Upper Limb (part 4) Flashcards
What bones form the radial-carpal joint?
Radius, Scaphoid, and Lunate bones
Which bones make up the Proximal row of Carpal bones? (4)
From Lateral to Medial:
-Scaphoid
-Lunate
-Triquetrium
-Pisiform
Which bones make up the distal row of carpal bones? (4)
These bones articulate with the metacarpal bones to form the carpal-metacarpal joints.
From Lateral to Medial:
-Trapezium
-Trapezoid
-Capitate
-Hamate
A large mound of muscle proximal to the thumb
Thenar Eminence
A large mound of muscle proximal to the little finger
Hypothenar Eminence
Found between the Thenar and Hypothenar Eminences
Intermediate Compartment
A triangular shaped structure that begins in the intermediate compartment.
-Has slips of connective tissue that feed into the digits and cover the proximal portions of the digits
-Improves our grasp by creating artificial friction with the skin when you pick up something
Palmar Aponeurosis
A band of tissue running between the two eminences
-Proximal to the Palmar Aponeurosis
Flexor Retinaculum
Joins the lateral, distal carpal bones (Trapezium & Trapezoid) with the medial, distal carpal bones (Capitate & Hamate) to form the Carpal Concavity.
Flexor Retinaculum
Formed by the Carpal bones attaching to the Flexor Retinaculum to make an oval space.
Carpal Tunnel
What structures run through the Carpal Tunnel? (4)
-MEDIAN NERVE
-Tendons of the Flexor Digitorum Superficialis m., Flexor Digitorum Profundus m., and Flexor Pollicis Longus m.
What causes Carpal Tunnel Syndrome?
Compromised Median Nerve due to buildup of pressure, usually due to fluid retention (edema, arthrtitis)
What structures do NOT go through the Carpal Tunnel? (5)
-Palmar Cutaneous Branch of the Median Nerve (branches off before tunnel, runs over it)
-Ulnar Nerve and Ulnar Artery (pass anterior to the tunnel)
-Flexor Carpi Radialis m. (runs through split in the tunnel fibers)
-Palmaris Longus m. (passes over the tunnel)
Nerve that branches off of the Median Nerve just before it gets to the Flexor Retinaculum. Runs over the tunnel, so not affected by CTS.
-Supplies General Sensation to the Thenar Eminence (lateral palm)
Palmar Cutaneous Nerve
Will CTS cause changes in sensation to the skin over the Thenar Eminence (lateral palm)?
NO: the Palmar Cutaneous Nerve branches off before the tunnel.
After the Median Nerve passes through the Carpal tunnel, it gives off this branch in the palm of the hand.
Supplies motor innervation to the muscles of the Thenar Eminence.
-Abductor Pollicis Brevis m.
-Flexor Pollicis Brevis m.
-Opponens Pollicis m.
Recurrent Branch of the Median Nerve
Which 3 muscles are innervated by the Recurrent Branch of the Median Nerve? (Muscles of the Thenar Eminence)
-Abductor Pollicis Brevis m. (abducts thumb)
-Flexor Pollicis Brevis m. (flexes thumb)
-Opponens Pollicis m. (thumb and little finger form a circle)
Found on the dorsal hand and more proximal.
-Connects the radius and the ulna.
-Crosses tendons coming from above and inserts them into the digits of the hand.
-Shifts the tendons down when dorsiflexing the wrist
-Has Compartments 1-6, with 1 starting on thumb side
Extensor Retinaculum
What are the contents of Compartment 1?
Abductor Pollicis Longus m. and Extensor Pollicis Brevis m.
Injury affecting Compartment 1 - occurs with overuse of thumb leading to tendon rubbing back and forth too much, causing pain, swelling, and tendonitis of these tendons
DeQuervain’s Tenosynovitis
What are the contents of Compartment 2?
Extensor Carpi Radialis Longus m. and Extensor Carpi Radialis Brevis m.
What are the contents of Compartment 3?
Extensor Pollicis Longus m.
What are the contents of Compartment 4?
Extensor Digitorum m. and Extensor Indicis m.
What are the contents of Compartment 5?
Extensor Digiti Minimi m.
What are the contents of Compartment 6?
Extensor Carpi Ulnaris m.
What is the purpose of the 6 compartments?
The Extensor Retinaculum crosses over these to hold them in place while you’re dorsiflexing your wrist and fingers.
Which nerve supplies sensation to:
-Dorsal, lateral side of hand
-Dorsal side of thumb
Superficial Radial Nerve
Which nerve supplies sensation to:
-Dorsal/Volar little finger
-Dorsal/Volar medial 1/2 of ring finger
-Dorsal/Volar medial side of hand
Ulnar Nerve
If you hit your funny bone, where will you feel tingling?
Medial Side of hand (due to Ulnar Nerve)
Which nerve supplies sensation to:
-Dorsal/Volar lateral 1/2 of ring finger
-Dorsal/Volar middle & index fingers
-Volar, lateral side of palm
-Volar side of thumb
Median Nerve
Would CTS cause discomfort of the pinky finger?
NO- innervated by the Ulnar nerve
Formed by a ligament between the hook of the hamate bone and the pisiform bone.
-Ulnar nerve passes through it
Guyton’s Canal
Swelling compromises the Ulnar nerve - causes tingling/sensation issues on the ulnar distribution (pinky finger, medial 1/2 of ring finger, medial side of hand)
Handlebar Syndrome (Injury to Guyton’s Canal)
Nerve that supplies sensation to the volar portion of the little finger and volar, medial 1/2 of the ring finger.
-Also supplies sensation to the skin over the hypothenar eminence (volar side)
Volar Cutaneous Nerve (branch of the Ulnar Nerve)
Nerve that supplies sensation to the dorsal aspect of the hand on the medial side, as well as sensation to the dorsal side of the little finger, and the dorsal, medial 1/2 of the ring finger.
Dorsal Cutaneous nerve (branch of the Ulnar Nerve)
Nerve that comes off in the Cubital Fossa, runs superficially to the Brachioradialis m., and runs all the way down forearm to the lateral aspect of the hand & the dorsal aspect of the thumb
-Supplies sensation to the dorsal aspect of lateral hand, and dorsal side of the thumb
Superficial Branch of the Radial Nerve
Formed by the:
-Superficial Palmar Branch of the Radial Artery
-Superficial Branch of the Ulnar Artery
Superficial Volar Arch
Formed by the:
-Radial Artery
-Deep Branch of the Ulnar Artery
Deep Ulnar Nerve runs with this.
Deep Volar Arch
Gives rise to the Common Palmar Digital Arteries (supply the fingers), which then split into the Proper Palmar Digital Arteries (run on either side of each finger).
-Running with the Proper Palmar Digital Arteries are the Proper Palmar Digital Nerves (sensation to the fingers - run on the side of each finger for anesthesia)
Superficial Volar (Palmar) Arch
Artery streams towards wrist, and gives off the Superficial Palmar Branch. Then, it moves dorsally, running on the dorsal side of the hand, passing through the Anatomical Snuff Box, and then turns and goes anteriorly between the index finger and the thumb to supply the volar portion of the hand (by merging with the Deep Ulnar Artery to form the Deep Volar Arch).
Radial Artery
The Deep Volar Arch gives rise to these arteries, which supply the Interosseous Muscles (those that lie between the metacarpals)
Volar Metacarpal Arteries
Name the two branches off of the Deep Volar Arch
-Radialis Indicis Artery (radial side of index finger)
-Princeps Pollicis Artery (center of palm and thumb)
Why can’t you take someone’s pulse with your thumb?
You will feel your own pulse due to the Princeps Pollicis Artery
Gives rise to the Cephalic Vein (lateral) and the Basilic Vein (medial)
-Fed distally by the Dorsal Digital Veins and the Dorsal Metacarpal Veins
Dorsal Venous Arch
What are the three muscles of the Thenar Eminence?
-Abductor Pollicis Brevis m. (abducts thumb)
-Flexor Pollicis Brevis m. (flexes the thumb)
-Opponens Pollicis m. (makes circle with pinky
Which nerve innervates the muscles of the Thenar Eminence?
Recurrent Branch of the Median Nerve
What are the three muscles of the Hypothenar Eminence?
-Abductor Digiti Minimi m. (abducts little finger)
-Flexor Digiti Minimi Brevis m. (Bends little finger down to flex it)
-Opponens Digiti Minimi m. (forms circle with thumb)
Which nerve innervates the muscles of the Hypothenar Eminence?
Deep Branch of the Ulnar Nerve
Which nerves (2) innervate the Intermediate Compartment?
-Deep Branch of the Ulnar Nerve
-Median Nerve
Triangular shaped muscle that originates from the 3rd metacarpal and inserts on the proximal phalanx of the thumb.
-Innervated by the Deep Branch of the Ulnar Nerve
-Transverse head and oblique head together make the triangular shaped muscle that inserts on the thumb.
Adductor Pollicis Muscle
Which nerve innervates the Adductor Pollicis Muscle?
Deep Branch of the Ulnar nerve.
-Nerve crosses the palm (innervates hypothenar eminence muscles), runs with the deep volar arch, and innervates this muscle on the opposite side of the hand.
Adduction/Abduction occur in which plane?
Sagittal Plane
Flexion/Extension occur in which plane?
Coronal Plane
5 total, each have a base (proximal), head (distal), and are connected in between by a shaft.
-Start with thumb -> little finger
Metacarpal bones
Joint formed by the base of the metacarpal bones and the distal row of carpal bones
Carpometacarpal Joint
Joint formed between the proximal phalanx and the metacarpal bones
Metacarpophalangeal Joint
14 total - make up the fingers.
-Index to pinky each have 3: Proximal, middle, and distal
-Thumb only has 2: distal and proximal
Phalanges
Joint found only in the index - little fingers (no thumb).
-Joins the Proximal Phalanx with the Middle phalanx
Proximal Interphalangeal (PIP) Joint
Joint found only in the index - little fingers (no thumb).
-Joints the Middle Phalanx with the Distal Phalanx
Distal Interphalangeal (DIP) Joint
Joint found in the thumb, between it’s two phalanges
Interphalangeal Joint
Branch off of the Medial Cord of the Brachial Plexus that supplies sensation to the medial aspect of the arm
Medial Brachial Cutaneous Nerve
Nerve that branches off of the Radial Nerve to supply sensation to the Posterior aspect of the arm (area over Triceps Brachii m.)
Posterior Cutaneous Nerve (branch of Radial Nerve)
Nerve that supplies sensation to the area over the shoulder
Upper Lateral Brachial Cutaneous Nerve (Branch of the Axillary Nerve)
Nerve that supplies sensation to the Lateral Brachial Region
Lower Lateral Brachial Cutaneous Nerve (Branch of the Radial Nerve)
Nerve that supplies sensation to the medial aspect of the arm, just distal to the axilla
-Has to be anesthetized separately
Intercostobrachial Cutaneous Nerve (T2)
Nerve that supplies sensation to the posterior aspect of the forearm
Posterior Antebrachial Cutaneous Nerve (branch of Radial Nerve)
Nerve that supplies sensation to the medial area of the forearm
Medial Antebrachial Cutaneous Nerve (Off of Medial Cord)
Nerve that supplies the muscles of the flexor compartment, and then travels through the Cubital Fossa where its motor fibers end, and continues as a sensory nerve to the lateral aspect of the forearm.
-Runs with the Cephalic Vein
Lateral Antebrachial Cutaneous Nerve (Musculocutaneous Nerve)
