Hand & Forearm PPT 2 Flashcards
The 5 carpi muscles are the muscles moving the hand at the _____
The 5 carpi muscles are the muscles moving the hand at the wrist
The 3 digitorum muscles are going to ______
The 3 digitorum muscles are going to digits 2-5
The 3 pronation/supination muscles in the forearm are:
- 3.
The 3 pronation/supination muscles in the forearm are:
- Supinator
- Pronator teres
- Pronator quadratus
The 4 extrinsic pollicis muscles are muscles going to the ____ and originate ____ of the hand.
The 4 extrinsic pollicis muscles are muscles going to the thumb and originate ____ of the hand
The three specialist muscles of the forearm arm:
- 3.
The three specialist muscles of the forearm arm:
- brachioradialis
- extensor indicis
- extensor digit minimi
The 3 types of “sock puppet muscles” are:
- 3.
The 3 types of “sock puppet muscles” are:
- Lumbricals (4)
- Palmar interossei (3)
- Dorsal interossei (4)
Total of 11 muscles
All of the “sock puppet” muscles perform ____ of the metacarpophalangeal joint and ______ of the interphalangeal joints
All of the “sock puppet” muscles perform flexion of the metacarpophalangeal joint and extension of the interphalangeal joints
The palmar interossei perform flexion, extension, as well as _____
The palmar interossei perform flexion, extension, as well as adduction;
REMEMBER PAD
The dorsal interossei perform flexion, extension, as well as _____
The dorsal interossei perform flexion, extension, as well as abduction
REMEMBER DAB
What is the only pollicis (thumb) muscle innervated by the ulnar nerve?
Adductor pollicis
Arterial Flow Chart
The superficial palmar arch is formed mainly by the continuation of the _____ artery and anastomoses with the superficial branch of the ___ artery;
The superficial palmar arch is formed mainly by the continuation of the ULNAR artery and anastomoses with the superficial branch of the RADIAL artery;
The deep palmar arch is formed b the continuation of the __ artery anastomosing with the deep palmar branch of the ____ artery.
The deep palmar arch is formed b the continuation of the radial artery anastomosing with the deep palmar branch of the ulnar artery.
Follow the pathway of lymphatic drainage from the hand to the upper limb
Lymphatic vessels of the palm & digits drain –> DORSUM of hand –> forearm & arm toward the cephalic & basilic veins –> lymph coming from the lateral aspect of the arm (following the cephalic vein) –> axillary nodes
lymph coming from the medial aspect of the arm (following the basilic vein) –> cubital nodes –> humeral nodes –> central lymph nodes
Ulnar nerve pathway: in the upper arm the ulnar nerve passes posterior to the ____ epicondyle; It does/does not pass through the carpal tunnel into hand
Ulnar nerve pathway: in the upper arm the ulnar nerve passes posterior to the medial epicondyle; It does/does not pass through the carpal tunnel into hand
Ulnar nerve: palmar and dorsal cutaneous branches provide _____ to skin of ___ part of palm and ____
Ulnar nerve: palmar and dorsal cutaneous branches provide sensory to skin of medial part of palm and dorsum
Ulnar nerve deep branch: provides ___ to all remaining muscles of hand (not ____ muscles or lateral 2 lumbricals)
Ulnar nerve deep branch: provides MOTOR to all remaining muscles of hand (not THENAR muscles or lateral 2 lumbricals)
Ulnar nerve superficial branch: supplies _____ to medial 1 1/2 digits (palmar and dorsal surface)
Ulnar nerve superficial branch: supplies SENSORY to medial 1 1/2 digits (palmar and dorsal surface)
Sensory innervation of the ulnar nerve: includes:
1. ____ part of palm & dorsum
2. half of digit __
3. All of digit _
Sensory innervation of the ulnar nerve: includes:
1. Medial part of palm & dorsum
2. half of digit 4 (ring finger)
3. All of digit 5 (pinky)
Claw hand occurs anywhere C_ and T_ axons are damaged
Claw hand occurs anywhere C8 and T1 axons are damaged
Damage to ulnar nerve at elbow results in patient unable to _____ the distal interphalangeal joint, making ____ hand more prominent
Damage to ulnar nerve at elbow results in patient unable to flex the distal interphalangeal joint, making “claw” hand more prominent
Damage to ulnar nerve at the wrist results in the patient unable to ___ metacarpophalangeal joint and move digit _.
Damage to ulnar nerve at the wrist results in the patient unable to flex metacarpophalangeal joint and move digit 5.
C8 ande T1 axons are damaged… which nerve are you concerned about?
Ulnar nerve
Damage to the ulnar nerve at the elbow affects which muscles
medial half of flexor digitorum profundus in addition to the hypothenar muscles, 3rd and 4th lumbrical and interossei
Damage to the ulnar nerve at the wrist affects which muscles
paralysis of hypothenar muscles, 3rd & 4th lumbricals, and interossei
Does damage to the ulnar nerve affect the ability to flex at the proximal interphalangeal joint
NO, it affects the distal interphalangeal (damage at elbow) or metacarpophalangeal joint (damage at wrist.
Flexor digitorum (responsible for flexion at the PIP joint) is innervated by median nerve
Symptoms of claw hand deformity:
- sudden severe onset of pain on ___ of _____
- _____ and _____ in forearm and __ & ____ digits;
- ___ nerve irritation or injury
Symptoms of claw hand deformity:
- sudden severe onset of pain on inside of elbow
- numbness and tingling in forearm and 4th & 5th digits;
- ULNAR nerve irritation or injury
Causes of Claw Hand: Avulsion Fracture of Medial Epicondyle
- Usually affects _____ age _ to __ years old
- ______ (sport)
- Fall causing severe _____ of an extended elbow
Causes of Claw Hand: Avulsion Fracture of Medial Epicondyle
- Usually affects children age 9 to 14 years old
- Pitchers (sport)
- Fall causing severe abduction of an extended elbow
Median nerve pathway:
- Enters cubital fossa ___ to the brachial artery
- Exits cubital fossa passing between heads of _____ _____
- courses through the forearm medially
- Runs deep to palmaris longus and into the _____ _____ EXCEPT the cutaneous branch of the median nerve
Median nerve pathway:
- Enters cubital fossa medial to the brachial artery
- Exits cubital fossa passing between heads of pronator teres
- courses through the forearm medially
- Runs deep to palmaris longus and into the carpal tunnel EXCEPT the cutaneous branch of the median nerve
Median nerve pathway in the hand: palmar cutaneous branch is/is not affected by carpal tunnel
Median nerve pathway in the hand: palmar cutaneous branch IS NOT affected by carpal tunnel
Median nerve pathway in the hand: recurrent branch is ____ to the _____ muscles
Median nerve pathway in the hand: recurrent branch is motor to the thenar muscles
Median nerve pathway in the hand:
“other branches”
- Motor to ___ & ___ lumbrical
- Sensory to the _____ palm and distal, dorsal digits of 1, 2, 3, and 1/2 of 4
Median nerve pathway in the hand:
“other branches”
- Motor to 1st & 2nd lumbrical
- Sensory to the anterior palm and distal, dorsal digits of 1, 2, 3, and 1/2 of 4
Sensory territory of median nerve
Supracondylar fracture of humerus:
- mechanism of injury: fall onto outstretched hand
- Clinical implications:
a) ____ shaft fragment displaced anteriorly/posteriorly (limb shortening)
b) risk of ____ artery laceration (ischemic contracture)
c) risk of ____ nerve damage (Volkmann’s) –> motor & sensory loss (Hand of Benediction when making a fist)
Supracondylar fracture of humerus:
- mechanism of injury: fall onto outstretched hand
- Clinical implications:
a) DISTAL shaft fragment displaced posteriorly (limb shortening)
b) risk of BRACHIAL artery laceration (ischemic contracture)
c) risk of MEDIAN nerve damage (Volkmann’s) –> motor & sensory loss (Hand of Benediction when making a fist)
Pronator syndrome
____ nerve contrapment;
Symptoms:
a) pain and tenderness in the proximal anterior/posterior forearm
b) hypesthesia/hypesthesia in ____ part of lateral 3 1/2 digits
Median nerve entrapment;
Symptoms:
a) pain and tenderness in the proximal anterior/posterior forearm
b) hypesthesia/hypesthesia in LATERAL part of lateral 3 1/2 digits
Damage to median nerve at wrist results in:
Paralysis of _____ muscles and radial _____
similar to hand of benediction BUT
RETAIN: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
LOSE: Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and lateral two lumbricals;
Damage to median nerve at wrist results in: ADDUCTED THUMB
Paralysis of THENAR muscles and radial LUMBRICALS
similar to hand of benediction BUT
RETAIN: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
LOSE: Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and lateral two lumbricals;
Damage to median nerve at the wrist is similar to hand of benediction BUT
there is a loss of _____ from digit 1, and WEAKENED digit 1 ____ and ______
Damage to median nerve at the wrist is similar to hand of benediction BUT
there is a loss of opposition from digit 1, and WEAKENED digit 1 flexion and abduction
Any condition that reduces the size of the tunnel in the hand and results in compression of the ___ nerve
Any condition that reduces the size of the tunnel in the hand and results in compression of the median nerve
Symptoms of carpal tunnel
sensory deficits
muscle weakness with associated musculature
Lateral epicondylitis also known as
tennis elbow
Medial epicondylitis also known as
golfer’s elbow
Disease of palmar fascia and aponeurosis, typically in > 50yr old caucasian men;
Dupuyten contracture
Dupuyten contracture causes shortening on the ____ end of hand resulting in ____ at the metacarpophalangeal and proximal PIP joints
Dupuyten contracture causes shortening on the medial end of hand resulting in flexion at the metacarpophalangeal and proximal PIP joints
Mallet finger: long ____ tendon avulsion
Presentation: ____ at the distal interphalangeal joint; inability to _____ DIP
Mallet finger: long EXTENSOR tendon avulsion
Presentation: flexion at the distal interphalangeal joint; inability to EXTEND DIP
Most commonly fractured carpal; Patient presents with pain and tenderness in anatomical ___ _____.
Common complication: _____ ______ - damage to the palmar carpal branch of the _____ artery
SCAPHOID
Most commonly fractured carpal; Patient presents with pain and tenderness in anatomical SNUFF BOX.
Common complication: AVASCULAR NECROSIS - damage to the palmar carpal branch of the RADIAL artery
Hamate fracture can compress the ___ nerve, leading to loss of sensation in the medial half of digit __ and the whole digit ___.
Hamate fracture can compress the ULNAR nerve, leading to loss of sensation in the medial half of digit 4 and the whole digit 5
Extension fracture of the distal radius;
Colles fracture
Flexion fracture of the distal radius (MUCH LESS COMMON)
Smith fracture
Dermatomes of the Hand
Radial nerve injury of the DEEP BRANCH ONLY:
results in no loss of sensation and inability to extend ___ and fingers at the ___ joint
Radial nerve injury of the DEEP BRANCH ONLY:
results in NO loss of sensation and inability to extend THUMP and fingers at the MCP joint
Radial nerve injury at humerus mid-shaft (radial groove) results in:
inability to extend wrist & fingers (metacarpophalangeal, PIP, DIP joints)
wrist remain partly _____ due to supposed flexor tone and gravity
Radial nerve injury at humerus mid-shaft (radial groove) results in:
inability to extend wrist & fingers (metacarpophalangeal, PIP, DIP joints)
wrist remain partly flexed due to supposed flexor tone and gravity
Anatomical SNUFF BOX
Radial nerve pathway in forearm
- enters cubital fossa between brachioradialis & brachial
- branches ANTERIOR to LATERAL epicondyle into deep (MOTOR) & superficial (SENSORY) branches
- Superficial branch divides into many superficial nerves
- Deep branch penetrates supinator and becomes the posterior interosseous nerve
