Hands

Question 1

Proximal row of carpal bones

Answer 1

Lateral to medial when viewed anteriorly
Scaphoid 
Lunate
Triquetrum
Pisiform (sesamoid bone in FCU - articulates with anterior surface of triquetrum)

Scaphoid and lunate articulate with radius to form wrist joint

Question 2

Distal row of carpal bones

Answer 2

Lateral to medial when viewed anteriorly
Trapezium - articulates with metacarpal of thumb
trapezoid
capitate - largest of carpal bones
hamate

Question 3

Carpal tunnel borders

Answer 3

lateral - scaphoid and trapezium
medial - pisiform and hook of hamate
Anterior - flexor retinaculum

Question 4

Wrist joint

Answer 4

Synovial joint between distal end of radius and ulna and scaphoid lunate and triquetrum

Question 5

Contents of carpal tunnel

Answer 5

4 tendons of FDP
4 tendons of FDS
Tendon of FPL 
Median nerve (anterior to tendons)

FCR passes through flexor retinaculum
ulnar artery, ulnar nerve and palmaris longus passes anterior to flexor retinaculum

Question 6

Extensors at wrist

Answer 6

Posterior surface has 6 compartments defined by an extensor retinaculum
ECU and EDM have their own synovial sheaths
ED and EI share a synovial sheath on posterior surface of wrist

Question 7

palmar aponeurosis

Answer 7

apex continuous with palmaris longus

Question 8

Palmaris brevis

Answer 8

Overlies the hypothenar muscle, ulnar artery and superficial branch of the ulnar nerve at medial side of palm.
Innervated by superficial branch of ulnar nerve

Question 9

Anatomical snuffbox

Answer 9

Medial border - EPL
lateral border - APL and EPB
Floor - scaphoid and trapezium + distal ends of ECRL and ECRB

Radial artery passes through deep to extensor tendons of thumb

Terminal parts of superficial branch of radial nerve + origin of cephalic vein passes subcutaneously over snuffbox

Question 10

Intrinsic muscles of hands

Answer 10

Palmaris brevis
Interossei
Adductor pollicis - radial artery comes out anteromedially between the two heads to form deep palmar arch
Hypothenar
Thenar 
Lumbricals

All innervated by deep branch of ulnar nerve

Question 11

Interossei

Answer 11

Between and attached to metacarpals
Insert into proximal phalanx of each digit and into extensor hood.

Radial artery pass between two heads of first dorsal interossei

Question 12

Thenar muscles

Answer 12

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

All originate from tubercle of trapezium
All innervated by recurrent branch of median nerve
Opponens pollicis deep to the other 2
APB is proximal to FPB, both insert onto extensor hood of thumb

Question 13

Hypothenar muscles

Answer 13

Flexor digiti minimi brevis
Opponens digiti minimi
Abductor digiti minimi

Opponens lies deep to the other 2. Base is penetrated by deep branch of ulnar nerve and ulnar artery
ADM is medial to FDMB

Question 14

Lumbricals

Answer 14

Medial 2 are bipennate
lateral 2 are unipennate
Pass dorsally around lateral side of each finger and insert into extensor hood.
Tendons are anterior to deep transverse metacarpal ligaments

Question 15

Arteries to hands

Answer 15

Radial artery - thumb and lateral side of index finger

Ulnar artery - remaining digits and medial side of index

Question 16

Ulnar artery

Answer 16

Lies between palmaris brevis and flexor retinaculum and is lateral to ulnar nerve and pisiform bone.
Forms superficial palmar arch (superficial to long flexor tendons of digits and just deep to palmar aponeurosis)

Branches into deep palmar arch and anatastomose with deep palmar arch derived from radial artery

Question 17

Radial artery

Answer 17

Passes between 2 heads of 1st dorsal interosseous and then 2 heads of adductor pollicis to form deep palmar arch

Question 18

Ulnar nerve

Answer 18

Divides into deep branch (mainly motor) and superficial branch (mainly sensory) distal to pisiform
Lateral to pisiform and medial to ulnar artery when it enters hand

Deep branch of ulnar nerve lies in Guyon’s canal between hook of hamate and flexor tendons.

Superficial branch of ulnar nerve supplies palmaris brevis and cutaneous to medial half of hand

Question 19

How to distinguish damage to ulnar nerve at wrist or site proximal to wrist

Answer 19

Evaluate function of dorsal branch of ulnar nerve, which supplies dorsal surface of medial side of hand. As this branches from distal regions in forearm.

Question 20

Median nerve

Answer 20

After carpal tunnel branches into recurrent branch and palmar digital branches (superficial to flexor retinaculum)

Recurrent - three thenar muscles. Passes between PFB and APB.
Palmar digital - Cutaneous and lateral two lumbricals

Question 21

Radial nerve in hand

Answer 21

Only part of radial nerve that enters hand is superficial branch. Passes over anatomical snuffbox.
Cutaneous supply