Hand I: Superficial structure, fascia, muscles

Question 1

palmar surface

Answer 1

• hairless
• thick skin
• fingerprints- “non-skid surface”
• transverse and longitudinal flexion creases

Question 2

dorsal surface

Answer 2

• hair
• loose skin
• dorsal venous neworl makes cephalic and basilic vein

Question 3

palmar fascia

Answer 3

1. superficial- thin, fibrous, bound to deep fascia
2. deep- continuous with deep fascia at ante brachium
   - forms:
   - palmar carpal ligament
   - flexor retinaculum
   - palmar aponeurosis
   - fibrou digital sheaths

Question 4

palmar aponeurosis

Answer 4

1. superficial layer (longitudinal fibers)
   - continuos with flexor retinaculum/ palamris longus ligament and fibrous digital sheaths
2. deep layer (transverse fibers)- continuos with thenar and hypothenar fascias; becomes thick distally

Question 5

dupuytren’s contracture

Answer 5

• pathological thickening and contracture of longitutindal bands of palmaris longus- constant state of contraction

Question 6

fibrous digital sheaths

Answer 6

• specialized deep fascia anchored to margins of phalanges
• forms fibro-osseous tunnel prevents bowstringing of digital flexor tendons during flexion
• synovial digital tendons between sheath and tendon

Question 7

superficial transverse metacarpal ligament

Answer 7

• unites longitudinal bands of palmer aponeurosis distally on anterior surface
• assists in strengthening region of inter digit webs

Question 8

synovial digital sheath

Answer 8

• fluid filled bursa
• located between fibrous digital sheath and digital flexor tendons to lubricate fibrous digital sheaths
• wrap around tendons for uninterrupted movement
• each digit has own sheath
• 2 robust one: ulnar and radial

Question 9

Radial bursa

Answer 9

• bursa of flexor pollicis longus tendon
• more robust
• extend from proximal to flexor retinaclum to flexor pollicis longus distally

Question 10

Ulnar bursa

Answer 10

• common flexor bursa
• robust
• surrounds long digital flexors
• extends flexor retinaculum to distal tip of 5th digit

Question 11

compartments of hand

Answer 11

• 4 compartments total
• 3 separated by connective tissue septa
  1. thenar
  2. central
  3. hypothenar
• deeper fascia separated 4th compartment
  4. adductor-interosseous compartment

Question 12

deep palmar space (cleft)

Answer 12

• separates compartments
• divides space into lateral palmar space (thenar) and medial palmar space
• creates reference plane for adduction and abdution of hand

Question 13

Thenar Compartment Contents

Answer 13

1. abductor pollicis brevis
2. flexor pollicis brevis
3. opponens pollicis
4. tendon of flexor pollicis longs
5. radial bursae
6. branches of median nerve
7. branches radial artery
8. first metacarpal

Question 14

Abductor pollicis brevis

Answer 14

O- flexor retinaculum, scaphiod and trapezium
I- ventral base of proximal phalanx of thumb
A- abducts thumb ( slight flexion of carpometacarpot- joint_
N- median nerve

Question 15

Flexor Pollicis Brevis

Answer 15

O- flexor retinaculum, trapezium
I- lateral base of proximal phalanx of thumb
A- flexes thumb at carpometacarpal and MP joints
N- Superficial head=median nerve
deep head= deep ulnar branch

**sesmoid bone can be found within this tendon

Question 16

Opponen Pollicis

Answer 16

O- flexor retinaculum, trapezium
I- radial palmar border of 1st metacarpal
A- opposition of thumb to digits
N- median nerve

Question 17

Hypothenar Compartment

Answer 17

1. abductor digiti minimi
2. flexor digiti minimi
3. opponents digiti minimi
4. branches of ulnar nerve
5. branches ulnar artery
6. 5th metacarpal

Question 18

Abductor digiti minimi

Answer 18

O- pisiform
I- medial base of proximal phalanx of digit minimi
A- abducts and flexes metacarpophalangeal joint of digit minima
N- ulnar nerve (deep branch)

Question 19

Flexor digiti minimi

Answer 19

O- flexor retinaculum, hamulus of hamate
I- medial base of proximal phalanx of digit minima
A- flexes digiti minimi at MP joints
N- ulnar nerve (deep branch)

Question 20

Central compartment

Answer 20

• structures beneath palmar aponeurosis
  1. superficial palmar arterial arch
  2. branches median nerve
  3. branches ulnar nerve
  4. tendons
  5. synovial linings
  6. long digital flexors (flexor digitorum superficiallis and flexor digitorum profundus)
  7. lumbricals

Question 21

Lumbricals

Answer 21

O- radial side of flexor digitorum profundus tendons
I- extensor expansion of extensor digitorum tendons
A- flexes MP joints and exends IP joints
N- median nerve (lumbrical 1&2)
Ulnar nerve (lumbricals 3&4)

Question 22

abductor- Interosseous compartment contents

Answer 22

1. deep palmar arterial arch
2. adductor pollicis
3. palmar and dorsal interossei
4. deep branch ulnar nerve
5. metacarpal 2,3,4

Question 23

Adductor pollicis

Answer 23

O- oblique head- capitate and bases of second and third metacarpal
transverse head- palmar surface, shaft of 3rd metacarpal
I- ulnar surface, base of proximal phalanx of thumb
A- ADDUCTS THUMB
N- ulnar nerve

Question 24

Palmar interossei

Answer 24

O- interosseous surface of ulnar side 1 & 2 metacarpal and radial side of metacarpals 4 &5
I- side of bases of proximal phalanx and extensor expansion of 1, 2, 4, 5
A- adducts 1, 2, 4, 5, flexes MP joints and extends IP joints 1,2,4,5
N- ulnar nerve

***flexor pollicis brevis is the 4th adductor of thumb

Question 25

Dorsal Interossei

Answer 25

O- adjacent sides of all metacarpal I- extensor expansion and side of bases of phalanges 2, 3, 4 A- abducts digits 2, 3, 4, flex MP joints and extend IP joints 2, 3, 4, N- ulnar nerve