Hand Flashcards
Deep fascia of the palm overlaying the long flexor tendons
Palmar aponeurosis
-ligamentous tubes enclosing the flexor tendons and synovial sheaths that surround them
Fibrous digital sheaths
Extends deeply from the medial border of the palmar aponeurosis to the 5th metacarpal
Medial fibrous septum
Extends deeply from the lateral border of the palmar aponeurosis to the 3rd metacarpal
Lateral fibrous septum
Contains:
-Sheaths
-Lumbrical muscles
-Superficial palmar arterial arch
-Digital vessels & nerves
Central compartment
Deepest muscular plane of palm
Adductor compartment
-Thenar space
-Midpalmar space (enter carpal tunnel)
These are between flexor tendons & fascia
2 potential spaces
Muscles:
-abductor pollicis brevis
-flexor pollicis brevis
-opponens pollicis
Nerve:
Innervated recurrent branch of the median nerve c8 T1 (except adductor pollicis)
-near lateral fibrous septum
Thenar muscles
Muscles:
-abductor digiti minimi
-flexor digiti minimi brevis
-opponens digiti minimi
Nerve:
Innervated by deep branch of ulnar nerve
-near medial to this septum
Hypothenar muscles
Median nerve: 1 & 2
Ulnar nerve: 3 & 4
-flex MCP joints
Lumbricals
Muscles innervated by deep branch of ulnar nerve
Interossei
Opponens pollicis
Opposition
-Covers ulnar nerve & artery
-wrinkles skin of hypothenar to aid palmar grip
-Attach to medial border of the palmar aponeurosis
Palmaris brevis
Abduct the fingers at the metacarpophalangeal joints in reference to the axial line of 3rd digit
4 Dorsal interossei
Hook of hamate
Flexor carpi ulnaris
Adduct the fingers at the metacarpophalangeal joints in reference to the axial line of 3rd digit
Palmar interossei
The tendons enter the central compartment of the hand and fan out to enter this
Digital synovial sheath
At the base, the tendon of the FDS splits and surrounds the tendon of the FDP
Proximal phalanx
-pass split in the FDS tendon (tendinous chiasm)
-pass distally to attach to the anterior aspect of the base of the distal phalanx
Tendon of the FDP
Ulnar artery enters hand anterior to flexor retinaculum between pisiform hook of hamate
Ulnar canal (Guyon canal)
-ulnar artery contributes to it
-it gives rise to 3 common palmar digital arteries that anastomose with palmar metacarpal arteries from the deep palmar arch
-proper palmar digital arteries present that run along the 2nd & 4th fingers
Superficial palmar arch
-passes along the lateral side of the index finger
Radialis indicis artery
Doesn’t supply the hand
The radial nerve
Fine motor
The ulnar nerve
-deep to the flexor retinaculum between tubercles of scaphoid & trapezium and pisiform & hook of hamate
-median nerve inside
Carpal tunnel
-Disease of the palmar fascia resulting in progressive shortening, thickening, & fibrosis of the palmar fascia & palmar aponeurosis
-bilateral fibrosis degeneration on medial side of longitudinal digital bands pulling 4th & 5th fingers to partial flexion at metacarpophalangeal & proximal interphalangeal joints
Dupuytren contracture
-Fibrous thickening of the sheath and stenosis of osseofibrous tunnel due to excessive friction of tendons
-causes pain in the wrist that radiates proximally to the forearm & distally to the thumb apl epb
De Quervain tenosynovitis
-lesion derived
-paresthesia (tingle)
-hypesthesia (low sensation)
-anesthesia (no sensation)
-unaffected central palm sensation (bc cutaneous branch not in tunnel)
Carpal tunnel syndrome
Wasting of Thenar bc of weak APB & opponens pollicis due to carpal tunnel syndrome
Ape hand
-bc of radial nerve injury by fracture of humoral shaft
-extensors are disabled
-anesthesia on small lateral dorsum part of hand
-hand remains flexed at wrist & metacarpophalangeal joints
Wrist-drop
