week 5 movement Flashcards

1
Q

what can the hand be divided into?

A

the wrist ( 8 carpal bones)
digits (phalanges)
5 metacarpals

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2
Q

what are the 3 divisions of the phalanges?

A

distal, middle and proximal

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3
Q

what phalanges does the thumb have?

A

distal and proximal no middle

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4
Q

which digits have all 3 of the phalanges?

A

2 to 5

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5
Q

what is the name of the joint between the distal and middle phalanges?

A

the distal interphalageal joint

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6
Q

what is the name of the joint between the proximal and middle phalanges?

A

the proximal interphalangeal joint

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7
Q

what is the name of the the joint between the phalanges and the metacarpals?

A

the metacarpo-phalangeal joint

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8
Q

name the 8 carpal bones?

A

Scaphoid, Lunate, Triquetrum, Pisiform, trapezium, trapezoid capitate, hamate

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9
Q

how do you ring the carpal bones?

A

from proximal to distal. Lateral to medial.

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10
Q

what is the name of the wrist joint?

A

radiocarpal joint

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11
Q

what two bones are involved in the radiocarpal joint?

A

the radius and carpal joint

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12
Q

which two carpal bones articulate with the radius?

A

the scaphoid and lunate

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13
Q

what joint is not involved in the radiocarpal joint?

A

the distal radioulnar joint

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14
Q

what is the function of the distal radioulnar joint?

A

its supports the posterior radioulnar joitn in supination

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15
Q

what does the radiocarparl ligament do?

A

it is supportive ligament which allow the hand to move with the radius

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16
Q

what are the movements of the wrist joint?

A

extension and flexion
abduction and adduction
all those movements together circumduction

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17
Q

which muscles of the forearm don’t act on the wrist?

A

pronator teres –> anterior flexor compartment

Brachioradialis and Anconeus of the posterior extensor compartmetn

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18
Q

what nerve controls the anterior flexor muscles of the wrist joint?

A

median and ulna nerve?

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19
Q

what nerve controls the posterior extensor muscles of the wrist joint?

A

radial nerve

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20
Q

which structures runs through carpal tunnel?

A

flexor digitorium superficials tendon
flexor digitorium profundus tendon
flexor pollicis longus tendon
median nerve

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21
Q

what is the boundaries of the carpal tunnel?

A

flexor retinaculum and carpal bones

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22
Q

which intrinsic muscle of the hand is not suppleid by the ulnar nerve and what nerve are they supplied by?

A

the 1st and 2nd lumbrical muscles (lateral) unipennate are not. The thenar muscles are not either. They are supplied by the medial nerve

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23
Q

what are the movements of the thumb?

A

abduction, adduction, flexion, extension, oppositiona dn reposition

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24
Q

what does the Palmar cutaneous branch of median nerve supply?

A

the lateral side of the palm

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25
Q

what branch of the median nerve supplies the thenar muscle?

A

the recurrent branch

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26
Q

what does the digital branch of teh median nerve supply?

A

Innervates the palmar surface and fingertips of the lateral three and half digits and 1st and 2nd lumbrical muscles

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27
Q

what do the lumbrical muscle do?

A

Flexion at metacarpophalangeal joint and extension at interphalangeal joint

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28
Q

what is the knuckle actually called?

A

the metacarpophalangeal joint

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29
Q

what is the medial attachment of the flexor retinaculum?

A

pisiform and hook around of the hamate

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30
Q

what is the lateral attachment of the flexor retinuculum?

A

scaphoid tubersosity and trapezium

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31
Q

what is the symptome of carpal tunnel syndrome?

A

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

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32
Q

what occurs in surgery to relieve carpal tunnel syndrome?

A

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

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33
Q

which carapal bone is most commonly dislocated and how is it done?

A

lunate bone and falling on a outstretched hand

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34
Q

how is the medial nerve damaged by dislocated of the lunate bone?

A

anterior dislocation of the lunate bone can stretch and damage the median nerve –> cause similar symptoms to carpal syndrome

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35
Q

what does the palm branch of the ulnar nerve supply?

A

the medial side of the palm

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36
Q

what does the deep branch of the ulnar nerve supply?

A

Hypothenar muscles, adductor pollicis, interossei and 4th + 5th lumbricals.

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37
Q

what is within the guyons canal?

A

the ulnar nerve and artery

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38
Q

what is the outcome of the compression of the ulnar nerve at the wrist?

A

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

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39
Q

what type of wrist fracture is common for young adults

A

scaphoid wrist fracture –> tenderness at the anatomical snuff box

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40
Q

what is the boundaries of the anatomical snuff box?

A

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.

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41
Q

how does scaphoid fracture occur?

A

fall on outstretched hand in the abduction position

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42
Q

how is blood supplied to the scaphoid bone?

A

it is supplied distally to the scaphoid bone

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43
Q

what is colles fracture and in whom does it most occur in?

A

fracture of the distal end of the radius, most common in older people especially women with osteporosis

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44
Q

why is there a good prognosis for colles fracture?

A

Because there is rich blood supply to the distan end of the radius

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45
Q

what are epiphysis ?

A

growth plates in children in the wrist

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46
Q

what can to much damage to epiphysis cause?

A

premature fusion of joints –> one limb shorter than the other

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47
Q

how is the lunate bone dislocated and what is its consequence?

A

if you land on a outstreatch hand –> dislocation

can compress the median nerve

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48
Q

what is the consquence of damage to the median nerve at the wrist?

A

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

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49
Q

what are the different aspects of the metacarpal?

A

Has a base, shaft, tubercle and head –> on the anterior (palm view)

50
Q

what is the borders of the cubital fossa made up off?

A

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

51
Q

what is the content of the cubital fossa?

A

tendon of bicep brachii
brachial artery
median nerve

52
Q

when does the brachial artery bifurcates and into what?

A

at the apex of the cubital fossae –> ulna (medial) and radial (lateral) arteries

53
Q

what does the radial nerve bifurcate too?

A

deep and superfecial branch

54
Q

where does the radial nerve lie in relation to the cubital fossae?

A

underneath the brachioradalis –> lateral border

55
Q

where does the ulnar nerve lie?

A

posterior to the medial epicondyle

56
Q

how can the ulna nerve get damaged?

A

posterior dislocation of the glenohumeral joint

57
Q

what is the anatomical name for the wrist joint?

A

radiocarpal joint

58
Q

what is the origion and insirtion of brachioradalis?

A

lateral supracondylar ridge of humerus to the styloid process of radius

59
Q

what is action of brachioradalis?

A

accessory flexor of the forearm

returns the arm back to mid pronation from either full supination or pronation –> racket grip

60
Q

what is the relation of ulna, radial and medial nerve to the flexor digitorum superficalis?

A

ulna –> medial
radial –> lateral
Median –> deep and between the flexor digitorum profuna

61
Q

what is the relation of the flexor digitorum profundus and superficialis?

A

the superficialis splits to go around profundus and attach to the middle phalanges –> allows profundus to attatch to the distal phalanges

62
Q

what part of the ulna and radius is the interosseous membrane attached to?

A

the medial side of the radius and lateral side of the ulna

63
Q

what is the roles of the interosseous membrane?

A

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

64
Q

what structures run through the carpal tunnel?

A

median nerve
flexor digitorum profundus
flexor digitorum superficialis
flexor pollicis longus

65
Q

what is the base of the flexor retinaculum formed by?

A

medially by the pisiform and the hook of hamate

laterally by the tubercles of the scaphoid and trapezium

66
Q

how is free movement of the tendons in the carpal tunnel facilitated?

A

synovial sheath seperate the tendons and allow free movement –> surround the tendons

67
Q

how do you read the carpal bones –> what order?

A

proximal to distal

radius to ulna side

68
Q

which structure is most sensitive to compression in the carpal tunnel?

A

median nerve

69
Q

what two joints allow pronation and supination to occur?

A

proximal and distal radioulnar joints

70
Q

how does the radioulnar joint allow pronation and supination to occur?

A

makes it possible for the radius to rotate around the ulnar

71
Q

what two muscles are invovled in pronation and their innervation?

A

pronator teres –> superficial muscle and powerful
pronator quadratus –> deep and less powerful
median nerve

72
Q

what two muscles are invovled in supination and their innvervation

A

bicep brachii –> superfecial and powerful –> musculocutaneous
supinator –> deep and less powerful –> radial nerve

73
Q

what structures holds all of the structures of the extensor compartment of the forearm in place at the wrist joint?

A

the extensor retinaculum

74
Q

from lateral to medial what is the positions of the superfecial muscles of extensor of forearm? lateral to medial

A

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

75
Q

from lateral to medial position of superficial muscles of flexor of forearm?

A

1) brachioradalis
2) flexor carpi radialis
3) palamaris longus
4) flexor carpi ulnaris

76
Q

from lateral to medial position of deep muscles of flexor of forearm?

A

medial is flexor digitorum profundus

lateral is flexor pollicis longus

77
Q

how does ulnar claw occur?

A

damage to the ulna nerve in the wrist

78
Q

what key muscle is affected in ulnar claw sydnrome?

A

the lumbricals of 3 and 4 –> digits 4 and 5

79
Q

what is ulnar paradox?

A

damage to the ulnar nerve at the elbow joint

80
Q

what happens in unar paradox?

A

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

81
Q

what happens in hand of benediction?

A

when there is damage to the median nerve at the elbow

82
Q

what is the difference between hand of benediction and ulnar claw

A

ulnar claw is spontaneous and therefore all the time

hand of benediction only occurs when the patient is asked to make a fist

83
Q

if a person has hand of benediction what happens to the index and middle finger when trying to make a fist

A

will not be able to flex these fingers

84
Q

if a person has a hand of benedicition what happens to the ring and little finger when trying to make a fist?

A

they flex

85
Q

what happens to the hand if the patinet has hand of benediction and they try to make a fist?

A

the lateral 2 digits will flex but not the rest and forma claw

86
Q

what nerve is damaged in hand of benediction and where?

A

the median nerve and either at the elbow or wrist

87
Q

why does scaphoid commonly fracture?

A

because it has a narrowed waist that makes it prone to fracture

88
Q

what is the problem with the blood supply entering the scaphoid distally?

A

if you get a fracture of the scaphoid then the proximal part of the scaphoid won’t have a blood supply –> get avascular necrosis

89
Q

how does colles fracture occur and what might happen?

A

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

90
Q

what nerve supplies the dorsal side of the lateral 3 and half digits?

A

the radial nerve

91
Q

what carpal bone attaches to the 1st metacarpal?What is the name of that joint?

A

trapezium and its called the carpometacarpal joint

92
Q

what is the shape of the surface of the trapezium with the metacarpal? What movements does it allow the thumb to do?

A

reciprocal saddled shapped articular surface
Abdction and adduction
Opsonisation and reposition
extension and flexion

93
Q

what is the structure of palmer aponeurosis ?

A

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

94
Q

what is the actions of small intrinsic muscles of the hand?

A

it allows precise hand movement

95
Q

what are the divisions of the small intrisic muslces?

A
hypothenar
thenar
central --> lumbricals
adductors
interosseous
96
Q

which metacarpals of the hand has palmer interossei’s attached to them?

A

2nd,4th and 5th

97
Q

from what border do the palmer interosseis come from the metacarpals~?

A

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

98
Q

what is the action of the palmer interosseis?

A

adduction –> pull the digits 2,4,5 towards the axial line of the hand ( middle of the middle finger)

99
Q

what direction does the palmer interosseis converge and the outcome of this?

A

tendons converge away from the axial line and therefore the digits converge towards the midline of 2,4,5

100
Q

what direction does the dorsal interosseis converge and outcome of thus?

A

they converge towards the axial line and therefore the digits move away from the midline –> 2 and 4

101
Q

what is the movement of the 3rd finger via which interosseis?

A

There is two dorsal interosseis attached to the 3rd digit and therefore the middle finger can be abduted either way

102
Q

what is the terminal branch of the ulna artery in the hand? What artery inputs into it?

A

the superficial palmar arch and gets input from the radial artery

103
Q

what is the terminal branch of the radial artery in the hand? What artery inputs into it?

A

deep palmar branch and gets input from the ulnar artery

104
Q

what is the blood supply to the digits?

A

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

105
Q

what does it mean by thenar and hypothenar muscles

A

thenar muscles that affect the thumb

hypothenar muscles affect the little finger

106
Q

what happens to the wrist when there is damage to the raidal nerve?

A

wrist drop

107
Q

is the pisiform bone a sesamoid bone?

A

yes

108
Q

what are the medial/posterior and lateral/anterior boundaries of the anatomical snuff box

A

medial/posterior –> extensor pollicis longus

lateral/anterior –> abductor pollicis longus, extensor pollicis brevis

109
Q

what two bones make the floor of the anatomical snuff box?

A

scaphoid and trapezium

110
Q

where does the subclavian pulse lie?

A

subclavian artery can be palpated lateral to the SCM

111
Q

where can the brachial artery be palpated in the arm?

A

in the medial bicipital groove –> between bicep and tricep brachii

112
Q

what is the relationship of the median nerve to the brahcial artery?

A

lies lateral to it and then passes anteriorly to like medial against it

113
Q

what is the relationship of the brachial artery to the tendon of bicep brachii in the cubital fossae

A

medial in the cubital fossae

114
Q

why would you want to sample arterial blood?

A

ABG –> Ph, oxygen, CO2

check nmetabolic or lung function

115
Q

what test is done before taking arterial blood and what is it testing?

A

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

116
Q

what artery is used for taking arterial blood?

A

radial artery

117
Q

what is the relation of the ulna nerve at the elbow?

A

lies medial to the olecranon process and posterior to the medial epicondyle

118
Q

what is the landmarks of the dermatome?

A
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
119
Q

what are the three reflexes test of the upper limb?

A

Bicep reflex
tricep reflex
brachioradalis reflex –> supinator reflex

120
Q

what happens in the upper reflex test?

A

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.

121
Q

what you see in bicep reflex and what veretbral levels being tested?

A

elbow flexion and C5 and C6

Hit the tendon of the bicep brachii at the cubital fossae –> elbow slightly flexed

122
Q

what you see in tricep reflex and what veretbral levels being tested?

A

elbow extension –> C6 and C7

Hold arm along their body and hit the ollecranon process ( where the tendon of the tricep brachii is)