hand Flashcards

1
Q

what are the main types of grip *

A

power grip

precision grip

hook grip

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2
Q

describe power grip *

A

the fingers are flexed around the object with opposing power from the thumb eg grasping a rod

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3
Q

muscles involved in the power grip *

A

long flexors of the finger and thumb

the intrinsic muscles of the palm

the extensors of the wrist joint - to give more power to the long flexors (posterior hand muscles are involved)

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4
Q

describe the precision grip *

A

the object is gripped between the tips of the fingers and the thumb

eg unbuttoning a shirt

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5
Q

muscles involved in the precision grip *

A

teh wrist and fingers are held rigidly by the long flexors and extensors

the intrinsic muscles of the hand carry out the dine movements needed

forearm control of the wrist - dont wnat the wrist to get floppy

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6
Q

describe the hook grip *

A

consumes little energy

eg carrying shopping bag

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7
Q

muscles involved in the hook grip *

A

mainly involves long flexors of the digits

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8
Q

summarise teh facia of the palm *

A

it is anatomically continuous with the fascia of the forearm

the palmar fascia is the fascia of hand that lies in the palm - dense

there are specialisations (condensations) of the palmar fascia that form the palmar aporneurosis and the fibrous digital sheaths

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9
Q

describe the palmar aporneurosis *

A

it overlies the long flexor tendons of the hand

the proximal end is continuous with the flexor retinaculum and the palmaris longus tendon

the distal end of the aporneurosis is continuous with teh fibrous digital sheaths

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10
Q

describe the fibrous digital sheaths *

A

they contain the flexor tendons and their synovial sheaths which wrap round the tendons and bones

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11
Q

describe the extensions of fascia called septa *

A

they extend from teh palmar aporneurosis to the boens of the hand - separating the space between the aporneurosis and bones into compartments

separate vessels and muscles and tendons running from wrist

a medial septum goes to the little finger metacarpal

a lateral septum goes to the middle finger metacarpal

these septi divide the space into a

  • hypothenar compartment
  • central compartment
  • thenar compartment
  • adductor compartment

deep to the thenar compartment is the adductor compartment which contains the adductor pollicus muscle

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12
Q

what are the bones of the wrist and hand *

A

the radius

ulnar

carpus (carpal bones)

  • proximal row: sphenoid, lunate, triquetrum, pisiform
  • distal row: trapexium, trapezoid, capitate, hamate

the metacarpal bones

the phalanges

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13
Q

what muscular compartments are involved in the hand region *

A

anterior compartment of the forearm - superficial and deep

posterior compartment of the forearm

posterior compartment of the forearm

intrinsic muscles of the hand

  • thenar compartment muscles
  • adductor comaprtment
  • hypothenar compartment
  • interossei and lumbricals
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14
Q

what are the muscles of the superficial anterior compartment of the forearm *

A

pronator teres

flexor carpi radialis

palmaris longis

flexor carpi ulnaris

flexor digitorum superficialis

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15
Q

what are the muscles of the deep anterior compartment of teh forearm *

A

flexor digitorum profundis

flexor pollicus longus

pronator quadratus

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16
Q

what are the muscles of the extensor compartment of the forearm *

A

muscles that move the wrist joint

  • Extensor carpi radialis longus (ECRL)
  • Extensor carpi radialis brevis (ECRB)
  • Extensor carpi ulnaris (ECU)

muscles that move the digits

  • Extensor digitorum (ED)
  • Extensor indicis (EI)
  • Extensor digit minimi (EDM)

muscles that move the the thumb

  • Abductor pollicis longus (APL)
  • Extensor pollicis brevis (EPB)
  • Extensor pollicis longus (EPL)

other muscles

  • Brachioradialis
  • Supinator
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17
Q

what are the intrinsic muscles of the hand *

A

thenar muscles

  • abductor pollicus brevis
  • flexor pollicus brevis
  • opponens pollicus

adductor muscle - single muscle

  • adductor pollicus

hypothenar muscle

  • abductor digiti minimi
  • flexor digiti minimi
  • opponens digiti minimi

interossei and lumbricals

  • lumbricals
  • palmer interossei (3)
  • dorsal interossei (4)

other

  • palmaris brevis
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18
Q

functions of the interossei and lumbricals *

A

lumbricals - flex the MCJ’s, extend the IPJ’s

palmar interossei - adduct the digits (PAD)

dorsal interossei - abduct the digits (DAB)

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19
Q

describe the anterior tendinous anatomy of teh hand *

A

teh fibrous digital sheaths extend from the level of teh metacarpal head to the base of teh distal phalanx in each digit

with the underlying bone the sheaths form the osseo-fibrous tunnels

the long flexor tendons and their synovial sheaths run in these tunnels

part of the digital sheaths form condensations called pulleys - allow for more function of the long flexor tendons

these are the annular and cruciform pulleys

after passing the wrist joint the flexor digitorum profundus and flexor digitorum superficialis pass in the carpal tunnel beneath the flexor retinaculum and enter a common tendinous sheath

the tendons pass to their respective digits in a digital synovial sheath (sheath is wrapped around the tendon forming a double layer, rather tahn the tendon being in the sheath), which is in its own fibrous digital sheath (synovial sheath prevents friction)

the digital synovial sheaths of the index, middle and ring fingers are separate from the common synovial sheath, those of the little finger and thumb are continuous with the common sheath

at the proximal base of the phalanx - the tendon of teh FDS splits around the FDP

the FDS attaches to the anterior surface of the middle phalanx and teh FDP attaches to the distal phalanx (FDS doesnt go as far)

the tendon of the flexor pollicus longus has its own synovial sheath at the flexor retinaculum - this runs to the distal phalanx of the thumb

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20
Q

describe the posterior tendinous anatomy of the hand *

A

all the extensor tendons are held to the dorsum of the wrist by the extensor retinaculum (not as tough as the flexor retinaculum)

there are synovial tendon sheaths that surround the tendons fascilitating free movement of the tendons - some sheaths are connected some are individual

the long extensor tendons to the digits are joined by intertendinous bands - they prevent free movement of 1 extensor tendon independantly of the others

at the metacarpals the long extensor tendons flatten to form extensor expansions - they form a hood on the back of the digit. they are intrically involved in the movement of the digits

the lumbrcals and interossei attach to the expansions

the extensor digitorum extends the metacarpo-pharyngeal joint and the interphalangeal joint. it extends the wrist joint after maximal extension of the digits

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21
Q

what are the joints in the hand *

A

distal radio-ulnar joint

wrist joint

intercarpal joint

carpo-metacarpal and inter-metacarpal joints

metacarpo-phalangeal joints

interphalangeal joints

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22
Q

what movements do the midcarpal (joint between prox and distal carpal row) and carpo-metacarpal joints allow *

A

flexion and extension

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23
Q

what are the series of intercarpal joints *

A

joints between the prox row

joints between the distal row

joints between the prox and distal row - midcarpal joint

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24
Q

what type of joint are the intercarpal joints and what is the movement *

A

plane synovial

gliding - augmenting the flexion and radial deviation of the wrist joint

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25
Q

describe the carpometacarpal joints *

A

the CMC joint of thumb is between the trapezium and the thumb metacarpal - synovial joint of saddle variety allows thuim to move in different direction

CMC of digits are between trapezoid, capitate, hamate and metacarpals - they are synovial elipsoid

CMC of index and middle finger is rigid

CMC of ring finger is less

CMC of little is very mobile

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26
Q

clinical importance of the carpometacarpal joint of the thumb *

A

becomes osteoarthritic

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27
Q

describe the intermetacarpal joints *

A

plane synovial joints

between the metacarpals at their bases

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28
Q

describe the movements at the carpometacarpal and intermtacarpal joints *

A

flexion and extension

radial deviation and ulnar deviationn

circumduction

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29
Q

describe the metacarpophalangeal joints *

A

condylar synovial joints between metacarpal heads and prox phalanges

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30
Q

what movements do the metacarpophalangeal joints allow *

A

flexion and extension

abduction and adduction

together - circumduction

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31
Q

describe the interphalangeal joints*

A

hinge synovial joints

there is a proximal IP and distal IP joint

in thumb only 1 IP joint

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32
Q

movements of the interphalangeal joints *

A

flexion and extension only

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33
Q

describe the ligaments holding teh metacarpophalangeal and interphalangeal joints together *

A

they include collateral ligaments both ulnar and radial

ulnar collataral ligament of thumb is frequently injured skiing

connection between phalanxes is not very strong - not good fit between bone therefore ligaments hold bone in place but only allow flexion and extensioon of IPJ

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34
Q

what is the volar plate *

A

it is on the anterior surface of the prox IP joint

it is a dense condensation of fibrous tissue formed by collateral ligaments

frequently damaged

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35
Q

what are the muscles that move the thumb *

A

abduction

  • abductor pollicus longus
  • abductor pollicus brevis

adduction

  • adductor pollicus
  • first doral interosseous

extension

  • extensor pollicus longus
  • extensor pollicus brevis
  • abductor pollicus longus

flexion

  • flexor pollicus longus
  • flexor pollicus brevis

opposition

  • opponens pollicus (works at carpo-metacarpal joint)
  • occurs at the metacarpo-phalangeal joint and involves abduction, flexion, and adduction at the metacarpo-phalangeal joint
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36
Q

describe the arterial supply of the hand *

A

hand supplied by the radial and ulnar arteries

in the hand there are extensive anastomoses between the ulnar and radial arteries

ulnar artery runs in anterior comp of forearm - passes on ulnar side of palmar surface of wrist. artery is lateral to ulnar nerve which is lateral to flexor carpi ulnaris. the artery supplies medial muscles of the forearm - branches into the common then posterior and anterior interosseous artery. enter hand passing over the flexor retinaculum lateral to pisiform through semi-rigid ulnar (Guyon’s) canal with teh ulnar nerve. It divides just below this into

  • superficial palmar arch (recieves branch from superficial palmar branch of radial artery)
    • gives off 3 common palmar digital arteries - they divide into palmar digital arteries
  • the deep palmar branch of ulnar artery

radial artery passes down lateral aspect of forearm under brachioradialis muscle and beside FCR at wrist. it crosses floor of anatomical snuff box and enters palm of hand between the 2 heads of the 1st dorsal interosseous muscle, then passes between the 2 heads of the adductor pollicus muscle. it anastomoses with deep palmar branch of ulnar artery to form deep palmar arch

deep palmar arch gives origin to palmar metacarpal arteries

arteries also form dorsal carpal arch

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37
Q

where is the radial artery palpable

A

at the wrist

lies superficially on palmar aspect of radial side of wrist

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38
Q

describe the venous drainge of the hand *

A

deep and superficial arterial arches have corresponding palmar venous arches - deep drainage

dorsal digital veins drain into dorsal venous arch (superficial system) on dorsum of hand

arch gives rise to cephalic and basilic vein laterally and medially

most drainage is through the superficial system

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39
Q

what are the 3 main nerves to the hand *

A

median nerve c6-t1

ulnar nerve c8-t1

radial nerve c5-t1

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40
Q

what nerves contribute to sensory supply of the hand *

A

ulnar

median

radial

they do so in the digits through digital nerves

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41
Q

effect of division of one of the digital nerves

A

anaesthesia in part of the digit

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42
Q

describe the path of the median nerve *

A

supply anterior compartment of the hand and forearm

descends through anterior comp of arm - no branches

in cubital fossa it lies medial to brachial artery (can be damaged by supracondylar fractures of humerus or dislocations)

passes between the heads of the pronator teres

at wrist lies superficially between the tendons of FDS and FDP and deep to palmaris longus

enters the carpel tunnel - here it is accompanied by 9 flexor tendons (FDP FDS FPL)

passes under the flexor retinaculum

the recurrent branch of median nerve leaves main trunk in carpel tunnel and supplies the 3 thenar muscles

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43
Q

what does the median nerve supply*

A

in forearm

  • pronator teres
  • FDS
  • lateral protion of FDP
  • FCR
  • pronator quadratus
  • palmaris longus

after passing under the flexor retinaculum

  • the 3 thenar muscles - abductor pollicus brevis, flexor pollicus brevis and opponens pollicus
  • the lateral (2 and 3) lumbricals

sensory

  • palmar surface of thumb
  • index and middle finger
  • lateral half of ring finger
  • some dorsal supply

(main nerve to the anterior compartment of the forearm, some supply to intrinsic hand muscles)

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44
Q

describe the path of the ulnar nerve *

A

initially descends in the anterior compartment of the arm

more distally enters the posterior comp - lies superficially posterior to medial epicondyle

no branches in arm

enters anterior comp of forearm between heads of flexor carpi ulnaris and descends on medial side of forearm

proximal to wrist it gives off 2 branches - palmar cutaneous branch, dorsal cutaneous branch

at wrist lies anteriorly - between FCU (medially) and ulnar artery (laterally) then passes into hand

passes over the flexor retinaculum in ulnar canal with ulnar artery, lateral to the pisiform bone

it divides distal to the flexor retinaculum to superfical and deep braches

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45
Q

what does the ulnar nerve supply *

A

in forearm

  • FCU
  • medial portion of FDP

palmar cutaneous branch supplies medial palm of hand

dorsal cutaneous branch supplies medial half of dorsum of hand, including little and ring fingers

superficial branch of ulnar nerve - sensory to palmar surface of little finger and medial sode of ring finger

deep branch of ulnar nerve - motor to

  • hypothenar muscles (abductor digiti minimi, flexor digiti minimi, and opponens digiti minimi)
  • abductor pollicis
  • the medial (fourth and fifth) lumbricals
  • all interossei

it controls most of muscles involved in fine movements of the hands

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46
Q

describe the path of the radial nerve *

A

lies on the humerus in the radial groove

superior to elbow divides into superficial radial nerve (sensory) and deep radial nerve (motor)

superficial branch is cutaneous - sensory to lateral 2/3 of dorsum of hand, dorsum of thumb and proximal portions of dorsal of index and middle fingers

posterior interosseous nerve is continuation of deep radial nerve as it passes between heads of the supinator

supplies all extensor parts of forearm and arm

doesnt supply any muscles in hand

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47
Q

what does the carpal tunnel contain *

A

median nerve

FPL tendon

4 tendons of FDP

4 tendons of FDS

48
Q

what is the carpal tunnel made from *

A

base - bony arch of teh carpal bones

roof- flexor retinaculum (called transverse carpal ligament)

bony attachments - palpable

  • scaphoid, trapezoid, (laterally)
  • pisiform, hamate (medially)
49
Q

what is carpal tunnel syndrome *

A

compression of the median nerve in the carpal tunnel

causes tingling, loss of sensation and pain in the hand

50
Q

what are the names and numbers of digits, would you use names or numbers clinically

A

thumb

index finger

middle

ring

little

1->5

never numbers - dont want people to count in emergancy, have to do it quickly

51
Q

what carpel bones articulate in wrist joint *

A

proximal row with forearm bones

pisiform not involved - it is a sesamoid bone

52
Q

how are the carpal bones involved in forming the carpal tunnel *

A

there are prominences medially and laterally formed by hook of hamate, pisiform (that sits anterior to the triquetum) tubercule of scaphoid and tubercle of trapezium

the form the bony attachments for the flexor retinaculum

53
Q

what is clinically significant about the compartments of the hand

A

way the infection might travel

54
Q

describe the thenar and hypothenar eminences *

A

they are the prominant parts on the thumb and little finger side of the hand - made by the muscles

55
Q

what does it mean if a muscle is called carpi

A

acts across the wrist but doesnt go into digits

56
Q

what does it mean if muscle is called digitorum

A

acts on medial digits 2-5

57
Q

how can anterior comnpartment forearm muscles act on teh hand *

A

they attach across elbow joints and go across wrist and to digits

58
Q

what are the intrinsic muscles of the hand involved in *

A

precise movements - small movements

59
Q

what are the movements of the thumb *

A

abduction

adduction

extension

flexion

opposition

60
Q

what are the muscles involved in moving the thumb *

A

abduction

  • APL
    APB

adduction

  • adductor pollicus
  • 1st dorsal interosseous

extension

  • EPL
    EPB
  • APL

flexion

  • FPL
    FPB

opposition

  • opponens pollicus
61
Q

muscles in the thenar compartment *

A

opponens pollicis

abductor pollicus brevis

flexor pollicus brevis

62
Q

muscles in the hypothenar compartment *

A

abductor digiti minimi

flexor brevis digiti minimi

opponens digitu minimi

63
Q

what supplies the thenar muscles *

A

median nerve - except for the adductor pollicis

64
Q

describe teh adductor pollicis *

A

broad attachment on the middle metacarple

fan shape - fibres converge and insert on prox phalanx of thumb

65
Q

describe the location of the lumbricals *

A

tehy attach top the tendons of the flexor digitorum profundus

distal attachment - converge to form tendon round to anterior of digit

insterts into connective tissue taht forms hood over digit - this is the extensor expansion

66
Q

descrieb the arrangement of the dorsal interossei *

A

prox attachment between bones

tendons attach towards axial line (ie middle fingers) for dorsal interossei

tendons attach away from axial line for palmar interossei

DAB - dorsal abduct

PAD - palmer adduct (pull digits to axial line)

67
Q

describe the tendinous anatomy of the digits anteriorly *

A

have annular and cruciate parts

tough ligamentosu structures wrap around the tendons’ synovial sheath

there are thicked palmar ligaments (plates) at joints

they ligaments pull the digit close to the tendon, so that tendon is held to the bone

68
Q

describe the tendinous anatomy of the digits posteriorly *

A

extensor expansion over MPJ to there is a tendinous hood over the proximal IPJ

FDS attaches to base of middle phalanx

FDP - go to deep phalanx piercing FPS

lumbrical pulls the extensor expansion - flex teh MPJ and straighten the IPJ

69
Q

describe the digital nerves *

A

purely sensory - no muscles in digits

often damaged - can cause disability, if cant feel things cant function properly

70
Q

what is the innervation of the intrinsic muscles of the hand *

A

median supplies the thenar and lateral 2 lumbricals

ulnar supplies all otehr intrinsic hand muscles

71
Q

describe teh palmar cutaneous branch of the median nerve *

A

branches before teh carpal tunnel

gives sensation to the arm

72
Q

illustarte the pattern of innervation to the palmer surface of teh hand &

A

ulnar - digital branch to little and 1/2 ring finger

73
Q

illustrate the pattern of innervation of innervation in the posterior of the hand *

A

superficial branch of radial nerve supplies the lateral aspect of the dorsal of the hand - sensory

dorsal branch of ulnar supplies the medial aspect of the palm

74
Q

illustrate teh areas of cutaneous innervation of the hand &

A
75
Q

describe the extensor digitorum tendon*

A

tendon expands over MCP - making the extensor expansion

lumbricles attach to the extensor expansion

the tendon carries on distally and then narrows out again

it allows complete extension of the digits

76
Q

what is guyon’s canal *

A

ulnar nerve passes through - not affected as often as the carpal tunnel

77
Q
A
78
Q

identify teh location of the thenar and hypothenar muscles and lumbricles *

A

-

79
Q

identify on the metacarpals the body (shaft) base (proximally) and head (distally) *

A
80
Q

identify in the phalanges the body (shaft) base (proximally) and head (distally) *

A
81
Q

where does secondary ossification of the metacarpals develop

A

the growth centres of the 4 fingers is at their heads

growth centre of the thumb is at base

82
Q

where does secondary ossification occur in the phalanges

A

teh centres are at the bases

83
Q

surface mark the cephalic, basilic and cubital veins *

A

mark them if can see

if not, illustrate where they would be - make sure median cubital is going down laterally

to demonstrate superficial veins - apply pressure around middle of arm by encircling with hands = venous congestion and distention distal to the compression

84
Q

identify and palpate head of ulnar

A

little finger side of wrist

85
Q

identify ulnar and radial styloid process *

A

wither side of teh wrist

86
Q

identify the prox (and middle if present) and distal wrist crease and what do they indicate *

A

prox/middle - marks radio-carpal joint line

distal wrist crease - prox extent of the flexor retinaculum

87
Q

identify teh dorsal venous arch

A

on dorsal of hand

88
Q

identify the long extensor tendons

A

extend the wrist against resistance

89
Q

palpate thenar and hypothenar eminance

A

by thumb and little finger

90
Q

identify prox, distal palmar skin creases adn radial longitudinal crease

A

distal - mark position of metacarpophalangeal joints

radial longitudinal - partly encircles the thenar eminence

91
Q

identify the digital creases on the palmar surface of fingers - prox, middle and distal

A
92
Q

palpate the pisiform, tubercle of scaphoid, hook of hamate, ridge of trapezium

A

pisiform - distal end of FCU tendon

scaphoid - fully extend the wrist and it is along the line of FCR

hook of hamate - palpate deep to hypothenar muscles, 1cm distal and lateral to the pisiform

trapezium - palpate deep to middle of root of thenar muscles, distal to scaphoid

93
Q

identify head of metacarpals and palpate

A

knuckes

94
Q

identify radial styloid

A

in anatomical snuff box

95
Q

identify scaphoid

A

in anatomical snuff box

96
Q

identify the tubercle of teh base of the thumb metacarpal

A

in the snuff box

97
Q

identify head of ulnar on dorsum of wrist

A

flex wrist to see

98
Q

identify dorsal radial tubercle

A

EPL tendon of extended thumb leads towards the tubercle

99
Q

identify the superficial palmar arch and deep palmar arch `

A

superficial - main artery is ulnar, distal limit of teh arch is at the level of the distal border of teh fully extened thumb just prox to prox palmar crease

deep - main artery is radial, teh arch lies 1cm proc to superficial arch at distal edge of the flexor retinaculum

100
Q

what is allen’s test

A

a visual test for teh relative contribution of radial and ulnar arteries to the hand

subject asked to raise hand and make clenched fist

examiner compresses both radial and ulnar arteries, when fist is released palmar skin appears pale

examiner releases either one of the arteries and notes the tie for colour return to the hand

fastest artery is the dominant

101
Q

would you use the dominant artery to take bloos

A

no - arteries go into vasospasm when needle in them so collapse for a while, so take from least dominant so dominant can maintain blood supply to the hand meanwhile

102
Q

assess integrity of flexor pollicis longus

A

nerve - median

examiner holds prox phalanx of thumb whilst distal phalanx is flexed against resistance - the muscle/tendon is deep for palpation

103
Q

assess integrity of the extensor pollicus longus

A

radial nerve

thumb extended against resistance at interphalangeal joint

tendon visible at medial border of snuff box and medial to dorsal tubercle of radius

104
Q

assess integrity of flexor digitorum profundus

A

ulnar and median nerves

examiner holds prox IP joint in extended position, while distal IP joint is flexed against resistance

105
Q

assess integrity of FDS

A

median nerve

each digit assessed individually

non-test fingers are held in full extension by examiner while prox IP joint of test finger is flexed against resistance

106
Q

assess integrity of extensor digitorum

A

radial nerve

forearm is pronated and the digits extend at MCP joints

examiner applies resistance on prox phalanges

tendons become visible and palpable on dorsum of hand

muscle belly is palpable on forearm

107
Q

assess integrity of dorsal interossei

A

ulnar nerve

examiner holds adjacent extended and adducted fingers of subject between thumb and index finger while subject attempts to abduct them

108
Q

assess integrity of palmer interossei

A

ulnar nerve subject holds slip of paper between adjacent fingers taht are extended and adducted

the subject is asked to close the fingers tightly on the paper while the examiner attempts to withdraw it

109
Q

movement of flexor digitalis superficialis *

A

flex fingers powerfully

median nerve

110
Q

muscle that only flexes the last phalanx

A

flexor digitalis profundus

ulnar and mendian

111
Q

how many hypothenar muscles are there and innervation

A

3

ulnar

112
Q

nerve supply of the intrinsic muscles of the hand *

A

adductor pollicus - ulnar

thenar - median

hypothenar - ulnar

113
Q

muscles that move the digits *

A

extension - radial nerve

  • extensor digitorum
  • extensor indicis
  • extensor digit minimi

hypothenar muscles - innervation ulnar nerve - lateral to medial, extensor flexor oponens digiti minimi

lumbricals

interosseus muscles

flexion

  • FDP - median nerve to index and middle fingers, ulnar to ring and little
  • FDS - median nerve
114
Q

what is mallet finger *

A

when the end of the finger bends in towards the palm because there is damage to the extensor digitorum tendon

115
Q

explain the spread of infection in tendinous sheaths *

A

in flexor tendinous sheaths it is a sergical emergancy because they are closed compartments, this is not true in extensor sheaths

in flexor infection can lead to necrosis

116
Q

what is the blood supply of the digits *

A

radial - thumb and lateral side of index

ulnar- medial side of index and other digits