W12 - Hands & Wrist Flashcards
SUPERFICIAL Anterior Forearm Muscles
FLEXORS
*orientate medial epicondyle, and lateral aspect
BRFrFu (BR frick fuck iits cold)
BRACHIORADIALIS
(radial n.)
supracondular ridge -> styloid of radius
PRONATOR TERES = pronator
(median n.)
medial epicondyle -> radial aspect (goes under the brachioradialis)
FLEXOR CARPI RADIALIS = flexes forearm and elbow
(median n.)
passes across to radial
medial epicondyle -> attach to radial side of hand (metacarpal/carpal/2nd finger)
PALMARIS BREVIS = not all have it = elbow flexion; not strong
FLEXOR CARPI ULNARIS = elbow and forearm flexion
(ulnar n.)
medial epicondyle -> attach to ulnar side of hand
Posterior Forearm Muscles
EXTENSORS
*orientate lateral epicondyle
EXTENSOR CARPI ULNARIS
(radial n.)
stretches across from radial to ulnar side 5th metacarpal
EXTENSOR CARPI RADIALIS
(radial n.)
stretches to 1st MC
PALMARIS LONGUS
(radial n.)
stretches to third MC
Which muscle in the anterior forearm acting singularly would produce ulnar deviation?
FLEX. CARPI ULNARI = ADDUCTION/ULNAR DEVIATION
+ulnar posterior muscles assist
Which muscle in the anterior forearm acting singularly would produce radial deviation?
FLEX. CARPI RADIALIS = ABDUCTION/RADIAL DEVIATION
+radial posterior muscles assist
INTERMEDIATE ANTERIOR AND POSTERIOR FOREARM
ant. = flexors
FLEXOR DIGITORUM SUPERFICIALIS = flexion of fingers & elbow flexor
(median n.)
medial epicondyle & radial ulnar interosseus membrane surface => 4 tendons @ middle phalynx bifurcates
posterior = extension
EXTENSOR DIGITORUM
medial epicondyle => attaches to all phalanges
EXTENSOR DIGITI MINIMI
from extensor digitorum -> attaches to little finger = produces tendon (source of tendon in sx)
DEEP ANTERIOR FOREARM
ant = flexion
FLEXOR DIGITORUM PROFUNDUS = flexion of interpharyngeal joints
(ulnar n. = medial 2; median n. = lateral 2)
attaches to ulnar bone = gives off 4 tendons = to distal phalynx
FLEXOR POLLICIS LONGUS = flexion at interphalyngeal. joint
(median n.)
attach at radius to distal thumb phalynx
Significance of Carpal Tunnel
encloses intermediate and deep tendons attaching to the distal phalynx of fingers
DEEP POSTERIOR FOREARM
Post = Deep extensors abductor
- ANCONEUS
small musle o: lateral epicondyle => ulnar bone
- SUPINATOR
- EXTENSOR INDICES
(radial n.)
ulnar bone => pass to index finger - EXTENSOR POLLICIS LONGUS (next to extensor indices)
THUMB EXTENSION
pass to thumb
- SNUFF BOX-
- EXTENSOR POLLICIS BREVIS
pass to thumb - ABDUCTOR POLLICIS LONGUS (most lateral)
- 5&6 share a sheath = lateral sheath
- 4 part of other sheath
What produces suffbox
Extension of thumb
Interossei
(ulnar n.)
PALMAR INTEROSSEI = ADDUCT PAD
DORSAL INTEROSSEI = ABDUCT DAB
* deeper than Palmar
Why is the scaphoid more at risk of developing AVN
Avascular Necrosis
d/t scaphoids retrograde blood supply, thus difficult to heal
* more proximal the # more likely to develop AVN
What are the boundaries and palpable contents of the anatomical snuffbox
EXTENSOR POLLICIS LONGUS
EXTENSOR POLLICIS BREVIS
ADDUCTOR POLLICIS
- radial artery
- radial styloid process
- scaphoid
- tzm
- Base of 1st MC
- Cephalic vein
What is the site of common flexor origin?
Medial epicondyle
Which clinical landmark is best for approaching radius
Flexor Carpi Radialis
Significance of the Flexor Digitorum Profundus
Only tendon acting on the DIPJ thus can test FDP in isolation
Significance of the Flexor Digitorum Superficialis
Two tendons acting on the PIPJ , thus to isolate FDS have to isolate the FDP - common belly
Significance of the Extensor Retinaculum
Tendinous band-like sheath that contains the extensors of the wrist
*attaches to Triquestrum and Pisiform
Vascularisation of the Hands
ULNAR A. => SUPERFICIAL ARCH => COMMON DIGITAL ARTERIES
RADIAL ARTERY => RADIAL ARTERY
Significance of Allens Test
Testing for presence/absence of ulnar and radial arteries
- occlude both art at wrist
- open and release fist until blanched
- release ulnar = sould reperfuse in 15s
- repeated ABGs or ABGs
Clinical Features of Dupuytren’s Disease
M>F; 15-64yo / 75+; early development in males
*myofibroblast=contractile elements => dysregulated
+collagen
* nil pain
* loss of finger extension; gripping; washing face
Clinical Features of trigger finger
F>M, 40-60s
*RA, DM, Gout
thickening of sheath; ring>thumb>middle
dx: clicking sensation w/ digit movement, progression to locking, lump in palm
Clinical Features of De Quervain’s tenovaginitis
F>M, 50-60yo; post-partum, lactating females
- 1st dorsal extensor compartment = EPB & AP retinaculum thickening = pain
- radial pain, aggr by thumb movement, +swelling
- consider thumb OArth.
Clinical Features of Basal thumb OA
women
Commonest OA; pain stiff swelling deform + loss of function
@ base of thumb; thenar eminence
- LOCALISED pain opening jars/pinching
reduced thumb movement
prominent metacarpal base
-
Management of Dupuytren’s Disease
Sx
> Partial fasciectomy
2-3w heal; physio for stiffness; 50% recurrence @5y
> Dermo-fasciectomy
more radical, less recurrence, intense physio
> Percutaneous needle fasciotomy
Quicker, no wounds, higher recurrence, rpts, n. injury risk
> > RadiotherapyCollagenase.
recurrence risk, 3 flexor tendon rupture, cost
