UL: Hand Flashcards
Carpal bones
Structures through the carpal tunnel
Median nerve
Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus
(flexor carpi radialis)
Structures going over the carpal tunnel
Ulnar nerve
Ulnar artery
Palmaris longus tendon
Palmar aponeurosis
Continuous of palmaris longus tendon if present otherwise anchored to the retinaculum
Anatomical snuffbox borders
Extensor pollicis longus
Extensor pollicis brevis
Anatomical snuffbox content
Scaphoid
Radial artery
Cephalic vein
Origin and insertion of palmaris brevis
palmar apneurosis to skin on medial side
Innervation of palmaris brevis
Superficial branch of ulnar nerve
Action of palmaris brevis
Improves grop
Origin and insertion of dorsal interossei
Adjacent metacarpals to proximal phalanges
Origin and insertion of palmar interossei
Side of metacarpals to extensor hoods and proximal phalanx of thumb
Innervation of dorsal and palmar interossei
Deep branch of ulnar
Action of interossei muscles
PAD DAB
Palmar adducts
Dorsal abducts
Origin and insertion of adductor pollicis
Transvers head: metcarpal 3
Oblique head: capitate and base of 2 and 3
To extensor hood of thumb
Innervation of adductor pollicis
Deep ulnar nerve
Origin and insertion of lumbricals
Tendon of flexor digitorum produndus
To extensor hoods
Innervation of lumbricals
Medial 2: deep ulnar
Lateral 2: digiatal branch of median
Action of lumbricals
MCP flexion
IP extension
Muscles of the thenar eminence
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Origin and insertion of opponens pollicis
Tubercle of trapezium to lateral and palmar metacarpal
Origin and insertion of Abductor pollicis brevis
Tubercle of scaphoid and trapezium to proximal phalanx
Origin and insertion of flexor pollicis brevis
Tubercle of trapezium to proximal phalanx
Innervation of thenar muscles
Recurrent branch of median nerve
Action of opponens pollicis
Medial rotation of thumb
Hypothenar muscles
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis
Origin and insertion of opponens digit minimi
Hook of hamate to medial metacarpal 5
Origin and insertion of abductor digiti minimi
Pisiform to proximal phalanx
Origin and insertion of flexor digiti minimi brevis
Hook of hamate to proximal phalanx
Action of opponens digiti minimi
Lateral rotation of metacarpal 5
Innervation of hypothenar muscles
Deep branch of ulnar nerve
Guyon’s canal
Ulnar nerve crossing over carpal tunnel
Median nerve branch at risk of damage over thenar eminence
recurrent branch
Extensor retinaculum tunnels
6
Structures superficial to extensor retinaculum
Cephalic and Basilic vein
Dorsal cutaneous branch of ulnar and superficial branch of radial nerve
Structures deep to extensor retinaculum
How are flexor tendons staying in place and not bow-stringing
Pulley system (thickening of fascia) that allows them to move but not come out
A1 - MCP
A2 - proximal phalanx
C1 (cruciate)
A3- PIP
C2
A4- middle phalanx
C3
A5 - DIP
Flexor sheath coverage
Synovial sheath covers flexor tendons of digits (doesn’t cover extensors)
At the ulnar and radial side forms bursae
Problems with flexor sheath infection
- Fixed tough fibros tissue. Cannot expand leading to do necrosis of tendon/later presents as atrophic tendon rupture
- Scarring between the tendon and the flexor sheath leads to reduced functionality
Branches of radial artery in hand
Princeps pollicis
Radialis indicis
Radial side of the deep palmar arch
Attachment of flexor retaniculum
Lateral edge of the trapezium
Tubercle of scaphoid
Hook of hamate
pisiform
What structures cut through for carpal tunnel release op
Skin, Subcut fascia, Palmar fascia, (palmaris brevis), flexor retaniculum
What structures at risk during carpal tunnel release
Nerves:
- Palmar cutaneous branch (median)
- Recurrent branch (median)
- Ulnar n (if incision too ulnar)
- Median (if too deep) +
Superficial palmar arch
Flexor tendons
