L10: Musculo-neuro-vascular systems of the hand and carpal tunnel Flashcards
palmar surface anatomy
central concavity separates 2 eminences
thenar eminence: lateral, more prominent
hypothenar eminence: medial, smaller
intrinsic muscles of the hand, 5 compartments
5 compartments separated by fibrous septa
- thenar compartment: thenar muscles (3)
- adductor compartment: adductor pollicis (1)
- hypothenar compartment: hypothenar muscles (3)
- central compartment: lumbricals (4)
- interosseous compartment: interossei (7)
thenar compartment: abductor pollicis brevis; origin + insertion
origin:
- tubercle of scaphoid
- flexor retinaculum
insertion:
- proximal phalanx of thumb, lateral surface of base
thenar compartment: abductor pollicis brevis; innervation + actions
innervation: recurrent branch of median nerve
actions: abducts thumb and assists in opposition at CMC joint
thenar compartment: flexor pollicis brevis; origin + insertion
two heads superficial and deep
origin: trapezium and adjacent flexor retinaculum
insertion: proximal phalanx of thumb
thenar compartment: flexor pollicis brevis; innervation + actions
innervation: recurrent branch of median nerve (superficial head), deep branch of ulnar nerve (deep head)
actions: flexes thumb at CMC/MCP joint
thenar compartment: opponens pollicis; origin + insertion
lies deep to abductor pollicis brevis (APB) and flexor pollicis brevis (FPB)
origin: trapezium and adjacent flexor retinaculum
insertion: lateral border of 1st metacarpal
thenar compartment: opponens pollicis; innervation + action
innervation: recurrent branch of median nerve
actions: assists with opposition of thumb, flexion, adduction + medial rotation at 1st CMC joint
adductor compartment: adductor pollicis; origin + insertion:
origin:
- transverse head: anterior surface of body of 3rd metacarpal
- oblique head: bases of metacarpals 2 and 3, capitate, and trapezoid
insertion: medial side of proximal phalanx of thumb
adductor compartment: adductor pollicis; innervation + actions:
innervation: deep branch of ulnar nerve
actions: adducts thumb at 1st CMC joint
hypothenar compartment:
abductor digiti minimi; origin + insertion
origin: pisiform and flexor retinaculum
insertion: medial base of proximal phalanx of little finger
hypothenar compartment:
abductor digiti minimi; innervation + actions
innervation: deep branch of ulnar nerve
actions: abducts little finger
hypothenar compartment:
flexor digiti minimi brevis; origin + insertion
origin: hook of hamate and flexor retinaculum
insertion: medial surface of base of proximal phalanx (little finger)
hypothenar compartment:
flexor digiti minimi brevis; innervation + actions
innervation: deep branch of ulnar nerve
actions: flexes little finger at CMC/MCP joint
hypothenar compartment:
opponens digiti minimi; origin + insertion
lies deep to abductor digiti minimi (ADM) and flexor digiti minimi brevis (FDMB)
origin: hook of hamate and flexor retinaculum
insertion: medial border of 5th metacarpal
hypothenar compartment:
flexor digiti minimi brevis; innervation + actions
innervation: deep branch of ulnar nerve
actions: rotates 5th metacarpal to oppose little finger to thumb
palmaris brevis; origin + insertion
is in hypothenar region, but not contained within the hypothenar compartment. it is superficial to this compartment
origin: proximal border of palmar aponeurosis
insertion: skin over hypothenar eminence
palmaris brevis; innervation + actions
innervation: superficial branch of ulnar nerve
actions: wrinkles of hypothenar eminence - aids in palmar gripping
central muscles:
Lumbricals (4)
4 lumbricals in total numbered 1 to 4
1 is most radial, 4 is most ulnar
1 and 2 are unipennate, 3 and 4 are bipennate
central muscles:
Lumbricals (4); origin
origins: in anterior hand they are attached to sides of flexor digitorum profundus (FDP) tendons
1st lumbrical> lateral 1st FDP tendon
2nd Lumbrical> lateral 2nd FDP tendon
3rd Lumbrical> medial 2nd FDP + lateral 3rd FDP tendon
4th lumbrical> medial 3rd FDP + lateral 4th FDP tendon
central muscles:
Lumbricals (4)
insertions:
insert into the posterior [dorsal] region of digits 2-5
all lumbrical insert into the lateral part of their respective extensor expansion
e.g. 1st lumbrical inserts into lateral part of extensor expansion covering dorsal index finger
central muscles:
Lumbricals (4)
innervation + actions
innervation:
- lateral 2 (1&2) median nerve
- medial 2 (3&4) ulnar nerve
actions:
- flex digits 2-5 at MCP joints
- extend digits 2-5 at IP joints
interosseous muscles (7)
simply called interossei
7 in total (3palmar, 4 dorsal)
all innervated by deep branched of ulnar nerve
'’3 on the P, 4 on the dor’’
palmar interossei (3), origin + insertion
origin: palmar surface of metacarpal 2,4,5
insertion:
1. medial base of proximal phalanx of index finger
2. lateral surface of base of 4th proximal phalanx
3. lateral surface of base of 5th proximal phalanx