Upper limb - hand Flashcards
What two nerves does the median nerve split into when it enters the hand?
Recurrent branch of median nerve
Palmar digital branch of median nerve
What are the contents of the carpal tunnel?
Median nerve Tendons of:
Flexor digitorum superficialis (4)
Flexor digitorum profundus (4)
Flexor pollicus longus (1)
What structure is affected in carpal tunnel syndrome?
Median nerve
Which muscle becomes the palmar aponeurosis?
Palmaris longus
Where is the flexor carpi radialis tendon found?
Within the flexor retinaculum
What does the recurrent branch of the median nerve innervate?
Thenar muscle group
What does the palmar digital branch of the median nerve innervate?
Lateral 2 lumbircal muscles
What does the median nerve give cutaneous sensation to?
Palmar skin
Dorsal nail beds of laterl 3 1/2 digits (including thumb)
Which hand muscles are supplied by the deep branch of the ulnar nerve?
Hypothenar muscles
Medial 2 most lumbrical muscles (ring/little finger)
Adductor pollicus Interossei of hand
Palmar brevis
What are the thenar muscles responsible for?
Opposition of the thumb
What are the 3 thenar muscles?
Adductor pollicus brevis
Flexor pollicus brevis
Opponens pollicus
Which nerve innervates the thenar compartment?
Median nerve
What nerve segmental fibres innervate the thenar muscles?
C8/T1
What are the hypothenar muscles? (3)
Abductor digit minimi
Flexor digit minimi
Opponens digiti minimi
What nerve innervates the hypothenar muscles?
Ulnar nerve
What is the segmental values of the nerves innervating the hypothenar muscles?
C8 + T1
What are the two heads of the adductor pollicus?
Transverse head
Oblique head
From what tendons do the lumbricals originate?
Tendons of the flexor digitorum profundus
What is the action of the lumbrical muscles?
Flex fingers at metacapophalangeal joint
Extend interphalangeal joint 2nd-5th digits
What nerves innervate the lumbricals?
Lateral 2 median nerve
Medial 2: ulnar nerve
How many dorsal interossei are there?
4
How many palmar interossei are there?
3
What is the action of the dorsal interossei?
Abduct the fingers DAB
What is the action of the palmar interossei?
Adduct the fingers PAD
What nerve innervates the interossei?
Ulnar nerves
What spinal segments innervate the interossei?
C8 +T1
What is the origin of the dorsal interossei?
From metacarpal proximal side.
What is the attachment of the dorsal interossei?
Extensor hood of each finger
Proximal phalanx of each finger
What is the origin of the palmar interossei?
Medial surface of metacarpal of index finger
Lateral surfaces of metacarpal of ring an pinky finger
What is the attachment of the dorsal interossei?
Extensor hood + distal phalangeal of the same finger
What trunk of the brachial plexus is affected in klumpke paralysis?
Inferior (roots C8-T1)
What is klumpke paralysis?
“claw hand”
What is the main contributor to the superficial palmar arch?
Ulnar artery
What is the main contributor to the deep palmar arch?
Radial arch
What muscles in the hand does the ulnar nerve not innervate?
Thenar muscles
First and second lumbricals
What branch of the brachial plexus does the ulnar nerve arise from?
Medial branch
What type of joint is the wrist?
Synovial condyloid joint
What bones make up the wrist joint?
Radius
Scaphoid
lunate
What movements are available at the wrist?
Flexion
Extension
Circumduction
Ulnar deviation
What is the combined action of the extensor and flexor carpi ulnaris?
Adduction (ulnar deviation)
What muscles abduct the wrist?
Extensors carpi radialis
Flexor carpi radialis
What is a synovial cyst?
A non tendor cystic growth appearing most commonly on dorsum of hand, often associated with tendon synovial shealths
What is another name for the anatomical snuffbox?
Radial fossa
What makes up the floor of the anatomical snuffbox?
Scaphoid bone,
trapezium
Which tendons form boundaries for the anatomical snuffbox?
Extensor pollicus brevis
Abductor pollicus brevis (both laterally)
Extensor pollicus longus (medially)
What are the contents of the anatomical snuffbox?
Radial artery
Superficial branch of radial nerve
Cephalic vein
Why is the anatomical snuffbox of clinical importance?
Site for palpation of the scaphoid fracture
What muscles attach to the extensor expansion?
Lumbricals
Dorsal interossei
Where are the extensor hoods located?
In each finger
contents of cubital fossa
median nerve, biceps brachii tendon, brachial artery
what nerve is innervation the skin in the shaded area (palmar surface)
median nerve
*ulnar skin innervation shaded in blue
mn: the ring finger is the one that gets split in half –> like a marriage
in the hand, the ulnar nerve goes through the ____________
tunnel of Guyon
mn: gUyon –> U for ulnar
located in the hypothenar region
what nerve innervates the dorsal portion of the hand up to 0.5 of the ring finger?
superficial branchb of the RADIAL nerve
what is the princeps pollicis
the thumb’s independent blood supply from the radial arter
what do you call the vessels that come from the deep palmar arch and anastomose with the superficial palmar arch
metacarpal arteries - starting with medial side of pointer finger to each side of each f inger to the medial side of the pinky
what nerves are responsible for this action
the dorsal interossei, aided by the abductor pollicis brevis, which abducts the thumb, and the abductor digiti minimi, which abducts the little finger.
mn: DAB PAD –> Dorsals ABduct
other than abduction, what is the secondary function of the dorsal interossei
In addition to their main function, the dorsal interossei contribute to the
- flexion in the metacarpophalangeal (MCP) joints –> curling hand so that knuckles are prominent)
- extension (straightening of ) the proximal (PIP) and distal interphalangeal (DIP) joints.
This is the reason a patient may have claw hand if there is an ulnar injury
what muscle
adductor pollicis
it inserts at the base of the proximal phalynx and the ulnar sesamoid bone of MCP
what innervation
deep branch of ulnar nerve
*** don’t confuse this just because its in the thenar compartment… it is not part of 1/2 LOAF
origin of opponens pollicis
origin of palmaris brevis
palmar aponeurosis
what is the origin of these lumbricals?
tendon of flexor digitorum profundus muscle
what is the origin of the dorsal interossei muscles
the metacarpal bones
which is more common capitate or lunate dislocation?
Capitate (perilunate) dislocation is more common than lunate dislocation
