hand

Question 1

what are the 7 layers of the palm

Answer 1

1. skin and palmaris brevis
2. palmar aponeurosis
3. thenar and hypothenar muscles
4. neurovascular plane
5. long flexor tendons and lumbricals
6. adductor pollicis and neurovascular plane
7. interossei and metacarpals

Question 2

explain the anatomy of the palmar aponeurosis

Answer 2

• connected to the skin by a whole series of fibrous bands
• extends from distal border of flexor retinaculum and divides into 4 slips that insert into the skin creases at the base of the fingers

Question 3

why isnt the thumb covered by the palmar aponeuroses

Answer 3

allows better range of movement

Question 4

what is it called when you have thickening of the palmar aponeurosis

Answer 4

dupuytrens contracture

Question 5

in which fingers can dupuytrens contracture occur

Answer 5

only in fingers 2-5

Question 6

where is dupuytrens contracture commonly seen

Answer 6

in epileptic
diabetics
alcoholics
manual worders

Question 7

which muscles dont have the palmar aponeurosis overlying it

Answer 7

thenar and hyothenar muscles

Question 8

which 3 muscles are in the thenar and hypothenar muscles

Answer 8

• abductor
• flexor
• opponens

Question 9

which 3 muscles are in the thenar muscles

Answer 9

abductor pollicus brevis
flexor pollicus brevis
opponens pollicus

Question 10

which 3 muscles are in the hypothenar muscles

Answer 10

abductor digiti minimi
flexor digiti minimi
opponens digiti minimi

Question 11

what is the positioning of abductor, flexor and opponens in the thenar and hypothenar muscles

Answer 11

abductor - superificial to opponens and lie on the outside of the hand
flexor tends to lie towards the centre of the hand

Question 12

where do the thenar and hypothenar muscles originate from

Answer 12

the flexor retinaculum and the adjacent carpal bones

Question 13

insertions of the thenar and hypothenar muscles

Answer 13

abductors and flexors insert together into the proximal phalanx
opponens go into the metacarpals

Question 14

explain the anatomy of the vessels that make up the superficial palmar arch

Answer 14

formed by ulnar artery and completed by radial artery, and then gives rise to a series of digital arteries for each of the fingers

Question 15

explain the positioning of the fibrous and synovial sheaths associated with the layer of the superficial neurovascular plane

Answer 15

fibrous sheaths - extend from the metacarpal heads to the distal phalanges
synovial sheaths - start more proximal and go down to the tip of the fingers (there is a gap in the synovial sheath of phalanges 2-4, but 5 is continuous)

Question 16

what is the significance of the “break” in the synovial sheaths for phalanges 2-4?

Answer 16

where the 4 lumbricals arise

Question 17

which musclse do the lumbricals arise from

Answer 17

the FDP tendons

Question 18

route of the lumbricals

Answer 18

wind around the RADIAL side of each finger and then insert into the dorsal extensor digitorum tendon (before it splits into 3 tendons)

Question 19

function of the lumbricals

Answer 19

flex the metacarpal-phalangeal joint (wave bye bye)

Question 20

origin of abductor pollicus

Answer 20

the shaft of the 3rd metacarpal

Question 21

what is the deepest layer of the palm of the hand

Answer 21

metacarpals and palmar interosseous muscles (PAD)

Question 22

function of PAD

Answer 22

adduct the fingers

Question 23

explain where the PAD are

Answer 23

2, 4 and 5th fingers only

Question 24

insertion of PAD

Answer 24

wind around their corresponding side and insert into the extensor expansion of extensor digitorum

Question 25

function of dorsal intraosseoi

Answer 25

abduct

Question 26

explain where the dorsal intraosseoi are

Answer 26

middle 3 fingers - not pinky or thumb