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MSK > S9L1 - Anatomy Of The Wrist > Flashcards

S9L1 - Anatomy Of The Wrist Flashcards

1
Q

What forms the worst joint?

A

Distal radius, triangular fibrocartilage complex, the scaphoid and the lunate.

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2
Q

What type of synovial joint is the wrist? What does this joint allow?

A

Ellipsoid, allowing movement in two axes. Flexion and extensions and adduction and abduction

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3
Q

What is circumduction?

A

Winding your hand in a circle, using all for types of possible movements of the wrist joint.

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4
Q

What muscles are responsible for flexion of the wrist?

A

Flexor carpi ulnaris
Flexor carpi radialis
Palmaris longus

(Flexor digitorum superficialis, flexor digitorum profunda, flexor pollicus longus)

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5
Q

What are the extensors of the wrist?

A

Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digitorum

(Extensor indicis, extensor digiti minimi, extensor pollicus longus, extensor pollicis brevis and abductor pollicis longus)

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6
Q

Wha muscles produce adduction at the wrist?

A

Extensor carpi ulnaris

Flexor carpi ulnaris

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7
Q

What muscles produce abduction at the wrist?

A

Extensor carpi radialis brevis
Extensor carpi radialis longus
Flexor carpi radialis

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8
Q

What nerves innervated the wrist?

A

The median, the ulnar and the radial nerve

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9
Q

What are the bones in the hand?

A

8 carpal bones
5 metacarpals
14 phalanges

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10
Q

Name the proximal row carpal bones

A

Scaphoid
Lunate
Triquetrum
Pisiform

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11
Q

Name the distal row carpal bones

A

Trapezium
Trapezoid
Capitate
Hamate

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12
Q

What important projection is present on the hamate?

A

The hook, a projection on the palmar surface of the hamate. Forms the ulnar border of the carpal tunnel and the radial border of Guyons canal.

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13
Q

What is the blood supply to the scaphoid?

A

The dorsal carpal branch of the radial artery, 80% by retrograde flow.

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14
Q

How are metacarpals numbered?

A

Radial to ulnar.

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15
Q

Why are the lateral and medial surfaces of the metacarpal shafts concave?

A

To accommodate the interosseous muscles.

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16
Q

What are the movements of the thumb?

A 
Flexion and extension
Palmar abduction / palmer adduction
Radial abduction / palmar adduction
Opposition / reposition
Retropulsion 
Circumduction
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17
Q

Describe the movements of the fingers

A

Flexion, extension, hyperextension
Abduction
Adduction
Circumduction

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18
Q

What are the four compartments can the intrinsic muscles of the hand be divided into?

A

Thenar compartment
Adductor compartment
Hypothenar compartment
Central compartment

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19
Q

What is the thenar eminence?

A

The muscular prominence on the radial aspect of the palm formed by the thenar muscles.

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20
Q

What muscles are in the thenar muscle compartment?

A

Flexor pollicus brevis
Abductor pollicus brevis
Opponens pollicus

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21
Q

What is the nerve supply to the thenar muscle compartment

A

Median nerve

deep head of the flexor pollicus brevis = ulnar nerve

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22
Q

What is the origin, insertion and action of opponenes pollicis?

A 
Origin = trapezium and flexor retinaculum
Insertion = lateral border of 1st metacarpal
Action = opposes thumb
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23
Q

What is the origin, insertion and action of abductor pollicis brevis?

A 
Origin = Scaphoid, trapezium and flexor retinaculum 
Insertion = Lateral border of proximal phalanx of thumb
Action = Palmar abduction of the thumb
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24
Q

What is the origin, insertion and action of flexor pollicis brevis?

A 
Origin = superficial head originates at the trapezium and flexor retinaculum, deep head at the trapezoid and capitate. 
Insertion = ulnar aspect of the proximal phalanx of the thumb
Action = Flexes the metocarpophalangeal joint of the thumb.
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25
Q

What muscles are in the adductor compartment of the intrinsic muscles of the hand

A

Adductor pollicis

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26
Q

What nerve innervated the adductor compartment of the hand?

A

Ulnar nerve

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27
Q

What is the origin, insertion and action of adductor pollicis?

A 
Origin= transverse head originates at the shaft of the 3rd matecarpa, oblique head originates at the capitate and base of the 2nd and 3rd metacarpals
Insertion = ulnar aspect if base of the proximal phalanx of the thumb 
Action = adductor of the thumb (both radial and palmar)
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28
Q

What is the hypothenar eminence?

A

A muscular prominence on the ulnar aspect of the palm caused by muscles of the hypothenar compartment.

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29
Q

What nerve innervates the hypothenar compartment

A

The ulnar nerve

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30
Q

What muscles make up the hypothenar compartment of the intrinsic muscles of the hand?

A

Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis

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31
Q

What is the origin, insertion and action of Opponens digiti minimi?

A 
Origin = Hook of the hamate, flexor retinaculum 
Insertion = ulnar margin of the 5th metacarpal
Action = Rotates the 5th metacarpal towards the palm, enabling opposition against the thumb.
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32
Q

What is the origin, insertion and action of Abductor digiti minimi

A

Origin = Pisiform and tendon of flexor carpi ulnaris
Insertion =Base of proximal phalanx of the little finger
Action = adduction of the little finger

33
Q

What is the origin, insertion and action of flexor digiti minimi brevis

A 
Origin = Hook of hamate and flexor retinaculum 
Insertion = base of proximal phalanx of little finger
Action = Flexion of metacarpophalangeal joint of the little finger
34
Q

What muscles are within the central compartment of the intrinsic hand muscles

A

Palmar brevis
Palmar interossei
Dorsal Interossei
Four lumbricals

35
Q

What nerves supply the central compartment?

A

Radial two lumbricals = median nerve

Ulnar two lumbricals, palmar interossei, dorsal interossei, palmaris brevis = ulnar nerve

36
Q

What is the origin, insertion and action of palmar brevis?

A 
Origin = Palmar aponeurosis and flexor retinaculum
Insertion = dermis of the skin on the medial margin of the hand
Action = depends the curvature of the hand, improving grip.
37
Q

What is the origin, insertion and action of the four lumbricals?

A 
Origin = Flexor digitorum profunda to the corresponding finger
Insertion = Extensor digitorum  to the respective finger
Action = Flexion at the metacarpophalangeal joint, extension at the interphalangeal joints
38
Q

Which lumbricals are unipennate/ bipennate?

A

The 1st and second lumbricals are unipennate, the third and fourth are bipennate.

39
Q

Where are the interossei?

A

Between the metacarpals.

40
Q

Describe the action of the interossei

A

The dorsal interossei abduct, and the palmar interossei adduct. Also assist the lumbricals (flexion of fingers at the MCPJ and extension at the IPJ)

41
Q

Describe the origin, insertion and action of the Dorsal interossei

A

DI1 - originates at the shaft of the first and second metacarpals, inserts onto the radial aspect of the proximal phalanx of the index finger and extensor expansion, abducts the index finger.

DI2 - originates at the shaft of the 2nd and 3rd metacarpals, inserts onto the radial aspect of the base of the proximal phalanx of the middle finger and the extensor expansion, radially abducts middle finger.

DI3 - originates at the third and fourth metacarpals, inserts into the ulnar aspect of the proximal phalanx of the middle finger and the extensor expansion, ulnar abducts the middle finger

DI4 - shaft of the fourth and fifth metacarpals, inserts onto the ulnar aspect of the base of the proximal phalanx of the ring finger and the extensor expansion, abducts the ring finger

42
Q

How do the dorsal interossei vary from the palmar interossei?

A

The dorsal interossei are bipennate, the palmar interossei are unipennate. There are 4 dorsal interossei, and only 3 palmar interossei.

43
Q

Why isn’t there a dorsal interosseous muscle to the little finger?

A

Abduction of the little finger is carried out by abductor digiti minimi

44
Q

What carries out adduction of the thumb?

A

Adductor pollicis

45
Q

Why isn’t there a palmar interosseous muscle to the middle finger?

A

The middle finger is moved from side to side by the second and third dorsal interosseous muscles.

46
Q

Describe the origin, insertion and action of the 3 palmar interosseous muscles

A

PI 1 - originates at the shaft of the second metacarpal , inserts into the ulnar aspect of the base of the proximal phalanx of the index finger and the extensor expansion.

PI2 - originates at the shaft of the fourth metacarpal, inserts into the radial aspect of the base of the proximal phalanx and extensor expansion of the ring finger, action is to adduct the ring finger,

PI3 - originates at the fifth metacarpal, inserting into the radial side of the base of the promial phalanx and extensor expansion of the little finger, action is to adduct the little finger.

47
Q

Name the 3 extrinsic muscles of the hand

A

Extensor digitorum
Flexor digitorum profundus
Flexor digitorum superficialis.

48
Q

Where does the extensor digitorum originate

A

At the common extensor origin on the lateral epicondyle of the humerus, and is a muscle of the superficial posterior compartment of the forearm.

49
Q

What innervates the extensor digitorum

A

Supplied by the posterior interosseous branch of the radial nerve

50
Q

Describe the insertion of the tensor digitorum

A

At the dorsal of the wrist the extensor digitorum splits into four tendons, each inserting into a different finger. Each tendon divides into three tendons, one central slip that inserts into the base of the middle phalanx and the two lateral slips converge and insert into the base of the distal phalanx.

51
Q

Describe the origin and insertion of the Flexor digitorum profundus

A

Origin : the proximal two thirds on the shaft of the ulna and the adjacent interosseous membrane on the anterior forearm.
Insertion : divides into four tendons at the wrist that pass through the carpal tunnel to insert on the distal phalanx of each of the four fingers.

52
Q

Describe the origin and insertion of the flexor digitorum superficialis

A 
Origin = has two heads. Humerus-ulnar head originates from the medial epicondyle of the humerus, the ulnar collateral ligament and the coronoid process of the ulna. The radial head originates from the superior half of the radius.
Insertion = divides into four tendons at the wrist, that pass through the carpal tunnel and the tendons divide into two slips at the proximal phalanx before recombining to insert onto the base of the middle phalanx of the four fingers.
53
Q

Where is the carpal tunnel?

A

The carpal tunnel is a narrow passageway on the anterior aspect of the wrist.
The deep border is the carpal bones that form a con cavity.
The superficial border is formed by the flexor retinaculum(transverse carpal ligament)

54
Q

Where does the flexor retinaculum/ transverse carpal ligament attach?

A 
Radially = scaphoid, trapezium
Medial = hook of hamate, pisiform.
55
Q

What structures pass through the carpal tunnel?

A

Flexor pollicus longus tendon
Flexor digitorum superficialis tendons x 4
Flexor digitorum profundus tendons x 4
Median nerve.

56
Q

What is the arrangement of the flexor digitorum superficialis tendons as they pass through the carpal tunnel

A

The tendons to the middle and ring finger pass superficial to those to the little and index finger

57
Q

When is the palmar cutaneous branch of the median nerve given off from the median nerve? Why is this clinically significant?

A

The palmar cutaneous branch of the median nerve is given off proximal to the carpal tunnel. This branch supplies sensation to the radial two thirds of the palm, and therefore when the median nerve is compressed in carpal tunnel syndrome, sensation to the palm is unaffected.

58
Q

What is Guyons canal?

A

A semi rigid longitudinal canal in the wrist that allows passage of the ulnar nerve and artery into the hand.

59
Q

Where is Guyons canal?

A

Superficial to the transverse carpal ligament, it can be palpated just radial to the pisiform bone, passing between the pisiform and the hook of the hamate.
The roof is formed by the palmar carpal ligament

60
Q

Why is Guyons canal clinically important?

A

Site of ulnar nerve compression

61
Q

Where is the anatomical snuffbox?

A

Triangular depression on the radial aspect of the dorsum of the hand

62
Q

What are the borders of the anatomical snuffbox?

A

Radial border = tendons of abductor pollicis longus and extensor pollicis brevis

Ulnar border = tendon of extensor pollicis longus

Proximal border = styloid process of the radius

Floor = scaphoid, trapezium

Roof = skin

63
Q

What is the contents of the anatomical snuffbox

A

Radial artery
Superficial branch of the radial nerve
Cephalic vein

64
Q

What arteries supply the hand?

A

The radial and ulnar artery vis the deep and superficial palmar arches

65
Q

How does the ulnar artery enter the hand?

A

The ulnar artery enters the hand anterior to the the flexor retinaculum through Guyons canal. The ulnar artery lies radial to the pisiform bone and ulnar nerve.

66
Q

How does the ulnar artery divide in the hand

A

Divides into 2 branches, the superficial branch and the deep branch. Both of these branches anastomoses with corresponding branches of the radial artery to form the superficial and deep palmar arches.

67
Q

What artery supplies the fingers?

A

The common palmar digital arteries are given off from the superficial palmar arch to supply the fingers. The ulnar artery mainly contributes to the superficial palmar arch and therefore provides most of the blood to the fingers.

68
Q

Describe how the radial artery enters the hand

A

Enters the hand between the tendons of brachioradialis and flexor carpi radialis.

69
Q

Describe the path of the radial artery within the hand

A

The radial artery gives off a superficial branch which anastomoses with the superficial palmar arch. After this, the radial artery passes dorsally to cross the floor of the anatomical snuffbox on the dorsum of the hand before reentering the palm between the two heads of the adductor pollicis. The radial artery anastomoses with the deep branch of the ulnar artery to form the deep palmar branch.

70
Q

What artery supplies the thumb?

A

The blood supply for the thumb and the radial side of the index finger is provided by the deep palmar arch. the radial artery contributes mainly to the deep palmar arch.

71
Q

What three branches of the brachial plexus supply the hand

A

Median
Ulnar
Radial

72
Q

What nerve supplies almost all intrinsic muscles of the hand?

A

The ulnar nerve

73
Q

Which intrinsic muscles of the hand are not supplied by the ulnar nerve?

A

LOAF
Lumbricals - the radial two lumbricals (unipennate)
Opponens pollicis
Abductor pollicis brevis
Flexor pollicus brevis (superficial head; the deep head is supplied by the ulnar nerve)

These are all supplied by the median nerve

74
Q

What nerve supplies the palm of the hand?

A

Radial two thirds = palmar cutaneous branch of the median nerve, arising proximally to the carpal tunnel.

Ulnar third = palmar cutaneous branch of the ulnar nerve, arising proximally to Guyons canal.

75
Q

Where do the palmar digital nerve branches branch?

A

Branch from their respective nerves in the palm.

76
Q

What does the palmar digital branches of the median nerve supply?

A

Supplies the thumb, index, finger, middle finger and radial border of the ring finger

77
Q

What does the palmar digital branches of the ulnar nerve supply?

A

The ulnar border of the ring finger and the little finger.

They also innervate the dorsum of these digits over the distal phalanx and nail bed.

78
Q

What does the dorsal cutaneous branch of the ulnar nerve supply?

A

Branches from the main nerve in the forearm, supplies the skin over the dorsal aspect of the ulnar border of the hand and the skin over the dorsum of the ulnar 1 and a half digits as far distally as the DIPJ.

79
Q

What regions are tested in the hand to check nerve supply and why?

A

Radial nerve = dorsum of first webspace
Median nerve = palmar surface of the tip of the index finger.
Ulnar nerve = ulnar border of the hand

Checked here as these regions have a consistent supply with no overlapping.

MSK (17 decks)

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