Lecture 13: Hand Flashcards
Palmar cutaneous branch of median supplies, arises, passes
Supplies central palm
Arises proximal to the flexor retinaculum
Passes superficial to flexor retinaculum
Palmar cutaneous branch of ulnar nerve supplies, arises, passes
Supplies medial side of palm
Arises proximal to wrist
Passes superficial to flexor retinaculum and palmar aponeurosis
Venous drainage of dorsum of hand
Dorsal venous arch medially drains into basilic, laterally drains into cephalic
Extensor indicis blood supply/innervation
BS- Posterior interosseous and perforating branch of anterior interosseous
I-Posterior interosseous
Superficial branch of ulnar nerve branches to
Muscular branch to palmaris brevis
Cutaneous branch to palmar aspect of ulnar side of little finger and adjacent sides of little and ring fingers, including tips and dorsum
Flexor pollicis brevis attachments
P- Flexor retinaculum and tubercles of scaphoid and trapezium
D- Lateral side of base of proximal phalanx of thumb
Medial branch of median nerve
To second lumbrical
cutaneous to adjacent sides of digits 2-4, including nailbed and fingertips
Opponens digiti blood supply/innervation
BS- Ulnar artery
I- Deep branch of ulnar nerve
Metacarpophalangeal joints vascularization
Deep digital arteries from superficial palmar arches
Abductor pollicis brevis attachments
P- Flexor retinaculum and tubercles of scaphoid and trapezium
D- Lateral side of base of proximal phalanx of thumb
Contents of carpal tunnel
Long flexor tendons of-
Flexor digitorum superficialis and profundus
Flexor pollicis longus
Median nerve
Lumbricals Distal attachments and function
They insert on lateral sides of the extensor expansions of digits 2-5
They flex the metacarpophalangeal joints and extend interphalangeal joints of digits 2-5
Palmar aponeurosis
Triangular layer of deep fascia between two eminences
Anchored to skin and flexor retinaculum
Ulnar nerve enters hand
Superficial to the flexor retinaculum
PAD (Palmar interossei) description
Four (three) unipennate muscles
-First is sometimes considered to be part of flexor pollicis brevis
Supply each digit except third- reference is middle finger
Extensor expansion function
Flexion at MCP joint
Extension at PIP, DIP joints
DAB (Dorsal interossei) description, attachments, action, innervation
Four bipennate muscles
Arise via two heads from adjacent sides of two metacarpals
Insert onto extensor expansions and radial sides of proximal phalanges 2/3, ulnar sides of proximal phalanges 3/4
Digit 3 has 2 dorsal interossei
Abduct MP joints of digits 2-4, reference line is middle finger
Ulnar nerve
Carpometacarpal joint vascularization
Dorsal/palmar carpal arch anastomoses, deep palmar arch
Metacarpal arteries
Metacarpophalangeal joint innervation
Digital nerves from ulnar/median nerves
PAD insertion
Action
Innervation
Onto ulnar sides of proximal phalanges 1 and 2
Onto radial sides of proximal phalanges 4 and 5
Adduct MP joints of digits 1,2,4,5
Ulnar nerve
Palmaris brevis origin, insertion, action
Origin: flexor retinaculum and palmar aponeurosis
Insertion: skin on medial side of palm
Action: tenses skin on palm
Colles fracture
Fracture in distal end of radius
Flexor digiti minimi actions
Flexes proximal phalanx of 5th digit
Function notes extensor expansion
Extension at the PIP is always accompanied by simultaneous extension at the DIO
When the PIP is flexed, the DIP may be extended or flexed
Midpalmar space
Located between metacarpals 4&5 and the long flexor tendons to digits 4&5
Guyons canal formed by, what passes through
Formed by a groove between the pisiform and the hook of hamate
Ulnar nerve and artery pass through
Third and fourth lumbricals origin, innervation, blood supply
Attached to medial 3 tendons of FDP
Deep branch of ulnar nerve
Superficial palmar arch(ulnar a), dorsal carpal arch (ulnar and radial artery)
Innervation of thenar eminence muscles
Recurrent branch of median nerve
Dupuytrens contracture
Progressive fibrosis of palmar aponeurosis
Results in marked flexion of fingers at MP joints
Lumbricals innervation, action
Two on radial side- median nerve
Two on ulnar side- ulnar nerve
Flex MCP joints and extend IP joints
Adductor pollicis blood supply/innervation
BS- Radial artery
I- Deep branch of the ulnar nerve
Abductor pollicis brevis actions
Abducts thumb, aids in opposition
Abductor digiti minimi attachments
P- Pisiform
D-Medial side of base of proximal phalanx of 5th digit
Flexor digiti minimi brevis attachments
P- Hook of hamate and flexor retinaculum
D- Medial side of base of proximal phalanx of 5th digit
Adductor pollicis actions
Adducts thumb toward lateral border of palm
Carpometacarpal joints motion
Almost none 2-3
Limited for 4
More mobile for 5- flexion/extension, abd/add, circumduction, opposition
Flexor retinaculum
Laterally attaches to tubercles of scaphoid and trapezium
Medially attaches to hook of hamate and pisiform
Arterial supply to dorsum of hand
Via dorsal arterial arch from radial & ulnar arteries
Mallet finger
Avulsion by long extensor tendon, results in hyperflexion of DIP
Ulnar nerve injury
Paralysis and atrophy of interosseous muscles
Loss of thumb adduction
Clawhand
Lymphatic drainage of dorsum of hand
Medial via lymph vessel accompanying basilic vein to supratrochlear nodes to lateral axillary nodes
Lateral branch of median nerve
To thenar muscles and first lumbrical
Cutaneous to anterior surface of thumb and radial side of index finger
Opponens digiti minimi actions
Brings 5th metacarpal anterior and rotates it to bring it to opposition with the thumb
Carpometacarpal joint innervation
Anterior interosseous-median
Posterior interosseous-radial
Dorsal/deep branches ulnar nerve
Flexor digitorum superficialis action, tendons characteristics and insertion
Flexes PIP and MCP and wrist
Each tendon passes through fibrous flexor sheath
Each tendon bifurcates opposite proximal phalanx
Each tendon inserts on middle phalanx
Opponens digiti minimi attachments
P- Hook of hamate and flexor retinaculum
D- Medial border of 5th metacarpus
Opponens pollicis actions
Oppose thumb and medially rotate first metacarpal
Opponens pollicis proximal/distal attachments
P-Flexor retinaculum and tubercles of scaphoid and trapezius
D-Lateral side of 1st metacarpal
Abductor digiti minimi actions
Abducts 5th digit, aids in flexion of 5th proximal phalanx
Vinculae
Small vascular bundles connecting palmar surface of phalanges with long flexor tendons
Median nerve injury
Loss of thumb opposition
Atrophy of thenar muscles
Ape hand
Flexor pollicis brevis actions
Flexes thumb
Opponens pollicis blood supply/innervation
BS- Radial artery
I- Recurrent branch of median nerve
Clinical notes extensor expansion
If lateral bands detach lateral bands will flex the PIP and hyperextend the DIP
Look at this more
Flexor digiti minimi blood supply/innervation
BS- Ulnar artery
I- Deep branch of ulnar nerve
Median nerve enters hand
Deep to flexor retinaculum, divides into lateral and medial branches
Flexor digitorum profundus action, insertion
Flexes DIP and PIP and MCP
More active than superficialis
Each tendon inserts on distal phalanx
Route of radial artery
Passes proximally deep to brachioradialis
Distally lies against radius lateral to tendon of flexor carpi radialis
Passes across scaphoid in anatomical snuff box
Wraps around dorsum of metacarpus one-gives off arteries to thumb/index finger
Pierces first dorsal interosseous muscle and reappears in palm
Forms deep palmar arch
Extensor expansion lateral/central band attachment
Lateral- Bases of distal phalanges
Central- Base of middle phalanx
First and second lumbricals origin, innervation, blood supply
Attached to lateral 2 tendons of FDP Median nerve Radialis indicis (radial), superficial palmar arch (ulnar)
Extensor indicis proximal/distal attachment
P-Posterior surface of distal 1/3 of ulna and interosseous membrane
D- Extensor expansion of index finger
Abductor pollicis brevis blood supply/innervation
BS- Radial artery
I- Recurrent branch of median nerve
Deep branch of ulnar nerve
Supplies hypothenar muscles, all interossei, two ulnar side lumbricals and adductor pollicis
Lumbricals description, origin
Four small, narrow, elongated muscles
Each arises from the radial side of a flexor digitorum profundus tendon
Hypothenar eminence muscles and their innervation
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digit minimi
Ulnar nerve innervates
Abductor digiti minimi blood supply/innervation
BS- Ulnar artery
I-Deep branch of ulnar nerve
Muscles of thenar eminence
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis attachments
P- Bases of 2nd/3rd metacarpals, capitite, and adjacent carpals
D- Medial side of base of proximal phalanx of thumb
Thenar space
Located between palmar side of adductor pollicis and the long flexor tendons to the index finger and thumb
Extensor indicis actions
Independent extension of index finger, helps with extension of wrist
Flexor pollicis brevis blood supply/innervation
BS- Radial artery
I- Recurrent branch of median nerve, deep branch of ulnar nerve
