Wrist and Palm of Hand Flashcards
1
Q
Define carpal tunnel.
A
the canal in the wrist bounded by osteofibrous material through which the flexor tendons and median nerve pass
2
Q
What runs through the carpal tunnel?
A
12 components:
1) NINE flexor tendons pass through the carpal tunnel, the flexor digitorum profundus (4), superficialis (4), and the flexor pollicis longus (1)
2) median nerve (1)
3) Synovial sheaths (2)
3
Q
What is the the fleshy prominence on the inner side of the palm next to the little finger?
A
Hypothenar eminence
4
Q
What is the fleshy prominence at the base of the thumb?
A
Thenar eminence
5
Q
What is also known as the transverse carpal ligament?
A
Flexor retinaculum
6
Q
What is the flexor retinaculum?
A
fibrous bands that arch of the carpals creating the deep groove into the carpal tunnel
7
Q
Where does the flexor retinaculum attach?
A
medial: pisiform and hook of hamate bone
lateral: scaphoid and trapezium
8
Q
Where does the flexor retinaculum lie?
A
deep to the palmar aponeurosis; between the bases of the thenar and hypothenar eminencies
9
Q
what is the palmar aponeurosis?
A
thick, central portion of the deep palmar fascia
10
Q
What is the palmar aponeurosis usually a continuation of?
A
palmaris longus tendon
11
Q
What is your first digit called?
A
Thumb
12
Q
What is your first finger called?
A
Index
13
Q
What is your 5th digit and 4th finger called?
A
Little finger
14
Q
What is the palmar hand fascia continuous with?
A
Antebrachial fascia
15
Q
What is the mid carpal joint?
A
joint between proximal rose and distal row of carpus
16
Q
What movements does the midcarpal joint allow?
A
limited flexion and extension
17
Q
What type of joint is the carpometacarpal (CM) joints?
A
synovial (although not a lot of movement, except at thumb)
18
Q
1st metacarpal bone forms a carpometacarpal joint (CM) with which carpal bone?
A
Trapezium
19
Q
2nd metacarpal bone forms a carpometacarpal (CM) joint with which carpal bone?
A
Trapezoid (planar)
20
Q
3rd metacarpal bone forms a carpometacarpal (CM) joint with which carpal bone?
A
capitate (planar)
21
Q
What is the 4th and 5th metacarpal bone forms a carpometacarpal (CM) joint with which carpal bone?
A
Hamate (planar)
22
Q
What are the three parts of the metacarpal bone?
A
Base (CM joint, finger) Shaft Head ( MP joints ie: knuckles)
23
Q
How many total phalanges are there?
A
14 phalanges (2 in thumb and 3 in each finger)
24
Q
Which part of the phalange is the smallest?
A
the distal segments are smaller; the proximal sections are the largest
25
What joints are located in the phalanxes?
PIP (proximal interphalangeal) joint and DIP (distal interphalangeal) joint
26
What forms the roof of the carpal tunnel?
flexor retinaculum
27
What forms the floor of the carpal tunnel?
carpal arch
28
Which tendons are stacked?
FDS (Flexor digitorum superficialis)
29
Which tendons are not stacked?
FDP (Flexor digitorum profundus)
30
Since the FDP (Flexor digitorum profundus) tendons are stacked, which ones are superficial and which ones are deep?
tendons to the middle and right finger= SUPERFICIAL
| tendons to the index and little fingers = DEEP
31
Function of synovial tendon sheath
secrete synovial fluid
32
what is a synovial tendon sheath?
- common tendon sheath for flexor digitorum superficialis and profundus
- separate flexor pollicis longs sheath
- extension for small finger tendon
- new tendon sheath for digits 2-4
33
what are fibrous digital sheaths?
fibrous sheaths attach to bone
34
what are the two different types of fibrous sheaths?
annular and cruciform
35
What doe the fibrous digital sheath surround?
FDS and FDP tendons & synovial sheaths
36
tendons of the FDS split and insert on?
middle phalanges
37
tendons of the FDP spit and insert on?
distal phalanges
38
Three groups of muscles in the hand?
1) Thenar muscles (4)
2) Hypothenar muscles (3)
3) Short muscles (11)
39
What three muscles form the thenar eminence?
1) Abductor Pollicis Brevis (APB)
2) Flexor Pollicus Brevis (FPB)
3) Opponens Pollicis
40
What are the movements of the thumb?
flexion, extension, opposition, reposition, abduction and adduction
41
Abductor Pollicis Brevis: Insertion
proximal thumb phalange (lateral side)
42
Abductor Pollicis Brevis: Origin
Flexor retinaculum, scaphoid and trapezium
43
Abductor Pollicis Brevis: Innervation
Recurrent branch of the median nerve
44
Abductor Pollicis Brevis: Actions
ABduct thumb
45
What lies medial and lapped by the APB?
Flexor Pollicus Brevis
46
How many heads does the flexor pollicus brevis have?
two: superficial and deep
47
Flexor Pollicus Brevis (Superifical Head): Origin
Flexor retinaculum and Trapezium
48
Flexor Pollicus Brevis (Deep head): Origin
trapezoid and capitate
49
Flexor Pollicus Brevis: Insertion
Proximal thumb phalange (palmer surface) via tendon containing radial seasmoid bone
50
What tendon passes between the superficial and deep head of the flexor pollicus brevis?
flexor pollicus longus
51
Flexor Pollicus Brevis: Innervation
Superficial head: Recurrent branch of the median nerve
| Deep: Deep branch of ulnar nerve
52
Flexor Pollicus Brevis: Actions
flexion of thumb at MP joint
53
Opponens Pollicis: Origin
Flexor retinaculum, Scaphoid and Trapezium
54
Opponens Pollicis: Insertion
1st metacarpal (lateral border)
55
Opponens Pollicis: Innervation
Recurrent median nerve
56
Opponens Pollicis: Actions
opposes thumb
57
What lies deep to the thenar eminence muscles?
Adductor Pollicis
58
What is the adductor pollicis muscle?
fan shaped muscle with two heads (oblique and transverse) that contribute to the web between thumb and index finger
59
adductor pollicis (Oblique head): origin
2nd and 3rd metacarpals & Capitate
60
adductor pollicis (transverse head): origin
3rd metacarpal
61
adductor pollicis: Insertion
proximal phalax of the thumb
62
the adductor pollicis tendon contains?
ulnar seasmoid bone
63
adductor pollicis: Innervation
deep ulnar
64
adductor pollicis: actions
adducts thumb
65
what shape is the opponens pollicis?
quadrangular shape
66
What lies deep to the abductor pollicus brevius?
opponens pollicis
67
What three muscles comprise the hypothenar eminence?
1) aBductor Digiti Minimi
2) flexor digiti minimi brevis
3) opponens digiti minimi
68
what are the functions of the hypothenar muscles?
1) move small finger (5th digit)
| 2) small finger movements- flexion, extension, opposition, reposition, aBduction and aDduction (not by hypothenars)
69
Which muscle is most superifical of the hypothenar muscles?
aBductor digiti minimi
70
abductor digiti minimi: origin
pisiform
71
abductor digiti minimi: insertion
proximal phalanx, 5th digit, lateral edge
72
abductor digiti minimi: innervation
Deep ulnar nerve
73
abductor digiti minimi: actions
aBducts 5th digit
74
What lies lateral to the abductor digiti minimi?
flexor digiti minimi (brevis)
75
flexor digiti minimi (brevis): origin
hook of hamate and flexor retinaculum
76
flexor digiti minimi (brevis): insertion
proximal phalanx 5th digit
77
flexor digiti minimi (brevis): innervation
deep ulnar nerve
78
flexor digiti minimi (brevis): action
flexes MP joint
79
Opponens Digiti Minimi: Origin
hook of hamate and flexor retinaculum
80
Opponens Digiti Minimi: Insertion
medial border of 5th metacarpal
81
Opponens Digiti Minimi: innervation
deep ulnar n
82
Opponens Digiti Minimi: actions
opposition
83
Most of the muscles of the thenar emminence have their counterpart in the hypothenar emminence, except?
Adductor pollicus brevis
84
What are the short muscles of the palmar hand?
1) Lumbrical mm (4)
2) Palmar Interossei mm (3)
3) Dorsal interossi mm (4)
85
which muscles are termed the "wormy" muscles?
Lumbricals
86
There are 4 lumbricals, which are unipennate and which are bipennate?
1st and 2nd= unipennate
| 3rd and 4th= bipennate
87
Lumbricals: Origin
lateral side of 1st and 2nd FDP tendons; Adjacent sides of (2nd&3rd) and (3rd&4th) tendons
88
Lumbricals: Insertion
lateral (radial) side of extensor expansion of digits 2-5
89
Lumbricals: Innervation
1st and 2nd --> by median n
| 3rd and 4th --> by deep ulnar n
90
Lumbricals: Actions
Flex MP
| Extend IP
91
T/F: Palmar Interossei are all unipennate.
True
92
Palmar Interossei: Origin
medial side of 2nd metacarpal
| lateral side of 4th and 5th metacarpal
93
Palmar Interossei: Insertion
proximal phalanges of 2nd, 4th and 5th digits AND
| extensor expansions of 2nd, 4th and 5th digits
94
True or False: Dorsal Interossei are all unipennate.
False, Dorsal Interossei are all bipennate
95
Dorsal interossei: Origin
adjacent surfaces of 1st through 5th metacarpals
96
Dorsal interossei: Insertion
via two tendons:
1) Proximal phalanges of 2,3 and 4 digits
3) extensor expansions of 2,3,4 digits
97
Dorsal interossei: Innervation
Deep ulnar nerve
98
What do the extensor expansions allow for in the doral interossei?
Flex MP joint
| Extend IP joint
99
Palmer interossei: actions
PAD= Palmer-ADuction
adducts 2,4 and 5th digit
can't really adduct the middle finger because its already in the middle
100
Dorsal interossei: actions
DAB- Dorsal- ABduct
| aBducts 2,3,4 digits
101
What vessel lies anterior to the flexor retinaculum?
Ulnar artery
102
What are the two branches of the ulnar artery?
Superficial and Deep
103
What makes up the superficial palmer arch
superficial palmar branch of radial and ulnar artery
104
Which artery is dominant in the superficial palmar arterial arch?
ulnar a.
105
What are the branches of the superficial palmar arterial arch?
1 proper palmar digital artery --> 5th digit
3 common palmar digital arteries which give rise to 6 proper palmar digital artery to 2/3, 3/4, 4/5 digits
106
Where does the radial artery pass before branching?
between two heads of the 1st dorsal interosseus then branches to and one form the deep palmar arterial arch
107
What is the dominant vessel in the deep palmar arterial arch?
radial artery
108
what is the median nerve pathway?
gives rise to a small superficial branch --> enters carpal tunnel --> enters midland --> branches --> into motor and cutaneous branches
109
what does the recurrent branch of the median nerve innervate?
1) aBductor pollicis brevis
2) Superifical head of flexor pollicis brevis
3) Opponens pollicis
110
the median nerve cutaneous branch and innervate the digits, each has a proper palmas digital nerve. However, there is no common palmar digital nerve to which digit?
1st digit (thumb)
111
What are the median nerve motor branches?
1) recurrent branch
| 2) nerves to 1st and 2nd lumbricals
112
What does the median nerve branches innervate?
```
MeatLOAF
Median n
Lumbricals (1&2)
Opponens (pollicis)
Abductor (pollicis)
Flexor (superficial)
```
113
What is the ulnar nerve pathway?
enters superfically to the flexor retinaculum --> divides into deep and superficial branches
114
What kinds of fibers does the superficial branch of the ulnar n carry?
sensory
115
What kinds of fibers does the deep branch of the ulnar n contain?
motor
116
The ulnar nerve cutaneous branches innervates which digits?
4th and 5th digit
palmer skin of medial 1.5 digits and palm
dorsum skin of medial 1.5 digits and midhand
117
which is the nerve "of fine hand movements"
Ulnar n
118
Where does the ulnar nerve enter the palm?
through the Guyon's canal
119
What does the deep branch of the ulnar nerve innervate?
```
motor!
3 hypothenar muscles
3&4 lunbricals
dorsal interossei
palmer interossei
adductor pollicis
deep head of flexor pollicis brevis
```
120
what is the manual part of the upper limb?
the hand
121
how many bones and muscles are in the hand?
27 bones (8 carpals, 5 metacarpal and 14 phalanges) and 19 muscles
