Hand Flashcards
lots of pressure on digit 3 does what?
dislocates lunate
lots of pressure on digit 1 does what?
fracture of scaphoid
palmar surface
hairless, many sweat glads, transverse and longitudinal flexion creases
fingerprints - non-skid tread
looser skin
dorsal surface
loose skin with hair
superficial palmar fascia
thin layer
highly fibrous
bound tight to deep fascia
deep palmar fascia
continuous with deep fascia of antebrachium
webs in fingers?
important bc its the location of blood vessels and nerve
fascia distal to wrist?
becomes palmar carpal ligament (thicker)
-which is continuous to the transverse carpal ligament (flexor retinaculum)
what muscles attaches to palmar aponeurosis?
palmaris longus
superficial palmar aponeurosis
longitudinal orientation
-continuous proximally with the flexor retinaculum
and palmaris longus tendon
distally extends onto four lesser digits to attach to base of proximal phalanges and fuse with fibrous digital sheaths
dupuytrens contracture
thickening and contracture of longitudinal bands of palmar aponeurosis
fingers force to flexion
deep layer of palmar aponeurosis
transverse fibers continuous with thenar and hypothenar fascias, thicker distally
superficial transverse metacarpal ligament
unites longitudinal bands distal on their anterior surfaces assist in strengthening region of interdigital webs
fibrous digital sheaths
specializations of deep fascia anchored to margins of phalanges
form a fibro-osseous canal for passage of digital flexor tendons
prevent bowstringing of flexor tendons
synovial digital sheaths
located between fibrous sheath and accompanying tendon
-lubricate the fibrous digital sheath
fluid filled connective tissue bursa wrapped around tendons
each digit has own sheath
radial bursa
aka bursa of flexor pollicis longus tendon
extends from proximal to flexor retinaculum to distal attachment of flexor pollicis longus
ulnar bursa
aka common flexor bursa
surrounds tendons of long digital flexors
-flexor digitorum superficialis and profundus
extends from proximal to flexor retinaculum distally to tip of 5th digit
connective tissue septa?
from palmar neurosis to shafts of metacarpals delineating three compartments:
thenar, central, hypothenar
deeper transverse fascal plane?
fourth compartment:
-adductor inter-osseous compartment
plane of reference in hand?
digit 3
deep palmar space
between opposing fascias of central and adductor-interosseous compartment
extension of palmar aponeurosis to shaft of thid metacarpal divids this space into lateral palmar space and medial (mid-palmar space)
compartments of hand
thenar, hypothenar, central, adductor interosseous
in plane of palm?
adducted
out of plane of palm
abducted
opposition what is moved?
metacarpals moving toward midline of hand
-opponins muscles
hypothenar
digit 5
thenar
digit 1
muscles of thenar compartment
abductor pollicic brevis
attachments of abductor pollicis brevis
origin:
flexor retinaculum, scaphoid, trapeqium
insertion:
ventral base of proximal phalanx of thumb laterally
action of abductor pollicis brevis
abducts thumb (with slight flexion of carpometacarpal joint)
out of plane of thumb**
innervation of abductor pollicis brevis
median nerve (recurrent)
attachments of flexor pollicis brevis
origin:
flexor retinaculum, trapezium
insertion:
lateral base of proximal phalanx of thumb
action of flexor pollicis brevis
flexion of thumb at carpometacarpal metacarpophalangeal joints
innervation of flexor pollicis brevis
superficial head - median nerve recurrent
deep head - deep branch ulnar nerve
order of muscles in thenar and hypothenar
-superficial to deep?
abductor, flexor, opponens
attachments of opponens pollicis
origin:
flexor retinaculum, trapezium
insertion:
most of radial palmar border of first metacarpal
action of opponens pollicis
opposition of thumb
innervation of opponens pollicis
median nerve recurrent
what else is in thenar compartment?
tendon of flexor pollicis longus with radial bursa
muscles of the hypothenar compartment
abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
attachments of abductor digiti minimi
origin:
pisiform
insertion:
medial base of proximal phalanx of digiti minimi
action of abductor digiti minimi
abducts and flexes metacarpophalangeal joint of digiti minimi
innervation of abductor digiti minimi
ulnar nerve (deep branch)
attachments of flexor digiti minimi
origin:
hamulus of hamate and flexor retinaculum
insertion:
medial base of proximal phalanx of digiti minimi (with abductor digiti minimi)
action of flexor digiti minimi
flexes digiti minimi at metacarpophalangeal joint
innervation of flexor digiti minimi
ulnar nerve (deep branch)
attachments of opponens digiti minimi
origin:
hamulus of hamate
insertion:
medial border of fifth metacarpal
action of opponens digiti minimi
pulls fifth petacarpal towards thumb during opposition
innervation of opponens digiti minimi
ulnar nerve (deep branch)
contents of central compartment
**structures beneath the palmar aponeurosis
superficial palmar arterial arch
branches of ulnar/median nerve
tendons and synovial linings of long flexors
lumbricals
attachments of lumbricals?
origin:
radial sides of flexor digitorum profundus tendons
insertion:
extensor expansion of extensor digitorum tendons
action of lumbricals?
flexes metacarpophalangeal joints and extends interphalangeal joints
MP joint - on palmar side
IP joint - on dorsal side
innervation of lumbricals?
median - 1 and 2
ulnar - 3 and 4
lumbricals 1 and 2?
unipennate
lumbricals 3 and 4?
bipennate stronger
contents of adductor-interosseous compartment?
deep palmar arterial arch
adductor pollicis
palmar and dorsal interossei
deep branch of ulnar arch
metacarpals 2 3 4
attachments of adductor pollicis
origin:
oblique head - capitate and bases of second and third metacarpals
transverse head - palmar surface, shaft of third metacarpal
insertion:
ulnar surface, base of proximal phalanx of thumb
action of adductor pollicis
adducts thumb
innervation of adductor pollicis?
ulnar deep branch
attachments of palmar interossei
origin:
interosseous surface of ulnar sides of 1st and 2nd metacarpal and radial side of metacarpal 4 and 5
insertion:
sides of base of proximal phalanx and extensor expansion of digits 1, 2, 4, 5
actions of palmar interossesi
adducts 1, 2, 4, 5
flex MP joint and extend IP joint of digit 1, 2, 4, 5
innervation of palmar interossei
ulnar nerve deep branch
deep head of flexor pollicis brevis?
considered an adductor of thumb by virtue of its deep position and by the fact that it is innervated by deep branch of ulnar nerve
attachments 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 digit 2, 3, 4
flex MP joint and extend IP joint digit 2, 3, 4
innervation of dorsal interossei?
ulnar nerve deep branch
two major arteries of arm
radial and ulnar
enter palm and anastomose
anastomosis of radial and ulnar arteries?
superficial and deep palmar arch
superficial palmar arterial arch
anastomose of:
superficial branch of radial artery
ulnar artery (chief contributor)
- under palmar aponeurosis
- over flexor tendons
- more distal and larger than deep arch
at risk to get cut
deep palmar arterial arch
major contributor is radial artery (dorsal side of thumb)
- sits on bones deep to flexor tendons on top of interossei muscles
- continuous with deep branch of ulnar artery
how many arteries on glomus of fingers?
4
**why you bleed alot on your fingers
radial artery
courses through snuff box and goes to dorsum of carpal bones
gives off dorsal carpal arch
-then dives deep to first interossei muscle two heads
dorsal carpal arch
of radial artery
-anastomoses with dorsal carpal branch of ulnar artery
**won’t see on body
give rise to dorsal metacarpal arteries
dorsal metacarpal arteries
from dorsal carpal arch
-two for every finger
form proper dorsal digital arteries
deep palmar arterial arch
small, proximal, deep to tendons
on the metacarpals and interossei muscles
forms from radial artery continuation
-branches princeps pollicis and radialis indicis
anastomose with deep branch of ulnar artery
princeps pollicis
arises from radial artery
radialis indicis
variable - sometimes from radial artery (distal to princeps pollicis) or from princeps pollicis
branches from deep palmar arterial arch?
palmar metacarpal arteries (usually 3)
anastomose with common palmar digital branches
-from superficial palmar arterial arch
perforating branches
connect dorsal metacarpal arteries with palmar metacarpal arteries
ulnar artery
goes over flexor retinaculum lateral to pisiform
forms the superficial palmar arterial arch
superficial palmar arterial arch
continuation of ulnar artery
- gives rise to common palmar digital arteries
- in webs branches to proper digital arteries
common palmar digital arteries
branch of superficial palmar arterial arch (3)
each finger receives how many arteries?
4
veins of fingers?
vena comitantes that accompany branches of radial and ulnar arteries in hand
cutaneous innervation of hand?
from C678
ulnar nerve
on top of bones next to ulnar artery
passes under pisohamate ligament
median nerve
cutaneous - 1, 2, 3, lateral 4
ulnar nerve
cutaneous - medial 4, 5
median motor innervation?
**recurrent branch
thenar and 1 2 lumbricals
ulnar nerve motor innervation
hypothenar muscles
3 4 lumbricals
dorsal and palmar interossei
ends at adductor pollicis and deep head of flexor pollicis brevis
branches of ulnar nerve
superficial - cutaneous (and palmaris brevis)
deep - follow deep palmar arterial arch
major innervation of forearm?
median
ulnar nerve
C8 T1
carpal tunnel what nerve?
median nerve
guyans tunnel
for ulnar nerve
