The Hand

Question 1

What structures does the palmar fascia form?

Answer 1

• palmar carpal ligament
• flexor retinaculum
• palmar aponeurosis
• fibrous digital sheaths

Question 2

What is Dupuytren’s contracture?

Answer 2

pathological thickening and contracture of the superficial layer (longitudinal bands) of the palmar aponeurosis

Question 3

What characteristic of the palmar aponerosis lends to its strength?

Answer 3

it bilaminar nature

- superficial layer is longitudinally oriented while the fibers of the deep layer are transversely oriented.

Question 4

Specialized deep fascia anchored to the margins of the phalanges forming a fibro-osseous canal for the passage of the digital flexor tendons. (prevent bowstringing of the digital flexor tendons)

Answer 4

fibrous digital sheaths

Question 5

What is present between the fibrous sheath and its accompanying tendon?

Answer 5

synovial digital sheath

Question 6

While each digit possesses its own synovial sheath, which two are more robust extending to the flexor retinaculum?

Answer 6

• radial bursa (bursa of the flexor pollicis longus tendon)

- ulnar bursa (common flexor bursa)

Question 7

What are the four compartments of the hand?

Answer 7

thenar, central, hypothenar, adductor-interosseous

Question 8

what is the main supplier of the superficial palmar arch?

Answer 8

ulnar artery

Question 9

Where is the superficial palmar arch?

Answer 9

located w/n central compartment between the palmar aponeurosis and the long digital flexor tendons
- largest and more distal arch

Question 10

What is the main supplier of the deep palmar arch?

Answer 10

radial artery

Question 11

Where is the deep palmar arch?

Answer 11

located w/in the adductor-interosseous compartment on the surface of the metacarpal bones deep to the long flexor tendons and the adductor pollicis muscles

Question 12

What forms the different compartments of the hand?

Answer 12

connective tissue septa extending from the palmar aponeurosis to the shafts of the metacarpal delineating 3 compartments (thenar, central, and hypothenar). A deeper transverse fascial plane delineates the adductor-interosseous compartment.

Question 13

what exists between the opposing fascias of the central and adductor-interosseous compartments which allows greater movement?

Answer 13

deep palmer space or cleft - further divided into lateral palmer space (thenar) and medial palmer space by extension of the palmar aponeurosis to the shaft of 3rd metacarpal

Question 14

What muscles are present in the thenar compartment?

Answer 14

intrinsic - abductor pollicis brevis, flexor pollicis brevis, opponens pollicis

extrinsic - tendon of flexor pollicis longus and accompanying synovial sheath (radial bursa)

Question 15

`What nerves are present in the thenar compartment?

Answer 15

branches of the median nerve

Question 16

what arterial branches are present in the thenar compartment?

Answer 16

radial artery

Question 17

what bones are present in the thenar compartment?

Answer 17

1st metacarpal

Question 18

What muscles are present in the hypothenar compartment?

Answer 18

inrinsic - abductor digiti minimi, flexor digiti minimi, opponens digiti minimi

Question 19

what nerves are present in the hypothenar compartment?

Answer 19

branches of the ulnar nerve

Question 20

What arteries are present in the hypothenar compartment?

Answer 20

branches of ulnar artery

Question 21

what bones are present in the hypothenar compartment?

Answer 21

5th metacapal

Question 22

What sits in the central compartment of the hand?

Answer 22

structures that lie beneath the palmar aponeurosis

• superficial palmar arch and branches
• branches of the median and ulnar nerves
• tendons and synovial linings (ulnar bursa) of long digital flexors
• lumbricals

Question 23

What sits in the adductor-interosseous compartment?

Answer 23

• deep palmer arterial arch and its branches
• adductor pollicis
• palmer and dorsal interossei deep branch of the ulnar nerve
• metacarpals 2, 3, 4

Question 24

What branch of the radial artery courses through the thenar musculature and passes superficial to the long digital flexor tendons to anastomose with the ulnar artery?

Answer 24

superficial palmar branch

Question 25

What branch of the radial artery arises in the vicinity of the anatomical snuff box and course deep to the extensor tendons to form the dorsal carpal arch by anastomosing with the dorsal carpal branch of the ulnar artery?

Answer 25

dorsal carpal branch

Question 26

What branches pring from the dorsal carpal arch?

Answer 26

3 dorsal metacarpal arteries - course on the dorsal surface of the dorsal interosseous muscles and will divid to form two dorsal digital arteries which course distally along the adjacent sides of the contiguous digits

Question 27

What branch arises from the radial artery to supply the thumb?

Answer 27

princeps pollicis

Question 28

What branch arises from the radial artery to supply the index finger?

Answer 28

radialis indicis

Question 29

What branches form from the deep palmar arterial arch?

Answer 29

palmar metacarpal arteries - arise from convexity of deep arch and course distally in the 2nd, 3rd, and 4th metacarpal intervals. at webs of fingers individual anastomose with common palmar digital branches of the superficial palmar arterial arch

Question 30

What branch from the ulnar artery anastomosis with the radial artery to form the deep palmer arch?

Answer 30

deep palmer branch a.

Question 31

What branches form from the superficial palmar arterial arch?

Answer 31

common palmar digital arteries - course distally on surface of long digital flexor tendons and at webs of fingers anastomoses with the palmar metacarpal arteries of the deep arch

Question 32

what are formed by the division of the short arterial trunks formed by the union of the palmar metacarpal, common palmar digital, and distal perforating arteries and course distally toward the fiber tips on adjacent sides of contiguous fingers?

Answer 32

proper digital arteries (each finger receives 4)

Question 33

What branch from the median nerve innervates the muscles of the thenar compartment?

Answer 33

recurrent or motor branch n.

Question 34

what branch of the median n (3 in number) supplies the cutaneous innervation to the thumb and 2nd, 3rd, and radial side of 4th digit (includes skin on dorsum of digits)

Answer 34

common palmar digital nerves

Question 35

what branches of the medan nerve proximal to the flexor retinaculum and descends superficial to the flexor retinaculum innervates the central area o the palm?

Answer 35

palmar cutaneous branches

Question 36

What two branches does the ulnar nerve divide into a the base of the hypothenar eminence w/in the hand?

Answer 36

superficial branch - provides common and proper digital branches to the 5th and ulnar side of the 4th digit

deep branch - follows course of the deep palmer branch of the ulnar artery to lie superficial and proximal to the deep palmar arterial arch; innervates hypothenar msucles, lumbricals 3 & 4, all interossei and adductor pollicis muscles.

Question 37

What branches of the ulnar nerve supply cutaneous innervation to the hand?

Answer 37

cutaneous palmer branch - arise in forearm and descends lateral to the ulnar artery where it enters the central palm

dorsal cutaneous branch - arise proximal to the wrist passes dorsally in the area of he ulnar styloid process and divides into three dorsal digital nerves, (innervates skin on medial dorsum of hand and portion of the the ulnar side of the 4th digit and entire 5th)

Question 38

What is the branch of the radial nerve in the hand?

Answer 38

superficial branch - possesses medial and lateral branches

• medial branch provides dorsal digits nerves which innervate the lateral dorsum of the hand, dorsum and ulnar side of the thumb, dorsum of the index finger and radial half of the dorsum of the middle finger
• lateral branch runs to radial side of the base of thumb which it innervates