Hand Flashcards
What side of the hand is the skin thicker
palmar surface
describe the superficial palmar fascia
thin layer highly fibrous in composition, bound tightly to deep fascia
describe the deep palmar fascia
continuous with deep fascia of the antebrachium
What does the deep palmar fascia form
palmar carpal ligament and flexor retinaculum, palmar aponeurosis and the fibrous digital sheaths
Describe the superficial layer of the palmar aponeurosis
longitudinally oriented fibers ocntinuous with flexor retinaculum and palmaris longus tendon,
where does the superficial layer of palmar aponeurosis attach?
distal on 4 lesser digits at base of proximal phalanges and fuses with digital sheaths
what is Dupuytren’s contracture
thickening and contracture of longitudinal bands- forces fingers to remain in state of severe flexion
describe the deep layer of the palmar aponeurosis
transversely oriented fibers continuous with thenar and hypothenar fascias; becomes thicker distally
what structure unites the longitudinal bands distally
superficial transverse metacarpal lig to strengthen webs
What prevent “bowstringing” of tendons when flexing fingers
fibrous digital sheaths that form canals
what lays between the fibrous digital sheaths and the actual tendon
synovial digital sheaths
Describe the radial bursa
bursa of flexor pollicis longus tendon that extends from proximal retinaculum to distal attachment
describe the ulnar bursa
common flexor bursa, surrounds tendons of long digital flexors and extends distally to tip of fifth digit
Connective tissue septae split the hand into how many compartments, what are they?
3
thenar, central and hypothenar
what creates the fourth compartment of the hand
deeper transverese fascial plane which makes the adductor-interosseous compartments
the aponeurosis to shaft of third metacarpa divides spaces into what
lateral palmar (thenar) and medial (mid palmar)
What structures are in the thenar compartment
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, tendon of flexor pollicis longus, branches of median n, branches of radial a and 1st metacarpal
origin and insertion of abductor pollicis brevis
origin: flexor retinaculum, scaphoid and trapezium
insertion: ventral base of proximal phalanx of thumb
action of abductor pollicis brevis
abducts thumb with slight flexion of carpometacarpal joint
what innervates abductor pollicis brevis
median n (recurrent)
origin and insertion of flexor pollicis brevis
origin: flexor retinaculum and trapezium
insertion: lateral base of proximal phalanx of thumb
action of flexor pollicis brevis
flexion of thumb at carpometacarpal and metacarpophalangeal joint
what innervates flexor pollicis brevis
superficial head: median n (recurrent)
deep head: deep branch ulnar n
origin and insertion of opponens pollicis
origin: flexor retinaculum and trapezium
insertion: most radial palmar border of first metacarpal
action of opponens pollicis
opposition
innervation of opponens pollicis
median n (recurrent)
what structures are within hypothenar compartment
abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, branches of ulnar n, branches of ulnar a and 5th metacarpal
origin and insertion of abductor digiti minimi
origin: pisiform
insertion: medial base of proximal phalanx of digiti minimi
what is the action of abductor digit minimi
abducts and flexes metacarpophalangeal joint of digiti minimi
what innervates abductor digiti minimi
ulnar n (deep branch)
origin and insertion of flexor digiti minimi
origin: hamulus of hamate and flexor retinaculum
insertion: medial base of proximal phalanx of digiti minimi (with abductor digiti minima)
What is the action of flexor digiti minimi
flexes digiti minimi at metacarpophalangeal joint
What innervates flexor digiti minimi
ulnar n (deep branch)
origin and insertion of opponens digiti minimi
origin: hamulus of hamate
insertion: medial border of fifth metacarpal
what is the action of opponens digiti minimi
opposition or grasping
what innervates opponens digit minimi
ulnar n (deep branch)
What structures are found in the central compartment of the hand
superficial palmar arterial arch and branches
branches of the median and ulnar nn
tendons and synovial linings of long digital flexors and lumbricals
where does flexor digitorum superficialis attach
sides of middle phalanx of digits 2-5
where does flexor digitorum profundus attach
palmar surface, base of distal phalanx, digits 2-5
origin and insertion of lumbricals
origin: radial side of flexor digitorum profundus tendons
insertion: extensor expansion of extensor digitorum tendons
action of lumbricals
flexes metacarpophalangeal joints and extends interphalangeal joints
what innervates the lumbricals
lumbricals 1 and 2- median
lumbricals 3 and 4- ulnar
what structures are in the adductor-interosseous compartment
deep palmar arterial arch and branches, adductor pollicis, palmar and dorsal interossei, deep branch of the ulnar n and metacarpals 2, 3 and 4
origins of adductor pollicis
origin: oblique head- capitate and bases of 2nd and 3rd metacarpal
transverse head- palmar surface, shaft of 3rd metacarpal
insertion of adductor pollicis
ulnar surface, base of proximal phalanx of thumb
action of adductor pollicis
adducts thumb
inn of adductor pollicis
ulnar (deep branch)
origin and insertion of palmar interossei
origin: interosseous surface of ulnar sides of 1st and 2nd metacarpal and radial side of 4th and 5th metacarpals
insertion: sides of base of proximal phalanx and extensor expansion of digits 1,2,4,5
action of palmar interossei
adduct digits 1,2,4,5 flexes MP joints and extends IP joints of digits 1,2,4,5
inn of palmar interossei
ulnar (deep branch)
what portion of flexor pollicis brevis is considered an adductor
deep head
origin and insertion of dorsal interossei
origin: adjacent sides of all metacarpals
insertion: extensor expansions and sides of bases of phalanges 2,3,4
Action of dorsal interossei
abduct digits 2,3,4 flex MP joints and extend IP joints of digits 2,3,4
inn of dorsal interossei
ulnar (deep branch)
what is the chief contributer to the superficial palmar arterial arch
ulnar artery
where is the superficial palmar arterial arch located
between palmar aponeurosis and long digital flexor tendons
what is the chief contributor to the deep palmar arterial arch
radial a
where is the deep palmar arterial arch located
in adductor-interosseous compartment deep to the long flexor tendons and adductor pollicis m
which arterial branch is more distal than the other
superficial. also its larger
branches of radial a
superficial palmar branch, dorsal carpal branch, princeps pollicis and radials indicis
where does the 1st dorsal metacarpal a spring from
radial a just prior to passing between 2 heads of 1st dorsal interosseous m
where does the 5th dorsal metacarpal a spring from
dorsal carpal branch of the ulnar a just prior to its anastomosis with dorsal carpal branch of radial a
where is princeps pollicis a located
ulnar side of thumb and divides into two branches- palmar surface of thumb
where is radialis indicis a
distal or in common with princeps pollicis and in courses along radial palmar side of index finger
what are the branches of the deep palmar arterial arch
palmar metacarpal aa
how are dorsal metacarpal aa connected with palmar metacarpal aa
perforating branches
Where does ulnar a enter hand
lateral to pisiform and superficial to flexor retinaculum
branches of ulnar’s superficial palmar arterial arch
common palmar digital aa (3 of them)
distall on surface of long flexor tendons
what aa supply the 2 proper digital aa
short arterial trunk from palmar metacarpal, common palmar digital and distal perfortating aa
Each finger receives how many aa input
4 aa each finger
what are the branches of median n in the hand
recurrent or motor
common palmar digital nn
palmar cutaneous branch
what innervates thenar compartment mm
recurrent branch of median n
how many common palmar digital nn from median are there and they go where
three, cutaneous inn to thumb, 2nd and 3rd (radial side of 4th) digits
what does the palmar cutaneous branch of median n inn
the central area of palm- cutaneous
where does the ulnar n split
base of hypothenar eminence
what does the superficial branch of ulnar n inn
common and proper digital branches of 5th and ulnar side 4th
Where is there usually a communicating branch n in the hand
between the fourth digit (ulnar) and 3rd (median
where does deep branch ulnar n course
superfical and proximal to the deep palmar arterial arch
what does the deep branch of ulnar a inn
hypothenar mm, lumbricals 3&4, all interossei and adductor pollicis muscle
where do cutaneous branches of ulnar n arise
forearm
where does the cutaneous palmar branch of ulnar n go to inn
central palm (same as the median)
Where does the dorsal cutaneous branch of ulnar n go
dorsal to ulnar styoid and divides into 3 dorsal digital n (skin medial dorsum of hand)
Does the radial n inn hand at all
superficial branch with a medial and lateral branc
what does the medial branch of superficial branch of radial n inn
4 dorsal digital nn for lateral dorsum of hand and dorsum and ulnar side of thumb forsum of index finger, and radial halff dorsum middle finger
what does the lateral branch of superficial branch of radial n inn
base of thumb
