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Year 2 Term 1 Movement > Lecture 4: Hand > Flashcards

Lecture 4: Hand Flashcards

1
Q

What 3 parts can the hand be subdivided into?

A

1) Wrist (8 carpal bones)
2) Metacarpals (5)
3) Phalanges/digits

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2
Q

Which is digit 1, which is digit 5?

A

Digit 1 = thumb

Digit 5 = little finger

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3
Q

How many carpal bones do we have?

A

8

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4
Q

How many phalanges are in each digit, what are they called?

A

Digit 1 = 2 phalanges, proximal and distal

Digits 2-5 = 3 phalanges, proximal, middle and distal

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5
Q

At what joint do the metacarpals articulate with the proximal phalanges?

A

Metacarpophalangeal joint

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6
Q

At what joint do the proximal phalanges articulate with the middle phalanges?

A

Proximal interphalangeal joint

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7
Q

At what joint do the middle phalanges articulate with the distal phalanges?

A

Distal interphalangeal joint

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8
Q

Where are the radial and ulnar styloid process seen?

A

Laterally (radial) and medially (ulnar) on the dorsal surface of the hand

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9
Q

What are the names of the 8 carpal bones (proximal row followed by distal row, lateral to medial)?

A 
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
Some Lover Try Positions That They Cant Handle
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10
Q

What is the anatomical name for the wrist joint, which bones articulate here?

A

Radiocarpal joint

Between the radius and scaphoid and lunate carpal bones - no participation by the ulnar

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11
Q

What kind of joint is the radiocarpal joint?

A

Synovial ellipsoid joint

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12
Q

What strengthens the radiocarpal joint capsule anteriorly and posteriorly?

A

Radiocarpal ligaments

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13
Q

What separates the ulnar from the radiocarpal joint?

A

A wedge of cartilage known as the articular disc

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14
Q

Other than the radiocarpal joint what other joint is found in the distal forearm, what does this do?

A

Distal radio-ulnar joint

Assists the proximal radio-ulnar joint in pronation and supination of the hand

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15
Q

What are the movements of the wrist joint?

A 
Abduction
Adduction
Extension
Flexion
Circumduction
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16
Q

Which kind of muscles are arranged in the anterior compartment of the forearm?

A

Flexors

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17
Q

Which type of muscles are arranged in the posterior compartment of the forearm?

A

Extensors

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18
Q

What is meant by extrinsic muscles of the hands?

A

Have origins outside of the hand but insert on the hand and their actions move the hand

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19
Q

Name the 6 extrinsic anterior flexor muscles of the hand?

A

1) Flexor carpi radialis
2) Palmaris longus
3) Flexor carpi ulnaris
Above all come from common tendon
4) Flexor digitorum superficialis
Above has a radial and humero-ulnar head
5) Flexor pollicis longus
6) Flexor digitorum profundus

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20
Q

What is meant by pollicis?

A

Thumb

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21
Q

Which nerves supply the extrinsic anterior flexor muscles of the hand?

A

median and ulnar nerves

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22
Q

What is important about the tendons of the extrinsic muscles of the hand?

A

They all pass over the wrist joint and act on the wrist joint

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23
Q

What are the extrinsic posterior extensor muscles of the hand? 8

A

1) Extensor carpi radialis longus
2) Extensor carpi radialis brevis
3) Extensor digitorum
4) Extensor carpi ulnaris
5) Extensor digiti minimi
6) Abductor pollicis longus
7) Extensor pollicis brevis
8) Extensor pollicis longus

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24
Q

Which nerve supplies the extrinsic posterior extensor muscles of the hand?

A

Radial nerve

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25
Q

What is the carpal tunnel made up of?

A

Posteriorly and on both sides the carpal bones

Anteriorly a sheet of cartilage known as the flexor retinaculum

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26
Q

What 4 things pass through the carpal tunnel?

A

1) Flexor digitorum superficialis tendons
2) Flexor digitorum profundus tendons
3) Flexor pollicis longus tendon
4) Median nerve

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27
Q

Name the intrinsic muscles of the hand? 4

A

1) Thenar muscles
2) Hypothenar muscles
3) Lumbricals
4) Adductor pollicis

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28
Q

What are the names of the 3 thenar muscles?

A

1) Flexor pollicis brevis
2) Opponens pollicis
3) Abductor pollicis

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29
Q

What are the names of the 3 hypothenar muscles?

A

1) Opponens digiti minimi
2) Flexor digiti minimi
3) Abductor digiti minimi

30
Q

What nerves supply the intrinsic muscles of the hand?

A

All supplied by the ulnar nerve except the thenar muscles and 1st and 2nd lumbricals which are supplied by the median nerve

31
Q

What is the thenar remnance?

A

Muscley area below thumb

32
Q

Why is the opponens pollicis important in evolution?

A

Allows thumb to rotate to face fingers and form a grip - opposable thumsbs

33
Q

What is unusual about the attachments of the 4 lumbricals and what implications does this have for their function?

A

Attached to the long tendons of the flexors on the anterior surface and pass lateral to the digits to attach to the extensor tendons on the dorsal surface giving them a dual function
Flexion of the metacarpopharyngeal joint and extension of the proximal interphalangeal joint

34
Q

In movements of the hand, what is considered the midline? What implications does this have for the movements of the thumb?

A

In movements of the hand the midline is shifted to the middle finger
All movements relate to the middle finger rather than the body
Thumb is rotated 90 degrees to the fingers - all movements are at 90 degrees to those of the finger

35
Q

What is flexion and abduction of the thumb?

A

Flexion is putting thumb towards palm

Abduction is moving the thumb towards the wrist

36
Q

What are the 3 main branches of the median nerve, which of these are given off after the nerve has passed through the carpal tunnel?

A

1) Palmar cutaneous branch - given off first
2) Recurrent branch
3) Digital branch - given off most distally after passing through carpal tunnel

37
Q

What does the palmar cutaneous branch of the median nerve innervate?

A

Sensory supply to lateral side of palm

38
Q

What does the recurrent branch of the median nerve innervate?

A

Motor to the thenar muscles

39
Q

What does the digital branch innervate?

A

1st and 2nd lumbricals - motor
Palmer - sensory to lateral 3 and 1/2 digits
Dorsal - sensory to distal half of 3 and 1/2 digits

40
Q

What does carpal tunnel commonly result from?

A

Repetitive wrist motion

41
Q

What is the flexor retinaculum also known as?

A

Transverse carpal ligament

42
Q

What are the medial and lateral attachments of the flexor retinaculum?

A

Medial - Pisiform and hook of hamate

Lateral - Scaphoid tuberosity and trapezium

43
Q

The carpal tunnel is a fibro-oseous tunnel, what is meant by this?

A

Has a bony bottom and fibrous roof

44
Q

What are the symptoms of carpal tunnel caused by?

A

Build up of fluid or inflammation in the carpal tunnel leading to compression of the median nerve

45
Q

What are the 3 symptoms of carpal tunnel syndrome?

A

1) Pins and needles in the cutaneous distribution of digital branches of median nerve
2) Weakness of thumb and muscle atrophy in thenar region
3) Inability to oppose thumb

46
Q

How is carpal tunnel cured?

A

By carpal tunnel release surgery - cut the flexor retinaculum to release the pressure

47
Q

Other than carpal tunnel syndrome how else may the median nerve be damaged?

A

By lunate dislocation - this most commonly occurs as result of a fall on an outstretched hand (FOOSH) extended at the wrist

48
Q

What is the most commonly dislocated carpal bone?

A

The lunate bone

49
Q

In which direction does the lunate bone dislocate?

A

Anteriorly

50
Q

What are the 4 main branches of the ulnar nerve?

A

1) Palmar branch
2) Dorsal branch
3) Superficial branch
4) Deep branch

51
Q

Where does the ulnar nerve pass in relation to the flexor retinaculum?

A

Passes superficial to the flexor retinaculum

52
Q

Is the ulnar nerve lateral or medial to the median nerve?

A

Medial

53
Q

What does the palmar branch of the ulnar nerve innervate?

A

Sensory to the medial side of palm

54
Q

What does the dorsal branch of the ulnar nerve innervate?

A

Sensory to the lateral side of the dorsum of the hand and the lateral 1 and 1/2 digits

55
Q

What does the superficial branch of the ulnar nerve innervate?

A

Sensory to palmer surface of lateral 1 and 1/2 digits

Motor to palmaris brevis

56
Q

What does the deep branch of the ulnar nerve innervate?

A

Hypothenar muscles, adductor pollicis, interossei and 4th and 5th lumbricals

57
Q

What is Guyon’s canal and where does it lie in relation to the flexor retinaculum?

A

Tunnel that the ulnar nerve and artery pass through

Lies superficial to the flexor retinaculum on the medial side

58
Q

What is ‘handlebar neuropathy’ caused by?

A

Compression of the ulnar nerve at the wrist

59
Q

What are the 3 clinical features of handlebar neuropathy?

A

1) sensory loss to the palmer surface of the lateral 1 and a 1/2 digits
2) Motor weakness in the intrinsic muscles of the hand (except thenar eminence and lateral 2 lumbricals)
3) Hyperextension of metacarpophalangeal joints of digits 4 and 5

60
Q

Why does hyperextension of the metacarpophalangeal joints of digits 4 and 5 occur in handlebar neuropathy?

A

The action of the powerful extrinsic extensor muscles of than in the forearm are unopposed due to paralysis of lumbrical muscles

61
Q

What tendons mark the lateral and medial borders of the anatomical snuff box?

A

Lateral border - Extensor pollicis brevis tendon

Medial border - Extensor pollicis longus tendon

62
Q

What can be palpated in the anatomical snuff box?

A

The radial pulse

63
Q

A scaphoid fracture is typical in who and typically presents with what?

A

Common injury in young adults

Presents with tenderness in the anatomical snuff box

64
Q

What does a scaphoid fracture normally result from and where does it normally break?

A

Results from a fall on an outstretched hand when the hand is abducted
Scaphoid bone has a narrow waist which is normally fractured

65
Q

What is unusual about the blood supply to the scaphoid bone and what complications can these lead to in a fractured scaphoid?

A

Blood enters the scaphoid distally and then travels through the bone to the proximal part, therefore, in the event of a fracture, blood supply to the proximal part may be disrupted
This could lead to avascular necrosis

66
Q

What is the blood supply to the scaphoid bone?

A

The palmar carpal branch of the radial artery

67
Q

What is a colles fracture, what is it associated with?

A

Fracture of the distal end of the radius - this gets displaced posteriorly
Most common in older people, particularly women due to osteoporosis
Usually the result of falling on a outstretched upper limb
Often the ulnar styloid process is avulsed (pulled away from ulnar)

68
Q

Why does a Colles fracture normally heal well?

A

There is a rich blood supply to the distal radius

69
Q

What are epiphyses?

A

Growth plates found in bone

70
Q

What are the complications of a fracture/separation of the distal radial epiphysis, who is it common in?

A

Common in children
Good prognosis with reduction of the epiphysis back to normal position
rarely, damage leads to premature fusion

Year 2 Term 1 Movement (8 decks)

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