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AoL > The hand > Flashcards

The hand Flashcards

1
Q

Which bones articulate with the carpals distally

A

Metacarpals

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2
Q

Metacarpals are numbered… which is first

A

First is nearest to the thumb (so actually the lateral one is 1st in the anatomyical psoiton)

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3
Q

What bones do the metacarpals articulate iwth

A

The proximal phalanges, thne middle phalanges then distal phalanges

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4
Q

What is the palmar aponeurosis- what is it continuous proximally and distally

A

Proximal- continuous with flexor retinuaculum (which the palmaris longus tendon attaches to)….

distally is it fibrous digital sheath

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5
Q

What underlies the palmar aponeurosis and what is contained within fibrous digital sheaths

A

palmar aponeurosius overlies the long flexor tendons of the hand (FDS/FDP)

Fibrous digital sheaths
contain the flexor tendons and their synovial sheaths

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6
Q

How does the FDP relate to the FDS in the proximal digit

A

FDP on theinside, FDS outside… both surrounded by the synovidal sheath/fibrous digit sheath…. superifical to the prox. phalanx

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7
Q

Where does the extensor expansion lie with respect to the phalanx

A

Deep (entensor dorsal expansion)

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8
Q

There are 2 fibrous septa of the palm, what are these and where are they

A

Medial septum: between the palmar aponeurosis and the 5st metacarpal

Lateral septum: from palmar aponeurosis to the 3rd metacarpal

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9
Q

State the compartments of the hand

A

Hypothenar compartment
Central compartment
Thenar compartment
Adductor compartment

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10
Q

On the surface of the hand, which lies more medial, thenar or midpalmar

and which septum divides the thenar and midpalmar space

A

thenar space

lateral septum divides

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11
Q

Where in the hand are the following:

Thena compartment, 
central compartment, 
Adductor compartment 
Thenar space 
Hyppothenar compartment 
Hypothenar fascia
A

Thenar is proximal to the thumb
Central is underneath the palmar aponeurosis in middle of palm
Adductor is deep to the thenar
Thenar space occurs between the thenar, central and adductor component
Hypothenar is near the little finger
Hypothenar fascia is medial to the hypothenar compartment

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12
Q

Name the categories of intrinsic muscles of the hand

A

thenar compartment
adductor compartment
hypothenar compartment
interossei and lumbricals

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13
Q

State the INTRINSIC thenar muscles

State the INTRINSIC adductor muscles

State the INTRINSIC hypothenar muscles

State the INTRINSIC interossei and lumbricals muscles

A

THENAR:

  • abductor pollicis brevis
  • flexor pollicis brevis
  • opponens pollicis

ADDUCTOR:
-adductor pollicis

Hypothenar muscles:

  • abductor digiti minimi
  • flexor digiti minimi
  • opponens digiti minimi

Interossei and lumbricals:

lumbricals – flex the MCP’s (metacarpalphalyngeal joints), extend the IPJs (interphalyngeal joints)

palmar interossei – adduct the digits (“PAD”)
dorsal interossei – abduct the digits (“DAB”)

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14
Q

Where is the opponens pollicis

A

The anterior part of hand below thumb….. opposition is bringing thumb towards little finger

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15
Q

Look at the diagram of tumb movements

A

…

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16
Q

Which muscles abduct the thumb

A

APL (not intrinsic hand muscle), APB

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17
Q

Which muscles adduct the thumb

A

Adductor pollicis, first dorsal interosseous

both intrinsic hand muscles

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18
Q

Which muscles extend the thumb

A

EPL, EPB, APL

none are intrinsic hand muscles

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19
Q

Whichmuscles flex the thumb

A

FPL (not an intrinsic hand muscle), FPB

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20
Q

Which muscle(s) cause opposition of thumb

A

Opponens pollicis

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21
Q

T/f lumbricals are superifical to the interossei

A

t

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22
Q

Where is te adductor pollicis attached

A

middle finger proximal phalanx to the middle phalynx of the thumb

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23
Q

What muscle is teh adducotr policis supplied by vs the thenar muscles

A

Adductor pillicis- ulnar nerve

Thenar muscles- median nerve

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24
Q

How many dorsal interossei, palmar interossei and lumbricals are there

where do the lumbricals originate

where do lumbricals insert

Where is the attachments of the inerossei muscles

Function of each interossei

A

interossei= 3 palmar interossei= 4 and lumbricals are there=4

from the flexor digitalis profundus…. from tendon not bone!! They come from anterior to posterior

Lumbicals insert into the extensor expansion

Inserted into the base of the proximal phalanx and the extensor expansion

PAD- palmar interossei ADDUCT in relation to the axial line which is down the middle phalanx (all toward the middle phalanx)

DAB- dorsal abduct

2/3 palmar interossei stabilise the middle finger….

look at the attachments

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25
Q

What are the anterior tendons of the hand

A

Fibrous digital sheath

Osseo-fibrous tunnels

In the tunnels run the long flexor tendons and their synovial sheaths

Annular and cruciform pulleys

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26
Q

Outline how flexor muscles of the digits enter the hand

A

FDP and FDS pass in the carpal tunnel,

under the flexor retinaculum,

enter common synovial sheath and

enter digital synovial sheath within its own fibrous digital sheath

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27
Q

T/f the flexor of thumb muscles enter the common synovial sheath

A

f: the FPL do not enter it

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28
Q

T/f the common synovial sheath is continuous with the digital synovial sheath

A

f: the digital synovial sheath for the little finger is continuous with the common synovial sheath.

The synovial sheath for thumb does not enter the common synovial sheath, so this sheath is just continuous with itself

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29
Q

Outline the structure of the FDS and FDP

A

FDS splits around FDP
FDS to middle phalanx, FDP to distal phalanx

as FDP supplies the distal phalyngeal joints

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30
Q

Outline the structure of the synovial sheath of the digit

A

It has two layers (then the fibrous digital sheath on the outside).

These are the synpvial lining of the tunnel (outside) and synovial covering of the tendon (inside)

The space in between these layers is the osseofibrous tunnel

31
Q

T/F an artery of the digit would run in the osseofibrous tunnel

A

F… it runs in the medotendon. This is an area where the two layers of the synovial tendon meet, forming vincula

32
Q

What are vincula

A

Within each osseo-aponeurotic canal, the tendons of the flexor digitorum superficialis and flexor digitorum profundus are connected to each other, and to the phalanges, by slender, tendinous bands, called vincula tendina

33
Q

Outline the parts of the fibrous digital sheath

A

Annular (A1-5 from prox. to dist….. look like rings)

Cruciate (C1-4 from prox to dist…. look like cross)

34
Q

State the tendons of the posterior hand

A 
Extensor retinaculum
Synovial tendon sheaths
Inter-tendinous bands
Extensor expansions
Lumbricals and interossei attach to the expansions
Extensor digitorum, EI, EDM
35
Q

Look at the cross section of the hand….
what is in compartment
1-6

A
  1. Abductor pollicis longus and extensor pollicis brevis
  2. Extensor carpi radialis longus and brevis
  3. Extensor pollicis longus
  4. Tendinous sheath for extensor digitorum and extensor indicis
  5. Extensor digit minimi
  6. Extensor carpi ulnaris
36
Q

Joints of the hand region

A 
Distal radio-ulnar joint
Wrist joint
Intercarpal joints
Carpo-metacarpal and inter-metacarpal joints
Metacarpo-phalangeal joints
Interphalangeal joints
37
Q

What is the axis of rotation from supination to pronation

A

A vertical line through the distal radioulnar joint (exactly where the two bones articulate)

38
Q

The wrist joint

A

Make notes….

39
Q

The articular disc between the ulna and the triquetrum/pisiform is comprised of what

A

The ligamentous border of the articular disc (between the radius and ulna)

and the sacciform recess of the snovial capsule

40
Q

Outline ligaments in the writ

A

……

41
Q

Outline ligaments in the writ

A

…….

42
Q

T/F there are two radial extensors and 1 ulnar

A

T:ECRL, ECRB, ECU

43
Q

Revision: which muscles would be involved in:

radial deviation
ulnar deviation

A

Radial: ECRB, ECRL, FCR, APL

Ulnar: FCU, ECU

44
Q

What are the intercarpal joints

A

Joints between the proximal row:
scaphoid, lunate, triquetral, pisiform

Joints between the distal row:
trapezium, trapezoid, capitate, hamate

Joints between the proximal and distal rows:
the midcarpal joint

45
Q

The CMC of the thumb is between which 2 bones

A

Trapezium –> thumb metacarpl (MC1)

46
Q

What type of joints are the metacarpals involved in

A

CMC of thumb and digit (i.e. metacarpal/carpal)

Intercarpal joints

47
Q

Which movements can occur at the Carpometacarpal and Intermetacarpal Joints (CHECK)

A

flexion and extension
radial deviation and ulnar deviation
circumduction

48
Q

What movement can occur at metacarpal-carpal joints

A

flexion and extension

abduction and adduction

49
Q

Why is the ulnar collateral ligament of the thumb important\?

A

Make notes

50
Q

What movements can happen at the IP joints

A

Flexion and extension only

51
Q

What is DIP and PIP

A

Proximal Interphalangeal PIP

Distal Interphalangeal DIP

52
Q

T/f thumb has both PIP and DIP

A

F…. only one interphalangeal joint

53
Q

What is a volar plate

A

the palmar ligament

54
Q

Outline the components of the metacarpo-phalangeal joint

A
  1. Collateral ligament (cord-like part and fan-like part)

2. Palmar ligament (volar plates)

55
Q

What is the extensor expansion and what is it anchored to

A

pecial connective attachments by which the extensor tendons insert into the phalanges. These flattened tendons (aponeurosis) of extensor muscles span the proximal and middle phalanges….

attach to the PALMAR ligament

56
Q

Slide 48

A

…..

57
Q

Slide 48

A

….

58
Q

Where is the ulnar present on the hand

A

Beside FCU at the wrist

59
Q

Which arch(es) does the ulnar artery form

A

Superficial palmar arch – palmar digital arteries

Deep palmar branch

These come from the interosseous arteries in the forearm of the ulnar

60
Q

Where is the radial artery present

A

Under brachioradialis and beside FCR at the wrist

+

Anatomical snuff box

61
Q

What arteries does the radial artery contribute to

A

Deep palmar arch

Palmar metacarpal arteries

62
Q

Arteries of hand….

A

there is anastamosis between the palmar arch and the dorsal carpal arch

63
Q

Nervous supply of the hand muscles

A

All by the median nerve apart from the adductor policis, which is supplied by the ulnar nerve

64
Q

Clinical significance of the synovial sheaths o fthe hand

A

The flexor pollicis longus has its synovial sheath, which is separate from the common synodival sheath.

As such, infection would not spread to the fingers from the thumb

65
Q

How does the pisiform join with the ulnar and the distal carpal bones

A

It doesn’t it is suspended in a tendon and doesn’t interact with the bones

66
Q

Fuction of each nerve in the forearm

A

Median nerve

  • Main nerve of the anterior compartment of forearm
  • Some supply to hand intrinsic muscles

Ulnar nerve

  • Main nerve of the hand
  • Some of anterior compartment (FCU, half of FDP)

Radial nerve

  • Posterior compartment of the forearm
  • Some sensory component to the hand
67
Q

What are the digital nerves

A

Purely sensory

Often damaged

68
Q

Median nerve function

A

Enters the carpal tunnel with FDP, FDS and FPL
Motor to:
Thenar muscles (APB, FPB, OP) and lumbricals I and II
Sensory to:
Palmar surface of thumb, IF, MF and half of RF
Some of the dorsal surface of those digits

69
Q

Ulnar nerve function

A 
Runs over (not under) the flexor retinaculum, lateral to the pisiform
Divides into;
Superficial branch, sensory to;
palmar surfaces of LF and half of RF
Deep branch, motor to;
hypothenar muscles
adductor pollicis
lumbricals III and IV
all the interossei
70
Q

What does the ulnar nerve pass through

A

The Guyon’s tunnel

71
Q

Outline the 3 types of grip

A
  1. Power Grip
    long flexors of the fingers and thumb
    intrinsic muscles of the palm
    extensors of the wrist joint!
  2. Precision grip
    the wrist and fingers are held rigidly by the long flexors and extensors
    the intrinsic muscles of the hand carry out the fine movements needed

3.Hook grip
consumes little energy, mainly involves long flexors of digits; e.g. carrying shopping bag or briefcase

72
Q

How thick is the extensor retinaculum compared tot he flexor retinaculum

A

NOT as thick and chunk as the flexor retinaculum, but it is able to hold the tendons down.

73
Q

Outline structure of extensor tendons vs flexor tendons

A

There are some connections between extensors of digits (i.e. between extensor digitum and extensor digiti minimi too)…

called INTERDENDINOUS CONNCTION

74
Q

Outline the ligaments of the wrist (not included on the ppt. but fairly simple)

A

There are four ligaments of note in the wrist joint, one for each side of the joint

Palmar radiocarpal – It is found on the palmar (anterior) side of the hand. It passes from the radius to both rows of carpal bones. Its function, apart from increasing stability, is to ensure that the hand follows the forearm during supination.

Dorsal radiocarpal – It is found on the dorsum (posterior) side of the hand. It passes from the radius to both rows of carpal bones. It contributes to the stability of the wrist, but also ensures that the hand follows the forearm during pronation.

Ulnar collateral – Runs from the ulnar styloid process to the triquetrum and pisiform. Works in union with the other collateral ligament to prevent excessive lateral joint displacement.

Radial collateral – Runs from the radial styloid process to the scaphoid and trapezium. Works in union with the other collateral ligament to prevent excessive lateral joint displacement.

AoL (9 decks)

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