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Anatomy Exam 1 > Hand > Flashcards

Hand Flashcards

1
Q

What are the 10 structures found in the CT?

A

FDS (4 tendons)
FDP (4 tendons)
FPL
Median N

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2
Q

What 2 structures are found in the Canal of Guyon?

A

Ulnar artery and nerve

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3
Q

what are the 3 possible causes of CTS?

A

excessive exercise
fluid retention
infection

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4
Q

what’s a physical manifestation of CTS?

A

thenar wasting

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5
Q

What are the 4 bones of the proximal row of the hand?

A 
(from thumb to pinky): So Long To Pinky
Scaphoid
Lunate
Triquetrum
Pisiform
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6
Q

What are the 4 bones of the distal row of the hand?

A 
(from pinky to thumb): Here Comes The Thumb
Hamate
Capitate
Trapezoid
Trapezium
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7
Q

What is the most frequently fractured carpal bone?

A

Scaphoid

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8
Q

What is the most frequently dislocated carpal bone?

A

Lunate

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9
Q

What is the largest carpal bone?

A

Capitate

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10
Q

What is palmar aponeurosis?

A

Formed by the deep palmar fascia; a strong, heavy, dense, well-defined triangular layer of the deep fascia in the middle of the palm

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11
Q

What is Dupuytren’s contracture?

A

manifests as a progressive fibrosus, which produces abnormal bands of fibrous tissue that extend from the aponeurosis to the bases of the phalanges, pulling one or more digits into marked flexion at the MCP joints so they can’t be straightened

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12
Q

what is the purpose of the synovial sheaths?

A

allow free movement of tendons into hand and fingers

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13
Q

what are the anterior and posterior boundaries of the CT?

A

anterior: flexor retinaculum
posterior: carpal bones

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14
Q

what are the 6 groups of intrinsic muscles in the hand?

A 
thenar
hypothenar
lumbricals
palmar
dorsal
adductor pollicis
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15
Q

what are the 3 muscles of the thenar component of the hand?

A

OAF
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

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16
Q

Relative to each other, where are the 3 muscles of the thenar component located?

A

(superficial –> deep: AFO) opponens pollicis - deep
abductor pollicis brevis - lateral
flexor pollicis brevis - medial

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17
Q

what are the 3 muscles of the hypothenar component?

A

OAF
opponens digiti minimi
abductor digiti minimi
flexor digiti minimi brevis

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18
Q

Relative to each other, where are the 3 muscles of the hypothenar component located?

A

(Superficial –> deep: AFO) Abductor digiti minimi - most superficial
Flexor digiti minimi brevis - intermediate
Opponens digiti minimi - most deep

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19
Q

where do the lumbricals originate, what is their general function

A

originate from FDP TENDONS, digits 2 -5

  • flex MCP joints, extends PIP and DIP joints
  • will help extend a flexed finger due to insertion on extensor expansion hood
  • allows pinching on pulp of fingers (not the tip) i.e. holding things
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20
Q

what muscles are received by the extensor expansion hood?

A

lumbricals, extensor digitorum, interossei

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21
Q

between the palmar and dorsal interossei, which ones are bipennate and which ones are unipennate muscles?

A

bipennate - dorsal

unipennate - palmar

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22
Q

what is the main function of the dorsal interossei (pneumonic)

A

DABS-
dorsal interossei ABduct
(extension and abduction of the PIP and DIP joints, flex the MCP joints)

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23
Q

the 1st dorsal interosseous is often confused with which muscle?

A

adductor pollicis m

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24
Q

what is the main function of the palmar interossei (pneumonic)

A

PAD - palmar interossei ADduct

extension and adduction of the PIP and DIP joints, flex MCP joints

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25
Q

relative to the adductor pollicis and lumbricals, where are the palmar interossei located?

A

deep to both the lumbricals and adductor pollicis

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26
Q

what are the shapes of each of the carpal bones in the proximal row?

A 
Proximal: SLTP 
scaphoid - boat shaped
lunate - crescent-shaped
triquetrum - pyramidal shaped 
pisiform - pea-shaped
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27
Q

why is the scaphoid the most frequently fractured carpal bone?

A

during the extensor thrust response when you fall, your hand smashes into the ground to prevent head from hitting. All of the F hitting the hand is transferred to the FA via 2 bones - mainly the scaphoid (larger), and also the lunate

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28
Q

what are the 4 attachment sites for the carpal ligament?

A

tubercle of triquetrum
tubercle of scaphoid
hamate
pisiform

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29
Q

what wrist bones articulate with the ulna

A

none, all F is transmitted to the FA via the radius

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30
Q

what is the general function of the sesamoid bones in the thumb?

A

help bending in the thumb; mainly there for correct geometry

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31
Q

what cutaneous nerve innervates a tiny part of the lateral thumb, palmarly?

A

superficial radial n

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32
Q

which cutaneous n innervates most of the thumb, and the next 2.5 digits, palmarly?

A

median n

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33
Q

which cutaneous n innervates the small finger and half of the ring finger, palmarly?

A

ulnar n

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34
Q

which cutaneous n innervates about 2.5 fingers radially on the dorsal side of the hand?

A

superficial radial n

35
Q

which cutaneous n innervates about 2.5 fingers ulnarly on the dorsal side of the hand?

A

ulnar n

36
Q

which cutaneous n innervates the finger tips of the middle three fingers, and part of the thumb tip?

A

median n

37
Q

what does the palmaris brevis m due in relation to the palmar fascia of the hand?

A

pulls the palmar fascia laterally to help tighten it up over the hypothenar region

38
Q

what nerve innervates the muscles of the thenar component of the hand?

A

recurrent median n

39
Q

of the 3 thenar muscles, which one is most superficial and cover the other 2?

A

abductor pollicis brevis

40
Q

of the 3 thenar muscles, which is the smallest and most medial relative to the others?

A

flexor pollicis brevis

41
Q

of the 3 thenar muscles, which one lies deep to the other 2, and whose fibers run across the thumb?

A

opponens pollicis

42
Q

what nerve innervates the muscles of the hypothenar component of the hand?

A

the ulnar n

43
Q

of the 3 hypothenar muscles, which lies deepest relative to the other 2?

A

opponens digiti minimi

44
Q

of the 3 hypothenar muscles, which is most medial (on the farthest side of the pinky), and is most superficial?

A

abductor digiti minimi

45
Q

of the 3 hypothenar muscles, which is the most lateral (in anatomical supine position)

A

flexor digiti minimi brevis

46
Q

from what do the lumbricals originate?

A

FDP tendons

47
Q

what is the main function of the lumbricals?

A

to flex the MCP joint and extend the PIP and DIP joints, allowing pinching of the PULP of the fingers

48
Q

lumbricals can help extend the finger due to …

A

their insertion into the extensor expansion hood as they come around the lateral side of the finger

49
Q

the fact that the lumbricals start on the front side and wrap around to the back is important for …

A

flexion

50
Q

where are the interossei muscles located in the hand?

A

“between bones”, originate from MCs

51
Q

what fingers do the dorsal interossei supply?

A

the middle 3 fingers, because the small finger and thumb have abductor muscles of their own

52
Q

both the palmar and dorsal interossei wrap around and insert into the extensor expansion hood, allowing both groups to assist with …

A

extension

53
Q

relative to the interossei muscles, where does the radial artery run?

A

crosses over to the back of the hand, comes between the 2 heads of the 1st dorsal interosseous muscle in order to get to the deep hand muscles

54
Q

which fingers do the palmar interossei muscles run to?

A

2, 4, and 5 (3rd MC can be done by the dorsal interosseous)

55
Q

what is the deepest muscle on the thenar side?

A

adductor pollicis (transverse and oblique head)

56
Q

what is the fan-shaped muscle that adducts the thumb?

A

adductor pollicis (has 2 heads)

57
Q

what nerve innervates the adductor pollicis?

A

the ulnar nerve (where it ends in the hand)

58
Q

describe the general course of the radial artery as it enters the hand.

A

continues around the lateral carpal bones (dorsally) and extends across the floor of the snuffbox, then pierces the 1st dorsal interosseous muscles (btw the 2 heads at the index finger base) to enter the palmar areas of the hand

59
Q

describe the general course of the radial artery once it has entered the hand

A
  • gives off princeps pollicis artery: supplies medial side of thumb
  • gives off radialis indicis artery, supplies lateral side of 2nd digit
  • continues thru palms as deep palmar arch (USRD), which eventually anastamoses w deep branch of ulnar a
  • superficial palmar branch comes off before it wraps around the lateral carpals, then passes thru thenar muscles to anastamose w superficial palmar arch of the ulnar a
60
Q

how does the ulnar a enter the hand?

A

both the ulnar a and n enter the hand thru the canal of Guyon

61
Q

describe the general course of the ulnar a once it enters the hand

A
  • the superficial branch of the radial a becomes the superficial palmar arch, which traverses across the palm, giving off common palmar digital arteries (which divide into proper palmar digital arteries)
  • the deep branch passes btw the abductor digiti minimi and flexor digiti minimi, and anastamoses w the deep palmar arch of the radial a
62
Q

where does the median n enter the hand, and how does it continue once it’s there?

A

enters under the flexor retinaculum via the CT

  • 1st branch distal to flexor retinaculum is the recurrent branch (thenar muscles)
  • becomes common palmar and then proper palmar digital nerves
  • provides cutaneous sensation to palmar aspect of the lateral 3.5 fingers, dorsal aspect of the same fingers distally (nail bed)
63
Q

where does the ulnar n enter the hand, what are the cutaneous and motor branches in the hand?

A

enters via the canal of Guyon
cutaneous
- palmar
- dorsal
distal to flexor retinaculum, gives off 2 branches:
- superficial: becomes common palmar then proper palmar digital nn
- deep: passes deep to flexor tendons along path of deep palmar arch

64
Q

where does the radial n enter the hand, and what are the cutaneous and motor branches in the hand?

A

superficial branch enters thru the anatomical snuffbox

  • continues as dorsal digital nn, giving cutaneous sensation to dorsal aspect of lateral 2.5 digits proximal to DIP joint
  • NO MOTOR branches
65
Q

what nerve is damaged in a claw hand? where does injury normally occur?

A

ulnar n, normally at the wrist

66
Q

how does claw hand occur?

A

ulnar nerve injury will lead to weakness of most intrinsic muscles of hand, especially in the lumbricals
- deformity occurs due to unopposed activity of the extensor digitorum

67
Q

what is the physical manifestation of a claw hand?

A
  • leads to hyperextension of the 4th and 5th MCP joints, and flexion at the PIP and DIPs
  • will also lose ability to spread fingers due to loss of interossei (can’t ab/adduct fingers)
68
Q

damage to which n causes ape hand?

A

median n injury

69
Q

how does ape hand occur?

A

wasting of the thenar muscles causes inability to oppose the thumb

70
Q

what is the physical manifestation of ape hand?

A

the thumb is pulled posteriorly and lines up w other digits

71
Q

where does injury normally occur to give ape hand?

A

injury to the median n usually occurs at the elbow or wrist, impairing the thenar muscles including opponens pollicis

72
Q

damage to which n causes hand of Benediction?

A

median n damage

73
Q

when will the hand of benediction manifest?

A

must be actively attempting to make a fist

74
Q

what causes the hand of benediction?

A

prolonged compression/injury of the median n at the level of the elbow/upper arm

75
Q

how does hand of benediction occur?

A

deformity caused by inability to flex the lateral 3.5 fingers, but are still able to flex the DIP of the 4th and 5th digits

76
Q

damage to which n causes a wrist drop?

A

radial n

77
Q

how does wrist drop occur?

A

wherever the injury to the radial n is, all the extensors below that point will be knocked out

  • loss of motor innervation to wrist extensors in the FA
  • no opposition to the wrist flexors
78
Q

where does injury causing wrist drop usually occur, and why?

A

usually damaged proximal to the elbow joint, because past the elbow the radial n runs deep, and is thus well-protected in the FA

79
Q

what is the difference btw the ulnar claw and hand of benediction?

A

ulnar claw - hypothenar wasting
benediction - thenar wasting
ulnar claw - typical presentation is AT REST
benediction - actively making a fist

80
Q

what are the muscles involved in an ulnar claw?

A

lumbricals 3+4 (to digits 4 and 5) are paralyzed

  • leads to a loss of flecion at the MCP joint and a loss of extension at the IP joints
  • results in hyperextension of the MCP joints by the unopposed extensor digitorum, and the flexion of the IP joints by the unopposed FDP and superficialis
81
Q

what muscles are involved in the hand of benediction?

A

lumbricals 1+2 and FDP (to digits 2 and 3) are paralyzed
- leads to a loss of flexion at the MCP joint and the DIP joints
(unable to flex these digits)

82
Q

true claw (different from ulnar claw) is caused by ….

A

lower trunk injury (Klumpke’s palsy)

83
Q

what causes a true claw?

A

median AND ulnar nerve damage, lost all lumbricals

Anatomy Exam 1 (8 decks)

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