Session 10 Flashcards
Which bone is not part of the wrist joint
Ulna
Carpal bones form a
Convex surface which articulates with convex surface of radius and triangular fibrocartilage
What type of joint is wrist
Ellipsoid synovial joint- movement in flexion, extension, adduction, abduction
2 axis
What is the wrist joint stabilised by
Dorsal and palmar radiocarpal ligaments (ensure hand follows radius during pronation and supination)
Ulnar and radial collateral ligaments
Muscles responsible for flexion of the wrist
Flexor carpi ulnaris
Flexor carpi radialis
Palmaris longus
Muscles responsible for extension of the wrist
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Wrist adduction produced by
Extensor carpi ulnaris
Flexor carpi ulnaris
Abduction at wrist is produced by
Extensor carpi radialis longus
Extensor carpi radialis brevis
Flexor carpi radialis
Bones of hand
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Carpitate Hamate
Hamate has what on palmar surface
Projection called the hook which forms ulnar border of carpal tunnel and radial border of Guyon’s canal
Blood supply of scaphoid?
Dorsal carpal branch of radial artery
Retrograde flow
Scaphoid fractures hence have high rate of non-union
Each metacarpal consists of
Base shaft and head
Medial and lateral surfaces are concave and accommodate interossei muscles
What is radial abduction
Continuation of extension beyond the anatomical position in the same plane of the palm
What is palmar abduction
Raising thumb in sagittal plane, perpendicular to palm
Difference between intrinsic and extrinsic muscles of the hand
Intrinsic- originate within the hand and insert with the hand
Extrinsic- originate within the forearm and insert within the hand
4 compartments of intrinsic muscles
Thenar compartment- abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
Adductor compartment- adductor pollicis
Hypothenar compartment- abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
central compartment- lumbricals, interossei, palmaris brevis
Thenar compartment-
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
Adductor compartment-
adductor pollicis
Hypothenar compartment-
abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
central compartment-
lumbricals, interossei, palmaris brevis
Thenar eminence supplied by
Median nerve, except deep head of flexor pollicis brevis supplied by ulnar
2 heads of adductor pollicis
Transverse head and oblique head
Hypothenar compartment innervated by
Ulnar nerve
Central compartment nerve supply
Radial 2 lumbricals- median nerve
Ulnar 2 lumbricals- ulnar nerve
What do lumbricals do
Link flexor digitorum profundus tendon on palmar surface to extensor digitorum tendon on dorsum
When they contract they flex the fingers at the MCPJ and extend at PIP
Lumbricals to index and middle fingers are
Unipennate
Lumbricals to ring and little fingers are
Bipennate
2 groups of interossei
Dorsal and palmar
Interossei actions
DAB (dorsal abduct)
PAD (palmar adduct)
Assist lumbricals in flexing MCPJs and extending IPJs
Ulnar nerve
Central slip in RA causes
Boutonnière deformity
FDP originates from
Proximal 2 thirds of shaft of ulna
Inserts into base of distal phalanx
FDS originated from
Medial epicondyle of humerus and superior half of radius
Insert into base of middle phalanx
Deep border of carpal tunnel
Carpal bones form concavity
Supericial border of carpal tunnel
Flexor retinaculum
Attachments of flexor retinaculum
Lateral- scaphoid, trapezium
Medial- hook of hamate, pisiform
Structures passing through carpal tunnel
Flexor pollicis longus
Flexor digitorum superficialis tendons x4
Flexor digitorum profundus tendons x4
Median nerve
Tendons of FDS through carpal tunnel
Middle and ring finger pas superficial to index and little finger
What supplies sensation to the radial 2/3rds of palm
Palmar cutaneous branch of median nerve given off proximal to carpal tunnel
This is why sensation to the palm is unaffected
What passes through Guyon’s canal
Ulnar nerve and artery
Guyon’s canal location
Superficial to flexor retinaculum
Lateral to pisiform bone and hook of hamate
Guyon’s canal roof
Palmar carpal ligament
What is anatomical snuff box
Radial fossa- triangular depression on radial aspect of dorsum of hand at level of carpal bones
Medial and lateral Borders of anatomical snuffbox
Lateral- tendons of abductor pollicis longus, extensor pollicis brevis
Medial- tendon of extensor pollicis longus
Proximal border, floor and roof of anatomical snuffbox
Proximal border- styloid process of radius
Floor- scaphoid and trapezium
Roof- skin
Contents of anatomical snuffbox
Radial artery
Superficial branch of radial nerve
Cephalic vein
Arterial supply of hand
Radial and ulnar artery via deep and superficial palmar arches
Superficial palmar arch gives off
Common palmar digital arteries
Ulnar contributes mainly to superficial palmar arch so fingers
Radial artery contributes mainly to
Deep palmar arch, blood supply of thumb and radial side of index finger
3 branches of brachial plexus that supply hand
Median radial and ulnar
Median and ulnar nerve arise from
Anterior brachial plexus - supply anterior forearm
Radial nerve arises from the
Posterior divisions of the brachial plexus and therefore supplies the posterior compartment of the forearm
ulnar nerve supplies
All intrinsic muscles of hand except LOAF
What are LOAF and what supplies them
Median nerve
Lumbricals- lateral 2
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis (superficial head)
Nerve supply to palm of hand is derived from the
Palmar cutaneous branch of median nerve
And palmar cutaneous branch of ulnar nerve
Palmar digital branches arise in palm
How do you test for sensation in radial nerve
Dorsum of 1st web space
How do you test for sensation in median nerve
Palmar surface of tip of index finger
How do you test for sensation in ulnar nerve
Ulnar border of hand
