Anatomy Block III- Wrist and Hand

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1
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a. phalanges
b. metatarsals
c. tarsals
d. distal interphalangeal joint
e. proximal interphalangeal joint
f. metacarpophalangeal joint

2
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a. hamate (with hook of hamate
b. pisiform
c. triquetrum
d. lunate
e. scaphoid (with tubercle)
f. capitate
g. trapezoid
h. trapezium (with tubercle)

3

where is the most lateral finger in the hand

thumb, finger 1

4

what are the bones of the hand generally

carpals
metacarpals
phalanges

5

how many carpals are there

8

6

how many metacarpals are there

5

7

how many phalanges are there

14

8

how many rows of carpals are there

2, from lateral to medial

9

what are the two rows of carpals

proximal and distal

10

what are the proximal carpals

scaphoid, lunate, triquetrum, pisiform

11

what are the distal carpals

trapezium, trapezoid, capitate, hamate

12

what is on top of the triquetrum

pisiform

13

what bone of the hand can you not see from the dorsum

pisiform

14

what did the scaphoid use to be called

navicular bone

15

what is interesting about the hamate

has a hook, extends anteriorly off palm and forms medial border of carpal tunnel

16

what forms lateral border of carpal tunnel

tubercles of scaphoid and trapezium

17

how many phalanges are in each finger

23333

18

what are the joints of the fingers

metacarpophalangeal joints
proximal interphalangeal joints
distal interphalangeal joints

19

what is a scaphoid fracture usually the result of

falling on outstretched hand

this is because the scaphoid is a protruding bone on the palmar side

20

what can often result from a scaphoid fracture

avascular necrosis proximally

21

why are scaphoid fractures susceptible to avascular necrosis

lack of adequate proximal blood supply

22

where can a scaphoid tubercle fracture be palpated

anatomical snuff box

23

what is a Boxer's fracture

distal metacarpal fracture

24

what is a barfight fracture

fractores of 4th or 5th metacarpal

25

what is a telltale sign of a barfight fracture

sunken knuckle

26
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a. palmar aponeurosis
b. hypothenar eminence
c. thenar eminence
d. fibrous digital sheath

27

what is the palmar aponeurosis

thickening of palmar fascia; triangle like tissue with palmaris longus blends with it

28

what are the fascias of the hand

palmar aponeurosis
thenar eminence
hypothenar eminence
dorsal fascia
fibrous digital sheaths

29

what are the spaces in the hand

midpalmar space
thenar space

30

what are the septa in the hand

medial fibrous septum
lateral fibrous septum

31

what does the palmar aponeurosis allow

union with overlying skin and for better grip

32

what is the palmar aponeurosis continuous with

fibrous digital sheaths supporting digits and flexor tendons underneath

33

what are the thickest aponeuroses

dorsal fascia
palmar aponeurosis

34

what is the thenar fascia

fascia around respective muscles at base of thumb

35

what is the hypothenar fascia

fascia around respective muscles at base of pinky

36

what is the role of the fibrous digital sheaths

covers flexor tendons extending to the fingers

37

what is tenosynovitis

infection/inflammation of synovial sheath

38

what is digital tenovaginitis stenosans

swollen tendon of a finger, doesn't want to go back into fibrous sheath, swelling will pop it in and out

39

what spinal segments innervate all of the hand muscles

C8-T1

40

what is the midpalmar space continuous with

carpal tunnel

41
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a. hypothenar compartment
b. interosseous compartment
c. adductor compartment
d. thenar compartment
e. central compartment
f. midpalmar space
h. thenar space

42

what does the thenar compartment of the hand form

thenar eminence

43

what innervates the intrinsic muscles of the thumb

recurrent branch of median nerve

44

what muscles are within the thenar compartment of the hand

intrinsic muscles of thumb:
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis

45

where is the abductor pollicis brevis in the hand relative to the other thumb muscles

more lateral

46

where is the flexor pollicis brevis in the hand relative to other thumb muscles

more medial

47

where is the opponens pollicis in the hand

deep to flexor pollicis brevis and abductor pollicis brevis

48

what does the opponens pollicis do

helps with opposition along with palmaris brevis

thenar eminence rotates and comes in with it, allowing thumb to come over and touch pinky finger

49
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a. recurrent branch of median nerve
b. abductor pollicis brevis
c. flexor pollicis brevis

50
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a. opponens pollicis
b. recurrent branch of median nerve

51
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a. abduction
b. adduction
c. extension
d. flexion
e. opposition
f. reposition

52

wwhat does the hypothenar compartment form

hypothenar eminence

53

what muscles are within the hypothenar eminence

intrinsic muscles of 5th digit:
abductor digiti minimi
flexor digiti minimi
oppponens digiti minimi

54

where is the abductor digiti minimi in the hypothenar compartment

lateral

55

what does the abductor digiti minimi do

draws pinky away from middle of hand

56

where is the flexor digiti minimi in the hypothenar compartment

middle

57

what is the role of the flexor digiti minimi

works on flexing fifth finger

58

where is the opponens digiti minimi

most lateral

59

what is the role of the opponens digiti minimi

assists in finger opposition

60

what innervates the hypothenar compartment muscles

deep branch of ulnar nerve

61
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a. opponens digiti minimi
b. flexor digiti minimi
c. abductor digiti minimi
d. abductor pollis brevis
e. opponens pollicis
f. fleoxr pollicis brevis

62
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a. transverse head of adductor pollicis
b. oblique head of adductor pollicis
c. ulnar nerve

63

what is in the adductor compartment of the hand

adductor pollicis

64

what are the two heads of the adductor pollicis

oblique head and transverse head

65

what is the role of the adductor pollicis

two heads help draw the thumb back to normal position from sticking out anteriorly

66

where is the transverse head of the adductor pollicis

webbing of thumb

67
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what muscles assist in this motion

lumbricals

68
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a. lumbricals

69

what is in the central compartment of the hand

lubricals
tendons of flexor digitorum superficialis and profundus
superficial and deep palmar arches
bracnhes of median and ulnar nerve

70

where are the lumbricals located

flexor digitorum profundus tendons; cross metacarpal phalangeal joint and go to dorsal side of digits and go into extensor sheaths on backside of fingers

71

what is the role of the lumbricals

flex joint but help extend and stabilize interphalangeal joints

72

what do the lateral 2 lumbricals control

middle and index finger

73

what innervates the lateral two lumbricals

median nerve

74

what do the medial two lumbrical control

pinky and ring finger

75

what innervates the medial two lumbricals

ulnar nerve

76

what are the arteries of the central compartment

superficial and deep palmar arches

77
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a. common flexor sheath
b. digital synovial sheaths

78

what is the common flexor sheath continuous with

digital synovial sheath of pinky

79

what covers up the digital synovial sheaths

fibrous digital sheath

80

what aare the interosseous compartmetns separated by

metacarpals

81
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a. deep branch of ulnar artery and nerve

82

what are interosseous compartments innervated by

deep branch of ulnar nerve

83

what finger does the palmar interossei not attach to

third finger

84

what are the muscles of the interosseus compartments

palmar interossei
dorsal interossei

85

how many palmar interossei are there

three

86

what is the role of the palmar interossei

adduct; draw fingers back toward midline

87

how many dorsal interossei are there

4

88

what is the role of the dorsal interossei

help abduct (bring fingers out)

89

what abducts the pinky finger

abductor digiti minimi

90
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what is this injury and where is it and when is this

median nerve at wrist

under normal conditions

91
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what is this injury

where is this injury

when is this

benediction deformity

median nerve at elbow

when asked to make a fist

92

what are symptoms of median nerve injury at the wrist

loss of two lateral lumbricals and thenar muscles (ape hand deformity where thumb rotate and is stuck next to hand) and loss of sensation over thumb and 2-4.5 digits

93

what is always affected in a median nerve injury

thumb and lumbricals

94

what types of injuries could affect the median nerve at the wrist

carpal tunnel syndrome and laceration of wrist

95

what types of injuries could afefct the median nerve at the elbow

anterior puncture would

96

what does the ulnar nerve injury alwasy affect

digits

97

what could result from ulnar nerve injury

claw hand deformity: loss of flexion of 4th and 5th metacarpophalangeal joints, extension of both proximal interphalangeal joints, and flexion of distal interphalangeal joints

98
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what type of deformity is this? when is it made? and where is the injury?

claw hand deformity

under normal conditions

injury is at wrist to ulnar nerve

99

what could reult from elbow level ulnar nerve injury

wrist abducts when asked to flex

100

what would an elbow level ulnar nerve injury result in

loss of flexor carpi ulnaris and sensory loss to medial side of hand and half of 4th and 5th digit

101
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a. radial artery
b. ulnar artery
c. superficial palmar arch
d. deep palmar arch

102

what supplies the superficial palmar arch with blood

mainly from ulnar artery

103

what supplies the deep palmar artch with blood

mainly from radial artery

104

what are teh braches of the ulnar artery and which one is larger

superficial and deep; superficial is usually larger

105

what does the superficial ulnar branch usually anastomose with

superficial radial branch

106

what does the deep palmar arch anastomose with

deep branch of ulnar artery

107

what do the deep palmar and superficial palmar arteries usually anastomoes with

palmar metacarpal arteries

108

what cutaneous innervatino does the ulnar nerve's superficial branch supply

medial hand and medial 4th and 5th digit

109

what cutaneous innervation does the radial nerve's superficial branch supply

lateral dorsum of hand, proximal 1/2 of 1st-3rd digit

110
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a. median nerve
b. radial nerve
c. ulnar nerve

111
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a. median nerve
b. radial nerve
c. ulnar nerve

112

what cutaneous innervation does the median nerve supply

latreal palm of hand and first 3.5 digits, distal portion of palmar side of 1st 3.5 digits