Hand Flashcards
Identify structures except:
-15, 17-21, 26-28.16 + 25 red
Where do the lumricals attach?
Lumbricals attachments
Identify Ulnar artery, radial artery, superficial palmar arch,superficial palmar branch of radial artery?
How is the superficial palmar arch formed?
-Mainly by arch of superficial division of ulnar artery and is completed by the superficial palmar branch of radial artery
posterior view. Identify listers tubercle?
Anterior view. Identify styloid process of radius?
What is the blood supply to the scaphoid bone?
-Retrograde blood supply from dorsal carpal branch of radial artery. Fracture of distal or middle portion can leave proximal part at risk of AVN
Describe clinical applicationof listers tubercle
Tubercle on dorsal radius. ‘Lighthouse of the wrist’. EPL tendon runs around it-serves as a pulley for EPL (wraps around medial side and takes 45 degree turn)
What are the attachments of the flexor retinaculum?
Proximal
–> pisiform
–> tubercle of scaphoid
Distal
–> hook of hamate
–> trapezium
What are the structures passing through the carpal tunnel?
-4 tendons of FDS
-4 tendons FDP
-1 tendon FPL
-Median nerve
-FCRL passes through flexor retinaculum
Thumb movements: which muscles do flexion at mcp/ipj and what is their innervation?
-FPL: median (anterior interosseous)
-FPB: median (recurrent branch)
Extension at MCP/IPJ thumb
-EPL
-EPB
Radial (PIN)
Abduction (palmar)
APL: radial (PIN)
APB: Median (recurrent branch
Adduction
Adductor pollicis: ulnar (deep branch)
Opposition
Opponens pollicis
Flexor pollicis brevis
Abductor pollicis brevis
Innervation
–> median nerve recurrent branch
How to test FDP?
By fixing PIP
How to test FDS?
Adjacent digits must be held in extension in order to eliminate FDP motion in adjacent fingers, which otherwise might give the impression of FDS motion in examined finger
Where do the tendons of FDS and FDP insert?
FDS: split tendon on both sides of middle phalanx
FDP: passes through split tendon of FDS to be inserted into the terminal phalanx
Which tendon is attached to the pisiform?
Flexor carpi ulnaris
What makes extensor tendons attached to the phalanges?
Extensor expansion
Where does extensor digitorum insert?
-Extensor expansion of middle and distal phalanges of 2nd, 3rd, 4th and 5th fingers
What is the function of the intertendinous connections?
-Create space between extensor tendons
-Redistribute force between tendons
-Coordinate extension of fingers
-Stabilise MCPJ
Identify the two tendons inserting into the index finger dorsally?
-Extensor indicis (medial)
-Extensor digitorum (lateral)
What is the origin/insertion/action/nerve supply of first dorsal interosseous
Identify 1st dorsal interosseous, extensor indicis, radius, ulna, extensor digitorum tendons, intertendinous connections, abductor digiti minimi
O: 1st metacarpal
I: lateral side of extensor expansion of index finger
Action: abduction of index finger
Nerve supply: deep branch ulnar nerve
When you are doing power grip of hand, what is the role of the radial nerve?
-Supplies wrist extensors which give mechanical advantage to power grip by synergistic activity which causes more efficient flexion of the digitis
Why is hand grip more powerful in extension than in flexion?
-Flexor muscles in extension are in a state of greater tension than in flexion, so contraction in this position is more powerful
What are the borders of the anatomical snuff box?
Boundaries
Posterior border (medial): EPL tendon
Anterior border (lateral): EPB tendon, APL tendon
Proximal border: styloid process of radius
Distal border: apex of snuffbox
Floor: trapezium and scaphoid
Contents: radial artery, superficial branch radial nerve, cephalic vein
Where does EPL insert?
Dorsum of base of terminal phalanx of thumb
Insertion of EPB?
Dorsum of base of proximal phalanx of thumb
Surface markings: show me anatomical snuff box on your hand
What is the median nerve sensory distribution in the hand?
-Lateral 2/3rd of palm of the hand
-Lateral (radial) 3.5 digits on the palmar side
-Dorsum of the tips of index/middle/thumb
Posterior hand/distal forearm innervation
Ulnar: medial 1.5 digits
Median: Tips of lateral 3.5 fingers
Radial: Lateral posterior dorsum of hand
What is the median motor distribution in hand?
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
FPB
What is the clinical picture of a median nerve injury at the elbow?
-Hyperextended thumb (paralysis FPB)
-Adducted thumb (paralysis of abductor pollicis brevis)
-Flat thenar eminence
-Loss of sensation from: lateral 2/3rd of palm of hand, lateral 3.5 digits (palmar and distal dorsal aspect)
Clinical picture of ulnar nerve injury at the wrist?
–> clawing of 4th and 5th digits (paralysis of medial lumbricals and interossei)
–> Loss of sensation of the medial 1/3rd of the palmar and dorsal aspects of hands and fingers
Cause of ulnar paradox?
-In proximal ulnar nerve injuries, there will be paralysis of the medial 1/2 of fdp which will decrease the flexion of the IP joints
Sensory distribution of axillary/musculocutaneous/radial/ulnar/median nerve in the arm
