The Hand (MSK) Flashcards
What are the Metacarpals? How many is there? How are they numbered?
Bones in the Hand distal to the Carpus
5
1-5 (Lateral to medial)
What are the Bones of the Digits? How many is there?
Phalanges
In digits 2-5 there is three
In digit 1/Thumb there is two
What are the three phalanges in the finger called? What about the thumb?
Proximal, Middle and Distal Phalanges
Proximal and Distal phalanges (Thumb only)
What type of Joints connect the Metacarpals and the Distal row of carpal bones?
Carpometacarpal joints
What is the First carpometacarpal joint between? What type of joint is it?
Trapezium and the 1st metacarpal/thumb
Saddle joint
What are the Knuckles known as? What are they between?
Metacarpophalangeal joints
Metacarpals and Proximal Phalanges
What types of joints are the Metacarpophalangeal joints?
Condyloid synovial joints
What type of joints are found in between the Phalanges? What type of joint are they?
Interphalangeal joints
Hinge synovial joints
Name joints a-c
a-Distal Interphalangeal joints
b-Proximal Interphalangeal joints
c-Metacarpophalangeal joints
Name joints d-f
d-Radiocarpal joint
e- Carpometacarpal joint
f- Interphalangeal joints
What are three types of grips the hands are important for?
Power grip- Squeeze
Hook grip- Carrying objects
Precision grip- Holding items between the pads of our thumbs and fingers
4 movements of digits 2-5
Flexion
extension abduction
adduction
What are the 5 movements of the thumb?
Flexion
Extension
Abduction
Adduction
Opposition
Describe the movement of opposition in the thumb?
A mixture of flexion, Adduction and internal rotation
Where are the extrinsic muscles of the Hand located?
Anterior and Posterior forearm
What are the Three muscles that flex the Digits in the Anterior forearm?
Flexor Digitorum superficialis
Flexor Digitorum Profundus
Flexor Pollicis Longus
What muscle is a? How does it attach to the Digits? What joints does it flex?
Flexor digitorum superficialis
Attached to each side of the Middle phalanx
Flexes the Metacarpophalangeal and Proximal Interphalangeal joints
Which muscle is the only one to flex the Distal Interphalangeal jointi in digits 2-5? Where do its tendons insert?
Flexor Digitorum Profundus
Palmar aspect of the distal phalanx of digits 2-5
What muscle is this? Where does it insert? What joint does it move?
Flexor pollicis longus
Distal phalanx of the thumb
Flexes the IP joint (Only muscle to do so)
Name structures a-d
a- Tendons of Flexor Digitorum Profundus
b- Tendons of Flexor Digitorum Superficialis
c- Lumbricals
d- Proximal Phalanx
Name structures e-h
e- Middle Phalanx
f- Distal Phalanx
g- Tendons of Flexor digitorum profundus
h- Tendons of flexor digitorum superficialis
Name structures i-k
i- Lumbricals
j- Tendon of flexor Pollicis Longus
k- Tendon of Flexor Pollicis Longus
What structures maintain the position of flexor tendons in the midline of each finger?
Fibrous sheaths known as Flexor tendon sheaths
What are the Tendons enclosed in? What does this do and allow?
Within a synovial sheath
Reduces friction and allows the tendons to slide freely
What is the only tendon that can move the Interphalangeal joint of the thumb?
Flexor Pollicis longus
What structure protects the Long flexor tendons, tendon sheaths and vessels as they pass through the hand?
Palma aponeurosis
What is the Infection, inflammation of the tendon and synovial sheath known as?
Tenosynovitis
What are the four muscle groups of the hand?
Thenar eminence
Hypothenar eminence
Lumbricals
Interossei
Which hand muscle does not fit into this group(Thenar eminence)?
What nerves innervates the muscles of the hand?
Adductor pollicis
Ulnar and Median nerves
What are the three muscles of the Thenar eminence? Functions?
Flexor Pollicis brevis- flexes thumb
Abductor Pollicis brevis- Abducts the thumb
Opponens pollicis- Opposes the thumb
What is the Origin of the Thenar muscles? Where is the Opponens pollicis in respects to the other two thenar muscles?
Carpal bones
It is deep to the Flexor and Abductor
Name a-c
a- Flexion
b- Abduction
c- Opposition
Name d-f
d- Proximal phalanx
e- Proximal phalanx (lateral aspect)
f- 1st Metacarpal
Name g
Recurrent branch of Median nerve
When does the Recurrent branch of the Median nerve leave the Median nerve? Which means?
After it has passed the Carpal tunnel
Carpal tunnel syndrome will impact these muscles
In which two ways does the Abductor Pollicis differ from the Thenar eminence muscles?
Deep in palm, not thenar eminence
Innervated by Ulnar nerve
Where does the Adductor Pollicis attach to and insert?
3rd metacarpal
Proximal phalanx of thumb
Describe the Hypothenar eminence and location?
Fleshy mass on the medial side of the palm of the hand proximal to the little finger
What are the three muscles of the Hypothenar eminence?
Flexor digiti minimi
Abductor Digiti minimi
Opponens digiti minimi
What is the origin of the Hypothenar muscles?
Proximal Carpal bones
Name a-c
a- Flexion
b- Abduction
c- Opposition
Name d-f
d- Proximal Phalanx
e- Proximal Phalanx
f- 5th metacarpal
Name g
Deep branch of the Ulnar nerve
Name a-c
a- Opponens Digiti minimi
b- Abductor Digiti minimi
c- Flexor digiti minimi brevis
Name structures d-f
d- Flexor retinaculum
e- Opponens Pollicis
f- Abductor Pollicis brevis
Name structures g and h
g- Flexor Pollicis brevis
h- Adductor Pollicis
What are the Lumbrical muscles origin?
Tendons of the Flexor digitorum profundus
Where do the Lumbrical muscles travel? and where do they insert?
Lateral aspects of the digits 2-5
Insert on the dorsal aspects of digits 2-5
What is the action of the lubrical muscles?
Flex the MCP joints of digits 2-5
Extend the IP joints
What are the Lateral two and Medial two digits innervated by respectively?
Lateral two- Median nerve
Medial two- Ulnar nerve
Where are the Interossei muscles located? Where do they insert onto?
Located between the Metacarpals
Dorsal aspect of digits 2-5
Two groups of Interossei muscles? How many in each one?
Palmar Interossei- Three
Dorsal Interossei- Four
Functions of the Palmar and Dorsal Interossei muscles respectively?
Palmar- adduct
Dorsal- Abduct
Pneumonic to remember Movements of Interossei muscles?
PAD-DAB
Palmar ADduct Dorsal ABduct
What can be seen on the Dorsum of the Hand?
Extensor tendons
Dorsal interossei
Superficial veins (Dorsal venous network)
What are the superficial veins on the Dorsum of the hand known as?
Dorsal venous network
Name structures a-c
a- Tendon of abductor Pollicis longus
b- Tendon of extensor Pollicis brevis
c- Tendon of extensor Pollicis longus
Name structures
e-g
e- Distal Phalanx
f- Extensor Expansions
g- Middle phalanx
Name structures h-j
h- Distal phalanx
i-Dorsal interossei
j- Tendon of extensor digiti minimi
Name structures k and L
k- Tendon of extensor indicis
l- Tendons of extensor digitorum
What is the fibrous structure located on the dorsal aspect of the digits? Where is it attached to proximally?
Extensor expansion
Proximal Phalanx
What does the Extensor expansion give rise to (3)? Where do each of these structures attach to?
a central slip- Middle phalanx
two marginal slips- Distal phalanx
Tendons of which three muscles attach to the dorsal aspect of the extensor expansion?
Extensor digitorum
Extensor Indices
Extensor digiti minimi
What does the extensor expansion allow? What inserts into the proximal parts of it?
Keep the tendons fixed in the midline
Lumbricals and interossei muscles
What do the Extensor expansion muscles contribute towards as a result of their attachments with the Interossei and lumbrical muscles?
Extension of the interphalangeal joints
What is the anatomical snuffbox?
Triangular shaped depression on the lateral aspect of the wrist (Base of thumb)
What are the Medial and lateral borders of the Anatomical snuffbox?
Extensor Pollicis longus (Medially)
Extensor pollicis brevis and Abductor pollicis longus (Laterally)
When is the Anatomical snuffbox best seen?
When the thumb is fully extended
4 important structures associated with the anatomical snuffbox
Scaphoid bone located at floor
Radial artery travels through it
Cephalic vein travels across
Superficial branch of the radial nerve travels over it
What two arteries supply the hand? What are they the terminal branches of?
Radial and Ulnar
Terminal branches of Brachial artery
Where do the radial and Ulnar arteries travel in the forearm? What does the ulnar artery run with?
Radial- lateral aspect
Ulnar- Medial (Ulnar nerve runs alongside)
Which arteries form when the Radius and Ulnar anastomose? How much blood does each artery contribute to the new arteries formed? (Roughly not numerically)
Superficial palmar artery- mostly by ulnar and small contribution from Radial artery
Deep palmar artery- Mostly radial with small contribution from ulnar artery
What arteries do the Palmar arteries give rise to? What are they accomponied by?
Metacarpal and digital arteries
Digital nerves
What parts of the skin does the Median nerve innervate?
- Palmar surface of lateral side of the hand
- Palmar surface of the lateral 3.5 digits
- Skin over the dorsum of the Distal phalanges of the lateral 3.5 digits
What parts of the skin does the Ulnar nerve provide sensory innervation for?
Palmar and dorsal surfaces of the medial hand
Medial 1.5 digits
The median nerve supplies :
the X surface of the Y side of the hand,
the Z surface of the lateral W digits
the skin over the A of the distal B of the lateral 3.5 digits
X- palmar
Y- Lateral
Z- Palmar
W- 3.5
A- Dorsum
B- Phalanges
Name nerves a,b,c
a- Ulnar nerve
b- Median nerve
c- Radial nerve
Where is the Median nerve tested on?
Central palm, proximal to middle finger
Where is the Ulnar nerve tested for?
Medial border of hadn
Where is the Radial nerve tested for?
Dorsum of the hand in the thumb and Index webspace
Name spinal nerves a and b and give general desciption of area
a- C4- superior aspect of shoulder
b-C5- Lateral shoulder aspects of arm
Name c and d
c- T1 (Medial sides of anterior and posterior surfaces of the arm)
d- C6 (Lateral side from arm to first two digits)
Name e and f
e- C7 (anterior and posterior surfaces of the middle finger and palm of hand)
f-C8 (Medial aspect from forearm to digits 4&5)
Where are the C5 and C6 spinal nerves tested?
C5- Upper lateral arm, over deltoid muscle
C6- thumb
Where are the C7,8 and T1 desmosomes tested for?
C7- middle finger
C8- Little finger
T1- Medial border of arm (proximal to elbow)
