by the ulnar a. and completed by
the superficial palmar branch of the radial a.
a. Lies deep to the palmar aponeurosis but superficial to the
extrinsic flexor tendons.
b. Gives rise to common palmar digital arteries, which pass
distally and give two terminal proper palmar digital arteries.

72
Q

Describe the Deep palmar arterial arch, where it lies, and what it gives rise to

A

formed primarily by the radial a. and
completed by the deep palmar branch of the ulnar a.
a. Proximal to the superficial arch.
b. Anterior to the metacarpal shafts and interosseous mm. but
posterior (deep) to adductor pollicis m.
c. Gives rise to palmar metacarpal arteries, which pass distally
in the intermetacarpal spaces.
d. Palmar metacarpal arteries terminate by anastomosing with the common palmar
digital arteries.

73
Q

The numerous anastomotic connections between branches of the ________& _________ provide the hand with excellent collateral circulation but make it
difficult to control bleeding.

A

radial and ulnar arteries

Anatomy Unit I (8 decks)

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