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Bloc H - Movement > May25 M3-Forearm and wrist > Flashcards

May25 M3-Forearm and wrist Flashcards

1
Q

movements the wrist can do

A
  • flexion
  • extension
  • ABDuction (radial deviation)
  • ADDuction (ulnar deviation)
  • supinates and pronates (when forearm (ulna and radius) do) bc articulated
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2
Q

why can’t rotate the wrist (relatively to the forearm)

A

bc articulated with the ulna and radius

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3
Q

how to really test for pronation-supination function and why

A

ask patient to flex elbow before the mvmt

-otherwise can be caused by rotation of the humerus and not real pronation, supination

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4
Q

2 different causes for a medial or lateral rotation of the hand and when do epicondyles of the humerus rotate

A
  • medial and lateral rot of humerus at shoulder joint (medial and lat epicondyles of humerus rotate)
  • pronation and supination of forearm at radio-ulnar joint (epicondyles of humerus don’t rotate)
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5
Q

function of the anterior compt of the forearm

A

-flexion of wrist
-flexion of fingers
-pronation-supination
(all the group surrounded with fascia)

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6
Q

innervation to the anterior compt of the forearm (general)

A
  • median n (mostly)

- ulnar n (just a bit)

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7
Q

2 muscles of pronation in the ant compt of the forearm

A

-pronator teres
-pronator quadratus
(allow flipping radius over the ulna)

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8
Q

pronator teres origin and insertion + specific about its location

A

medial epicondyle of the humerus to radius

*found in cubital fossa

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9
Q

pronator quadratus origin and insertion

A

ulna to radius (near the hand)

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10
Q

finger flexors in the ant compt of the forearm

A
  • flexor digitorum superficialis and profundus (fingers)

- flexor pollicis longus (thumb)

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11
Q

FDS muscle origin and insertion

A
  • O: medial epicondyle of the humerus+bit of ulna and radius
  • I: middle phalanges of the 4 fingers
  • 4 tendons*
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12
Q

FDP muscle origin and insertion

A
  • O: ulna
  • I: distal phalanges of the 4 fingers
  • 4 tendons* (so FDS + FDP total 8 tendons)
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13
Q

flexor pollicis longus origin and insertion

A
  • O: radius

- I: distal phalanx of the thumb

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14
Q

muscles of wrist flexion in the ant compt of the forearm

A

lateral to medial starting on pronator teres most laterally:

  • flexor carpi radialis
  • palmaris longus
  • flexor carpi ulnaris
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15
Q

flexor carpi radialis origin and insertion

A

medial epicondyle of humerus to wrist (runs on radius)

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16
Q

palmaris longus origin and insertion

A

medial epicondyle of humerus to wrist, forming palmar aponeurosis

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17
Q

flexor carpi ulnaris origin and insertion

A

medial epicondyle of humerus to wrist (runs on ulna)

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18
Q

what’s the palmar aponeurosis of the palmaris longus

A

its tendon spreads into a triangular aponeurosis on the wrist

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19
Q

Dupuytren’s contracture is what

A
  • fibrosis of the palmar aponeurosis (becomes more rigid)

- patients have incomplete flexion of their fingers bc of that

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20
Q

golfer elbow is what + cause of that

A

medial epicondylitis

-inflammation there bc is common attachment for the 3 wrist flexors + pronator teres)

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21
Q

function of the post compt of the forearm

A
  • extension of the fingers
  • extension of the wrist
  • supination of the forearm
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22
Q

innervation to the post compt of the forearm

A

all radial n.

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23
Q

supination muscles in the post compt of the forearm

A

supinator m.

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24
Q

supinator m. O and I

A
  • O: lateral epicondyle of the humerus

- I: radius (bc wants to pull it back on side of ulna)

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25
Q

muscles for extension of the thumb and extension of the index finger

A
  • extensor pollicis longus
  • extensor pollicis brevis
  • extensor indicis
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26
Q

diff between extensor pollicis longus vs brevis

A
  • longus is more medial so has to travel further to reach the thumb laterally
  • longus has to cross a bony process on extensor surface of the radius called Lister’s tubercle
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27
Q

extensor pollicis brevis O and I

A
  • O: radius

- I: thumb (to proximal phalanx bc brevis)

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28
Q

extensor pollicis longus O and I

A
  • O: ulna (makes sense bc starts more medially)

- I: thumb (to distal phalanx bc longus)

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29
Q

extensor indicis O and I

A
  • O: ulna (makes sense bc is medial to extensor pollicis longus)
  • I: index finger
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30
Q

muscles for extension of wrist and fingers (3,4,5) in post compt of forearm

A

most superficial on extensor surface, lateral to medial:

  • extensor digitorum
  • extensor digiti minimi
  • extensor carpi ulnaris
31
Q

extensor digitorum O, I, shape and fct

A

-O: lateral epicondyle of the humerus
-I: fingers 2,3,4,5
sends 4 tendons, one to each finger

32
Q

extensor digiti minimi O and I

A
  • O: lat epicondyle of the humerus

- I: pinky finger

33
Q

extensor carpi ulnaris m. O and I

A
  • O: lat epicondyle of humerus, ulna

- I: wrist

34
Q

only 2 fingers with 2 extensor tendons on their dorsal (extensor) surface

A
  • index finger (extensor indicis and extensor digitorum tendons)
  • little finger (extensor digitorum and extensor digiti minimi tendons)
35
Q

what surrounds tendons that forearm muscles send (extensor digitorum, indicis, digiti minimi, pollicis longus and brevis. flexor pollicis longus, flexor digitorum S and P)

A

synovial sheaths enclose the tendons. (bag with fluid in it that covers the tendon)

36
Q

clinical relevance of synovial sheaths on tendon

A

can get a synovial cyst (bump on skin will appear) due to synovial sheath swelling

37
Q

wrist extensors on the lateral side

A

extensor carpi radialis longus (more lateral, more on radius side) and extensor carpi radialis brevis (more medial)

38
Q

extensor carpi radialis longus O and I

A
  • O: humerus

- I: wrist

39
Q

extensor carpi radialis brevis O and I

A

-O: lat epicondyle of the humerus to wrist

40
Q

what’s tennis elbow and how do you get it

A

lateral epicondylitis

  • inflammation there bc is common attachment of the wrist extensors
  • origin of extensor carpi ulnaris and extensor carpi radialis longus and brevis
41
Q

ant compt of forearm how many muscles and diff layers

A

total: 8
- 5 superficial: lat to med = 1. pronator teres, 2. flexor carpi radialis, 3. palmaris longus, 4. flexor carpi ulnaris. + 5. FDS big on top
- 2 intermediate: lat to med: 1. flexor pollicis longus, 2. FDP below FDS
- 1 deep: 1. pronator quadratus

42
Q

post compt of forearm how many muscles and the diff layers

A

total: 11
- 6 superficial: med to lat: 1. extensor carpi ulnaris 2. extensor digiti minimi 3. extensor digitorum 4. extensor carpi radialis brevis and 5. longus 6. brachioradialis
- 5 deep: med to lat: 1. extensor indicis 2. extensor pollicis longus 3. extensor pollicis brevis 4. ABDuctor pollicis longus (next lec) 5. supinato m.

43
Q

median n (C5 to T1) location in the forearm

A

ant compt: pierces pronator teres and runs between FDP and FDS. + sends a branch

44
Q

branch that the median n sends in the ant forearm

A

anterior intereosseus nerve (motor branch of the median n.)

45
Q

what the anterior interosseus nerve (AIN) innervates

A

FDP, flexor pollicis longus, pronator quadratus

46
Q

how AIN injury appears clinically

A
  • can’t do the OK sign with index and thumb

- weakness of the grip

47
Q

what happens if you have a lesion of the median nerve at the level of the elbow

A 
can't do:
-pronation
-flexion of the fingers
-flexion of the wrist
(the functions of the ant compt of the forearm)
48
Q

muscles that the ulnar n. (C8-T1) innervates and that are NOT inn. by the median n.

A

flexor carpi ulnaris

+ half of FDP that runs on the medial side of the ulna

49
Q

where ulnar n. travels in the ant compt of the forearm

A

crosses elbow at the cubital tunnel posterior to the medial epicondyle. in elbow, travels on side of ulna

50
Q

cubital tunnel syndrome is what

A

compression of the ulnar n. in the cubital tunnel behind medial epicondyle of the elbow. get specific symptoms

51
Q

how do you test radial n. (C5 to T1) function clinically

A

ask patient to extend their wrist or fingers or thumb

52
Q

what’s Wartenberg’s syndrome

A
  • radial n. injury or compression in the forearm

- forearm extensors are paralyzed

53
Q

signs of Wartenberg’s syndrome clinically

A
  • wrist drop (can’t extend it)

- can’t supinate

54
Q

signs of Wartenber’s syndrome clinically if the radial n. injury is more proximal, in the arm

A

also see incapability of extending the forearm (bc triceps m. does that and inn. by radial n.)

55
Q

cutaneous inn. that the radial n. provides

A

posterior arm and a band in the middle of the posterior forearm

56
Q

what nerve innervates the lateral forearm skin

A

musculocutaneous n. (C5,C6,C7)

57
Q

mnemonic for the bones of the wrist

A

so long the pinky (4 first proximal going towards pinky) here comes the thumb

58
Q

8 bones of the wrist

A
  • scaphoid lunate triquetrum pisiform

- hamate, capitate, trapezoid, trapezium

59
Q

bone of the wrist most vulnerable to fracture and why

A

scaphoid bone bc is aligned with the radius (2nd step of shock transmission in the forearm, if you fall for example)

60
Q

problem with scaphoid fracture

A

supplied by an artery, which, during a fracture, can split the bone in 2 regions: one supplied by blood and one not.
not artery that splits. just that region that didn’t receive blood directly before is now separate

61
Q

what is the artery feeding the scaphoid bone

A

radial artery and its branches

62
Q

consequence of one scaphoid region not having blood supply after a fracture

A

avascular necrosis (in 10-15% of scaphoid bone fractures) in proximal part of the scaphoid

63
Q

brachius = arm. what’s the name for the wrist in anatomy

A

carpus

64
Q

shape of the carpus on a palmar view

A

has an inwards curvature, a groove is formed by the carpal bones

65
Q

what structure encloses the carpal tunnel superiorly (on palmar border) and what is it

A

flexor retinaculum

  • ligament
  • 4 corners attached to carpal bones (is rectangle shaped)
66
Q

name of the hole formed by the flexor retinaculum

A

carpal tunnel/groove of the carpal tunnel

67
Q

4 bones that have protrusions serving as attachments for the flexor retinaculum

A

lateral proximal: scaphoid
lateral distal: trapezium
medial proximal: pisiform
medial distal: hamate

68
Q

structures passing in the carpal tunnel

A
  • 9 tendons (4 of FDS, 4 of FDP + tendon of flexor pollicis longus)
  • median nerve
69
Q

what structures are NOT passing in the carpal tunnel

A
  • ulnar a.
  • ulnar n.
  • flexor carpi radialis m.
70
Q

where the ulnar n. passes at the level of the wrist if it’s not in the carpal tunnel

A

in Guyon’s canal

71
Q

Guyon’s canal syndrome is what

A

pathology of the ulnar nerve because of Guyon’s canal problem. caused by hammering or pressing against a bike handlebar

72
Q

carpal tunnel syndrome is what

A
  • inflammation of flexor retinaculum (will have fluid accum. there, swelling)
  • compression of median n. (and all the structures in the carpal tunnel)
  • weakness of thumb and loss of sensation around the thumb
73
Q

clinical case: a nerve is compressed and leads to a person incapable of untightening a screw counterclockwise using the right hand. the pt says they have finger weakness when doing that: ulnar, radial, median or musculocutaneous n.

A

median n. (pronator teres. + also goes to finger flexors)

Bloc H - Movement (48 decks)

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