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MD2002 - MSA > Hand and Wrist > Flashcards

Hand and Wrist Flashcards

1
Q

What is the palmar aponeurosis?

A

A broad tendinous sheathe attached strongly to the skin and bones of the hand
It is located in the superficial palm of the hand

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2
Q

What does the palmar aponeurosis do?

A

1) Prevents degloving of the hand when gripping
2) Allows for better group
3) Gives protection to deeper structures

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3
Q

Where does the palmaris longus insert?

A

Inserts into the superior end of the superficial palm

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4
Q

Where does the tendon of the palmaris longus spread?

A

Into the palmar aponeurosis; this helps to shape and tense it

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5
Q

Where is the flexor retinaculum located in relation to the palmar aponeurosis?

A

The flexor retinaculum is located more proximal than the palmar aponeurosis; also known as transverse carpal ligament

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6
Q

What does the flexor retinaculum form?

A

The form of the carpal tunnel

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7
Q

Where are the deep attachments of the flexor retinaculum?

A

At the 3rd and 5th metacarpals

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8
Q

What is located around the tendons of the digits?

A

Osseofibrous tunnels

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9
Q

What 3 things do osseofibrous tunnels allow?

A

1) Help hold the tendon to the bone
2) Prevent bowstringing - Bowstringing is a rare complication of trigger finger release caused by excessive loss of the proximal pulleys
3) Improve efficiency

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10
Q

What is the thenar eminence?

A

The thenar eminence is a bulge located at the base of the thumb, and consists of 3 muscles

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11
Q

Where is the hypothenar eminence located?

A

The hypothenar eminence is located at the opposite side of the thumb

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12
Q

What is Dupuytren’s contracture?

A

Dupuytren’s contracture is the pathological thickening of the palmar aponeurosis

This results in the digits being in a fixed flexed position

This condition is linked with alcoholism

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13
Q

Where does Dupuytren’s contracture happen?

A

On the medial side of the palm

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14
Q

What is the solution to Dupuytrens contracture

A

to cut the fibrous attachments between the digits and palm, which is not a great solution, as it will normally form back the same

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15
Q

What does the hypothenar compartment of the hand contain?

A

The hypothenar compartment of the hand is around the hypothenar muscles opposites to the side of the thumb

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16
Q

What does the thenar compartment contain?

A

The thenar compartment contains the thenar muscles

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17
Q

What does the central compartment of the hand contain?

A

The central compartment contains all the long flexors of the digits

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18
Q

What structure is in between the compartments?

A

Fibrous septae

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19
Q

What is deep to the central compartment?

A

Midpalmar space

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20
Q

What is the midpalmar limited by?

A

The midpalmar space is limited medially and laterally by the palmar aponeurosis

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21
Q

Where does the midpalmar space extend to?

A

It extends proximal to the wrist, and can be the place where infection can spread from the proximal to distal ends of the wrist and vice versa

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22
Q

What is located deep to the thenar muscles?

A

Thenar space

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23
Q

What are long flexor tendons?

A

Long flexor tendons are flexor tendons that have come down from the forearm into the hand

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24
Q

Which flexor tendon has a separate sheathe?

A

The flexor pollicis longus has a slightly separate synovial sheathe

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25
What is unique about the digiti minimis?
Each digit’s synovial sheathe has a gap, but the digiti minimis synovial sheathe is continuous to the palm, which can cause a spread of infection from the little palm to the wrist
26
How do the superficial and deep tendons attach to the digits?
The superficial tendon can split and insert into the middle phalanx of the digit, while the deep tendon passes through the split e.g tendon of Flexor Digitorum Superificialis (FDS) splits to allow the tendon of Flexor Digitorum Profundus (FDP) through distally
27
What is inside a fibrous sheathe?
Inside a fibrous sheathe is a synovial sheathe, inside that is a tendon
28
What are the 2 appearances of fibrous sheathes?
The appearance of fibrous sheathes can either be annular (over the bone) or cruciform (near the joints)
29
Describe what nerves innervate the palmar surface and dorsum of the hand.
The palmar cutaneous branch off the median nerve branches from the median nerve before the carpal tunnel to supply the palm of the hand
30
Where do neurovascular structures lie in the hand?
Neurovascular structures lie superficially in the hand
31
Where does the ulnar nerve and artery enter into the hand?
Guyon’s canal, which is a separate fascial tunnel over the top of the flexor retinaculum
32
What happens when the ulnar nerve comes into the palm?
When the ulnar nerve comes into the palm it bifurcates into the webspace to supply the medial side of the third finger, and both sides of the small finger
33
What happens when the median nerve comes into the palm?
When the median nerve comes into the palm it bifurcates in the webspace to supply the lateral side of the third finger, and both sides of the middle and first finger The median nerve also throws off a recurrent branch which comes backwards into the thenar eminence to supply the thumb
34
What does the superficial palmar arch give off?
The superficial palmar arch gives off digital palmar arteries, which split into proper digital palmar arteries (same principle with nerves)
35
Where do the nerve and blood supply run up digits?
In digits, the nerve and blood supply tend to run up the sides of the digits, with some anastomoses at the top
36
What are thenar muscles associated with?
Thenar muscles are associated with the base of the thumb
37
What are the 4 thenar muscles?
1) Abductor pollicis Brevis 2)Opponens pollicis 3)Flexor pollicis brevis 4)Adductor pollicis
38
What is the abductor pollicis brevis innervated?
By the recurrent branch of medial nerve C8 and T1
39
What is the abductor pollicis brevis form?
Form more of the anterior bulk of the thenar muscles
40
Where does the abductor pollicis brevis?
Inserts into the proximal phalanx of the thumb
41
What innervates the opponens pollicis?
Innervated by recurrent branch of medial nerve – roots C8 and T1
42
What are the 2 heads of the flexor pollicis brevis?
Superficial and deep
43
What is the superficial head flexor pollicis brevis innervated by?
Innervated by the recurrent branch of the median nerve
44
What is the deep head of flexor pollicis brevis innervated by?
Deep Ulnar nevre
45
Where does the flexor pollicis brevis insert?
Into the proximal phalnx of the thumb
46
Where do thenar muscles take origin?
various carpel bones and the flexor retinaculum
47
What are the 2 heads of the abductor pollicis?
Has 2 heads: Transverse and Oblique
48
What innervates the adductor pollicis?
Innervated by the deep branch of the ulnar nerve
49
Where does the adductor pollicis insert?
Sesamoid bone of the thumb
50
Which of the thenar muscles are deep and superficial?
The Flexor pollicis brevis and Opponens pollicis are deep thenar muscles Abductor pollicis brevis and Adductor pollicis are superficial thenar muscles
51
Where hypothenar muscles located?
Hypothenar muscles are located on the medial side of the palm, at the base of the little finger
52
What are the 3 hypothenar muscles?
- Abductor digiti minimi - Flexor digiti minimi brevis - Opponens digiti minimi
53
What nerve are hypothenar innervated by?
Deep branch of the ulnar nerve
54
How is the extensor hood formed?
Tendons of the extensor digitorum comes into the hand and spreads out to form this extensor expansion called the extensor hood
55
How many bands does the extensor hood have?
It has median and lateral bands to it
56
What joints in the digits are moved when the extensor digitorum contracts
When the extensor digitorum contracts, the whole digit is extended (meta-carpal phalangeal joint, and the 2 interphalangeal joint)
57
What do tendinous connections between extensor digitorum prevent?
Tendinous connections between extensor digitorum prevent you from extending the middle finger when holding down the third finger
58
What 2 things does extensor retinaculum provide?
Tendinous connections between extensor digitorum prevent you from extending the middle finger when holding down the third finger
59
What are lumbricals?
Worm like muscles that take origin from the tendons of flexor digitorum profundus, distal to the metacarpal phalangeal joint
60
Where do lumbricals insert?
Insert into the extensor hood distal to metacarpal phalangeal joint
61
What action do lumbricals allow for?
flex the metacarpal phalangeal joint, whilst also extending the interphalangeal joint They pull on the extensor expansion, which extends the interphalangeal joint, but they are doing it distal to the metacarpal-phalangeal joint, so they’ll flex the metacarpal phalangeal joint (like typing)
62
What type of muscles are lumbricals?
The lateral 2 lumbricals are unipennate, while the medial 2 are bipennate arising from adjacent tendons
63
What is the innervation of these muscles?
The lateral 2 lumbricals are innervated by the median nerve – roots C8 and T1 The medial 2 lumbricals are innervated by the deep ulnar nerve – roots C8 and T1
64
What are interossei?
Interossei are muscles that lie between the bones, more specifically the metacarpals
65
What are the 2 types of interossei
Dorsal and Palmar However, both are considered palmar muscles
66
Describe Dorsal interossei
1) Dorsal interossei * There are 4 dorsal interossei * They abduct digits * They are bipennate muscles * DAB – dorsal abduct
67
Describe Palmar interossei
There are 3 palmar interossei * They adduct the digits * They are unipennate * PAD – palmar adduct
68
What are all the interossei innervated by?
Innervated by the deep ulnar nerve C8 and T1
69
What can interossei act together with?
Can act together with each other, and other lumbricals to get all the various movements of the digits
70
How many dorsal interossei does the middle finger have?
2
71
What is the origin and insertion of dorsal interossei?
Dorsal interossei take origin at the metacarpals They insert at the proximal phalanx and extensor hood
72
What does the first dorsal interosseous muscle?
The first dorsal interosseous muscle has a gap between its 2 heads, through which the radial artery comes from around the back in the anatomical snuff box and through these 2 heads, at which point it becomes the deeper palmar arch
73
What is the primary action of dorsal interossei?
Abduction
74
How many palmar interossei does the middle?
No palmar interossei
75
Where do palmar interossei take origin and insert?
They take origin on the adductor side of the metacarpal The palmar interossei insert proximal to the phalanx and extensor hood
76
What 3 things does the ulnar nerve innervate?
1) Medial 2 lumbricals 2) All interossei 3) 1/2 Flexor Digitorum Profundus
77
What does injury to the ulnar nerve present
Injury to the ulnar nerve presents with extension of the MCP joints and flexion at the IP joints
78
Why is claw hand an ulnar paradox?
proximal injuries are worse, but in the case, the more distal the ulnar nerve injury, the more severe the claw hand is.
79
What is carpal tunnel syndrome?
compression of the medial nerve in the carpal tunnel This can lead to pain or paraesthesia (changes in sensation), and weakness of the thenar muscles in more severe cases?
80
Why should carpal tunnel syndrome not affect the palm?
because the median nerve branch that supplies the palm comes off before the carpal tunnel
81
How can carpal tunnel syndrome be tested for?
Phalen’s test, where the patient brings the dorsal side of their hands together
82
What is pronator teres syndrome?
Pronator teres syndrome is when the median nerve that runs between the ulnar and humeral heads of the pronator teres becomes impinged This condition is exacerbated by pronation against resistance
83
What can be an indication of radial neve damage?
Radial nerve damage can be indicated by changes in sensation of the dorsum of the hand
84
What occurs if damage is high up?
If the radial nerve is injured high up enough, this will cause wrist drop, as innervation has been lost to muscles of the posterior compartment
85

MD2002 - MSA (34 decks)

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