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Locomotor Anatomy > Hand > Flashcards

Hand Flashcards

1
Q

What are the functions of the hand?

A

-Tactile/ sensory
-Communication
-Manipulation
-Grip/ hold
=Power
=Precision
=Opposition/ defensive

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2
Q

What are the bones of the hand?

A

27 bones (+ sesamoids)- protuberances on palm side for ligament and muscle attachment
-Carpals (x8)
=2 rows: 4 proximal (curved surfaces, articulation in ellipsoid joint), 4 distal (flatter, articulation with metacarpals)
-Metacarpals (x5) (longer than phalanges, flat proximal end, rounded distal)
-Proximal phalanges (x5)
-Middle phalanges (x4)
-Distal phalanges (x5)
=Phalanges have concave base and convex surface distally

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3
Q

What is the pneumonic to remember the carpals?

A

Some= scaphoid (lateral, wrist articulation)
Lovers= Lunate (medial, wrist articulation)
Try= Triquetral (medial to lunate, 3 sided triangular bone)
Positions= Pisiform (sesamoid, anteriorly on top of triquetral)
-
That= Trapezium (most lateral, elongated, saddle shape articular surface for metacarpal 1, thumb has more movement)
They= Trapezoid (medial, wedged in, does not lie under the thumb, bigger posteriorly, narrow triangular)
Cant= Capitate (largest carpal, central axis of movement)
Handle= Hamate (articulates with two metacarpals, elongated distal end, protrusion into palm= hook/ hanalus)

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4
Q

What are the joints of the hand?

A
  • Radiocarpal (wrist)
  • Intercarpal= planar, limited movement (sliding)
  • 1st Carpo-metacarpal= saddle
  • Carpo-metacarpal (x4)= plane
  • Metacarpophalangeal (x5)= ellipsoid, increased mobility
  • Interphalangeal (x9)= proximal/distal, hinge joint, flexion/extension only
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5
Q

What are the movements of the wrist, fingers and thumb?

A
  • W: flexion/extension, abduction/adduction, circumduction (no rotation)
  • F: flexion/extension (MCP, DIP, PIP), abduction/ adduction (MCP only relative to 3rd digit), circumduction (MCP only)
  • T: flexion/extension (CMC, MCP, IP), abduction/adduction (CMC, MCP), Circumduction/ Opposition (CMC, MCP)- movements take place at 90 degrees to finger movements
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6
Q

What are the extrinsic muscles?

A

Forearm muscles= move hand from afar for power
-Anterior (flexor)
-Posterior (extensor)
Complex movements= interaction between groups

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7
Q

What are the intrinsic muscles?

A

Within hand, smaller muscles moving few digits for precision, fine digital control
=Flexion and extension of digits
=Abduction and adduction of digits
=Specific movements of the thumb and little finger
=Intrinsic structures do not affect the wrist joint
=Majority of motor innervation comes from the ulnar nerve
-Thenar eminence
-Hypothenar eminence
-Deep muscles

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8
Q

What are the extrinsic wrist/ hand flexors?

A

Anterior forearm, median nerve
-Flexor retinaculum
-Palmar aponeurosis
-Flexor digitorium profundus (FDP)= flexes to distal interphalangeal joint
-Flexor digitorium superficialis (FDS)= flexes to proximal
=Flexor tendons of wrist, wrist and digits, thumb
=FDS tendon (split)
=FDP tendon (emerging)

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9
Q

What are the features of the carpal tunnel?

A

Gateway to hand, extrinsic flexor tendons, median nerve

  • Flexor pollicis longus tendon
  • Flexor retinaculum/ transverse carpal ligament
  • Ulnar NVB
  • Median nerve
  • FDS, FDP tendons
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10
Q

What are the extrinsic extenders?

A 
All radial nerve innervated
Only 1 extensor digitrum in forearm but designated long extensor for index and little finger
-Extensors of :
=the wrist
=wrist and digits  
=retinaculum
=digits 2 and 3
=thumb muscles
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11
Q

Describe the hand

A
  • Highly complex
  • 19 muscles within hand
  • 2 major named nerves and branch of third
  • 2 arteries forming 2 arches
  • 2 veins forming 2 plexi
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12
Q

What are the parts of the Thenar Eminence?

A

Muscles associated with the thumb
Moves thumb (digit 1 ), median nerve, all insert on base of proximal phalanx
-Abductor pollicis brevis (most superficial)
-Opponens pollicis (deepest)
-Flexor pollicis brevis (deep to abductor p.b. and medial)
(All For One)
=All muscles median nerve innervated

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13
Q

What are the parts of the Hypothenar Eminence?

A

Muscles associated with little finger
Moves little finger (digit 1), ulnar nerve, all insert on base of proximal phalanx
-Abductor digiti minimi (most superficial and medial)
-Flexor digit minimi brevis (deep and lateral) no longus
-Opponens digiti minimi (deepest and most lateral)
(All For One and One For All)
=All muscles ulnar nerve innervated

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14
Q

What are the deep hand muscles?

A

Additional control over digits/ thumb, mainly ulnar nerve, mixed functions

  • Lumbricals
  • Adductor pollicis (oblique)
  • Palmar interossei (x3)
  • Adductor pollicis (transverse)
  • Dorsal interossei (x4)
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15
Q

What are the nerves of the hand?

A

-Median
-Ulnar
-Radial
=Includes motor and sensory information, intrinsic and extrinsic supply

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16
Q

Describe the anatomy of the hand

A 
27 named bones (+ sesamoids)
6 joint levels
24 tendons from extrinsic muscles
19 intrinsic muscles
3 major nerves
2 major arteries
17
Q

What are the connective tissues of the hand?

A

-Palmar aponeurosis
=Thick layer of deep fascia
=Protective, covers palm
=Anchored to skin and subcutaneous tissue minimises loose tissue
-Transverse Carpal Ligament / Flexor Retinaculum
=Thick ligamentous band
=Connects medial and lateral side of carpal arch
=Forms carpal tunnel
-Digital sheaths:
=Lie on the anterior surface
=Begin at metacarpophalangeal joints
=Prevent tendon ‘bowstringing’
-Extensor hood
=Posterior continuation of sheaths
=Expands around metacarpophalangeal joints
=Anchors extensor tendons; provides insertion point

18
Q

Describe wrist movements

A

-Major wrist movements controlled by 5 muscles:
=3 extensors (posteriorly)= extensor carpiulnaris (medial), extensor carpiradialis longus (lateral), brevis underneath
=2 flexors (anteriorly)= flexor carpiradialis muscle (lateral), flexor carpiulnaris (medial, bigger belly)
-‘Carpi’ muscles: insert into carpals
=Sit at the four ‘corners’ of the wrist
-Same compartment: flexion / extension
-Opposing compartments: abduction / adduction

19
Q

What are the digit (2-5) movements and extrinsic muscles?

A

-Forearm provides gross movements of the four fingers:
=Flexion / extension only
=Abduction / adduction = intrinsic muscles
-Primary muscles (tendons to phalanges:
=Flexor digitorum superficialis / profundus (deep)- anterior compartment
=Extensor digitorum- posterior
-Secondary muscles to specific fingers:
=Extensor indices
=Extensor digiti minimi

20
Q

What are the movements and extrinsic muscles of digit 1?

A

-The thumb received dedicated extrinsic muscles:
=All contain ‘pollicis’ – ‘strong’ digit
-Four extrinsic muscles:
=Flexor pollicis longus (large, anterior)
=Extensor pollicis longus + brevis
=Abductor pollicis longus (oblique arrangement)

21
Q

What is the Anatomical Snuffbox?

A

-Triangular depression at the base of the thumb posteriorly
-Most obvious with thumb extended
-Borders formed from tendons passing to thumb:
=Medially: extensor pollicis longus
=Lateral: abductor pollicis longus, extensor pollicis brevis
-Clinical landmark:
=Radial artery passes through – pulse
=Scaphoid can be palpated

22
Q

What makes up the carpal tunnel?

A

-Route for extrinsic flexor tendons to reach palmar surface of hand
=Floor and walls: carpal bones
=Roof: Flexor retinaculum
-9 tendons pass through
=FDS, FDP, FPL
-Accompanied by median nerve (superficial to tendons)

23
Q

What is carpal tunnel syndrome?

A

-Carpal tunnel is a restrictive space
-Any swelling, inflammation or irritation can cause compression
-Nerve compression impinges on nerve function
-Carpal Tunnel Syndrome
=Loss of motor function
=Loss of sensation

24
Q

Describe the structures of the Palm

A

Additional centrally-positioned structures control hand movements
=Long flexor tendons from forearm
=Adductor pollicis (2 heads= proximal oblique and distal transverse)
=Branching vasculature
-Three ‘sets’ of muscles also reside here:
=Lumbricals + Interossei (x2)
-Muscles located deep to palmar aponeurosis

25
Q

What are the Lumbricals?

A

-A group of 4 thin muscles
=Lumbricus – worm-like
-Unusual course:
=Originate from the tendons of FDP
=Insert into the extensor hoods of fingers
-Flex metacarpophalangeal joints (cross anteriorly)
-Extend interphalangeal joints (insert posteriorly)

26
Q

What are the Interossei?

A

-Deepest’ muscles located in the hand
=Inter - between ; Ossei – bones
-Originate from shafts of each metacarpal
-Insert into the base of the proximal phalanges
-Two sets:
=Dorsal x4: abduction (Digits II – IV only) (deepest layer)
=Palmar x3/4: adduction (Digits II, IV and V (not III; sometimes I)
PAD and DAB

27
Q

Describe the arterial blood supply to the hand

A
  • Brachial artery located in arm divides into radial and ulnar arteries distal to elbow joint
  • Ulnar artery merges medially and superficial to carpal tunnel, radial artery passes lateral to carpal tunnel
  • Deep palmar: ulnar
  • Superficial palmar: radial
28
Q

Describe the Superficial Palmar Arch

A 
-Arterial arch formed from
=Ulnar artery (dominant)
=Superficial palmar artery (radial)
-Located deep to palmar aponeurosis
=Superficial to long tendons in palm
-Branches supply medial have of digit 2, all of digits 3-5
29
Q

Describe the Deep Palmar Arch

A 
-Arterial arch formed from:
=Radial artery (dominant)
=Deep palmar artery (ulnar)
-Located deep to long flexor tendons
=Pass between adductor pollicis heads
-Supplies:
=Thumb (princeps pollicis), lateral ½ digit II
-Radial artery also supplies dorsal hand:
=Dorsal carpal arch
30
Q

Describe the venous return of the hand

A

-Mimics pattern of arterial supply
-Deep veins follow arterial supply
=Return to ulnar + radial venae comitantes
-Superficial veins drain to dorsal venous network
=Medially: basilic vein
=Laterally: Cephalic vein
-Highly variable!

31
Q

Describe the extrinsic motor innervation of the hand

A

-Follow rules of compartmentalisation
-Anterior forearm:
=Majority = median nerve
=Ulnar innervates ½ FDP, Flexor carpi ulnaris
-Posterior forearm:
=Entirely innervated by radial nerve

32
Q

Describe the intrinsic motor innervation of the hand

A 
Two motor nerves in hand:
-Ulnar:
=Hypothenar eminence
=Majority of deep palmar muscles
-Median
=Thenar eminence
=Lateral 2 lumbricals
-No radial nerve motor supply
33
Q

Describe cutaneous innervation of the hand

A

All three nerves provide cutaneous / sensory innervation:
-Ulnar nerve:
=Medial aspect of hand: ½ digit IV, full V
-Median nerve:
=Palmar surface; ½ digit IV, full I – III, dorsal fingertips
-Radial nerve:
=Dorsal surface; thumb, ½ digit IV, full II + III (minus fingertips)

Locomotor Anatomy (6 decks)

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