2-Hand

Front 1

What is the palmer fascia (deep fascia) a continuation of?

Back 1

antebrachial deep fascia

Front 2

What is the strong deep fascia in the palm region?

Back 2

palmar aponeurosis

Front 3

What does the proximal end of the palmar aponeurosis continue with? distal end?

Back 3

proximal-flexor retinaculum and palmaris longus tendon
distal-fibrous digital sheaths

Front 4

What does the distal end of the palmar aponeurosis form?

Back 4

four longitudinal digital bands that radiate and attach to the bases of the proximal phalanges

Front 5

What are the ligamentous sheaths on th epalmar aspect of the digits that enclose all the flexor tendons and their synovial sheaths?

Back 5

fibrous digital sheaths

Front 6

What is the fibrous digital sheath composed of?

Back 6

five anular and four cruciform parts

Front 7

Name the septums of the palm.

Back 7

medial fibrous and lateral fibrous

Front 8

What does the medial fibrous septum separate?

Back 8

hypthenar compartment (on medial side) from the potential midpalmar space

Front 9

What does the lateral fibrous septum separate?

Back 9

thenar compartment and the potential thenar space (one the lateral side) from the central compartment and potential midpalmar space

Front 10

Where does the medial fibrous septum extend from?

Back 10

medial border of palmar aponeurosis to the 5th metacarpal

Front 11

Where does the lateral fibrous septum extend from?

Back 11

lateral border of palmar aponeurosis to the 3rd metacarpal

Front 12

Name the compartments of the hand.

Back 12

thenar, hypothenar,central, adductor, (interosseous)

Front 13

Which compartment is located the deepest? Which muscles does it contain?

Back 13

adductor
adductor pollicis muscle

Front 14

What does the central compartment contain?

Back 14

flexor tendons and their sheaths, lubricals, superficial palmar arterial arch, digital vessels and nerves

Front 15

When there is accumulation of fluids in the palm where is the fluid restricted to?

Back 15

midpalmar and thenar spaces

Front 16

What is a progressive shortening, thickening and fibrosis of the palmar fascia and aponeurosis?

Back 16

Dupuytren's contracture of palmar faxcia

Front 17

Which fingers are affected in Dupuytren's contracture of palmar fascia? What happens to the fingers?

Back 17

medial side of 4th&5th fingers, pulled into partial flexion at the metacarpophalangeal and proximal interphalangeal joints

Front 18

Who is more likely to have Dupuytren's contracture of palmar fascia?

Back 18

males over 50, commonly bilateral

Front 19

Discuss the progression of Dupuytren's contracture of palmar fascia.

Back 19

starts w/ painless nodular thickenings on palmar aponeurosis, develops into contracturing longitudinal bands in the palm

Front 20

What is the treatment for Dupuytren's contracture of palmar fascia?

Back 20

surgical excision of all fibrotic parts of the palmar fascia

Front 21

What is the chief function of the thenar muscles?

Back 21

thumb opposition

Front 22

Which muscles make up the thenar muscles?

Back 22

abductor pollicis brevis, flexor pollicis brevis, opponens pollicis

Front 23

Which muscle is the only muscle that flexes the interphaangeal joint of the thumb?

Back 23

flexor pollicis longus

Front 24

Describe the positions of the thenar muscles in their compartment.

Back 24

abductor pollicis brevis is anterolateral, flexor pollicis brevis, medial to APB, opponens pollicis is ddep to APB and lateral to FPB

Front 25

In addition to opposition of the thumb, what other function can the abductor pollicis brevis do?

Back 25

abducts the carpometacarpal joint of the thumb

Front 26

In addition to opposition of the thumb, what other function can the flexor pollicis brevis do?

Back 26

flexes carpometacarpal, metacarpophalangeal joints of the thumb

Front 27

Which muscle is located deep in the adductor compartment? What is its function?

Back 27

adductor pollicis
adducts the thumb

Front 28

Which muscles are located in the hypothenar compartment?

Back 28

abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi

Front 29

Describe the location of the muscles in the hypothenar compartment.

Back 29

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

Front 30

What is the function of the abductor digiti minimi?

Back 30

abducts the 5th digit, helps to flex the proximal phalanx of the 5th digit

Front 31

What is the function of the flexor digiti minimi brevis?

Back 31

flexes 5th digit at the metacarpophalangeal joint

Front 32

What is the function of the opponens digiti minimi?

Back 32

flexes and laterally rotates the 5th metacarpal bone for opposition action

Front 33

What is the small, thin, superficial muscle in the hypothenar eminence but not in the hypothenar compartment? What is its function?

Back 33

palmaris brevis
wrinkles hypothenar skin, aids in palmar gripping

Front 34

What aree the short muscles of the hand?

Back 34

lumbricals and interossei

Front 35

What is the function of the lumbricals? How many lumbricals are there?

Back 35

flexes teh metacarpophalangeal joint and extends interphalangeal joints of the medial four fingers
4

Front 36

What is the function of the interossei? How many are there?

Back 36

dorsal interossei-abduct the digits (DAB)
palmar interossei-adduct (PAD)
both help lumbricals function
there are 4 dorsal and 3 palmar

Front 37

Describe the synovial sheath of the FDS and FDP, especially regarding the digits.

Back 37

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

Front 38

What is outside of the digital synovial sheath?

Back 38

digital fibrous sheath

Front 39

What regions is the fibrous sheath tougher?

Back 39

anular and cruciate regions

Front 40

Where do the FDS tendons split?

Back 40

base of middle phalanx

Front 41

The FDS tendons go around the FDP tendons and attach where?

Back 41

anterior aspect of base of middle phalanx

Front 42

Where does the FDP tendon attach?

Back 42

base of the distal phalanx

Front 43

What is infection of the synovial sheath called? What can cause it?

Back 43

tenosynovitis
injury such as puncture of the palm by a rusty nail

Front 44

Why is the infection able to spread? Where can it spread to?

Back 44

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

Front 45

In tenosynovitis if the digital synovial sheath ruptures where can the infection spread?

Back 45

into the midpalmar space

Front 46

What is De Quervain's tenovaginitis tenosans?

Back 46

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

Front 47

Repetitive foreceful use of the fingers can lead to what?

Back 47

digital tenovaginitis stenosans, a thickening of the fibrous digital sheath

Front 48

Which tendons may enlarge w/ digital tenovaginitis tenosans? Why does this occur?

Back 48

FDS and FDP
due to friction in the osseofibrous tunnel

Front 49

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?

Back 49

finger cannot extend

Front 50

Is the ulnar artery medial or lateral to the ulnar nerve?

Back 50

lateral

Front 51

What does the superficial palmar arch of the ulnar artery branch into?

Back 51

common palmar digital arteries and proper palmar digital arteries

Front 52

Where do the proper palmar digital arteries run?

Back 52

along the adjacent sides of 2-4 digits

Front 53

What does the deep palmar arch branch into?

Back 53

palmar metacarpal arteries

Front 54

what do the palmar metacarpal arteries anastomose with?

Back 54

common palmar digital arteries (a branch of the superficial palmar arch of the ulnar artery)

Front 55

Where is the deep palmar arch located?

Back 55

distal to bases of metacarpals

Front 56

What does the deep palmar arch give rise to?

Back 56

palmar metacarpal and princeps pollicis arteries

Front 57

What does the princeps pollicis artery supply?

Back 57

palmar surface and sides of thumb

Front 58

What does the palmar metacarpal arteries anastomose with?

Back 58

common palmar digital arteries

Front 59

What can occur with laceration of the palmar arterial arches?

Back 59

profuse bleeding due to extensive anastomoses, may have to stop bleeding above elbow at brachial artery

Front 60

What type of disease is 'Raynaud's disease'? What can occur?

Back 60

sympathetic nerve disfuction
ischemia of the fingers

Front 61

How many tendons pass through the carpal tunnel? nerves?

Back 61

9
4 FDS, 4 FDP, 1 flexor pollicis longus
1 nerve-median

Front 62

What is the passageway deep to the flexor retinaculum called?

Back 62

carpal tunnel

Front 63

Which bones are on the lateral side of the carpal tunnerl? medial?

Back 63

lateral-scaphoid & trapezoid
medial-pisiform and hook of hamate

Front 64

The midian nerve enters the hand and supplies what muscles?

Back 64

the three thenar muscles, the 1st & 2nd lumbricals=2 on lateral side

Front 65

On the hand, which skin is supplied by the median nerve?

Back 65

entire palm, sides of 1,2,3 digits, lateral half of 4th digit, distal halves of dorsum of these fingers

Front 66

The central palm supply is from which branch of the median nerve?

Back 66

palmar branch

Front 67

Why is the palmar branch of the median nerve not affected in carpal tunnel syndrome?

Back 67

it branches prior to the carpal tunnel and enters the palm superficial to the carpal tunnel

Front 68

Where do lesions of the median nerve commonly occur?

Back 68

forearm and most often in carpal tunnel

Front 69

Trauma to the median nerve can produce what?

Back 69

Ape hand, thumb movement is limited in flexion and abduction

Front 70

Discuss the location of the ulnar nerve with regards to the flexor retinaculum pisiform and ulnar artery?

Back 70

anterior to flexor retinaculum, lateral to pisiform, medial to ulnar artery

Front 71

Which nerve is referred to as the nerve of fine movements?

Back 71

ulnar nerve

Front 72

What are the branches of the ulnar nerve in the region of the hand?

Back 72

palmar cutaneous, dorsal cutaneous, superficial, deep

Front 73

What does the palmar cutaneous branch supply?

Back 73

skin on the medial side of the palm

Front 74

What does the dorsal cutaneous branch supply?

Back 74

medial half of dorsum hand, 5th digit and medial half of 4th digit

Front 75

What does the superficial branch of the ulnar nerve supply?

Back 75

medial 1 1/2 digits on anterior surface

Front 76

What does the deep branch of the ulnar nerve supply?

Back 76

hypothenar muscles, medial 2 lumbricals, adductor pollicis, and all interossei, also wrist, intercarpal, carpometacarpal, and intermetacarpal joints

Front 77

Which 2 branches of the ulnar nerve brach proximal to the wrist? distal?

Back 77

proximal-palmar cutaneous and dorsal cutaneous
distal-superficial and deep

Front 78

Discuss the radial nerve with regards to supplying the hand.

Back 78

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

Front 79

Where is the ulnar nerve most likely to be injured? What are 3 other areas

Back 79

posterior to medial epicondyle of humerus
tendinous cubital tunnel formed by flexor carpi ulnaris, wrist (Guyon's canal), hand (cyclist's palsy)

Front 80

What is a characteristic appearance of radial nerve injury?

Back 80

wrist-drop