Outline 9: Wrist and Hand Flashcards
1
Q
The flexor retinaculum has attachments to:
A
(From) Pisiform, hook of hamate
(to) Trapezium, Scaphoid
2
Q
The extensor retinaculum has attachments to:
A
Radius, ulna, pisiform, and triquetrum
3
Q
Flexor retinaculum + carpal arch =
A
The carpal tunnel
4
Q
What enters the hand through the carpal tunnel?
A
- Median nerve
Tendons of:
- FDS
- FDP
- Flexor pollicis longus
5
Q
Bursa in the hand, filled with (X), enclose (Y).
A
X = SA fluid Y = Tendons
6
Q
Tendons of (X) and (Y) pass (over/under) flexor retinaculum and continue up digit 5. They are enclosed by (Z) bursa.
A
X = FDS Y = FDP
Under
Z = ulnar
7
Q
Tendon of (X) passes (over/under) flexor retinaculum and continues up digit 1. It’s enclosed by (Y) bursa.
A
X = FPL
Under
Y = radial
8
Q
What can be palpated in the anatomical snuffbox?
A
- Scaphoid
- Trapezium
- Radial artery
9
Q
Where is the flexor retinaculum, wrt the wrist?
A
Distal
10
Q
Superficial layer of the palm contains:
A
Palmar aponeurosis
11
Q
What’s between the superficial and middle layers of the palm?
A
- Median and superficial ulnar nerve branches
2. Superficial palmar arch
12
Q
The middle layer of the palm contains:
A
Long flexor tendons and lumbricals
13
Q
What’s between the middle and deep layers of the palm?
A
- Deep branch of ulnar nerve
2. Deep palmar arch
14
Q
The deep branch of the ulnar nerve is the (muscular/cutaneous) branch.
A
Muscular
15
Q
The median and superficial branches of the ulnar nerve are the (muscular/cutaneous) branches.
A
Primarily cutaneous
16
Q
The superficial palmar arch supplies which part(s) of the hand?
A
Fingers
17
Q
The deep palmar arch supplies which part(s) of the hand?
A
Wrist and Palm
18
Q
The deep layer of the hand contains:
A
Interossei
19
Q
What’s even more dorsal than the deep layer of the hand?
A
Extensor tendons
20
Q
Palmaris brevis, an example of (superficial/deep) fascia in hand, attaches:
A
Superficial
Attaches skin to palmar aponeurosis
21
Q
List the deep fascia present in the hand:
A
- Flexor retinaculum
- Palmar aponeurosis
- Thenar fascia
- Hypothenar fascia
22
Q
What attaches to the palmar aponeurosis?
A
- Palmaris longus tendon
- Transverse fasciculi
- Deep transverse metacarpal ligament
- Superficial transverse metacarpal ligament
23
Q
Fibro-osseous tunnels contain:
A
Phalanges and fibrous digital sheaths
24
Q
Fibrous digital sheaths are composed of:
A
- Annular pulleys (vaginal ligaments)
2. Cruciate fibers
25
Annular pulleys are mainly attached to (cartilage/bone/tendons/other)
Bone
26
Synovial digital sheaths are essentially (X) surrounding (Y) of which digits?
```
X = bursa
Y = flexor tendons
```
Digits 2-4
27
Bowstringing is prevented by which structure(s)?
Annular pulleys A4 and A2
28
Palmar plates are (X) that are (anterior/posterior) to which joints?
X = fibrocartilagenous covers
Anterior to IP and MCP joints
29
What do palmar plates connect to?
Connect to distal bone and hang over proximal bone
30
Vinculae are fibers of (X) that attach to (Y). What is their function?
```
X = long flexor tendons (FDS and FDP)
Y = periosteum of bone
```
Provide blood supply to distal tendons
31
Structure(s) that protect/aid wrist in gliding mechanism during finger flexion.
Flexor retinaculum and radial/ulnar bursae
32
Structure(s) that protect/aid digits in gliding mechanism during finger flexion.
Annular pulleys and synovial tendon sheaths
33
List the general categories of intrinsic hand muscles:
1. Interosseous
2. Lumbricals
3. Thenar
4. Hypothenar
34
How many dorsal interossei? How many palmar?
4 dorsal and 3 palmar
35
Describe the architecture of the palmar interossei. And the dorsal?
Palmar are unipennate. Dorsal are bipennate.
36
General interossei insertion:
Extensor expansions and bases of proximal phalanges
37
Actions of palmar interossei:
1. Flex MCP
2. Extend IP
3. Adduction at MCP
38
Actions of dorsal interossei:
1. Flex MCP
2. Extend IP
3. Abduction at MCP
39
Lumbricals attach to (ulnar/radial/both) sides of what?
Radial sides of extensor expansions
40
Superficial thenar muscles:
Abductor pollicis brevis
Flexor pollicis brevis
41
Which tendon(s) contain(s) a sesamoid bone? Why?
Flexor pollicis brevis and adductor pollicis
Protects the FPL tendon as it goes out to attach to distal phalanx of thumb
42
Middle layer of thenar muscle:
Opponens pollicis
43
Deep layer of thenar muscle:
Adductor pollicis
44
The less-mobile of digits 2-5 are which two? They have 1 (X) and 2 (Y).
3 and 4
```
X = extensor muscle
Y = intertendonous connection
```
45
The more-mobile of digits 2-5 are which two? They have 1 (X) and 2 (Y).
2 and 5
```
X = intertendonous connection
Y = extensor muscles
```
46
Extensor expansion consists of:
1. Central tendon of ED
2. Lateral bands of ED
3. Transverse retinacular ligaments
4. Tendons of interossei and lumbricals
47
When MCP joints are flexed, extensor expansion is (proximal/distal) because ED is (relaxed/contracted).
Distal; relaxed
48
What pulls on the extensor hood during MCP Flexion?
Lumbricals and interossei
49
When ED and intrinsics are activated, which joint(s), if any, are in extension?
All joints (MCP, IP) are extended
50
When ED contracts, what happens to the extensor hood?
Extensor hood is pulled proximally, covers MCP joints
51
The ulnar artery enters the hand and branches off into:
1. Dorsal carpal branch
2. Palmar carpal branch
3. Superficial palmar arch
4. Deep branch
52
Which two branches off the ulnar artery supply the wrist?
The dorsal and palmar carpal branches
53
The ulnar artery's (X) branch gives off the dorsal carpal rete, which then gives off:
X = dorsal carpal
The dorsal carpal rete gives off:
Dorsal metacarpal and dorsal digital branches
54
The (X), which stems from the (ulnar/radial) artery, gives off the (Y), which are the main blood supply for the fingers.
X = superficial palmar arch
Ulnar
Y = common and proper palmar digital branches
55
The (X) branch of the ulnar artery completes the deep palmar arch.
X = deep
56
Which arteries feed into the common palmar digital arteries?
Palmar metacarpal arteries
57
The palmar metacarpal arteries, which feed into (X), stem from (Y).
X = common palmar digital arteries
Y = deep palmar arch
58
The (X) branches of (Y) arteries feed into the dorsal metacarpal arteries.
```
X = perforating
Y = palmar metacarpal
```
59
Before turning toward the (palmar/dorsal) side of the hand at the (X) process, the radial artery gives off which branches?
Dorsal
X = Styloid
1. Palmar carpal branch
2. Superficial palmar branch
60
The radial artery's (X) branch supplies the wrist.
X = palmar carpal
61
The radial artery's (X) branch completes the superficial palmar arch.
X = superficial palmar branch
62
In the snuff box, the radial artery branches into:
1. Princips pollicis
2. Radialis indicis
3. Dorsal carpal branches
63
Which branch(es) off the radial artery contribute to the dorsal carpal rete?
The dorsal carpal branches
64
The radial artery eventually travels between (X) and completes the (Y).
X = two heads of first dorsal interosseous
Y = deep palmar arch
65
List the veins in the hand.
1. Dorsal digital veins
2. Intercapitular (or dorsal metacarpal) veins
3. Lateral veins
4. Medial veins
66
The (X) vein in the hand becomes the (Y) vein in the antebrachium and then becomes the axillary vein.
```
X = lateral
Y = cephalic
```
67
The (X) vein in the hand becomes the (Y) vein in the antebrachium and then becomes the brachial vein.
```
X = medial
Y = basilic
```
68
When you think of SENSATION, which nerve should you think of?
Median nerve
69
Median nerve enters hand by passing under:
Flexor retinaculum
70
Upon entering the hand, the median nerve branches into:
1. Palmar cutaneous branch
2. Muscular (recurrent) branch
3. Common and proper palmar digital nerves
4. Communicating branch
71
The (X) branch off the median nerve goes to flexor retinaculum.
X = palmar cutaneous
72
Which branches of the (X) nerve are affected by Carpal Tunnel Syndrome?
X = median
1. Muscular branch
2. Common and proper palmar digital nerves
3. Communicating branch
73
The muscular branch of the median nerve innervates:
2.5 thenar muscles
| We know these from lab: 1/2 LOAF
74
Nerves to lumbricals 1 and 2 branch off of (X), which branches off of (Y) nerve.
X = common palmar digital nerves
Y = median
75
Compression of median nerve results in (X). What are mild symptoms? And severe?
X = carpal tunnel syndrome
Mild: tingling, buzzing sensation and muscle weakness
Severe: loss of sensation and muscle paralysis
76
A cut or severed median nerve in the wrist area results in:
Severe cutaneous loss
77
A cut or severed median nerve in the thenar eminence results in:
Loss of 2.5 thenar muscles (not big handicap)
78
Before entering the palm, the ulnar nerve gives off which branch(es)?
Palmar cutaneous branch and dorsal branch
79
The (X) branch of the (Y) nerve innervates the cutaneous portion of medial palm.
X = palmar cutaneous
Y = ulnar
80
The (X) branch of the ulnar nerve innervates cutaneous ulnar half of digit (Y) and
```
X = dorsal
Y = 4
```
Dorsal body
81
Canal of Guyon is a space made by which four structures?
Scaphoid, pisiform, flexor retinaculum and palmar carpal ligament
82
Which structures would you find in the Canal of Guyon?
Ulnar artery
Ulnar nerve
FCU tendon
("ANT")
83
The (X) branch of the (Y) nerve is cutaneous except for the motor branch that innervates (Z), a muscle that connects skin to palmar aponeurosis.
X = superficial
Y = ulnar
Z = palmaris brevis
84
The ulnar nerve's (X) branch divides and branches into:
X = superficial
1. Motor to palmaris brevis
2. Common and proper palmar digital nerves
3. Communicating branch
85
The ulnar nerve's (X) branch supplies multiple muscles. List them.
X = deep
Hypothenar muscles, interossei, lumbricals 3 and 4, adductor pollicis, deep head FPB
86
In claw hand, the thumb is (abducted/adducted) because which muscle is lost?
Abducted
Adductor pollicis
87
In claw hand, the MCP joints are (flexed/extended) because (X) muscle(s) is/are lost and (Y) muscle(s) dominate(s).
Extended
X = Lumbricals 4 and 5; interossei
Y = ED
88
In claw hand, the IP joints are (flexed/extended) because (X) muscle(s) is/are lost and (Y) muscle(s) dominate(s).
Flexed
X = interossei; lumbricals 4 and 5
Y = FDS and FDP
89
In claw hand: Between digits 2-5, which digit(s) is/are not as affected as the others? Explain.
Digits 2 and 3 not as affected
Median nerve innervation for the two radial lumbricals
90
In claw hand, is there any cutaneous loss? If so, where?
Yes
Ulnar side of palm and dorsum
Digit 5 and ulnar half of digit 4
91
List the wrist and hand joints (total of 6):
1. Radiocarpal (wrist)
2. Intercarpal
3. Carpometacarpal
4. Intermetacarpal
5. Metacarpo-phalangeal
6. Interphalangeal
92
The radiocarpal joint is which type of joint?
Condyloid
93
The most important ligament in the palm is:
Palmar radiocarpal ligament
94
In MCP joints, what ligament(s) attach(es) to the palmar ligaments?
1. Collateral
2. Fibrous digital sheaths
3. Deep transverse metacarpal
95
Which ligament in MCP joint is tightest during flexion?
Collateral ligament
96
What does the deep transverse metacarpal ligament attach to? In which digits?
Both sides of adjacent finger metacarpals; between all digits EXCEPT between 1 and 2
97
Blood and nerve supply for MCP and IP joints:
Digital arteries and digital nerves
