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Bloc H - Movement > May28 M2-Hand > Flashcards

May28 M2-Hand Flashcards

1
Q

bones of the hand

A
  • carpal bones
  • metacarpal bones (phalanx like)
  • phalanges (3 for fingers proximal, middle and distal. 2 for thumb proximal and distal)
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2
Q

joints in the hand + one that doesn’t move

A
  • carpometacarpal joints (doesn’t move)
  • metacarpophalyngeal joints (MCPs)
  • proximal interphalangeal joints (PIP)
  • distal interphalangeal joint (DIP)
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3
Q

OA vs RA in terms of what joints of the hand they affect

A
  • OA = DIP

- RA = PIP and MCP

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4
Q

movements that the fingers can do

A
  • ABDuction and ADDuction

- flexion and extension at the MCP, PIP and DIP

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5
Q

movements that the thumb can do

A
  • ADDuction and ABDuction
  • flexion and extension
  • opposition (stick to pinky) and reposition (requires rotation of the thumb metatarsal bone not just ABDuction of thumb)
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6
Q

muscles for ABDuction of the fingers + O and I

A

dorsal interossei muscles (between all metacarpals)

  • O: ALL metacarpal bones (1,2,3,4,5)
  • I: phalanges of fingers 2,3,4 only
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7
Q

muscles for ADDuction of the fingers + O and I

A

palmar interossei (between metacarpals but attached to their finger, to the side closer to axis of ADDuction)

  • O: metacarpal bones of fingers 2,4,5
  • I: first phalanx of same finger (2,4,5)
  • lie on side of metacarpal closest to ADDuction axis*
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8
Q

muscles for MCP flexion and PIP + DIP extenstion + O and I

A

lumbricals (are in the metacarpal region but not related to metacarpals)

  • O: tendons of FDP (on palmar side) (4 tendons)
  • I: tendon of extensor digitorum m. (on dorsal side)
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9
Q

why lumbricals can flex MCP and extend PIP and DIP

A

cross the MCP joint on palmar side and then reach the dorsal side at the first phalanx. then cross PIP and DIP on dorsal side.

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10
Q

what’s claw hand

A

a weakness of all intrinsic muscles of the hand due to a lower brachial plexus injury to ulnar nerve (C8, T1)
-lumbricals are damaged or paralyzed = MCP extended all the time + PIP and DIP flexed all the time

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11
Q

thenar eminence def + its muscles + O and I of all

A

muscle bulk of thumb (4 muscles)

  • med: adductor pollicis
  • middle: flexor pollicis brevis (longus in intermediate layer ant forearm, laterally)
  • lat: abductor pollicis brevis (longus in deep posterior forearm. 2nd muscle lat)
  • deep: opponens pollicis
  • all O: wrist and I: thumb*
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12
Q

hypothenar eminence def + its muscles + O and I of the muscles

A

muscle bulk of the little finger (3 muscles)

  • med: abductor digiti minimi
  • lat: flexor digiti minimi
  • deep: opponens digit minimi
  • all O: wrist and I: 5th finger*
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13
Q

muscles for flexion, extension, ABDuction and ADDuction of the pinky

A
  • flexion: FDS and FDP + flexor digiti minimi + lumbricals (MCP)
  • extension: extensor digiti minimi + extensor digitorum + lumbricals (PIP DIP)
  • ABDuction: ABDuctor digiti minimi
  • ADDuction: palmar interossei
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14
Q

muscles for flexion, extension ABDuction and ADDuction of the thumb

A
  • flexion: flexor pollicis brevis and longus
  • extension: extensor pollicis brevis and longus
  • ABDuction: ABDuctor pollicis brevis and ABDuctor pollicis longus
  • ADDuction: adductor pollicis
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15
Q

muscles for flexion, extension, ABDuction, ADDuction of the 4th finger

A
  • flexion: FDS and FDP + lumbricals (MCP)
  • extension: extensor digitorum + lumbricals (PIP DIP)
  • ABDuction: dorsal interossei
  • ADDuction: palmar interossei
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16
Q

muscles for flexion, extension, ABDuction, ADDuction of the 3rd finger

A
  • flexion: FDS and FDP + lumbricals (MCP)
  • extension: extensor digitorum + lumbricals (PIP DIP)
  • ABDuction: dorsal interossei
  • ADDuction: none
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17
Q

muscles for flexion, extension, ABDuction, ADDuction of the index finger (2nd finger)

A
  • flexion: FDS and FDP + lumbricals (MCP)
  • extension: extensor indicis, extensor digitorum + lumbricals (PIP and DIP)
  • ABDuction: dorsal interossei
  • ADDuction: palmar interossei
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18
Q

blood supply to the hand

A
  • superficial (and also a deep less visible) palmar arch (an artery that is an anastomose between ulnar and radial a.)
  • send digital arteries to fingers 2,3,4,5
  • send princeps pollicis a. to the thumb
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19
Q

where take ulnar and radial pulses

A 
ulnar = on medial wrist
radial = on lateral wrist near thumb
20
Q

which of ulnar vs radial a normally has the most importance in blood supply

A

either can be more important (and sometimes they are of equal importance)

21
Q

Allen test is what

A
  1. lift upper extremity
  2. block both ulnar and radial artery
  3. check if freeing the radial artery makes hand red as fast as freeing the ulnar artery. or check which one made hand red faster (would be the most important, dominant for palmar surface of the hand)
22
Q

two tendons defining the anatomical snuff box

A

extensor pollicis brevis and longus (abductor pollicis longus is more lat to extensor pollicis longus and is not in the snuff box)

23
Q

structures in the anatomical snuff box

A
  • deep part of the radial artery (to deep hand)

- (radial nerve passing superficially to the snuff box)

24
Q

what’s De Quervain tenosynovitis (or gamer thumb or mommy thumb)

A

inflammation of the tendons of the snuff box (extensor pollicis longus and brevis)

25
Q

what’s the intersection syndrome

A

a pain in the posterior forearm located lateral to the snuff box. caused by repetitive extension of the wrist as in shoveling for example

26
Q

what happens in intersection syndrome (what’s the cause)

A

extensor carpi radialis brevis and longus muscles (superficial lat post forearm) are sliding on ABDuctor pollicis longus (deep lat post forearm) which is lat to the snuffbox

27
Q

3 nerves supplying the hand

A

median (C5 to T1), ulnar (C8-T1) and radial (C5 to T1)

28
Q

what movement separates us from great apes

A

opposition of the thumb

29
Q

pathway the median nerve uses to reach the hand

A

passes through the carpal tunnel (was running between FDS and FDP after pierced pronator teres)

30
Q

most important branch of the median nerve in the hand and what it does

A

recurrent branch of the median nerve. supplies the thenar eminence:

  • abductor pollicis brevis
  • flexor pollicis brevis
  • adductor pollicis
  • opponens pollicis
31
Q

what other branches of the median n. in the hand than recurrent do

A

innervate first two lumbrical muscles (to index and middle finger)

32
Q

motor dysfunction resulting from a median n. injury in the hand (at the wrist for example)

A

ape hand

  • atrophy of thenar eminence (can’t do opposition especially*)
  • reduced ability to flex index and middle fingers (MCP)
33
Q

extra branches of median n to finger tips do what

A

cutaneous branches (cutaneous inn.)

  • palmar surface = palmar skin + finger skin related to 3.5 most lat fingers (so thumb + index + middle + lat half of 4th)
  • dorsal surface = skin related to medial distal half of the thumb + 1.5 distal phalanges of fingers 2, 3 and lat 1.5 distal phalanges of 4.
34
Q

how ulnar nerve gets to the hand

A

gets through the Guyon canal

35
Q

muscles of the hand inn. by the ulnar n.

A
  • hypothenar eminence muscles
  • lumbricals
  • interossei muscles
36
Q

consequence of an ulnar nerve injury where it can’t inn. hand muscles (as in Guyon’s canal syndrome = injured or compressed ulnar n. at the wrist)

A

claw hand

  • MCP extended and PIP and DIP flexed
  • no ABDuction and ADDuction of fingers possible (but thumb is fine bc median n.)
  • no opposition of the pinky
  • less flexion of pinky is not just bc of lumbricals but also bc flexor digiti minimi working less
37
Q

cutaneous inn. of the ulnar n. on the hand

A
  • palmar surface = palmar skin and finger skin related to most medial 1.5 fingers
  • dorsal surface = dorsum skin and finger skin related to most medial 1.5 fingers
38
Q

feeling when you hit the funny bone and why

A
  • ulnar nerve was hit in the cubital tunnel posterior to medial epicondyle of humerus
  • will feel tingling down forearm and hand+fingers only on pinky + medial half of 4th finger (bc is region of cutaneous inn. of ulnar n.)
39
Q

radial n.: muscles it innervates in the hand

A

none

40
Q

radial n. cutaneous inn. to the hand

A

dorsal surface only: dorsum skin and finger skin related to proximal 1.5 phalanges of the 3 most lat fingers (thumb, index, middle)
think dorsum skin that the median n. didn’t cover

41
Q

muscle of the hand that is innervated by two nerves

A

lumbricals

  • median n. for first two (index and middle finger)
  • ulnar n. all lumbricals
42
Q

nerve and level for skin inn. over the deltoid m.

A

C5. axillary n.

43
Q

nerve and level for skin inn. over the central posterior surface of the arm and forearm

A

radial n. (C5 to T1)

44
Q

nerve and level for skin inn. over lateral half of the forearm anteriorly and extending to the back

A

C6. musculocutaneous n.

45
Q

level for skin inn. over the medial half of the forearm anteriorly and extending to the back

A

T1

46
Q

consequence of the carpal tunnel syndrome that’s most important

A

compression of the median nerve

47
Q

in carpal tunnel syndrome, where would you feel the tingling and the pain: palmar surface of index finger? palmar surface of little finger? dorsal surface of hand? dorsal surface of wrist?

A

palmar surface of the index finger
median n. on dorsum = 1.5 distal phalanges of thumb, index, middle and half of 4th finger + on palmar surface = palm + fingers surface of thumb, index, middle and half of 4th finger

Bloc H - Movement (48 decks)

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