Hand Flashcards
At the MCP what kind of movements can occur in digits 2-5?
What about for the thumb?
Where does the other action occur for the thumb?
•For digits 2-5: flexion/extension and abduction/adduction
Thumb:•For the thumb (digit 1): only flexion and extension occur at the MCP joint-opposition and ab- and adduction occur at the carpo-metacarpal joint
Label
Red?
Green?
Yellow?
Red- cephallic
green- basillic
yellow- dorsal venous network
What is yellow?
extensor retinaculum
Extensor retinaculum is a thickening of the_____ ____that holds in place the ____ passing from the forearm into the hand. The ER attaches to the ____ ___ and ____ to create 6 compartments (_____) for the tendons passing over the _____ of the wrist
antebrachial fascia
tendons
distal radius and ulna
tunnels
dorsum
_____ ___ ___ cover the tendons that go to the ___ to reduce friction
synovial tendon sheaths
digits
Extendor retinaculum creates _____ ____ on the back of the ____ through which certain specific tendons run together or alone through. The individual compartments may become inflamed and cause disease states.
dorsal compartment
wrist
tendons
label 1-8
- Compartment 1: Abductor pollicis longus and extensor pollicis brevis
- Compartment 2: Extensor carpi radialis longus and brevis
- Compartment 3: Extensor pollicis longus
- Compartment 4: Extensor digitorum and extensor indicis
- Compartment 5: Extensor digiti minimi
- Compartment 6: Extensor carpi ulnaris
7 Radius
8 Ulna
The extensor tendons from the forearm fan out from wrist to the digits and ____ to form ____ ____ ____(extensor expansions, extensor hoods). The extensor expansions Form a hood that wraps around the sides of the ___ ___. This allows more muscles to help control the digits.
flatten
dorsal digital expansions
MCP joint
The extensor hood Inserts onto the___ &____ ____ via median and 2 lateral ___. The hood is reinforced by _____ and _____ ___ of the ____, which connect to the lateral bands and assist in _____ of ____ joints
iddle and distal phalanges
bands
lumbrical
interosseous muscles
palm
extension
IP
The ____ muscles will help regulate and pull the dorsal digital expansion tight so that when it is pulled the interphalangial joint will be _____
lumbrical
extended
Traumatic finger injuries can cause rupture of the ______ _____ tendon at the distal ____, which prohibits extension of the ____ joint. If this happens, unopposed action of ____ _____ ___ produces “____ ____” in which the distal phalanx remains ________. (like a constant dino finger)
extensor digitorum tendon
distal phalanx
DIP
flexor digitorum profundus
mallet finger
flexed
Deep fascia over the central palm forms a tough, thickened _____ _____. Right under this, there is the ____ ___ ___ that gives rise to blood vessels that will supply the digits.
Flanking the palmar aponeurosis at the base of the thumb you have the _____ ____ and on the side of the 5th digit, you will have the _____ ____. These are separated by a _____ ____.
palmar aponeurosis
superficial palmer arch
thenar eminence
hypothenar eminence
central concavity
____ ______ is a disease of the palmar fascia resulting in progressive shortening and thickening of the ____ ____. Nodular like structures can be formed at the base of each digit due to this disease.
Dupuytren contracture
palmer aponeurosis.
red
yellow
green
blue
R- extensor expansions
Y- interosseous muscles
G- Extensor tendon
B- lumbrical muscle
label 1-10
- palmar aponeurosis
- midpalmer space
- medial fibrous septum to 5th metacarpal
- hypothenar fascia
- 5th metacarpal
- thenar space
- thenar fascia
- 1st metacarpal
- 1st dorsal interosseous
- adductor pollicis
Extrinsic vs intrinsic muscles of the hand?
intrinsic muscles start and end in the hand
extrinsic muscles may originate somewhere else
The palmar aponeurosis and deep palmar fascia divide the palm into 5 muscular compartments, what are they?
- thenar
- hypothenar
- central
- adductor
- interosseous
The main supply to innervation of intrinsic muscles of the hand is the ____ ___, however, the ____ muscles are an exception as they are innervated byThe ___ _____ branch of the ____ ___.
ulnar nerve
thenar muscle
reccurent motor branch of the median nerve
The Thenar compartment contains the ____ ____ that ___, ___, and ___ the thumb. These muscles are Innervated by the ____ ____ ____ of the ___ ___. What are the muscles?
Thenar muscles
flex
adduct
oppose
recurrent motor branch of median nerve
Abductor pollicis brevis
Flexor pollicis brevis
•Opponens pollicis
Tell me the following about Abductor pollicis brevis:
Compartment:
Action:
Proximal attachment:
Distal attachment:
Innervation:
C-thenar
A-abducts
PA- Flexor retinaculum, scaphoid, trapezium
DA- Base of proximal phalanx of thumb
Inner.: •recurrent motor branch of median nerve
Tell me the following about Flexor pollicis brevis:
Compartment:
Action:
Proximal attachment:
Distal attachment:
Innervation:
Tell me the following about flexorr pollicis brevis:
Compartment: Thenar
Action: flexes thumb
Proximal attachment: •Flexor retinaculum, scaphoid, trapezium
Distal attachment: Base of proximal phalanx of thumb
Innervation:• recurrent motor branch of median nerve
Tell me the following about Opponens pollicis:
Compartment:
Action:
Proximal attachment:
Distal attachment:
Innervation:
Tell me the following about Opponens pollicis:
Compartment: thenar
Action: opposes thumb
Proximal attachment: •Flexor retinaculum, scaphoid, trapezium
Distal attachment: 1st metacarpal
Innervation:•recurrent motor branch of median nerve
What is it
abductor pollicis brevis
Name it
Flexor pollicis brevis
name
•Opponens pollicis
The Central compartment contains the ____ ____ ___ that ____ the digits and _____ that ___ &___ the ___ of the digits. It also contains the Tendons of ___ ___ ___ and ___ as well as _____ (1-4).
forearm flexor tendons
flex
lumbricals
flex and extend the joints
flexor digitorum superficialis and profundus
lumbricals
Lumbricals (1-4) are found in the central compartment. Describe the following:
Action:
Proximal attachment:
Distal attachment:
Innervation:
- Action: Flex metacarpophalangeal joints, extend interphalangeal joints of digits 2-5
- •Proximal attachment: Tendons of flexor digitorum profundus
- •Distal attachment: Extensor expansions of digits 2-5
- Innervation: 1&2 are innervated by the medial nerve and 3&4 are innervated by the ulnar nerve
• Hypothenar compartment contains hypothenar muscles that ____, ____, and ____ the 5th digit. These muscles are innervated by the ____ __ of ___ ____
flex, abduct and oppose 5th digit•
Innervated by deep branch of ulnar nerve
What is in blue
lumbricals
What are the muscles in the hypothenar compartment?
What are they innervated by?
•Flexor digiti minimi brevis
abductor digiti minimi
•Opponens digiti minimi
deep branch of the ulnar nerve
Tell me the following about abductor digiti minimi
Action:
prox. attachment:
distal attachment:
Abductor digiti minimi
- Action: Abducts digit 5
- Proximal attachment: Pisiform
- Distal attachment: Proximal phalanx of digit 5
Tell me the following about flexor digiti minimi brevis
Action:
prox. attachment:
distal attachment:
- Flexor digiti minimi brevis
- Action: Flexes proximal phalanx of digit 5
- Proximal attachment: Hook of hamate and flexor retinaculum
- Distal attachment: Proximal phalanx of digit 5
Tell me the following about opponens digiti minimi
Action:
prox. attachment:
distal attachment:
- Opponens digiti minimi
- Action: Opposes 5th digit to thumb
- Proximal attachment: Hook of hamate and flexor retinaculum
- Distal attachment: 5th metacarpal
Adductor compartment contains the ____ ___ ___ that _____ the thumb. It has a ___ head and a ____ head.
adductor pollicis muscle
adducts
oblique
transverse
What is the action of adductor pollicis?
Proximal attachment of each head?
distal attachment?
What innervates?
- Adductor pollicis
- Action: Adducts thumb
- Proximal attachment:
–Oblique head: Base of 2nd and 3rd metacarpals and capitate
–Transverse head: Base of 3rd metacarpal
•Distal attachment: Proximal phalanx of digit 1
Innervation: ulnar nerve
The interosseous compartment contains interossei muscles that ____ and _____ ___ ___. What are these muscles called?
abduct and adduct digits 2-5
palmer interossei
dorsal interossei
The Dorsal interossei (1-4) will work the ____ digits ___-___.
What are the proximal and distal attachments?
Abduct digits 2-4 (“DAB”: Dorsal ABduct)
- Proximal attachment: Adjacent sides of 2 metacarpals
- Distal attachment: Base of proximal phalanges and extensor expansions of digits 2-4
The Palmar interossei (1-3) will work to _____ digits __, __, and __. What are the proximal and distal attachments?
Adduct
2,4,5
- Proximal attachment: 2nd, 4th, 5th metacarpals
- Distal attachment: Base of proximal phalanges and extensor expansions of digits 2, 4, 5
The _____ and _____ spaces are potential spaces deep in the palm between the long flexor tendons and the fascia over the deep palmar muscles. The midpalmar space is continuous with the anterior forearm via the ____ ____
Thenar and midpalmar spaces
carpal tunnel
The carpal tunnel is located on ____ wrist. The____ ____form the floor and sides of the tunnel; ____ ____ forms the roof.
anterior
Carpal bones
flexor retinaculum
The carpal tunnel allows for the passage of the tendons of ____ ____ ___, ____ ___ _____ and ____, and the ___ ____
•Tendons of flexor pollicis longus, flexor digitorum superficialis and profundus, along with the median nerve, pass through the tunnel
A ____ ____ ____ ____ ____ encloses the flexor tendons as they pass through the carpal tunnel
common flexor synovial tendon sheath
The carpal tunnel is defined by ____ ___ and ___- boundaries and can be compromised by _____ of its contents, infiltration of fluid from _____, or _____ of a dislocated ___ ____. The ____ ____ is the most sensitive to increased pressure and signs of ____ ____ ____; this reflects the nerve’s distribution and leads to ____ or____ on the palmar surface of the lateral 3 ½ digits.)
inflexible fascia
bony
swelling
infection
protrusion
carpal bone
median nerve
carpal tunnel syndrome
(tingling or weakness
The ____ ___ (___ ___) is a narrow passageway on the medial side of the anterior wrist. The _____ ____forms the floor; ____ ____ ___ forms the roof. ___ and ____ form medial and lateral borders. The ____ ____ and ____ ____ through the tunnel into the palm of the hand
Ulnar tunnel (Guyon’s canal)
flexor retinaculum
palmar carpal ligament
pisiform
hamate
Ulnar artery and nerve pass
Compression of the ulnar nerve at the wrist affects innervation of most intrinsic hand muscles; notably, the ____ ____ ____ of digits __&__ are _______ and the ___ ____ are flexed (bc the ____ of these digits are innevated by the ulnar nerve). This is called ___ ___.
Metacarpo-phalangeal joints of digits 4 and 5
hyperextended
interphalangeal joints
lumbricals
claw hand
If a pt is asked to make a fist, but digits 2&3 are extended at the ___ and ___ joints, this means there is ____ ____ damage at the ____ so _____ _____ ____(lateral half) and the ____ _ ____ aren’t working. this is called the ___ of ____.
IP & MCP
median nerve
elbow
flexor digitorum profundus
lateral 2 lumbricals
hand of benediction
The ____ & _____ arteries provide blood supply to the hand. The ulnar artery enters the hand via ____ ___ ( ___ ___ ), lying ____ to the ulnar nerve. It gives rise to a deep palmar branch and continues as the superficial palmar arch; the arch gives rise to __ ____ _____ ____ ____ that will come down and split at each digit as ___ ___ ___ ___ and supply the digits
ulnar and radial
Guyon’s canal (ulnar canal)
lateral
deep palmar branch
palmar arch
3 common palmar digital arteries
proper palmar digital arteries
The Radial artery travels through the floor of the ___ ___ and enters the palm. The radial artery anatomoses with the ___ ___ of the ___ ___ to form the___ ___ ___ which lies across the _____.The deep arch gives rise to 3 ____ ___ ___, _____ ____ ___, and ____ __ ___.
anatomical snuffbox
deep branch of the ulnar artery
deep palmar arch
metacarpals
3 palmar metacarpal arteries, princeps pollicis artery and radial indicis artery
The median nerve enters the hand via the ___ ___. Distal to the carpal tunnel, it supplies the muscles of the ___ ___ and the __&__ ____. It provides sensory innervation to the skin on the ___ ___ and ___ ___ of the ____ __ ___, along with the ___ ___half of these digits.
carpal tunnel
thenar compartment and the 1st 2 lumbricals
lateral palm and palmar surfacelateral 3.5 digits
dorsal distal
The ulnar nerve enters the hand via ____ ____ (____ ___). It is proximal to the wrist, it gives rise to a ____ ____ ___ that supplies the skin on the medial palm. The____ ___ ____ supplies the ___ ___of the dorsal skin of the hand and medial___ ___.
Guyon’s canal (ulnar canal)
wrist
palmar cutaneous branch
The dorsal cutaneous branch
medial half
1 ½ digits.
The ulnar nerve terminates by splitting into a ____ and __ ____; the superficial branch supplies______-branches to the _____ surface of ___ ___ __ while the deep branch supplies the ____ ____, ___&___ _____, ____ ___, and ____ ____.
superficial and deep branch
cutaneous
anterior surface
medial 1 ½ digits,
hypothenar muscles, 3rd and 4th lumbricals, adductor pollicis and interossei muscles.
The radial nerve supplies NO ____ ___. Its superficial branch supplies ____ over the lateral aspect of the hand and dorsum of proximal parts of lateral___ ____
hand muscles.
skin
3 ½ digits
What is purple
abductor digiti minimi
What is red
Flexor digiti minimi brevis
Green
Opponens digiti minimi
green and yellow? what to they make up?
Adductor policis
oblique head-green
transverse head-yellow
yellow
•Dorsal interossei (1-4)
green
•Palmar interossei (1-3)
What is the big circle?
Pink
green
blue
Carpal tunnel
P- flexor pollicis longus
G- flexor digitorium superficialis
blue- flexor digitorium profundus
What is the green circle with the arrows?
What is the pink border?
what is the purple border?
what are the arrows pointing to?
circle- Ulnar tunnel or guyons tunnel
pink border-palmar carpal ligament
purple border- flexor retinaculum
ulnar nerve and artery (hollow)
If a pt’s hand is like this without them trying to make a fist or hold it in any position, this indicates what? What is it called?
Ulnar nerve compression
Claw hand/
If a pt is attempting to make a fist but it looks like this, what is happening? What is it called?
Median nerve damage at the elbow
hand of benediction
1-5
