week 5 movement Flashcards
what can the hand be divided into?
the wrist ( 8 carpal bones)
digits (phalanges)
5 metacarpals
what are the 3 divisions of the phalanges?
distal, middle and proximal
what phalanges does the thumb have?
distal and proximal no middle
which digits have all 3 of the phalanges?
2 to 5
what is the name of the joint between the distal and middle phalanges?
the distal interphalageal joint
what is the name of the joint between the proximal and middle phalanges?
the proximal interphalangeal joint
what is the name of the the joint between the phalanges and the metacarpals?
the metacarpo-phalangeal joint
name the 8 carpal bones?
Scaphoid, Lunate, Triquetrum, Pisiform, trapezium, trapezoid capitate, hamate
how do you ring the carpal bones?
from proximal to distal. Lateral to medial.
what is the name of the wrist joint?
radiocarpal joint
what two bones are involved in the radiocarpal joint?
the radius and carpal joint
which two carpal bones articulate with the radius?
the scaphoid and lunate
what joint is not involved in the radiocarpal joint?
the distal radioulnar joint
what is the function of the distal radioulnar joint?
its supports the posterior radioulnar joitn in supination
what does the radiocarparl ligament do?
it is supportive ligament which allow the hand to move with the radius
what are the movements of the wrist joint?
extension and flexion
abduction and adduction
all those movements together circumduction
which muscles of the forearm don’t act on the wrist?
pronator teres –> anterior flexor compartment
Brachioradialis and Anconeus of the posterior extensor compartmetn
what nerve controls the anterior flexor muscles of the wrist joint?
median and ulna nerve?
what nerve controls the posterior extensor muscles of the wrist joint?
radial nerve
which structures runs through carpal tunnel?
flexor digitorium superficials tendon
flexor digitorium profundus tendon
flexor pollicis longus tendon
median nerve
what is the boundaries of the carpal tunnel?
flexor retinaculum and carpal bones
which intrinsic muscle of the hand is not suppleid by the ulnar nerve and what nerve are they supplied by?
the 1st and 2nd lumbrical muscles (lateral) unipennate are not. The thenar muscles are not either. They are supplied by the medial nerve
what are the movements of the thumb?
abduction, adduction, flexion, extension, oppositiona dn reposition
what does the Palmar cutaneous branch of median nerve supply?
the lateral side of the palm
what branch of the median nerve supplies the thenar muscle?
the recurrent branch
what does the digital branch of teh median nerve supply?
Innervates the palmar surface and fingertips of the lateral three and half digits and 1st and 2nd lumbrical muscles
what do the lumbrical muscle do?
Flexion at metacarpophalangeal joint and extension at interphalangeal joint
what is the knuckle actually called?
the metacarpophalangeal joint
what is the medial attachment of the flexor retinaculum?
pisiform and hook around of the hamate
what is the lateral attachment of the flexor retinuculum?
scaphoid tubersosity and trapezium
what is the symptome of carpal tunnel syndrome?
Pins and needles in the cutaneous distribution of digital branches of median nerve
Weakness of thumb and muscle atrophy in thenar region –> Inability to oppose thumb
what occurs in surgery to relieve carpal tunnel syndrome?
cut the flexor retinaculum –> this will relieve pressure on the median nerve and tendons. When the flexor retinaculum heals and joins it will have lengthened giving it more space which will reduce pressure
which carapal bone is most commonly dislocated and how is it done?
lunate bone and falling on a outstretched hand
how is the medial nerve damaged by dislocated of the lunate bone?
anterior dislocation of the lunate bone can stretch and damage the median nerve –> cause similar symptoms to carpal syndrome
what does the palm branch of the ulnar nerve supply?
the medial side of the palm
what does the deep branch of the ulnar nerve supply?
Hypothenar muscles, adductor pollicis, interossei and 4th + 5th lumbricals.
what is within the guyons canal?
the ulnar nerve and artery
what is the outcome of the compression of the ulnar nerve at the wrist?
Handlebar neuropathy –> ulna claw
Sensory loss palmer surface of lateral 1 ½ digits
Hyperextension of metacarpophalangeal joints of digits 4 and 5 and flexion at the IP
Motor weakness in the intrinsic muscle of the hand
what type of wrist fracture is common for young adults
scaphoid wrist fracture –> tenderness at the anatomical snuff box
what is the boundaries of the anatomical snuff box?
Medial boundary –>extensor pollicis longus tendon –> extrinsic and long
Lateral border –> extensor pollicis brevis tendon –> the shorter version and along with the abductor pollicis longus.
how does scaphoid fracture occur?
fall on outstretched hand in the abduction position
how is blood supplied to the scaphoid bone?
it is supplied distally to the scaphoid bone
what is colles fracture and in whom does it most occur in?
fracture of the distal end of the radius, most common in older people especially women with osteporosis
why is there a good prognosis for colles fracture?
Because there is rich blood supply to the distan end of the radius
what are epiphysis ?
growth plates in children in the wrist
what can to much damage to epiphysis cause?
premature fusion of joints –> one limb shorter than the other
how is the lunate bone dislocated and what is its consequence?
if you land on a outstreatch hand –> dislocation
can compress the median nerve
what is the consquence of damage to the median nerve at the wrist?
loss of motor innervation/weakness in the lateral 2 digits
cannot abudct or opsonise your thumb
sensory loss in the lateral 3 1/2 digits
what are the different aspects of the metacarpal?
Has a base, shaft, tubercle and head –> on the anterior (palm view)
what is the borders of the cubital fossa made up off?
lateral –> supinator and brachioradalis
medial –> pronator teres
superiorly –> imaginary line from the 2 human epicondyles
roof –> deep fasica of arm and bicipital aponeurosis
floor –> brachialis and supinator muscles
what is the content of the cubital fossa?
tendon of bicep brachii
brachial artery
median nerve
when does the brachial artery bifurcates and into what?
at the apex of the cubital fossae –> ulna (medial) and radial (lateral) arteries
what does the radial nerve bifurcate too?
deep and superfecial branch
where does the radial nerve lie in relation to the cubital fossae?
underneath the brachioradalis –> lateral border
where does the ulnar nerve lie?
posterior to the medial epicondyle
how can the ulna nerve get damaged?
posterior dislocation of the glenohumeral joint
what is the anatomical name for the wrist joint?
radiocarpal joint
what is the origion and insirtion of brachioradalis?
lateral supracondylar ridge of humerus to the styloid process of radius
what is action of brachioradalis?
accessory flexor of the forearm
returns the arm back to mid pronation from either full supination or pronation –> racket grip
what is the relation of ulna, radial and medial nerve to the flexor digitorum superficalis?
ulna –> medial
radial –> lateral
Median –> deep and between the flexor digitorum profuna
what is the relation of the flexor digitorum profundus and superficialis?
the superficialis splits to go around profundus and attach to the middle phalanges –> allows profundus to attatch to the distal phalanges
what part of the ulna and radius is the interosseous membrane attached to?
the medial side of the radius and lateral side of the ulna
what is the roles of the interosseous membrane?
does not restrict pronation or supination, allows the attachment of muslces of the posterior and anterior compartment. Aperture in the final 1/3rd to allow access of different vessels and nerve. Also the orientation of the fibres of the membrane means that forces can transfer from ulna to radius and therefore from hand to humerus
what structures run through the carpal tunnel?
median nerve
flexor digitorum profundus
flexor digitorum superficialis
flexor pollicis longus
what is the base of the flexor retinaculum formed by?
medially by the pisiform and the hook of hamate
laterally by the tubercles of the scaphoid and trapezium
how is free movement of the tendons in the carpal tunnel facilitated?
synovial sheath seperate the tendons and allow free movement –> surround the tendons
how do you read the carpal bones –> what order?
proximal to distal
radius to ulna side
which structure is most sensitive to compression in the carpal tunnel?
median nerve
what two joints allow pronation and supination to occur?
proximal and distal radioulnar joints
how does the radioulnar joint allow pronation and supination to occur?
makes it possible for the radius to rotate around the ulnar
what two muscles are invovled in pronation and their innervation?
pronator teres –> superficial muscle and powerful
pronator quadratus –> deep and less powerful
median nerve
what two muscles are invovled in supination and their innvervation
bicep brachii –> superfecial and powerful –> musculocutaneous
supinator –> deep and less powerful –> radial nerve
what structures holds all of the structures of the extensor compartment of the forearm in place at the wrist joint?
the extensor retinaculum
from lateral to medial what is the positions of the superfecial muscles of extensor of forearm? lateral to medial
1) extensor carpi radialis longus –> 2nd metacarpal
2) extensor carpi readialis brevis –> 3rd metacarpal
3) extensor digitorum –> 2-5 extensor expansion
4) extensor digiti minimi –> extensor expansion of 5th
5) extensor carpi ulnaris –> 5th metacarpal
from lateral to medial position of superficial muscles of flexor of forearm?
1) brachioradalis
2) flexor carpi radialis
3) palamaris longus
4) flexor carpi ulnaris
from lateral to medial position of deep muscles of flexor of forearm?
medial is flexor digitorum profundus
lateral is flexor pollicis longus
how does ulnar claw occur?
damage to the ulna nerve in the wrist
what key muscle is affected in ulnar claw sydnrome?
the lumbricals of 3 and 4 –> digits 4 and 5
what is ulnar paradox?
damage to the ulnar nerve at the elbow joint
what happens in unar paradox?
same symptoms as ulnar claw but the medial side of flexor digitorum profudus and flexor carpi ulnaris are affected as well –> so the ulnar claw is not as prominent
what happens in hand of benediction?
when there is damage to the median nerve at the elbow
what is the difference between hand of benediction and ulnar claw
ulnar claw is spontaneous and therefore all the time
hand of benediction only occurs when the patient is asked to make a fist
if a person has hand of benediction what happens to the index and middle finger when trying to make a fist
will not be able to flex these fingers
if a person has a hand of benedicition what happens to the ring and little finger when trying to make a fist?
they flex
what happens to the hand if the patinet has hand of benediction and they try to make a fist?
the lateral 2 digits will flex but not the rest and forma claw
what nerve is damaged in hand of benediction and where?
the median nerve and either at the elbow or wrist
why does scaphoid commonly fracture?
because it has a narrowed waist that makes it prone to fracture
what is the problem with the blood supply entering the scaphoid distally?
if you get a fracture of the scaphoid then the proximal part of the scaphoid won’t have a blood supply –> get avascular necrosis
how does colles fracture occur and what might happen?
occurs when you land on a outstretched upper limb. Fracture of the distal part of the radius and avulsion of the styloid process of the ulna
what nerve supplies the dorsal side of the lateral 3 and half digits?
the radial nerve
what carpal bone attaches to the 1st metacarpal?What is the name of that joint?
trapezium and its called the carpometacarpal joint
what is the shape of the surface of the trapezium with the metacarpal? What movements does it allow the thumb to do?
reciprocal saddled shapped articular surface
Abdction and adduction
Opsonisation and reposition
extension and flexion
what is the structure of palmer aponeurosis ?
it is a triangle shape thickening on the deep fascia of the hand –> it has 4 slips –> carries tendons of flexors, blood vessel and nerves
what is the actions of small intrinsic muscles of the hand?
it allows precise hand movement
what are the divisions of the small intrisic muslces?
hypothenar thenar central --> lumbricals adductors interosseous
which metacarpals of the hand has palmer interossei’s attached to them?
2nd,4th and 5th
from what border do the palmer interosseis come from the metacarpals~?
1st one from the medial border of digit 2
2nd one from lateral border of digit 4
3rd one from lateral borders of digit 5
what is the action of the palmer interosseis?
adduction –> pull the digits 2,4,5 towards the axial line of the hand ( middle of the middle finger)
what direction does the palmer interosseis converge and the outcome of this?
tendons converge away from the axial line and therefore the digits converge towards the midline of 2,4,5
what direction does the dorsal interosseis converge and outcome of thus?
they converge towards the axial line and therefore the digits move away from the midline –> 2 and 4
what is the movement of the 3rd finger via which interosseis?
There is two dorsal interosseis attached to the 3rd digit and therefore the middle finger can be abduted either way
what is the terminal branch of the ulna artery in the hand? What artery inputs into it?
the superficial palmar arch and gets input from the radial artery
what is the terminal branch of the radial artery in the hand? What artery inputs into it?
deep palmar branch and gets input from the ulnar artery
what is the blood supply to the digits?
digits 1 too 2 1/2 get blood supply from the deep palmar arch –> mainly radial artery
digits 2 1/2 too 5 get blood supply from the superficial palmar arch –> mainly ulna artery
what does it mean by thenar and hypothenar muscles
thenar muscles that affect the thumb
hypothenar muscles affect the little finger
what happens to the wrist when there is damage to the raidal nerve?
wrist drop
is the pisiform bone a sesamoid bone?
yes
what are the medial/posterior and lateral/anterior boundaries of the anatomical snuff box
medial/posterior –> extensor pollicis longus
lateral/anterior –> abductor pollicis longus, extensor pollicis brevis
what two bones make the floor of the anatomical snuff box?
scaphoid and trapezium
where does the subclavian pulse lie?
subclavian artery can be palpated lateral to the SCM
where can the brachial artery be palpated in the arm?
in the medial bicipital groove –> between bicep and tricep brachii
what is the relationship of the median nerve to the brahcial artery?
lies lateral to it and then passes anteriorly to like medial against it
what is the relationship of the brachial artery to the tendon of bicep brachii in the cubital fossae
medial in the cubital fossae
why would you want to sample arterial blood?
ABG –> Ph, oxygen, CO2
check nmetabolic or lung function
what test is done before taking arterial blood and what is it testing?
the allens test and testing that there is suffecient collateral blood supply to the hand from the ulnar artery –> that the anastomeses have properly formed between the raidal and ulnar artery –> so not thrombus
what artery is used for taking arterial blood?
radial artery
what is the relation of the ulna nerve at the elbow?
lies medial to the olecranon process and posterior to the medial epicondyle
what is the landmarks of the dermatome?
C5 --> insertion of deltoid muscle C6 --> tip of the thumb C7 --. middle finger --> from digit 2 1/2 too 4 1/2 digit C8 --> tip of little finger T1 --> medial epicondyle
what are the three reflexes test of the upper limb?
Bicep reflex
tricep reflex
brachioradalis reflex –> supinator reflex
what happens in the upper reflex test?
the tendon tested is hit by a tendon hammer –> this will cause the muscle to stretch
Occurs by the stretch receptors in the muscle spindles detect this.
Send afferent fibres to the spinal cord and synapse with efferent fibres and cause muscle contraction.
what you see in bicep reflex and what veretbral levels being tested?
elbow flexion and C5 and C6
Hit the tendon of the bicep brachii at the cubital fossae –> elbow slightly flexed
what you see in tricep reflex and what veretbral levels being tested?
elbow extension –> C6 and C7
Hold arm along their body and hit the ollecranon process ( where the tendon of the tricep brachii is)
