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The Hand Flashcards

1
Q

How are the thumb and digits named?

A 
Thumb (1st)
Index Finger (2nd)  
Middle Finger (3rd)
Ring Finger (4th)
Little Finger (5th)
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2
Q

What bones other than the carpals make up the hand?

A

Metacarpals

Proximal, Middle and Distal Phalanges

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3
Q

How many radio-ulnar joints are there?

A

2 – proximal and distal

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4
Q

Describe the distal articulation of the radius and ulna with the carpal bones.

A

Radius – articulates with scaphoid and lunate

Ulna – doesn’t directly articulate with the carpal bones, it articulates with an articular disc

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5
Q

What separates the anterior and posterior compartments of the forearm?

A

Interosseous membrane

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6
Q

What are the four parts of the metacarpals?

A

Head (distal), tubercle, shaft and base

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7
Q

Which two carpal bones have bone protrusions?

A

Hook of Hamate

Tubercle of Trapezium

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8
Q

What type of skin do you get on the palms of your hands?

A

Palmar-plantar skin

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9
Q

Which muscle forms the palmar aponeurosis?

A

It is the distal end of palmaris longus

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10
Q

What is the palmar aponeurosis distally and proximally continuous with?

A

Distal – fibrous digital sheaths

Proximal – flexor retinaculum

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11
Q

What is contained within the fibrous digital sheaths?

A

Flexor tendons and their synovial sheaths

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12
Q

Which muscle tendons are found within the fibrous digital sheaths? Describe their attachments.

A

Flexor digitorum superficialis
Flexor digitorum profundus

FDS lies superficial to FDP and splits in two about midway up the proximal phalanx
FDP then runs between the two divisions of FDS

The two branches of FDS attach to the middle phalanx and FDP attaches to the distal phalanx

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13
Q

Which small quadrate muscle is found proximal to the hypothenar compartment?

A

Palmaris brevis

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14
Q

What is another name for the flexor retinaculum?

A

Transverse carpal ligament

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15
Q

Name the compartments of the hand.

A

Thenar
Hypothenar
Adductor
Central

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16
Q

What separates the compartments of the hand?

A

Fibrous septa

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17
Q

What are the two main spaces found within the hand?

A

Midpalmar

Thenar

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18
Q

What structures do the septa form within the hand?

A

Channels that contain various structures e.g. long flexors passing from the wrist into the digits

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19
Q

Which muscles have a proximal attachment along the ulna rather than the common extensor tendon?

A 
Abductor pollicis longus (APL)
Extensor pollicis longus (EPL) 
Extensor pollicis brevis (EPB) 
Extensor indicis (EI)
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20
Q

Describe the attachment of brachioradialis.

A

PA - Distal lateral side of the humerus

DA - lateral part of the styloid process of the radius

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21
Q

Name all the intrinsic muscles of the hand.

A

Thenar: Abductor pollicis brevis (APB), Flexor pollicis brevis (FPB), Opponens pollicis (OP)

Hypothenar:Abductor digiti minimi (ADM), Flexor digiti minimi (FDM), Opponens digiti minimi (ODM)

Adductor: Adductor pollicis (AP)

Interossei and Lumbricals: Palmar interossei
Dorsal interossei
Lumbricals

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22
Q

What movements are the lumbricals responsible for?

A

Flexion of metacarpophalangeal joint (MCP)

Extension of the interphalangeal joints (IPJs)

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23
Q

What movements are the palmar and dorsal interossei responsible for?

A

PAD & DAB
Palmar = ADduction of the fingers
Dorsal = ABduction of the fingers

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24
Q 
Which muscles are responsible for the following thumb movements:
Abduction
Adduction
Extension 
Flexion
Opposition
A

Abduction: Abductor pollicis longus (APL), Abductor pollicis brevis (APB)

Adduction: Adductor pollicis (AP), First dorsal interosseus

Extension: Extensor pollicis longus (EPL), Extensor pollicis brevis (EPB), Abductor pollicis longus (APL)

Flexion: Flexor pollicis longus (FPL), Flexor pollicis brevis (FPB)

Opposition: Opponens pollicis

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25
Q

Why is adductor pollicis in a different compartment to the other pollicis muscles?

A

It is innervated by the ulnar nerve whereas the thenar muscles are all innervated by the median nerve

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26
Q

How many lumbricals, dorsal interossei and palmar interossei are there?

A

Lumbricals – 4
Dorsal interossei – 4
Palmar interossei - 3

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27
Q

Describe the attachments of the dorsal interossei and explain why they cause abduction of the fingers.

A

Dorsal interossei are attached proximally to adjacent metacarpals
They attach distally to the base of the proximal phalanx and extensor expansion towards the axial line (through the middle finger) of the hand
Dorsal interossei 2 and 3 are attached to opposite sides of the middle finger so it fixes the middle finger in the midline while dorsal interossei 1 and 4 cause abduction of the index and little fingers

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28
Q

Describe the attachments of the palmar interossei.

A

Palmar interossei are attached to the extensor expansion away from the axial line (there is no palmar interossei attached to the middle finger)
The cause adduction of the fingers whilst the middle finger remains still

29
Q

Describe the attachments of the lumbricals.

A

They are attached proximally to the tendons of flexor digitorum profundus
They come around the lateral side of the digits and inserts onto a hood of connective tissue called the extensor expansion over the proximal interphalangeal joint

30
Q

Describe the sheaths that that the tendons of flexor digitorum superficialis and flexor digitorum profundus travel in after passing under the flexor retinaculum.

A

They travel under the flexor retinaculum in the carpal tunnel then they enter a common synovial sheath
Then the tendons going to the middle three fingers enter digital synovial sheaths

31
Q

Describe how the little finger and thumb sheaths are different to the other three fingers.

A

Their digital synovial sheaths are continuous with the common synovial sheath

32
Q

Describe the arrangement and attachment of flexor digitorum superficialis and flexor digitorum profundus as it runs along the fingers.

A

Flexor digitorum superficialis splits around flexor digitorum profundus around the middle of the proximal phalanx
Flexor digitorum superficialis then attaches to the middle phalanx
Flexor digitorum profundus attaches to the distal phalanx

33
Q

Describe the arrangement of the digital fibrous sheaths, synovial sheaths and osseo-fibrous sheaths.

A

The entire thing is an osseo-fibrous sheath

This contains digital fibrous sheaths, which, in turn, contain synovial sheaths

34
Q

What are the two types of pulley that hold the tendons down to the bone?

A

Annular and Cruciform

35
Q

Describe the posterior tendinous anatomy of the hand.

A

You get the extensor retinaculum followed by synovial tendon sheaths and intertendinous bands
At the end of the long extensors there are extensor expansions

36
Q

Which muscles attach to the extensor expansions?

A

Lumbricals and some interossei

37
Q

What are the two fibrous capsules found at the wrist joint?

A

Radio-carpal joint

Distal radio-ulnar joint

38
Q

Which two ligaments are found on the radial and ulnar sides of the wrist?

A

Radial Collateral Ligament

Ulnar Collateral Ligament

39
Q

Which carpal bone does the thumb metacarpal articulate with?

A

Trapezium

40
Q

What movements are the metacarpophalangeal joints capable of?

A

Flexion and extension

Abduction and adduction

41
Q

What ligament prevents hyperextension of the interphalangeal joints?

A

Palmar plates (AKA volar plates)

42
Q

Which ligaments prevent abduction and adduction of the interphalangeal joints?

A

Collateral ligaments

43
Q

What are the two main arteries of the hand and what do they divide into?

A

Ulnar Artery: found beside the flexor carpi ulnaris
Interosseous arteries of the forearm
Superficial palmar arch – palmar digital arteries
Deep palmar branch

Radial Artery: under brachioradialis and beside flexor carpi radialis in the wrist
Found in the anatomical snuff box
Deep palmar arch
Palmar metacarpal arteries

44
Q

What are the anterior and posterior interosseous arteries a branch of?

A

Ulnar Artery

45
Q

What is the arch on the dorsal side of the hand called?

A

Dorsal carpal arch

46
Q

What are the two divisions of palmar digital arteries that come off these arches?

A

Common palmar digital arteries

Proper palmar digital arteries

47
Q

Where do you find anastomoses in the hand?

A

Between the dorsal and palmar digital arteries

The arches and plexuses are also places of anastomoses between the radial and ulnar arteries

48
Q

What are the two main superficial veins of the arm?

A

Cephalic and Basilic

49
Q

What happens to the basilic and cephalic veins as they pass into the upper arm?

A

The basilic vein dives deep just above the elbow to form the axillary vein
The cephalic vein joins the axillary vein higher up

50
Q

At what point does the axillary vein become the subclavian vein?

A

As it passes over the first rib

51
Q

What pattern do the deep veins from the hand follow?

A

They pass in the opposite direction to the arteries

52
Q

What vein links the cephalic and basilic vein in the cubital fossa?

A

Median cubital vein

53
Q

Which spinal nerves contribute to the ulnar, median and radial nerves

A

Ulnar Nerve : C8-T1
Median Nerve: C6-T1
Radial Nerve: C5-T1

54
Q

What is the main motor nerve of the hand?

A

Ulnar nerve

55
Q

What is the radial nerve responsible for in the hand?

A

Sensory innervation of the lateral half of the dorsum of the hand

56
Q

What type of nerve are the digital nerves?

A

They are purely sensory because the motor innervation to the muscles controlling the fingers happens more proximally

57
Q

What are the contents of the carpal tunnel?

A

4 tendons of flexor digitorum superficialis
4 tendons of flexor digitorum profundus
Flexor pollicis longus tendon
Median nerve

58
Q

Where does the median nerve lie relative to the forearm muscles at the wrist?

A

In between FDP and FDS

Deep to PL

59
Q

What intrinsic hand muscles does the median nerve provide motor supply to?

A 
LOAF
Lumbricals (1 and 2) 
Opponens pollicis 
Abductor pollicis brevis 
Flexor pollicis brevis
60
Q

What does the median nerve provide sensory supply to?

A 
Palmar surface of thumb
Index finger 
Middle finger 
Half of the ring finger 
Tips of the dorsal surface of those digits
61
Q

Describe the position of the ulnar nerve at the wrist.

A

It lies by flexor carpi ulnaris

It runs over the flexor retinaculum, lateral to the pisiform

62
Q

What are the two branches of the ulnar nerve in the hand and what are their roles?

A

Superficial branch sensory to:
Little finger and medial half of right finger

Deep branch motor to: 
Hypothenar muscles 
Abductor pollicis 
Lumbricals 3 and 4 
All the interossei 
(In other words: all the muscles except LOAF)
63
Q

The radial nerve divides into two branches just above the elbow. What are the two branches of the radial nerve?

A

Superficial radial nerve (sensory)

Posterior interosseous nerve (motor)

64
Q

Which part of the hand does the radial nerve supply sensory innervation to?

A

Dorsum of the hand (mainly thumb, index finger and middle finger)

65
Q

What sensory branches does the median nerve give off before passing under the flexor retinaculum?

A

Palmar cutaneous branch

Dorsal branch

66
Q

What are the bony attachments of the carpal tunnel that forms a gutter?

A

Scaphoid
Trapezium
Pisiform
Hamate

67
Q

Through which canal do the ulnar nerve and artery pass through?

A

Guyon’s Canal

68
Q

What are the three different types of grip and which muscles are involved in each type?

A

Power Grip:
Long flexors of the fingers and thumb
Intrinsic muscles of the palm
Extensors of the wrist joint

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

Hook Grip:
Consumes little energy
Mainly involves long flexors of the digits (e.g. carrying shopping bag or briefcase)

69
Q

What wrist movement do you need to achieve full flexion of the fingers and why?

A

The flexors have to be slightly longer than need be to allow the wrist and fingers to fully extend
This means that to get full flexion you need to extend the wrist to shorten the flexors so that they can fully flex
This is why you can more easily take something from someone’s grip if you flex the wrist to loosen the grip

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