Upper Extremity: Hand (Part 2) Flashcards
Hypothenar Muscles
- Abductor digiti minimi
- Flexor digiti minimi brevis
- Opponens digiti
Hypothenar Muscles Proximal Attachment
- Carpals
- Flexor retinaculum
Hypothenar Muscles Distal Attachment
- Distal attachment
5th metacarpal (ODM)
Base of 5th proximal phalanx (FDMB, ADM)
Hypothenar Innervation
- Deep branch of ulnar
Hypothenar Function
- Name tells you function
- ADM can also help flex proximal phalanx of 5th digit
Lumbricals (“Worm-Like”) Proximal Attachment
- Tendons of FDP
- 1st and 2nd attach to one tendon
- 3rd and 4th attach to 2 adjacent tendons
Lumbricals (“Worm-Like”) Distal Attachment
- Extensor expansion of digits 2-5 (lateral side)
- Ex: 1st lumbrical > 2nd digit extensor expansion
1st and 2nd Lumbricals (“Worm-Like”) Innervation
- Median nerve
3rd and 4th Lumbricals (“Worm-Like”) Innervation
- Deep branch of ulnar nerve
Lumbricals (“Worm-Like”) Function
- Flex MCP joint and extend IP joints
Palmar Interossei Proximal Attachment
- Metacarpals 2 (1st), 4 (2nd), 5 (3rd)
Palmar Interossei Distal Attachment
- Base of proximal phalanges
- Extensor expansion of digits
- Medial 2nd (1st), Lateral 4th (2nd), Lateral 5th (3rd)
Palmar Interossei
- 3 in number (numbered from lateral to medial)
Palmar Interossei Function
- Adduct digits 2,4,5
- Flex MCP and extend IP’s of respective digits
Dorsal Interossei
- 4 in number
Dorsal Interossei Proximal Attachment
- Adjacent metacarpals
- Ex: 1st dorsal interossei attaches to 1st and 2nd metacarpal
Dorsal Interossei Distal Attachment
- Base of proximal phalanges and extensor expansion of digits 2-4
- Lateral 2nd (1st), lateral 3rd (2nd), medial 3rd (3rd), medial 4th (4th)
Dorsal Interossei Innervation
- Deep branch of ulnar nerve
Dorsal Interossei Function
- Abduct digits 2,4,5
- Flex MCP and extend IP’s of respective digits
Palmar Interossei Innervation
- Deep branch of ulnar nerve
Radial and Ulnar Arteries of Hand
- Form the dorsal carpal arch, superficial and deep palmar arches
Dorsal Carpal Arch
- Formed by branches of radial and ulnar arteries
- Gives off 2nd – 4th dorsal metacarpal arteries
- 1st dorsal metacarpal is a branch off of radial
Superficial Palmar Arch
- Formed by ulnar artery + superficial branch of radial
- Superficial to long flexor tendons
- Located about mid-palm
- Gives off 3 common palmar digital branches
3 Palmar Digital Branches
- Travels on the lumbricals 2 - 4
- Proper palmar digital branch off from common palmar digital
Radial passes through snuffbox and through 1st dorsal interossei. Gives off:
- Princeps pollicis artery: palmar side of 1st digit
- Radialis indicis: lateral side of 2nd digit
Deep Palmar Arch
- Formed by radial + deep branch of ulnar
- Deep to long flexor tendons and adductor pollicis
- Located at the base of metacarpals
Deep Palmar Arch Gives Off
- Palmar metacarpal arteries
- Perforating branches
Palmar Metacarpal Arteries of Deep Palmar Arch
- Anastomose with common palmar digital
Perforating Branches of Deep Palmar Arch
- Anastomose with dorsal metacarpal arteries
Nerves of the Hand (Palmar Aspect)
- Median nerve
- Ulnar nerve
Median Nerve of Hand (Palmar Aspect)
- Palmar cutaneous branch
- Recurrent branch
- Common palmar digital nerves
Palmar Cutaneous Branch
- Arises before carpal tunnel and innervates palm
Recurrent Branch
- Supplies thenar muscles
Common Palmar Digital Nerves
- Proper palmar digital nerves
Ulnar Nerve (In the Ulnar Canal)
- Palmar cutaneous branch
- Superficial branch
- Deep branch
Ulnar nerve (in the ulnar canal)
Palmar cutaneous branch
Superficial branch
Palmaris brevis muscle
Common palmar digital and proper palmar digital
Sensory to 5th digits and medial ½ of 4th
Deep branch
supplies all muscles of the hand innervated by ulnar nerve, except palmaris brevis
Joints
Accompanies deep branch of ulnar artery and deep palmar arch
Ulnar nerve (in the ulnar canal)
Palmar cutaneous branch
Superficial branch
Palmaris brevis muscle
Common palmar digital and proper palmar digital
Sensory to 5th digits and medial ½ of 4th
Deep branch
supplies all muscles of the hand innervated by ulnar nerve, except palmaris brevis
Joints
Accompanies deep branch of ulnar artery and deep palmar arch
Superficial Branch of Ulnar Nerv
- Palmaris brevis muscle
- Common palmar digital and proper palmar digital
- Sensory to 5th digits and medial ½ of 4th
Deep Branch of Ulnar Nerve
- Supplies all muscles of the hand innervated by ulnar nerve, except palmaris brevis
- Joints
- Accompanies deep branch of ulnar artery and deep palmar arch
Common Palmar Digital and Proper Palmar Digital (Ulnar Nerve)
- Sensory to 5th digits and medial ½ of 4th
Nerves of the Hand (Dorsal Aspect)
- Ulnar nerve
- Radial nerve
Ulnar Nerve
- Dorsal branch of ulnar (sensory)
- Dorsal digital nerves
- Supplies dorsum and medial 1 ½ digits
Radial Nerve
- Superficial branch of radial (sensory)
- Dorsal digital branches
- Supplies dorsum and lateral 3 ½ digits
- Lateral portion of thenar eminence
Palmar Digital Nerves from Median and Ulnar Nerves
- Supplies distal aspect of fingers
Floor (Posterior) of Carpal Tunnel
- Carpal bones
Roof (Anterior) of Carpal Tunner
- Flexor retinaculum (transverse carpal ligament)
Transverse Carpal Ligament Lateral Attachment
- Scaphoid
- Trapezium
Transverse Carpal Ligament Medial Attachment
- Pisiform
- Hook of hamate
Content of Carpal Tunnel
- 4 tendons of FDS
- 4 tendons of FDP
- Tendon of FPL
- Median nerve
Carpal Tunnel Syndrome
- Signs and symptoms due to median nerve compression in the carpal tunnel
- Caused by different factors
Carpal Tunnel Syndrome Symptoms
- Pain, anesthesia, paresthesia (numbness, prickling sensation) to lateral 3 ½ digits
- Hand clumsiness/weakness
- Weakness and wasting of (LOAF muscles)
- Ape-hand deformity
Pain, anesthesia, paresthesia (numbness, prickling sensation) to lateral 3 ½ digits in Carpal Tunnel Syndrome
- Pain can extend into distal forearm
- Central palm and lateral thenar sensation are normal
Weakness and Wasting of (LOAF Muscles) in Carpal Tunnel Syndrome
- 1st and 2nd Lumbricals
- Opponens pollicis
- APB
- FPB
Ape-Hand Deformity
- Atrophy of thenar
- Inability to move thumb away from hand
Ganglion Cyst
- Common benign soft tissue tumor found in the hand/wrist
- Most common over dorsal wrist
- Volar ganglion cyst can cause compression of median or ulnar nerves (or branches)
- Pathogenesis is unknown, originates from joints of the wrist or flexor sheaths
Origination of Pathogenesis from Joints of the Wrist or Flexor Sheaths (Ganglion Cyst)
- Connective tissue degeneration and cystic space formation
- Herniation of synovium
- Leakage of synovial fluid into surrounding space
Pathogenesis of Ganglion Cysts
- Unknown
- Originates from joints of the wrist or flexor sheaths
Ganglion Cyst Treatment
- Observation
- Aspiration
- Surgical resection
