Wrist And Hand

Question 1

1. What muscle serves as the muscle insertion into skin?

2. Where does it come from?

Answer 1

1. Palmaris brevis

2. From flexor retinaculum and palmar aponeurosis

Question 2

Where does the sensory nerve supply of the palm of the hand come from? (2 nerves)

Answer 2

Palmar cutaneous branches of both the median and ulnar nerve

Question 3

Sensory innervation of the skin on the dorsum of the hand? (3 nerves)

Answer 3

Superficial branch of the radial nerve, posterior cutaneous branch of the ulnar nerve, and palmer digital branches of median nerve

Question 4

Look at cutaneous innervation of hand note and label which nerve innervates which color

1. Green?
2. Orange?
3. Blue?

Answer 4

1. Ulnar nerve
2. Radial nerve
3. Median nerve

Question 5

Blood supply to the hand?

Answer 5

Radial artery (lateral)
Ulnar artery (medial)
Superficial and deep arch vessels in hand

Question 6

What two veins drain the dorsal venous arch?

Answer 6

Cephalic vein (lateral side) and basilic vein (medial side)

Question 7

1. The superficial and deep palmar venous arches drain into what two veins?
2. These two veins merge at the ___ to form ____

Answer 7

1. Radial and ulna veins

2. Merge at the cubital fossa to form brachial veins

Question 8

Why is carpal tunnel common in pregnant women?

Answer 8

Fluid retention during pregnancy can cause the flexor retinaculum to be unable to expand, thus median nerve can get compressed

Question 9

1. Palmar aponeurosis runs from where to where? (Proximal to distal)
2. Function?

Answer 9

1. Distal border of flexor retinaculum to base of the fingers
2. Provides attachment to skin and helps improve grip

Question 10

Tendons of what three muscles make up the anatomical snuff box?

Answer 10

Extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus

Question 11

1. ____ of the median nerve lies in the palm of the hand
2. This is the nerve to muscles of ___
3. What 2 arterial arches are located in the central part of the palm?

Answer 11

1. Recurrent branch
2. Thenar eminence
3. Superficial and deep palmar arterial arch

Question 12

1. 1st metacarpal is on what finger?

2. 3 components of a metacarpal from proximal to distal

Answer 12

1. Thumb

2. Base, shaft, head

Question 13

Common synovial sheath is different from flexor retinaculum because it runs from where to where?

Function?

Answer 13

Common synovial sheath runs from metacarpal heads to the base of the distal phalanges

Allow the long tendons of the flexors to move with minimal friction beneath the flexor retinaculum (which is across wrist like from thumb to pinky)

Question 14

1. Synovial sheaths run through?
2. Which tendon is contained in this tunnel for the thumb?
3. Which tendons are contained in this tunnel for other 4 fingers?

Answer 14

1. Osteofibrous tunnels
2. Tendon of the flexor pollicis longus
3. Flexor digitorum superficialis and profundus

Question 15

1. The carpal tunnel is formed by?
2. Flexor retinaculum runs from what bone to what bone?
3. What 4 things are contained in the carpal tunnel?

Answer 15

1. The concavity of the carpal bones and flexor retinaculum
2. Scaphoid/trapezium to pisiform/hook of the hamate
3. Median nerve, flexor pollicis longus tendon, and tendons of the flexor digitorum superficialis and profundus

Question 16

What 3 things are contained in the anatomical snuff box?

Answer 16

Radial artery, branch of radial nerve, and cephalic vein

Question 17

1. What is the most commonly fractured carpal bone and how would a fracture of this bone present itself?
2. Fracture of this bone may cause what?

Answer 17

1. Scaphoid bone; pain in the snuff box

2. Interruption of its ‘retrograde’ blood supply which could lead to avascular necrosis

Question 18

What tendons are located in each of the 6 compartments on the dorsum of the hand? (Compartments are located by wrist)

Answer 18

Compartment 1= extensor pollicis brevis and abductor pollicis longus

2= extensor carpi radialis longus and brevis

3= extensor pollicis longus

4= extensor digitorum and extensor indicis

5= extensor digiti minimi

6= extensor carpi ulnaris

Question 19

What is listers tubercle?

Answer 19

Bony prominence of radius that separates compartments 2 and 3

Question 20

Difference in location between extrinsic and intrinsic hand muscles?

Answer 20

Extrinsic means they originate outside of hand but insert into the hand; intrinsic originates inside the hand

Question 21

1. 4 muscles that make up the thenar eminence?
2. 3 muscles that make up the hypothenar eminence?
3. All muscles of the hypothenar eminence are innervated by?

Answer 21

1. Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, tendon of flexor pollicis longus
2. Abductor digiti minimi, flexor digiti minimi, opponens digiti minimi
3. Deep branch of the ulnar nerve

Question 22

1. The 4 short muscles of the thumb?

2. 3 short muscles of the pinky?

Answer 22

1. The 3 muscles that form the thenar eminence + adductor pollicis (not part of thenar eminence because it doesnt originate from thenar side)
2. The same 3 muscles that make up the hypothenar eminence

Question 23

Abductor pollicis brevis

Origin
Insertion
Innervation
Action

Answer 23

O- flexor retinaculum, trapezium, scaphoid

I- radial side of base of 1st proximal phalanx

Inn- median nerve

A- abduction of 1st CMC and MCP joint

Question 24

Adductor pollicis

Origin
Insertion
Innervation
Action

Answer 24

O- capitate and base of 2nd and 3rd metacarpal

I- ulnar side of base of 1st proximal phalanx

Inn- ulnar nerve

A- adduction of 1st CMC and MCP joints; opposition

Question 25

Flexor pollicis brevis Origin Insertion Innervation Action

Answer 25

O- flexor retinaculum, trapezoid, capitate I- radial side of base of 1st proximal phalanx Inn- median and ulnar nerve A- flexion of 1st CMC and MCP joints; opposition

Question 26

Opponens pollicis Origin Insertion Innervation Action

Answer 26

O- flexor retinaculum and trapezium I- 1st metacarpal shaft Inn- median nerve A- thumb opposition

Question 27

Abductor digiti minimi Origin Insertion Innervation Action

Answer 27

O- flexor carpi ulnaris tendon and pisiform I- ulnar side of base of 5th proximal phalanx Inn- ulnar nerve A- abduction of 5th finger

Question 28

Flexor digiti minimi Origin Insertion Innervation Action

Answer 28

O- hook of hamate I- ulnar side of 5th proximal phalanx Inn- ulnar nerve A- flexion of 5th MCP joint; opposition

Question 29

Opponens digiti minimi Origin Insertion Innervation Action

Answer 29

O- flexor retinaculum and hook of hamate I- ulnar side of shaft of 5th metacarpal Inn- ulnar nerve A- opposition of 5th finger

Question 30

3 muscle groups that are considered the small muscles of the hand

Answer 30

``` Lumbricals (4) Palmar interossei (3) Dorsal interossei (4) ```

Question 31

Lumbricals (there are 4; first one is on pointer finger - 4th is on pinky) Origin Insertion Innervation Action

Answer 31

Origin- palmar: on radial side of flexor profundus tendons of fingers 2-5 Insertion- radial border of extensor tendons of respective tendons Innervation- 1st and 2nd= median nerve; 3rd and 4th= ulnar nerve (deep branch) Action- flexion of MCP joints and extension of PIP and DIP joints

Question 32

Palmar interossei Origin Insertion Innervation Action

Answer 32

O- second, fourth, and fifth metacarpals (2nd is ulnar border; 4th and 5th at radial border) I- proximal phalanx of related finger (on same side as origin) Inn- deep branch of ulnar nerve A- adduction of 2nd 4th and 5th fingers, flexion at MCP and extension at IP

Question 33

Dorsal interossei Origin Insertion Innervation Action

Answer 33

O- adjacent sides of all metacarpals (2-4) I- proximal phalanx of related finger Inn- deep branch of ulnar nerve A- abduction of fingers 2-4, flexion at MCP, extension at IP

Question 34

Median nerve innervates what hand muscles? Median nerve cutaneous branches innervate?

Answer 34

3 muscles of thenar eminence and 1st and 2nd lumbricals Palmar aspect of the lateral 3 1/2 fingers and distal part of the dorsal aspect of same fingers

Question 35

The deep branch of the ulnar nerve innervates what muscles?

Answer 35

3 hypothenar muscles, palmar and dorsal interossei, 3rd and 4th lumbrical muscles, and adductor pollicis

Question 36

1. Deep branch of ulnar nerve passes between what two muscles? 2. What muscle does it pierce before it passes within the deep palmar arch?

Answer 36

1. Abductor digiti minimi and flexor digiti minimi | 2. Opponens digiti minimi

Question 37

Ulnar artery enters hand __ to the flexor retinaculum Its gives off the deep palmar branch and then continues into palm as____

Answer 37

Superior Superior palmar arch

Question 38

Superficial palmar arch gives off the palmar digital arteries that supply?

Answer 38

The medial side of the index finger, and both sides of the middle, ring, and little fingers

Question 39

The radial artery leaves dorsum of hand by passing between the two heads of what muscle? It then passes between the two heads of what muscle

Answer 39

1st dorsal interosseous Adductor pollicis

Question 40

What artery mainly contributes to the deep palmar arch? Superficial palmar arch?

Answer 40

Radial Ulnar

Question 41

1. Name the 3 palmar fascial spaces of the hand | 2. 3 dorsal fascial spaces

Answer 41

1. Midpalmar, thenar spaces, pulp space of fingers | 2. Dorsal subcutaneous space, dorsal subtendinous space, space of Parona

Question 42

When midpalmar space is infected, where do you drain the pus from? What about if thenar space is infected?

Answer 42

3rd and 4th web spaces 1st web space

Question 43

Clinical significance of pulp space?

Answer 43

Whitlow

Question 44

Location of the following: 1. Dorsal subcutaneous space 2. Dorsal subtendinous space 3. Space of parona

Answer 44

1. Immediately deep to the loose skin of the dorsum of the hand 2. Between metacarpals and extensor tendons 3. Deep in the lower part of forearm just above the wrist