Movement of the hand Flashcards
1
Q
what is the joint called that articulates between the carpals and metacarpals
A
carpometacarpals
2
Q
what is the joint called when the metacarpals articulate to the carpals
A
metacarpophalangeal joints
3
Q
what are the movements of the metacarpophalangeal joints
A
flexion
extension
abduction and adduction
4
Q
what are the joints between the phalanges
A
- Proximal interphalangeal (PIP) and distal interphalangeal (DIP)
5
Q
what are the movements on the interphalangeal joints
A
flexion
extension
6
Q
what are the joints in the thumb
A
- Has 1 MCP and has 1 interphalangeal joint as it only has two phalanges
7
Q
what are the movements of the thumb
A
- Flexion – moves the thumb across the palm of the hand
- Extension – returns from flexion and continues
- Abduction – takes the thumb away from the palm at right angles
- Adduction – return from abduction
- Opposition – combination of flexion, medial rotation and abduction at CMC (carpometacarpal joint) and flexion at IP
8
Q
where do the muscles that move the fingers originate
A
- Partly in hand (intrinsic) and partially in forearm(extrinsic) with tendons going into hand
9
Q
why aren’t the muscles present in the hand
A
- Haven’t go enough space to but big powerful muscles in the hand therefore they are put in the forearm
10
Q
describe the muscles of the hand and how they lead into tendons
A
- Muscle is housed in the forearm but the tendons from the muscle pass over the wrist to the palm of the hand and to the fingers
- They have long tendons that go into the hand, these are both flexors and extensors that are in the posterior compartment of the forearm
- Muscle is weaker than the tendon, therefore the muscle tends to tear rather than the tendon
11
Q
what are the attachment point for muscles that go into the forearm
A
medial and lateral epicondyles
12
Q
where is the common origin of the flexors
A
medial epicondyle
13
Q
where is the common origin for the extensors
A
lateral epicondyle
14
Q
what are the superficial layers of flexors responsible for
A
responsible for flexing the wrists
15
Q
what makes up the superficial flexors
A
– Pronator teres,
– Flexor carpi radialis
– Palmaris longus
– Flexor carpi ulnaris
16
Q
where do the flexor carpi radials and flexor carpi ulnas go to
A
they go to the carpals
17
Q
where does the palmar is longus go to
A
– small muscle that tenses the palmer apenruosis
18
Q
what does the bronchioradialis do
A
- part of the superficial flexros
- technically it is a muscle in the posterior compartment - innervated by the radial nerve this proves that it is in the posterior compartment
19
Q
what are the muscles that are responsible for closing the hand
A
- flexor muscles
- flexor digitorum superficialis
- Flexor digitorum profundus
- Flexor pollicis longus
20
Q
where does the flexor digitorum superficialis originate from, and what does it split into
A
comes from the medial epicondyle
this divides into 4 tendosn, these go through the carpal tunnel and down to the digit
21
Q
where does the Flexor digitorum profundus originate from and what does it divide into
A
this start in the ulnar
this divides into the 4 tendons that go through the carpal tunnel an into the digits
22
Q
how many tendons does the flexor polices longus have
A
- it has 1 tendon
23
Q
why do tendons need to be protected
A
- Can become damaged if they rub on the bone therefore they need to be protected especially when they go through the carpal tunnel
24
Q
what is the tendon sheath full of
A
synovial fluid
25
what does the retinaculum do
– holds tendons in place as they go through the carpal tunnel
26
what goes through the carpal tunnel
- 9 tendons and this nerve that goes underneath with those tendons is the median nerve
27
what protects tendons int he digits
- In the fingers there are digisit tendon sheaths – bands of tissue that hold them in place and firmly attach them to the fingers
28
how are tendons protected in the hand
- Protect them by wrapping them in a tendon sheath which is full of synovial fluid, it enters the common flexure sheath, it wraps around them forms a cushion protecting them, the tendons then come out and as they go into the fingers they re-enter tendon sheaths as they run close to the phalanges of the bones and they could be damaged as they run through the fingers
29
describe how the tendons FDS and FDP are protected
- Tendons of FDS and FDP enter common flexor sheath deep to flexor retinaculum
- In central compartment they separate into respective digital synovial sheaths
- Synovial sheaths held in place by fibrous digital tendon sheath
30
what is synovial fluid made out of
- blood plasma and hyaluronic acid
31
what happens if the tendon sheaths tear
- If the tendon sheaths tear and become damaged then the synovial fluid can leak out, the blood plasma can be reabsorbed but the hyaluronic acid is not reabsorbed and this forms a lump where the tear is and no has a consistency of thick set honey which forms a cyst
- They have a stalk where the tendon sheath is stored
- Only surgically removed when they compress a nerve or blood vessel
32
what is the carpal tunnel
- this is a dense thick flexor retinaculum sheath
33
where do the ulnar artery and nerve travel in respect to the carpal tunnel
- they travel above the carpal tunnel
34
what goes through the carpal tunnel
- Median nerve goes underneath the retinaculum sheath with the tendon sheaths
35
what happens when the size of the carpal tunnel is reduced
- compresses the median nerve and leads to median nerve problems
36
what does the median nerve innervate
gives sensation to thumb half of ring finger and index finger, innervates the thenar muscle group at the base of the thumb
37
what does Flexor digitorum superficialis (FDS) do
- Flexes MCP and PIP
38
what does Flexor digitrum profundus (FDP) do
- Flexes MCP, PIP and DIP
39
describe how FDP and FDS interact
FDP has to go through the tendon of FDS, the tendon of FDS splits and FDP goes through it, so it can inset onto the distal phalange
40
what does Flexor pollicis longus do
flexes MCP and IP of the thumb
41
what do instruct muscles of the hand do
- Intrinsic muscles of the head help close the hand, act on the thumb (thenar muscles) and little finger (hypothenar muscles)
- Instrinsic muscles are between the metacarpals, they help with the movement of the fingers
42
what are the muscles of the thumb
thenar muscles
43
what are the muscles of the little finger
hypothenar muscles
44
what is the cause of trigger finger
- If tendons of FDS and FDP enlarge proximal to tendon sheath person is unable to extend the finger
- If extended passively a snap is audible as tendon moves into sheath
- Normally is resolved by a few months
45
what are the muscles responsible for opening the hand
```
Extensor digitorum communis,
- 4 tendons
Extensor indicis
- index finger
Extensor digiti minimi
- little finger
```
46
where are the muscles responsible for opening the hand based and what innervates them
Posterior side of the forearm
| - all innervated by the radial nerve
47
what forms the anatomical snuff bock
- extensor pollocis longus, extensor pollicis brevis, abdouctor pollics longus
48
how are the tendons in the anatomical snuff box protected
- there is no common sheath, but there is an extensor retinaculum, they are protected especially over the wrist and as they go over the carpals by tendon sheaths, they are held against the carpal bones
49
what movements does the anatomical snuff box do
- they extend the thumb and abduct the thumb
50
what is the dorsal expansion
- tendons insert onto dorsal surface of fingers via a complex arrangement of fibrous tissue; dorsal expansion
51
what does tendon extensor digitorium do
.- forms protective band over flexors linking in to the dorsal expansion are the intrisc muscles of the hand, these are the small muscles that will do the intrinsic movements
52
what does thenar muscles do
– act of the thumb – this has flexors, opposition muscles
53
what do the hyothenar muscles do
– act on the little finger – this has flexion, opponens muscles that help with opposition
54
what are the intrinsic muscles of the hand
* Lumbricals, flex MCP and keep these interphalangeal extended joints of 2nd-5th digits – insert into the dorsal expansion which is the extensor muscles
* Dorsal interossei, abduct 2nd-4th digits. Assist lumbricals
* Palmar interossei, adduct 2nd,4th and 5th digits, assist lumbricals
* PAD and DAB
* PAD – adduct palmar interossei
* DAB – abduct dosal interossei
55
describe the fascia of the hand
* Fascia of palm and dorsum of hand continuous with antebrachial fascia (fasica in the forearm)
* Thin over thenar and hypothenar muscles as these are muscles and you want them to move but it is thick in central areas such as at the palmer aponeurosis
56
what are the two spaces in the fascia of the hand
• Two potential spaces midpalmar and thenar bounded by fibrous muscle septa – if these open up it can cause a problem if there is an infection
57
what are the causes of compartment syndrome o fate hand
- Caused by trauma and most often iatrogenic causes (something that the medical professional has caused and it happens further down in the arm due to the infection)
58
what is the treatment of compartment syndrome of the hand
- fasciotomy
59
what cuts have to be made in a fasciotomy of the hand
- 2 dorsal
- 1 lateral
- 1 medial or 1 carpal tunnel
60
what is dupuyten's contracture
- Palmer fascia can get thicker or have the wrong type of collagen in it this can cause dupuyten’s contracture
- Fixed flexion contracture of the hand
- Palmar fascia thickens – collagen type 1 to collage type III
61
who does dupuyten's contracture effect
- Northern European
- Men 10:1
- Greater than 40 years
- Family history
- Liver cirrhosis
