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MSK anatomy > The Hand > Flashcards

The Hand Flashcards

1
Q

Carpus

A

2 rows of 4 small bones that articulate with each other at small joints

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2
Q

Metacarpals

A

Located distal to carpals
Numbered 1-5 from lateral (thumb) to medial (little finger)

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3
Q

Phalanges

A

Bones of the digits
3 phalanges in each finger
2 phalanges in thumb

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4
Q

Name of 3 phalanges in each finger

A

Proximal
Middle
Distal

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5
Q

Name of phalanges in thumb

A

Proximal
Distal

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6
Q

Carpometacarpal joints

A

Between distal row of carpal bones and proximal bases of metacarpals

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7
Q

First carpometacarpal joint

A

Between trapezium and thumb
Saddle joint

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8
Q

Metacarpophalangeal joints

A

Knuckles
Condyloid synovial joints

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9
Q

Interphalangeal joints

A

Hinge synovial joints

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10
Q

Movements of the fingers

A

Flexion
Extension
Abduction
Adductiom

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11
Q

Movements of the thumb

A

Flexion
Extension
Abduction
Adduction
Opposition

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12
Q

Opposition

A

A mixture of Flexion, Adduction, and internal rotation of the thumb metacarpal

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13
Q

Power grip

A

To hold or squeeze objects tightly

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14
Q

Hook grip

A

Carrying objects with handles

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15
Q

Precision grip

A

Hold objects between the pads of our thumbs and fingers eg pen

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16
Q

3 types of grip

A

Power grip
Hook grip
Precision grip

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17
Q

Extrinsic muscles of the hand

A

Muscles of anterior and posterior forearm

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18
Q

Anterior forearm muscles that are primary flexors of the wrist

A

Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus

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19
Q

Where does the flexor carpi radialis insert

A

2nd metacarpal

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20
Q

Where does the flexor carpi ulnaris insert

A

5th metacarpal

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21
Q

Where does the Palmaris longus insert

A

Palmar fascia

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22
Q

Anterior compartment muscles that flex the digits

A

Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus

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23
Q

Tendon of flexor digitorum superficialis insertion

A

Splits into 2 slips which insert either side of the middle phalanx of digits 2-5

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24
Q

Tendon of flexor digitorum superficialis function

A

Flexes the metacarpophalangeal and proximal interphalangeal joints of digits 2-5

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25
Q

Tendon of flexor digitorum profundus insertion

A

Passes through the gap in the Tendon of flexor digitorum superficialis to inert onto the palmar aspect of the distal phalanx of digits 2-5

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26
Q

Tendon of flexor digitorum profundus function

A

Flexion of distal interphalangeal joints
Also flexes MCP and PIP joints of digits 2-r5

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27
Q

Which tendon is the only tendon that can cause Flexion of the distal interphalangeal joints

A

Tendon of flexor digitorum profundus

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28
Q

Tendon of flexor pollicis longus insertion

A

Distal phalanx of thumb

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29
Q

Tendon of flexor pollicis longus function

A

Flexes the interphalangeal joint of the thumb

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30
Q

What encloses long flexor tendons

A

Fibrous tendon sheaths enclosed within a synovial sheath

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31
Q

Function of flexor tendon sheaths

A

Maintain the position of the flexor tendon in the midline of each finger

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32
Q

Function of synovial sheaths

A

Reduce friction and allows the tendons to slide freely within the fibrous sheath

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33
Q

Thick palmar aponeurosis

A

Protects the long flexor tendons , tendon sheath and vessels as they pass through the palm of the hand

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34
Q

Tenosynovitis

A

Inflammation of the tendon and synovial sheath

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35
Q

Intrinsic muscles of the hand

A

4 groups:
Thenar eminence
Hypothenar eminence
Lumbricals
Interossei

And adductor pollicis

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36
Q

Thenar eminence muscles

A

Flexor pollicis brevis
Abductor pollicis brevis
Opponens pollicis

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37
Q

Opponens pollicis

A

Deep to flexor and abductor
Opposes the thumb

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38
Q

Insertion of the flexor pollicis brevis

A

Proximal phalanx of thumb

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39
Q

Insertion of the abductor pollicis brevis

A

Lateral aspect of proximal phalanx of thumb

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40
Q

Insertion of the opponens pollicis

A

First metacarpal of thumb

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41
Q

What innervates all of the thenar eminence muscles

A

Recurrent branch of median nerve

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42
Q

Where does the recurrent branch of the median nerve branch off

A

After the carpal tunnel

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43
Q

Adductor pollicis muscle location

A

Deep in the palm

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44
Q

Adductor pollicis insertion

A

3rd metacarpal and proximal phalanx of thumb

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45
Q

Function of adductor pollicis muscle

A

Pulls thumb towards the palm

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46
Q

Innervation of adductor pollicis muscle

A

Ulnar nerve

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47
Q

Importance of thenar eminence muscles

A

Precision grip

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48
Q

What muscles comprise the fleshy mass on the palm of the hand at the base of the thumb

A

Thenar eminence muscles

49
Q

What constitutes the fleshy mass on the medial side of the palm of the hand proximal to the little finger

A

Hypothenar eminence

50
Q

Muscles of the hypothenar eminence

A

Flexor digiti minimi
Abductor digiti minimi
Opponens digiti minimi

51
Q

Insertion of the flexor digiti minimi

A

Proximal phalanx of digit 5

52
Q

Insertion of the abductor digiti minimi

A

Proximal phalanx of digit 5

53
Q

Insertion of the opponens digiti minimi

A

5th metacarpal

54
Q

Innervation of all muscles of the hypothenar eminence

A

Deep branch of ulnar nerve

55
Q

Muscles of the lumbricals

A

4 muscles - one for each finger

56
Q

Origins of the lumbricals

A

Tendons of the flexor digitorum profundus

57
Q

Insertion of the lumbricals

A

Dorsal aspect of digits 2-5

58
Q

Function of the lumbricals

A

Flex the metacarpophalangeal joints and extend the interphalangeal joints simultaneously

59
Q

Innervation of the lumbricals

A

Digits 2/3 = median nerve
Digits 4/5 = ulnar nerve

60
Q

Location of interossei muscles

A

Between the metacarpals and insert into the dorsal aspects of digits 2-5

61
Q

2 groups of interossei muscles

A

Palmar group
Dorsal group

62
Q

Number of palmar interosseous muscles

A

3

63
Q

Number of dorsal interosseous muscles

A

4

64
Q

Function of palmar interosseous muscles

A

Adduction of the fingers

65
Q

Function of the palmar interosseous muscles

A

Abduction of the fingers

66
Q

Muscles found in the dorsum of the hand

A

4 dorsal interosseous muscles

67
Q

What does the dorsal venous network of the hand drain into

A

Cephalic vein laterally
Basilic vein medially

68
Q

Extensor expansion/ extensor hood

A

Fibrous structure located on the dorsal aspect of the hand
Attached to the base of the proximal phalanges and gives rise to a central slip and 2 marginal slips

69
Q

Central slip of extensor expansion

A

Inserts onto the middle phalanx

70
Q

Marginal slips of the extensor expansion

A

Converge on the distal phalanx

71
Q

Function of extensor expansion

A

Tendons of extensor digitorum, extensor indicis and extensor digiti minimi insert onto dorsal aspect of it helping to keep the tendons fixed in the midline of the digits
Lumbricals and interossei insert into sides of the proximal parts helping to contribute to extension of interphalangeal joints

72
Q

Anatomical snuffbox

A

A triangular- shaped depression in the lateral aspect of the wrist at the base of the thumb

73
Q

Boundaries of the anatomical snuffbox

A

Extensor pollicis longus medially
Tendons of the extensor pollicis brevis and abductor pollicis longus laterally

74
Q

Clinical significance of anatomical snuffbox

A

Floor = scaphoid bone
Radial artery travels through it
Cephalic vein travels across it
Superficial branch of radial nerve travels over it

75
Q

Blood supply of the hand

A

Radial and ulnar arteries

76
Q

Terminal branches of brachial artery

A

Radial and ulnar

77
Q

Anastomoses of the radial and ulnar artery

A

Form 2 palmar arches
Superficial and deep

78
Q

Superficial palmar arch

A

Formed largely by the ulnar artery

79
Q

Deep palmar arch

A

Formed largely by the radial artery

80
Q

What do the palmar arches give rise to

A

Metacarpal and digital arteries that supply the palm and digits

81
Q

Course of the radial artery

A

Lateral aspect of forearm

82
Q

Course of ulnar artery

A

Medial aspect of forearm

83
Q

Which 3 peripheral nerves innervate the skin of the hand

A

Median
Ulnar
Radial

84
Q

Territories of the median nerve

A

Palmar surface of the lateral side of the hand
Palmar surface of the lateral 3 1/2 digits
Skin over the dorsum of the distal phalanges of the lateral 3 1/2 digits

85
Q

Territories of the ulnar nerve

A

Palmar and dorsal surfaces of the medial side of the hand and medial 1 1/2 digits

86
Q

Territories of the radial nerve

A

Dorsal surface of the lateral side of the hand
Skin over the dorsum of the lateral 3 1/2 digits as far as the distal interphalangeal joint

87
Q

How to test for sensation of the median nerve

A

Central palm just proximal to middle finger

88
Q

How to test for sensation of the ulnar nerve

A

Medial border of the hand

89
Q

How to test for sensation of the radial nerve

A

Dorsum of the hand in the thumb and index webspace

90
Q

Region innervated by C4

A

Superior aspect of shoulder

91
Q

Region innervated by C5

A

Lateral shoulder over the deltoid
Anterior and posterior aspects of the arm

92
Q

Region innervated by C6

A

Lateral side of anterior and posterior aspects of forearm
Lateral sides of anterior and posterior surfaces of the palm
Anterior and posterior surfaces of the thumb and index finger

93
Q

Region innervated by C7

A

Anterior and posterior surfaces of middle finger and middle palm (over the 3re]d metacarpal)

94
Q

Region innervated by C8

A

Medial side of the anterior and posterior surfaces of the forearm
Medial side of the anterior and posterior surfaces of the palm
Anterior and posterior surfaces of the ring and little finger

95
Q

Region innervated by T1

A

Medial side of the anterior and posterior surfaces of the arm

96
Q

Peripheral nerves supplying the upper limb

A

Supraclavicular nerve
Axillary nerve
Intercosto-brachial nerve
Medial cutaneous nerve of the arm
Posterior cutaneous nerve of the forearm
Lateral cutaneous nerve of the forearm
Medial cutaneous nerve of the forearm
Radial nerve
Median nerve
Ulnar nerve

97
Q

How to test for the C5 dermatome

A

Upper lateral arm over the deltoid muscle

98
Q

How to test for the C6 dermatome

A

Thimb

99
Q

How to test for the C7 dermatome

A

Middle finger

100
Q

How to test for the C8 dermatome

A

Little finger

101
Q

How to test for the T1 dermatome

A

Medial border of the arm just proximal to the elbow

102
Q

Testing the tendons of FDP and FPL

A

In the case of palmar injuries (e.g., a laceration over the palmar aspect of a finger), we need to assess if the long flexor tendons are intact. The tendons of FDS and FDP both cross, and hence can move, the PIP joint. However, only FDP can move the DIP joint. To test FDP, the PIP joint is held immobile by the examiner and the patient is asked to flex the finger. If the FDP tendon is intact, flexion is seen at the DIP joint. To test the tendon of FPL, movement at the IP joint of the thumb is assessed.

103
Q

Dupuytren’s contracture

A

In this condition, the fingers (usually the little and ring fingers) are pulled into flexion by progressive fibrosis of the palmar fascia and palmar aponeurosis. The palmar fascia is attached to the flexor tendon sheaths of the fingers. The fascia shortens and pulls the fingers into flexion. The fascia can be released surgically.

104
Q

Arthritis

A

Osteoarthritis is ‘wear and tear’ arthritis and is more common in older people. It primarily affects large, ‘load bearing’ joints like the hips and knees. However, rheumatoid arthritis is an autoimmune condition that affects various synovial joints, and the small joints of the hands are typically involved. The MCP and PIP joints are predominantly affected. Rheumatoid arthritis can damage these joints causing significant deformity such as ulnar deviation of the digits at the MCP joints, and fixed flexion and extension deformities of either of the interphalangeal joints. This can lead to significant functional impairment for these patients.

105
Q

Fracture of the 5th metacarpal

A

Otherwise known as a ‘boxer’s fracture’, as it is typically sustained by punching something hard, there is usually pain, swelling and tenderness over the 5th metacarpal.

106
Q

Which joints are predominantly afffeccted by rheumatoid arthritis

A

MCP and PIP

107
Q
  1. Which bone lies in the floor of the anatomical snuffbox?
A

Scaphoid

108
Q
  1. Which neurovascular structures are associated with the anatomical snuffbox?
A

Cephalic vein
Radial artery
Superficial branch of radial nerve

109
Q
  1. In a patient with a T1 nerve root injury, which muscles will be weak / paralysed? Which area of skin will be affected?
A

Small muscles of the hand will be weak
Sensory impairment over medial arm

110
Q
  1. Which fingers have two extensor muscles and tendons?
A

Index finger
Little finger

111
Q
  1. Which muscles comprise the thenar eminence? Which nerve innervates them?
A

Abductor pollicis brevis
Extensor pollicis brevis
Opponens pollicis

Recurrent branch of median berve

112
Q
  1. How would you test the function of the interosseous muscles?
A

Abduction and Adduction of the fingers

113
Q
  1. How would a patient present if they injured their median nerve at their wrist? In comparison, how would a median nerve injury at the elbow present?
A

Wrist- weakness of the thenar eminence muscles and lateral 2 lumbricals
Sensory of palmar aspect of lateral 3 1/2 fingers but NOT lateral palm
Elbow- also weakness of anterior forearm muscles except for FCU and medial half of FDP

o Median nerve injury at the wrist results in weakness / paralysis of the muscles innervated by the nerve distal to the wrist i.e. the thenar eminence muscles and the lateral two lumbricals.
o The patient presents with weakness of the thumb (but not of adduction) and over time, atrophy of the thenar eminence occurs. o The patient will also have sensory deficits over the palmar aspect of the lateral 3 ½ fingers, but not the lateral palm as the palmar sensory branch of the median nerve branches from the median nerve proximal to the wrist.
o Median nerve injury at the elbow results in weakness / paralysis of the muscles innervated by the nerve distal to the elbow i.e. all the anterior forearm muscles (except for FCU and the medial / ulnar half of FDP), the thenar eminence muscles and the lateral two lumbricals.
o The patient is unable to flex the DIP and PIP joints of the 2nd and 3rd digits (i.e. index and middle fingers). o Flexion of the MCP joints of these fingers is also impaired due to loss of function in the lumbricals to these fingers.
o Movements of the thumb (except adduction and extension) are also weak due to weakness of FPL and the thenar eminence muscles.
o The patient would also have sensory deficits over the palmar aspect of the lateral 3 ½ fingers and lateral palm.
o Sensation over the lateral palm would also be impaired in this case, as the branch of the median nerve that innervates the palm leaves the median nerve in the distal forearm, so would be affected by a lesion at the elbow.

114
Q

Where does the palmar sensory branch of the median nerve branch

A

Proximal to the wrist

115
Q
  1. A patient with carpal tunnel syndrome has normal sensation over the lateral side of their palm. Why is this?
A

o Compression of the median nerve in the carpal tunnel typically leads to sensory disturbance over the palmar aspect of the lateral 3 ½ digits, as the sensory branches to these regions of skin leave the median nerve distal to the carpal tunnel.
o Although the lateral palm is also innervated by the median nerve, the branch to the lateral palm leaves the median nerve in the distal forearm, proximal to the wrist. It travels superficially to the flexor retinaculum (i.e. not through the carpal tunnel), hence is unaffected by compression of the median nerve in the carpal tunnel.

116
Q

What does the Musculocutaneous nerve become

A

Lateral cutaneous nerve of the forearm

117
Q

What innervates the interossei muscles

A

Ulnar nerve

118
Q

What forms nerves

A

Epineurium
Fascicles

MSK anatomy (13 decks)

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