L10: Musculo-neuro-vascular systems of the hand and carpal tunnel Flashcards

1
Q

palmar surface anatomy

A

central concavity separates 2 eminences

thenar eminence: lateral, more prominent

hypothenar eminence: medial, smaller

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2
Q

intrinsic muscles of the hand, 5 compartments

A

5 compartments separated by fibrous septa

  1. thenar compartment: thenar muscles (3)
  2. adductor compartment: adductor pollicis (1)
  3. hypothenar compartment: hypothenar muscles (3)
  4. central compartment: lumbricals (4)
  5. interosseous compartment: interossei (7)
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3
Q

thenar compartment: abductor pollicis brevis; origin + insertion

A

origin:
- tubercle of scaphoid
- flexor retinaculum

insertion:
- proximal phalanx of thumb, lateral surface of base

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4
Q

thenar compartment: abductor pollicis brevis; innervation + actions

A

innervation: recurrent branch of median nerve

actions: abducts thumb and assists in opposition at CMC joint

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5
Q

thenar compartment: flexor pollicis brevis; origin + insertion

A

two heads superficial and deep

origin: trapezium and adjacent flexor retinaculum

insertion: proximal phalanx of thumb

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6
Q

thenar compartment: flexor pollicis brevis; innervation + actions

A

innervation: recurrent branch of median nerve (superficial head), deep branch of ulnar nerve (deep head)

actions: flexes thumb at CMC/MCP joint

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7
Q

thenar compartment: opponens pollicis; origin + insertion

A

lies deep to abductor pollicis brevis (APB) and flexor pollicis brevis (FPB)

origin: trapezium and adjacent flexor retinaculum

insertion: lateral border of 1st metacarpal

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8
Q

thenar compartment: opponens pollicis; innervation + action

A

innervation: recurrent branch of median nerve

actions: assists with opposition of thumb, flexion, adduction + medial rotation at 1st CMC joint

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9
Q

adductor compartment: adductor pollicis; origin + insertion:

A

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

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10
Q

adductor compartment: adductor pollicis; innervation + actions:

A

innervation: deep branch of ulnar nerve

actions: adducts thumb at 1st CMC joint

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11
Q

hypothenar compartment:
abductor digiti minimi; origin + insertion

A

origin: pisiform and flexor retinaculum

insertion: medial base of proximal phalanx of little finger

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12
Q

hypothenar compartment:
abductor digiti minimi; innervation + actions

A

innervation: deep branch of ulnar nerve

actions: abducts little finger

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13
Q

hypothenar compartment:
flexor digiti minimi brevis; origin + insertion

A

origin: hook of hamate and flexor retinaculum

insertion: medial surface of base of proximal phalanx (little finger)

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14
Q

hypothenar compartment:
flexor digiti minimi brevis; innervation + actions

A

innervation: deep branch of ulnar nerve

actions: flexes little finger at CMC/MCP joint

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15
Q

hypothenar compartment:
opponens digiti minimi; origin + insertion

A

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

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16
Q

hypothenar compartment:
flexor digiti minimi brevis; innervation + actions

A

innervation: deep branch of ulnar nerve

actions: rotates 5th metacarpal to oppose little finger to thumb

17
Q

palmaris brevis; origin + insertion

A

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

18
Q

palmaris brevis; innervation + actions

A

innervation: superficial branch of ulnar nerve

actions: wrinkles of hypothenar eminence - aids in palmar gripping

19
Q

central muscles:
Lumbricals (4)

A

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

20
Q

central muscles:
Lumbricals (4); origin

A

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

21
Q

central muscles:
Lumbricals (4)
insertions:

A

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

22
Q

central muscles:
Lumbricals (4)
innervation + actions

A

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

23
Q

interosseous muscles (7)

A

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’’

24
Q

palmar interossei (3), origin + insertion

A

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

25
palmar interossei (3); innervation + action
innervation: deep branch of ulnar nerve action: palmar ADduct: ''pAD'' > adduction of index, ring and little fingers
26
dorsal interossei (4); origin + insertion
origin: bipennate muscles, originate on adjacent sides of metacarpal insertion: 1. lateral base of index proximal phalanx + DDE 2. lateral base of middle finger proximal phalanx + DDE 3. medial base of middle finger proximal phalanx + DDE 4. medial base of 4th finger proximal phalanx + DDE DDE= dorsal digital expansion
27
dorsal interossei (4); innervation + action
innervation: deep branch of ulnar nerve action: Dorsal ABduct: ''DaB'' abducts digits 2-4
28
innervation of hand
motor *Thenar Muscles: median nerve branches* Adductor Pollicis: deep branch of ulnar nerve *Hypothenar Muscles – deep branch of ulnar nerve *Lumbricals Lateral 2 – median nerveMedial 2 – ulnar nerve *Interossei – deep branch of ulnar nerve
29
arterial supply to hand
*Superficial Palmar Arch *Located between palmar aponeurosis and tendons of flexor digitorum superficialis (FDS) *Formed from: *Terminal branch of ulnar artery *Superficial palmar branch of radial artery*Deep Palmar Arch *Located between metacarpals and deep flexor tendons *Formed from: *Deep palmar branch of ulnar artery *Branch of radial artery *Common palmar digital arteries *Proper palmar digital arteries
30
dorsal surface of hand
- dorsal carpal arch -ulnar-radial anastomosis - dorsal metacarpal arteries - dorsal digital arteries
31
deep venous drainage of hand
*Deep veins tend to follow arteries *Superficial and deep venous palmar arches both drain into radial and ulnar veins
32
superficial venous drainage of hand
dorsal venous plexus ^ dorsal metacarpal veins ^ dorsal digital veins
33
anatomical snuffbox; floor
styloid process of radius scaphoid proximally trapezium distally base of 1sy metacarpal
34
anatomical snuffbox; boundaries
extensor pollicis longus extensor pollicis brevis abductor pollicis longus
35
anatomical snuffbox; roof
skin superficial branch of radial nerve
36
carpal tunnel
located at anterior surface of wrist floor: carpal bones walls: carpal bones roof: flexor retinaculum many structure pass through to access anterior hand
37
carpal tunnel contents
*Flexor digitorum profundus tendons (4) *Flexor digitorum superficialis tendons (4) *Flexor pollicis longus tendon *Median nerve *Flexor carpi radialis tendon* > Does not strictly pass through carpal tunnel, rather passes through an adjacent tunnel
38
carpal tunnel syndrome
Compression of median nerve as it passes through the carpal tunnel Causes sensory and motor symptoms Sensory: Paraesthesia (tingling), hypoesthesis(diminished sensation), anaesthesia (numbness) Motor: reduced power in abductor pollicis brevis and opponens pollicis muscles, over time reduced muscle bulk (atrophy)
39
simian hand (ape hand)
Median nerve injury causes paralysis of the thenar muscles: *Abductor Pollicis Brevis *Flexor Pollicis Brevis *Opponens Pollicis Unopposed action of Adductor Pollicis leaves thumb fixed in same plane as other fingers (like an ape's hand)