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80 Cards in this Set

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What is the palmer fascia (deep fascia) a continuation of?
antebrachial deep fascia
What is the strong deep fascia in the palm region?
palmar aponeurosis
What does the proximal end of the palmar aponeurosis continue with? distal end?
proximal-flexor retinaculum and palmaris longus tendon
distal-fibrous digital sheaths
What does the distal end of the palmar aponeurosis form?
four longitudinal digital bands that radiate and attach to the bases of the proximal phalanges
What are the ligamentous sheaths on th epalmar aspect of the digits that enclose all the flexor tendons and their synovial sheaths?
fibrous digital sheaths
What is the fibrous digital sheath composed of?
five anular and four cruciform parts
Name the septums of the palm.
medial fibrous and lateral fibrous
What does the medial fibrous septum separate?
hypthenar compartment (on medial side) from the potential midpalmar space
What does the lateral fibrous septum separate?
thenar compartment and the potential thenar space (one the lateral side) from the central compartment and potential midpalmar space
Where does the medial fibrous septum extend from?
medial border of palmar aponeurosis to the 5th metacarpal
Where does the lateral fibrous septum extend from?
lateral border of palmar aponeurosis to the 3rd metacarpal
Name the compartments of the hand.
thenar, hypothenar,central, adductor, (interosseous)
Which compartment is located the deepest? Which muscles does it contain?
adductor
adductor pollicis muscle
What does the central compartment contain?
flexor tendons and their sheaths, lubricals, superficial palmar arterial arch, digital vessels and nerves
When there is accumulation of fluids in the palm where is the fluid restricted to?
midpalmar and thenar spaces
What is a progressive shortening, thickening and fibrosis of the palmar fascia and aponeurosis?
Dupuytren's contracture of palmar faxcia
Which fingers are affected in Dupuytren's contracture of palmar fascia? What happens to the fingers?
medial side of 4th&5th fingers, pulled into partial flexion at the metacarpophalangeal and proximal interphalangeal joints
Who is more likely to have Dupuytren's contracture of palmar fascia?
males over 50, commonly bilateral
Discuss the progression of Dupuytren's contracture of palmar fascia.
starts w/ painless nodular thickenings on palmar aponeurosis, develops into contracturing longitudinal bands in the palm
What is the treatment for Dupuytren's contracture of palmar fascia?
surgical excision of all fibrotic parts of the palmar fascia
What is the chief function of the thenar muscles?
thumb opposition
Which muscles make up the thenar muscles?
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
Which muscle is the only muscle that flexes the interphaangeal joint of the thumb?
flexor pollicis longus
Describe the positions of the thenar muscles in their compartment.
abductor pollicis brevis is anterolateral, flexor pollicis brevis, medial to APB, opponens pollicis is ddep to APB and lateral to FPB
In addition to opposition of the thumb, what other function can the abductor pollicis brevis do?
abducts the carpometacarpal joint of the thumb
In addition to opposition of the thumb, what other function can the flexor pollicis brevis do?
flexes carpometacarpal, metacarpophalangeal joints of the thumb
Which muscle is located deep in the adductor compartment? What is its function?
adductor pollicis
adducts the thumb
Which muscles are located in the hypothenar compartment?
abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
Describe the location of the muscles in the hypothenar compartment.
abductor digiti minimi is most superficial, flexor digiti minimi brevis is lateral to ADM, opponens digiti minimi is ddep to the other 2 hypothenar muscles
What is the function of the abductor digiti minimi?
abducts the 5th digit, helps to flex the proximal phalanx of the 5th digit
What is the function of the flexor digiti minimi brevis?
flexes 5th digit at the metacarpophalangeal joint
What is the function of the opponens digiti minimi?
flexes and laterally rotates the 5th metacarpal bone for opposition action
What is the small, thin, superficial muscle in the hypothenar eminence but not in the hypothenar compartment? What is its function?
palmaris brevis
wrinkles hypothenar skin, aids in palmar gripping
What aree the short muscles of the hand?
lumbricals and interossei
What is the function of the lumbricals? How many lumbricals are there?
flexes teh metacarpophalangeal joint and extends interphalangeal joints of the medial four fingers
4
What is the function of the interossei? How many are there?
dorsal interossei-abduct the digits (DAB)
palmar interossei-adduct (PAD)
both help lumbricals function
there are 4 dorsal and 3 palmar
Describe the synovial sheath of the FDS and FDP, especially regarding the digits.
the FDS and FDP are contained in the same synovial sheath, this extends to the 5th digit, but digits 2,3,4 have their own synovial sheath
What is outside of the digital synovial sheath?
digital fibrous sheath
What regions is the fibrous sheath tougher?
anular and cruciate regions
Where do the FDS tendons split?
base of middle phalanx
The FDS tendons go around the FDP tendons and attach where?
anterior aspect of base of middle phalanx
Where does the FDP tendon attach?
base of the distal phalanx
What is infection of the synovial sheath called? What can cause it?
tenosynovitis
injury such as puncture of the palm by a rusty nail
Why is the infection able to spread? Where can it spread to?
infection can spread through connections, such as the 5th digit synovial sheath communicated w/ the common synovial sheath of the flexors, can spread to palm, carpal tunnel and forearm
In tenosynovitis if the digital synovial sheath ruptures where can the infection spread?
into the midpalmar space
What is De Quervain's tenovaginitis tenosans?
excessive friction of the tendons of abductor pollicis longus and extensor pollicis brevis, this causes fibrous thickening of the synovial sheath=pain in wrist that radiates into forearm and thumb
Repetitive foreceful use of the fingers can lead to what?
digital tenovaginitis stenosans, a thickening of the fibrous digital sheath
Which tendons may enlarge w/ digital tenovaginitis tenosans? Why does this occur?
FDS and FDP
due to friction in the osseofibrous tunnel
In digital tenovaginitis stenosans, the proximal thckening of the tendons may result in difficulty for the tendon to pass the anular region of the fibrous sheath, what does this prevent?
finger cannot extend
Is the ulnar artery medial or lateral to the ulnar nerve?
lateral
What does the superficial palmar arch of the ulnar artery branch into?
common palmar digital arteries and proper palmar digital arteries
Where do the proper palmar digital arteries run?
along the adjacent sides of 2-4 digits
What does the deep palmar arch branch into?
palmar metacarpal arteries
what do the palmar metacarpal arteries anastomose with?
common palmar digital arteries (a branch of the superficial palmar arch of the ulnar artery)
Where is the deep palmar arch located?
distal to bases of metacarpals
What does the deep palmar arch give rise to?
palmar metacarpal and princeps pollicis arteries
What does the princeps pollicis artery supply?
palmar surface and sides of thumb
What does the palmar metacarpal arteries anastomose with?
common palmar digital arteries
What can occur with laceration of the palmar arterial arches?
profuse bleeding due to extensive anastomoses, may have to stop bleeding above elbow at brachial artery
What type of disease is 'Raynaud's disease'? What can occur?
sympathetic nerve disfuction
ischemia of the fingers
How many tendons pass through the carpal tunnel? nerves?
9
4 FDS, 4 FDP, 1 flexor pollicis longus
1 nerve-median
What is the passageway deep to the flexor retinaculum called?
carpal tunnel
Which bones are on the lateral side of the carpal tunnerl? medial?
lateral-scaphoid & trapezoid
medial-pisiform and hook of hamate
The midian nerve enters the hand and supplies what muscles?
the three thenar muscles, the 1st & 2nd lumbricals=2 on lateral side
On the hand, which skin is supplied by the median nerve?
entire palm, sides of 1,2,3 digits, lateral half of 4th digit, distal halves of dorsum of these fingers
The central palm supply is from which branch of the median nerve?
palmar branch
Why is the palmar branch of the median nerve not affected in carpal tunnel syndrome?
it branches prior to the carpal tunnel and enters the palm superficial to the carpal tunnel
Where do lesions of the median nerve commonly occur?
forearm and most often in carpal tunnel
Trauma to the median nerve can produce what?
Ape hand, thumb movement is limited in flexion and abduction
Discuss the location of the ulnar nerve with regards to the flexor retinaculum pisiform and ulnar artery?
anterior to flexor retinaculum, lateral to pisiform, medial to ulnar artery
Which nerve is referred to as the nerve of fine movements?
ulnar nerve
What are the branches of the ulnar nerve in the region of the hand?
palmar cutaneous, dorsal cutaneous, superficial, deep
What does the palmar cutaneous branch supply?
skin on the medial side of the palm
What does the dorsal cutaneous branch supply?
medial half of dorsum hand, 5th digit and medial half of 4th digit
What does the superficial branch of the ulnar nerve supply?
medial 1 1/2 digits on anterior surface
What does the deep branch of the ulnar nerve supply?
hypothenar muscles, medial 2 lumbricals, adductor pollicis, and all interossei, also wrist, intercarpal, carpometacarpal, and intermetacarpal joints
Which 2 branches of the ulnar nerve brach proximal to the wrist? distal?
proximal-palmar cutaneous and dorsal cutaneous
distal-superficial and deep
Discuss the radial nerve with regards to supplying the hand.
no hand muscle supply, supplies the skin of lateral 2/3 of dorsum of hand, dorsum of thyumb and lateral 1 1/2 digits on proximal part
Where is the ulnar nerve most likely to be injured? What are 3 other areas
posterior to medial epicondyle of humerus
tendinous cubital tunnel formed by flexor carpi ulnaris, wrist (Guyon's canal), hand (cyclist's palsy)
What is a characteristic appearance of radial nerve injury?
wrist-drop