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ANAT30007 > L13 UL Bones and Muscles > Flashcards

L13 UL Bones and Muscles Flashcards

Hand

1
Q

Features of the human hand

A
  • not weight bearing
  • for power and precision grips
  • palm to pad interactions
  • gripping action - use of tools
  • opposable thumb
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2
Q

carpal bones

A
  • proximal row (from radial to ulna)
    1. scaphoid - contact with radius
    2. lunate - contact with radius
    3. triquetrum - no contact with ulna
    4. pisiform - no contact with ulna but sits on top of triquetrum

cartilaginous disc b/w 3./4. and ulna

  • distal row (from radial to ulna)
    1. trapezium
    2. trapezoid
    3. capitate
    4. hamate
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3
Q

scaphoid bone

A

“wasting” in the centre - weak point ⇒ FOOSH weakness

  • convex part of scaphoid and lunate - connect to radius
  • concave part of scaphoid and lunate - join with distal row of carpal bones
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4
Q

lunate bone

A

semilunar shape

  • convex part of scaphoid and lunate - connect to radius
  • concave part of scaphoid and lunate - join with distal row of carpal bones
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5
Q

triquetrum bone

A

pyramidal shape

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6
Q

pisiform bone

A

sesamoid bone that is embedded in flexor calpi ulnaris

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7
Q

trapezium bone

A

articular facet with first metacarpal - saddle joint

  • saddle joint is key for thumb opposition
  • has tubercle and grooves (2x flexor retinaculum attachments)
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8
Q

trapezoid bone

A

triangular and “just inzoid” - just inside the trapezium

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9
Q

capitate bone

A

largest carpal bone and centrally placed

  • contact with 3rd metacarpal (axis of the hand - 3rd metacarpal)
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10
Q

hamate bone

A

distinctive hook on palmar side - “Hook of Hamate”

  • hook of hamate connects to pisiform via pisohamate ligament
    • ulnar nerve and artery passes here
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11
Q

scaphoid fracture

A
  • most susceptible carpal bone to fracture - commonly fractures at wasting area
  • can get necrotic and die
    • compromised blood supply to proximal half
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12
Q

fracture of hook of hamate

A
  • hook of hamate can be easily palpated
  • when hook is compressed ⇒ handlebar neuropathy → press on ulnar nerve
  • ulnar nerve innervates only flexor carpi ulnaris and 1/2 of flexor digitorum profundus in forearm
    • but innervates a lot in hand → pain detected via muscles of hand
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13
Q

metacarpals

A
  • base articulates proximally
  • body long stick part
  • head articulates distally

above also applies to phalanges

  • most robust metacarpal = 1st metacarpal - shortest & fattest
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14
Q

phalanges

A
  • base articulates proximally
  • body long stick part
  • head articulates distally

usually three parts

  • proximal phalanx
  • middle phalanx
  • distal phalanx

thumb only has proximal and distal phalanges

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15
Q

fascia in the hand

A
  • deep antebrachial fascia → retinacula
    • flexor retinaculum - aka transverse carpal ligament
      • forms pyramid shaped palmar aponeurosis - apex is at flexor retinaculum
    • extensor retinaculum
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16
Q

fascial compartments

A
  • hypothenar: pinky
  • thenar: thumb
  • central: middle
  • adductor: below thenar - but also technically part of thenar
    • is just the adductor pollicis muscle
  • interosseous: most dorsal - between bones
17
Q

hypothenar fascial compartment

A
  • medial fibrous septum
    • from medial of hand to 5th metacarpal - separates little finger compartment
  • little finger compartment
18
Q

thenar fascial compartment

A
  • lateral fibrous septum: from lateral border of palmar aponeurosis to 3rd metacarpal, another fibrous tissue goes beyond this septum and attaches onto the 1st metacarpal
  • thumb compartment
19
Q

central fascial compartment

A
  • b/w medial and lateral fibrous septa
  • muscles that work on main fingers
20
Q

thenar space

A

deep to thenar compartment

adductor pollicis muscle is deeper than thenar space

21
Q

palmar aponeurosis

A
  • palmaris brevis: small muscle - attaches to palmar aponeurosis
    • when flexed - helps make fist
  • palmar aponeurosis - main function = make fist
22
Q

contracture of palmar fascia

A

thickening and shrinking of the palmar fascia, usually affecting ring and little finger - no known aetiology, but believed to be hereditary

23
Q

Dupuytrens contracture

A

ring and little finger go into palmar flexion, difficult for movement - needs to be surgically corrected and relieved

24
Q

flexor retinaculum

A
  • forms roof of carpal tunnel - fibro-osseous
  • contains median nerve, tendons etc.
  • attachments: tubercle of Scaphoid, tubercle of Trapezium, hOok of hamate, Pisiform bone - STOP
25
Q

carpal tunnel

A

hollow shape w/ tendons, synovail sheaths and median n.

  • floor: carpal bones
  • proximal end: distal wrist crease

carpal tunnel syndrome = inflammation

26
Q

structures passing superficial to flexor retinaculum

A
  • palmaris longus tendon: inserts onto palmar aponeurosis
  • ulnar artery, ulnar nerve: deep to pisohamate ligament
  • superficial branch of radial nerve: travels past wrist and goes posteriorly
    • ulnar and radial a. from brachial a.
  • cutaneous branch of median nerve - doesn’t go via tunnel
  • flexor carpi ulnaris: placed very medially
27
Q

structures passing deep to flexor retinaculum

A
  • flexor digitiorum superficialis tendons: attaches to base of middle metacarpal, bunches up at carpal tunnel
  • flexor digitorum profundus tendons
  • median nerve: recurrent thenar branch - lateral and medial branch
  • flexor carpi radialis: trapezium has groove - 2 places of attachement for flexor retinaculum = FCR place
  • flexor pollicis longus

​​also synovial sheaths - these can get inflammed

28
Q

extensor retinaculum

A
  • posterior side
  • don’t typically have many problems
  • attachments:
    • laterally → radius
    • medially: triquetrum, pisiform, FCU tendon (extensor retinaculum wraps around this)
29
Q

contents of extensor retinaculum

A

six tunnels

  1. APL, EPB (outcropping)
  2. ECRL, ECRB
  3. EPL (also outcropping)
  4. ED, EI
  5. EDM
  6. ECU
30
Q

anatomical snuff box

A
  • found by extending the thumb
    • b/w EPL (medial) and EPB (lateral)
  • roof structures: skin, cutaneous tissue, cephalic vein, radial nerve
  • floor structures: scaphoid and trapezium
  • most important structure: radial artery - scaphoid fracture in snuff box = damaged radial artery
31
Q

intrinsic muscles of the hand (layer 1)

A
  • originates: edges of flexor retinaculum
  • inserts: base of proximal phalanx
32
Q

intrinsic muscles of the hand (layer 2)

A
  • lumbricals (x4) - because they’re “worm-like”
  • no bony origins
  • originates: FDP tendons
    • goes to lateral side of digit
    • inserts dorsally to external expandion
  • helps with finger flexion
33
Q

intrinsic muscles of the hand (layer 3)

A
  • opponens pollics: starts from scaphoid and trapezium - inserts at first metacarpal
  • opponens digiti minimi: from edges of flexor retinaculum - inserts at 5th metacarpal
  • adductor pollicis: only on thumb - quite large and deep
    • 2 heads: base of 2nd and 3rd metacarpal + body of 3rd metacarpal
    • inserts: proximal phalanx of thumb
34
Q

intrinsic muscles of the hand (layer 4)

A

interossei muscles

  • lie b/w metacarpals
  • 3 x palmar - unipennate - adduction (pAd)
  • 4 x dorsal - bipennate - abduction (dAb)
  • from metacarpals (similar to lumbricals)
35
Q

nerve supply of intrinsic hand muscles

A
  • median nerve: most of forearm
    • thenar compartment - recurrent branch of median n.
      • AbdPB, FPB, OP
    • lateral branch of median n.: 1st and 2nd lumbrical
  • ulnar nerve:
    • ​hypothenar compartment: AbdDM, FDM, ODM, AddP
    • 3rd and 4th lumbrical
    • interossei muscles

ANAT30007 (17 decks)

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