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Anatomy II Fall 2023 > Hand & Wrist region > Flashcards

Hand & Wrist region Flashcards

1
Q

What is the Triangular Fibrocartilage (TFC)?

A
  • a triangular articular disc in the wrist
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2
Q

Where does the TFC live?

A
  • runs from the ulnar notch of the radius to the ulnar styloid
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3
Q

What does the TFC do?

A
  • binds radius & ulna together
  • slides across ulnar head during pronation/supination
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4
Q

What are the 8 carpal bones?

A

Proximal:
- scaphoid
- lunate
- triquetrum
- pisiform

Distal
- trapezium
- trapezoid
- capitate
- hamate

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5
Q

What is special about the scaphoid?

A
  • largest bone in proximal row
  • most frequently fractured
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6
Q

What is special about the lunate?

A
  • most frequently dislocated
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7
Q

What is special about the triquetrum?

A
  • connects to the TFC
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8
Q

What is special about the pisiform?

A
  • technically a sesamoid bone
  • embedded in FCU tendon
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9
Q

What is special about the trapezium?

A
  • thumb side
  • has 4 sides
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10
Q

What is special about the trapezoid?

A
  • connects to 2nd metacarpal
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11
Q

What is special about the capitate?

A
  • largest of all carpals
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12
Q

What is special about the hamate

A
  • hook projects anteriorly
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13
Q

What bones make up the radiocarpal joint?

A
  • radius
  • proximal carpals
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14
Q

What bones make up the midcarpal joint

A
  • proximal carpals
  • distal carpals
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15
Q

What bones make up the carpometacarpal joints (CMC)?

A
  • distal carpals
  • metacarpals
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16
Q

What is special about the first CMC joint?

A
  • it is a saddle joint that allows for the movement of the thumb
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17
Q

What bones make up the metacarpophalangeal joints (MCP)?

A
  • metacarpals
  • proximal phalanges
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18
Q

What bones make up the proximal interphalangeal joints (PIP)?

A
  • proximal phalanx
  • middle phalanx
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19
Q

Does the thumb have a PIP?

A
  • NO
  • it only has an interphalangeal joint (IP)
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20
Q

What bones make up the distal interphalangeal joints (DIP)?

A
  • middle phalanx
  • distal phalanx
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21
Q

What are the four main ligaments that surround the wrist?

A

Radiocarpal
- palmar
- dorsal

Collateral
- radial
- ulnar

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22
Q

What bones do the radiocarpal ligaments attach to?

A
  • radius to both rows of carpals on the palmar and dorsal side of the hand/wrist
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23
Q

What bones do the collateral ligaments attach to?

A

Radial -> scaphoid to radial styloid

Ulnar -> ulnar styloid to triquetrum

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24
Q

What do the radiocarpal ligaments do?

A
  • keep hand connected to the radius during supination/pronation
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25
What do the collateral ligaments do?
- strengthen the medial/lateral aspects of the joint
26
What are the myotomes for wrist flexion and extension?
- flexion: C7 - extension: C6
27
What are the myotomes for finger ab/dduction?
- abduction: T1 - adduction: T1
28
What is the myotome for thumb extension?
- C8
29
What are palmar ligaments (plates) & what is their job?
- they keep MCP's and IPs from hyperextending - provide a smooth groove for flexor tendons and keep them centrally on the fingers
30
Describe the palmar aponeurosis of the hand
Includes - palmaris longus tendon (if present) - connects to flexor retinaculum - continuous with fibrous digital sheaths
31
Describe the fibrous digital sheaths (pulleys) of the hand
- long tubes of fascia that enclose the synovial sheaths & the long finger flexors within them
32
How is an infection able to spread from the hand to the forearm?
- mid palmar space is continuous with the anterior compartment of the forearm through the carpal tunnel
33
Describe the carpal tunnel
- keeps tendons from bowstringing from wrist - helps produce better force - site for compression of the median nerve
34
What are the boundaries of the carpal tunnel?
Roof: flexor retinaculum Walls: scaphoid/trapezoid & pisiform/hook of hamate Floor: carpals between walls and their ligaments
35
What are the contents of the carpal tunnel?
9 tendons - 4 from FDS - 4 from FDP - 1 from FPL 1 nerve - median nerve
36
What are the 2 different fibrous digital sheaths and which are most important?
Anular - A1-5 Cruciform - C1-3 A2 & A4 are most important
37
How does the Tunnel of Guyon differ from the carpal tunnel?
- located on pinky side - fibrous bridging groove between pisiform and hook of hamate - ulnar nerve/artery pass through this opening
38
List the compartments from lateral to medial in the extensor retinaculum
1 -> 2 -> 3 -> 4 -> 5 -> 6
39
List the muscles that run through compartment 1
- abductor pollicis longus (APL) - extensor pollicis brevis (EPB)
40
List the muscles that run through compartment 2
- extensor carpi radialis longus (ECRL) - extensor carpi radialis brevis (ECRB)
41
List the muscles that run through compartment 3
- extensor pollicis longus (EPL)
42
List the muscles that run through compartment 4
- extensor digitorum (ED) - extensor indicis (EI)
43
List the muscles that run through compartment 5
- extensor digiti minimi (EDM)
44
List the muscles that run through compartment 6
- extensor carpi ulnaris (ECU)
45
Which muscles perform thumb flexion?
- flexor pollicis brevis - flexor pollicis longus
46
Which muscles perform thumb extension?
- extensor pollicis longus - extensor pollicis brevis - abductor pollicis longus
47
Which muscles perform thumb abduction?
- abductor pollicis brevis - abductor pollicis longus
48
Which muscles perform thumb adduction?
- adductor pollicis (scissors muscle) - 1st dorsal interosseous
49
Which muscles perform thumb opposition?
- opponens pollicis
50
Which muscles perform finger flexion?
- flexor digitorum superficialis - flexor digitorum profundus - flexor digiti minimi brevis - lumbricals
51
Which muscles perform finger extension?
- extensor digitorum - extensor digiti minimi (5th digit) - extensor indicis
52
Which muscles perform finger abduction?
- abductor digiti minimi (5th digit) - dorsal interossei
53
Which muscles perform finger adduction?
- palmar interossei
54
Explain how the extensor expansion (or hoods) works to extend the fingers
- lumbricals & interosseous muscles join with the lateral bands of ED - the pull on these helps allow for extension because the force is behind the axis of movement
55
Describe the arterial flow of blood from the heart to the hand
aorta -> aortic arch -> brachiocephalic -> subclavian -> axillary -> brachial -> ulnar & radial -> hand 1) ulnar artery -> superficial & deep palmar arches a) superficial palmar arch -> common palmar digital -> proper digital arteries b) deep palmar arch -> palmar metacarpal arteries 2) radial artery -> superficial & dorsal branches a) superficial branch -> superficial palmar arch b) dorsal branch -> runs through anatomical snuff box -> around thumb (to princeps pollicis & radialis indicis) -> dives palmar through 1st dorsal interossei & adductor pollicis -> connects to deep palmar arch made by ulnar artery
56
Describe the flow of venous return from the hand to the heart
Deep - superficial venous palmar arch -> deep venous palmar arch -> deep veins of forearm Dorsal venous network: drains into superficial veins of the arm (basilic & cephalic)
57
What is the difference between a dermatome and a peripheral sensory distribution?
Dermatome: more general and lines up with a single nerve root Peripheral distribution: named nerve branches that are more specific
58
What is a myotome?
an embryological mass of muscle innervated by a nerve
59
What myotomes are found in the hand?
mostly T1 but also C8
60
How could you test the myotomes in the hand?
- finger adduction against resistance - abduction against resistance
61
Why does a scaphoid fracture have trouble healing & what is the consequence of this?
- caused from a FOOSH and it has poor blood supply - avascular necrosis could occur from this kind of injury - could lead to degenerative joint disease
62
What is Dupuytren's Contracture?
- usually found in men with northern European descent over 50yrs - cause is unknown - nodular thickening adheres palmar aponeurosis to skin - degenerative fibrosis which contracts the 4th & 5th digits into flexion - surgery needed to fix
63
What is Tenosynovitis?
- inflammation of the synovial sheath tendon
64
What is trigger finger?
- inflammation, injury from repetitive forceful use - fibrous digital sheath becomes thickened/narrowed - this thickening can't slide through pulleys for flexion/extension
65
What is De Quervian's?
- 1st dorsal compartment (APL & EPB) - excessive friction from repetitive use - leads to tendon enlargement & synovial sheath fibrosis, thickening and narrowing - pain over compartment & up lateral forearm
66
What is carpal tunnel syndrome?
- caused from decreases in the size of the tunnel, enlargement of structures inside the tunnel (fluid, infection, excessive use of finger flexors)
67
What are some signs and symptoms you see with carpal tunnel syndrome?
Median nerve compression: - sensation loss (not central palm) - thenar muscle loss (atrophy) - poor coordination of thumb PT helps - if that doesn't work then carpal tunnel release from surgery
68
Describe Mallet finger
- extensor tendon avulsed from distal phalanx during forced hyperflexion - can't extend DIP - sliding into a plate in baseball
69
Describe jersey finger
- distal insertion of FDP avulsed from distal phalanx during loss of forceful grip - can't flex DIP
70
Describe skier's thumb
- tear in UCL of thumb of MCP - hyperabduction - from FOOSH
71
Explain why we see wrist drop
Radial nerve injury: - occurs at radial groove in humerus - radial nerve innervates wrist & hand extensors - can't extend wrist - drops into flexion due to gravity
72
Explain why we see claw hand
Distal ulnar nerve injury: - at the tunnel of guyon - loss of intrinsic hand muscles - handle bar neuropathy - loss of sensation to medial 1 1/2 fingers & medial hand - extensors are unopposed so looks like a claw
73
Explain why we see a Hand of Benediction
Proximal median nerve injury: - at the elbow/forearm - FDS & 1/2 of FDP affected - can't flex PIP's or DIP's of 2-3 digits - thenar muscles can't abduct
74
Explain why we see Ape hand
Distal median nerve injury: - FDS & FDP intact - thenar muscles can't abduct - FPL & 1/2 FPB can flex thumb across palm

Anatomy II Fall 2023 (11 decks)

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