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Medicine Year 1 - Semester 2 - Part 1 > Hand and Wrist > Flashcards

Hand and Wrist Flashcards

1
Q

Describe the superficial palm

A

Proximally :

  • Flexor retinaculum
  • Palmar aponeurosis
  • Fibrous digital sheaths
  • Thenar eminence
  • Hypothernar eminence
  • Dupuytren’s contracture
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2
Q

What is the palmar aponeurosis ?

A

Has deep attachments - 3rd and 5th metacarpals

Palmar longus and brevis

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3
Q

Function of the palmar aponeurosis

A

Anchor your skin to deeper tissues
Helps with grip

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4
Q

Where are fibrous digital sheaths found ?

A

Over each digit on the palmar side

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5
Q

What is Dupuytren’s contracture ?

A

When you get a contraction in the palmar aponeurosis, affects the 3rd digit.

Pulls the 3rd digit down

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6
Q

State the palmar spaces

A

Thenar space

Midpalmar space continuous with forearm

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7
Q

Long flexor tendons

A

Common flexor synovial sheath wrist –> mid palm

Flexor policis longus; separate sheath –> distal phalynx

Synovial sheaths for each digit

Digiti mini sheath; continuous to the palm

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8
Q

Where are fibrous sheaths found ?

A

Superficial to the synovial sheaths

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9
Q

Function of the fibrous sheaths

A

Pulleys:

Annular over bone
Cruciform near the joints

“Osseofibrous” tunnel

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10
Q

In order to allow the deeper tendon (flexor digitorum profundus) to get to the deeper phalynx what happens ?

A

Tendon of Flexor digitorum superficialis splits to allow flexor digitorum profundus through distally.

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11
Q

What does the median nerve supply on the anterior hand ?

A

Supplies :

  • Palm of hand laterally
  • The lateral 3 + 1/2 digits
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12
Q

What does the median nerve supply on the posterior hand ?

A

Supplies :

  • Distal ends of the lateral 3 + 1/2 digits
  • (nail beds)
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13
Q

Describe the palmar cutaneous branch of the median nerve

A

Supplies skin of the palm

Doesn’t pass through the carpal tunnel like the rest of the median nerve.

Emerges before the carpal tunnel

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14
Q

In carpal tunnel syndrome, why won’t you get pain in the palm of the hand ?

A

As the palmar cutaneous branch of the median nerve emerges before the carpal tunnel.

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15
Q

What does the radial nerve supply on the anterior hand ?

A

Supplies :

  • Area of anatomical snuffbox
  • Lower thumb
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16
Q

What does the radial nerve supply on the posterior hand ?

A

Supplies :

  • Lateral dorsum of the hand
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17
Q

What does the ulnar nerve supply on the anterior hand ?

A

Supplies :

  • Medial border of the hand
  • Medial 1 + 1/2 digits
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18
Q

What does the ulnar nerve supply on the posterior hand ?

A

Supplies :

  • Medial aspect of the dorsal of the hand
  • Fingertips of 1 + 1/2 digits
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19
Q

If you want to test for sensation from the medial nerve, where should you press

A

Tip of index finger

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20
Q

If you want to test for sensation from the ulnar nerve, where should you press

A

Tip of little finger
OR
Medial border of the hand

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21
Q

If you want to test for sensation from the radial nerve, where should you press

A

Over the dorsal webspace

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22
Q

Where do palmar nerves lie ?

A

Neuromuscular structures lie superficially

Common digital arteries and nerves run together

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23
Q

Where does the ulnar nerve and artery emerge ?

A

Through Gyon’s canal.

The Ulnar artery into the palm of the hand, forming superficial palmar arch.

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24
Q

What does the recurrent branch of the median nerve supply ?

A

Supplies :

  • Thenar muscles of the hand
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25
Q

Name the thenar muscles

A

Abductor Pollicis Brevis
Opponens Pollicis
Flexor Pollicis Brevis
Adductor Pollicis

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26
Q

Where are the thenar muscles found ?

A

At the base of the thumb

27
Q

What supplied the abductor pollicis brevis ?

A

Recurrent median

28
Q

Describe flexor pollicis brevis

A

2 heads :

Superficial (supplied by the recurrent median nerve)

[Deep (supplied by the deep ulnar nerve) T1]–> not required

29
Q

Describe opponens pollicis

A

Supplied by :

  • The recurrent branch of the median nerve C8

Allows grip and tool use (opposition of the thumb)

30
Q

Function of opponens pollicis

A

Opposition of the thumb

31
Q

Describe the adductor pollicis muscle

A

Deep branch of ulnar (T1)

2 heads :

  • Transverse
  • Oblique
32
Q

What are the deep thenar muscles ?

A

Flexor Pollicis Brevis
Opponens pollicis

33
Q

Name the hypothenar muscles

A

Abductor digiti minimi
Opponens digiti minimi
Flexor digiti minimi brevis

34
Q

What are the hypothenar muscles supplied by ?

A

The deep branch of the ulnar nerve

35
Q

What is found in the extensor hood ?

A

Extensor expansion
Extensor digitorum tendon

36
Q

Describe the origin of the lumbrical muscles

A

Radial side of the flexor digitorum profundus tendon.

Lateral 2 - unipennate
Medial 2 - bipennate

37
Q

State the insertion of the lumbrical muscles

A

Extensor expansion

38
Q

State the action of the lumbrical muscles

(Exam type Q)

A

Flex metacarpal phalangeal joint and extend interphalangeal joint

Flex MCP AND extend IP

39
Q

State the innervation of the lumbrical muscles

A

Medial 2 : deep ulnar
Lateral 2 : median

40
Q

Where are interossei muscles found ?

A

Found between the bones

(particularly metacarpals)

41
Q

What innervates interossei muscles ?

A

Deep ulnar nerve (C8, T1)

42
Q

What are the 2 groups of interossei ?

A

Dorsal (4) DAB
Palmar (3) PAD

43
Q

Function of the dorsal interossei

A

Abduct digits
Bipennate

DAB

44
Q

Function of palmar interossei

A

Adduct digits
Unipennate

PAD

45
Q

Action of interossei

A

Can act together with each other, and lumbricals

46
Q

What are the muscles of the hand innervated by ?

A

The ulnar nerve (C8, T1)

EXCEPT :

L - Lumbricals (lat 2)
O - Opponens Pollicis
A - Abductor Pollicis Brevis
F - Flexor Pollicis Brevis

47
Q

State the origin of dorsal interossei

A

Metacarpals

48
Q

State the insertion of dorsal interossei

A

Base of proximal phalynx and extensor hood

49
Q

Describe dorsal interossei

A

1st and 5th digits have their own intrinsic abductors

50
Q

Describe palmar interossei

A

No adduction at middle finger

51
Q

State the origin of the palmar interossei

A

Adductor side of metacarpal

52
Q

State the insertion of the palmar interossei

A

Proximal phalynx and extensor hood

53
Q

Describe ulnar nerve injury

A

Claw hand - Ulnar paradox

  • Determined by Froment’s sign
54
Q

What muscles lose innervation in an ulnar nerve injury

A

Median 2 lumbricals
All interossei
1/2 FDP (flexor digitorum profundus)

55
Q

Describe claw hand

A

Extension @ metacarpal phalangeal joint
Flexion @ interphalangeal joint

56
Q

Describe the ulnar paradox

A

Distal injury appears worse
FDP action

57
Q

Describe the test for carpal tunnel syndrome

A

Phalens test

58
Q

What is carpal tunnel syndrome ?

A

Compression of the carpal tunnel

Weakness of thenar muscles

59
Q

Describe median nerve injury

A

Hand of benediction
Ape hand

60
Q

What muscles are affected by median nerve injury ?

A

Lateral 2 lumbricals
FDS and 1/2 FDP
Thenar muscles

61
Q

Describe the hand of benediction

A

Inability to form a fist

62
Q

Describe ape hand

A

Loss of opposition

63
Q

Anterior interosseous nerve damage

A

FDP
Flexor Pollicis Longus

Medicine Year 1 - Semester 2 - Part 1 (51 decks)

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