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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
Q

What do the collateral ligaments do?

A
  • strengthen the medial/lateral aspects of the joint
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26
Q

What are the myotomes for wrist flexion and extension?

A
  • flexion: C7
  • extension: C6
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27
Q

What are the myotomes for finger ab/dduction?

A
  • abduction: T1
  • adduction: T1
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28
Q

What is the myotome for thumb extension?

A
  • C8
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29
Q

What are palmar ligaments (plates) & what is their job?

A
  • they keep MCP’s and IPs from hyperextending
  • provide a smooth groove for flexor tendons and keep them centrally on the fingers
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30
Q

Describe the palmar aponeurosis of the hand

A

Includes
- palmaris longus tendon (if present)
- connects to flexor retinaculum
- continuous with fibrous digital sheaths

31
Q

Describe the fibrous digital sheaths (pulleys) of the hand

A
  • long tubes of fascia that enclose the synovial sheaths & the long finger flexors within them
32
Q

How is an infection able to spread from the hand to the forearm?

A
  • mid palmar space is continuous with the anterior compartment of the forearm through the carpal tunnel
33
Q

Describe the carpal tunnel

A
  • keeps tendons from bowstringing from wrist
  • helps produce better force
  • site for compression of the median nerve
34
Q

What are the boundaries of the carpal tunnel?

A

Roof: flexor retinaculum
Walls: scaphoid/trapezoid & pisiform/hook of hamate
Floor: carpals between walls and their ligaments

35
Q

What are the contents of the carpal tunnel?

A

9 tendons
- 4 from FDS
- 4 from FDP
- 1 from FPL

1 nerve
- median nerve

36
Q

What are the 2 different fibrous digital sheaths and which are most important?

A

Anular
- A1-5

Cruciform
- C1-3

A2 & A4 are most important

37
Q

How does the Tunnel of Guyon differ from the carpal tunnel?

A
  • located on pinky side
  • fibrous bridging groove between pisiform and hook of hamate
  • ulnar nerve/artery pass through this opening
38
Q

List the compartments from lateral to medial in the extensor retinaculum

A

1 -> 2 -> 3 -> 4 -> 5 -> 6

39
Q

List the muscles that run through compartment 1

A
  • abductor pollicis longus (APL)
  • extensor pollicis brevis (EPB)
40
Q

List the muscles that run through compartment 2

A
  • extensor carpi radialis longus (ECRL)
  • extensor carpi radialis brevis (ECRB)
41
Q

List the muscles that run through compartment 3

A
  • extensor pollicis longus (EPL)
42
Q

List the muscles that run through compartment 4

A
  • extensor digitorum (ED)
  • extensor indicis (EI)
43
Q

List the muscles that run through compartment 5

A
  • extensor digiti minimi (EDM)
44
Q

List the muscles that run through compartment 6

A
  • extensor carpi ulnaris (ECU)
45
Q

Which muscles perform thumb flexion?

A
  • flexor pollicis brevis
  • flexor pollicis longus
46
Q

Which muscles perform thumb extension?

A
  • extensor pollicis longus
  • extensor pollicis brevis
  • abductor pollicis longus
47
Q

Which muscles perform thumb abduction?

A
  • abductor pollicis brevis
  • abductor pollicis longus
48
Q

Which muscles perform thumb adduction?

A
  • adductor pollicis (scissors muscle)
  • 1st dorsal interosseous
49
Q

Which muscles perform thumb opposition?

A
  • opponens pollicis
50
Q

Which muscles perform finger flexion?

A
  • flexor digitorum superficialis
  • flexor digitorum profundus
  • flexor digiti minimi brevis
  • lumbricals
51
Q

Which muscles perform finger extension?

A
  • extensor digitorum
  • extensor digiti minimi (5th digit)
  • extensor indicis
52
Q

Which muscles perform finger abduction?

A
  • abductor digiti minimi (5th digit)
  • dorsal interossei
53
Q

Which muscles perform finger adduction?

A
  • palmar interossei
54
Q

Explain how the extensor expansion (or hoods) works to extend the fingers

A
  • 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
Q

Describe the arterial flow of blood from the heart to the hand

A

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
Q

Describe the flow of venous return from the hand to the heart

A

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
Q

What is the difference between a dermatome and a peripheral sensory distribution?

A

Dermatome: more general and lines up with a single nerve root

Peripheral distribution: named nerve branches that are more specific

58
Q

What is a myotome?

A

an embryological mass of muscle innervated by a nerve

59
Q

What myotomes are found in the hand?

A

mostly T1 but also C8

60
Q

How could you test the myotomes in the hand?

A
  • finger adduction against resistance
  • abduction against resistance
61
Q

Why does a scaphoid fracture have trouble healing & what is the consequence of this?

A
  • 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
Q

What is Dupuytren’s Contracture?

A
  • 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
Q

What is Tenosynovitis?

A
  • inflammation of the synovial sheath tendon
64
Q

What is trigger finger?

A
  • inflammation, injury from repetitive forceful use
  • fibrous digital sheath becomes thickened/narrowed
  • this thickening can’t slide through pulleys for flexion/extension
65
Q

What is De Quervian’s?

A
  • 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
Q

What is carpal tunnel syndrome?

A
  • caused from decreases in the size of the tunnel, enlargement of structures inside the tunnel (fluid, infection, excessive use of finger flexors)
67
Q

What are some signs and symptoms you see with carpal tunnel syndrome?

A

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
Q

Describe Mallet finger

A
  • extensor tendon avulsed from distal phalanx during forced hyperflexion
  • can’t extend DIP
  • sliding into a plate in baseball
69
Q

Describe jersey finger

A
  • distal insertion of FDP avulsed from distal phalanx during loss of forceful grip
  • can’t flex DIP
70
Q

Describe skier’s thumb

A
  • tear in UCL of thumb of MCP
  • hyperabduction
  • from FOOSH
71
Q

Explain why we see wrist drop

A

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
Q

Explain why we see claw hand

A

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
Q

Explain why we see a Hand of Benediction

A

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
Q

Explain why we see Ape hand

A

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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