The Hand

Front 1

carpals

Back 1

PROXIMAL ROW
SCAPHOID
LUNATE
TRIQUETRUM
PISIFORM
distal row
TRAPEZIUM
TRAPEZOID
CAPITATE
HAMATE

Front 2

metacarpals and phalanges

Back 2

5 METACARPALS
DIGITS
FIRST DIGIT (THUMB)
TWO (2) PHALANGES
DIGITS 2-5
THREE PHALANGES

Front 3

radiocarpal joint

Back 3

COMPOUND JOINT --SINGLE CAPSULE
LIGAMENTS
DORSAL AND PALMAR RADIOCARPAL
RADIAL COLLATERAL
ULNAR COLLATERAL

Front 4

radiocarpal joint is between what bones?

only which two carpals articulate directly with the radius?

Back 4

Joint between radius and the proximal row of carpals.

Only scaphoid & lunate articulate directly with radius.

Front 5

intercarpal and carpometacarpal joint

Back 5

-COMPOUND JOINT
SINGLE CAPSULE
EXCEPT PISOTRIQUETRAL
PLANAR TYPE OF SYNOVIAL JOINTS
LIGAMENTS
INTERCARPAL
DORSAL
PALMAR

Front 6

intercarpal and carpometacarpal joint

Back 6

Pisiform has it’s own joint with triquetrum.

It’s the sum of all of the planar type joints (in the common capsule) that gives the total flexibility of motion.

Front 7

metacarpophalangeal

Back 7

-CONDYLOID
LIGAMENTS
COLLATERAL LIGAMENT
PALMAR LIGAMENT
DEEP TRANSVERSE METACARPAL LIGAMENT

Front 8

metacarpophalangeal

Back 8

Condyloid – like a ball and socket but oval rather than round – so movement in just two direction, not three. CANNOT ROTATE!! can circumflex...

Deep transverse metacarpal ligament -It’s relaxed until you reach a stop point and then kicks in.

Also has a superficial transverse metacarpal ligament.

Front 9

interphalangeal

Back 9

HINGE TYPE-flex and extend only
1 IN FIRST DIGIT
2 IN DIGITS 2-5
PROXIMAL
DISTAL
COLLATERAL LIGAMENTS

Front 10

opposition

Back 10

motion of mostly thumb with a little bit of flexion of pinky. Adduction + flexion at metacarpal-phalange joint with thumb.

Front 11

where is the point of reference for the hand?

Back 11

Abduction / adduction of fingers does NOT use body’s midline – it uses a line along the 3rd digit. Spreading fingers is abduction. Muscles are labeled for these motions.

Front 12

skin and fascia

Back 12

RELATIVELY THIN SKIN (on dorsum)
PALM THICKER
THIN LAYER OF SUPERFICIAL FASCIA
PALMAR APONEUROSIS
PALMARIS BREVIS

Front 13

superficial palmar fascia

Back 13

Lots of collagen in superficial palmar fascia Padding but stable enough to allow you to grip- don’t want loose skin. Soft but fixed.

Front 14

palmar aponeurosis

Back 14

is also heavy with collagen fibers – gives form to palm and acts as a retinaculum for tendons passing through the area.

pt of insertion for palmaris longus

Front 15

palmaris brevis

Back 15

it’s small an often missed. Deepens the hollow (cup) of hand. Not critical – sometimes not even present.


-origin from flexor retinaculum and palar aponeurosis
-inserts on skin

innervated by the ulnar nerve
like most hand muscles, except lumbricals and thenar eminence

Front 16

where is there a superficial flexor tendon

Back 16

SUPERFICIAL FLEXOR TENDON ON THE BASE OF MIDDLE PHALANX

Front 17

deep flexor tendon where?

Back 17

DEEP FLEXOR
TENDON ON DISTAL
PHALANX

Front 18

flexor tendons

Back 18

Running through the palm are the tendons for flexion. Two flexion muscles (flexor digitorum superficialis (also functions as a retinaculum for f.d.profundus (keeps it stable)& flexor digitorum profundus) each split into 4 tendons.Extensor digitorium – digits 2-5 – also splits its tendons.

Note split of each of the superficial tendons to anchor on sides of fingers. Note also that the deep passes through the superficial. Superficial is acting as a reticulum for deep ligament.

Front 19

EXPANSION OR HOOD.
"WINGS"
TENDON DIVIDES INTO 3 BANDS
LUMBRICALS INSERT ON LATERAL BANDS

Back 19

common extensor hood

Front 20

extensors insert where? at what points? and originate where?

Back 20

Note all of the tendons that insert on/in the “hood”. These are the “long” extensors – originate in the forearm & insert here.

Hood is actually a diamond shaped area. Muscles attach to the side points (wings) (proximal end) of the diamond.

Front 21

thenar eminence

Back 21

thumb to little finger – watch bulges in palm.

Front 22

tendon from extensor digitorum joins with the tendons of what muscles? to form an expansion of the hood of each of the metacarpophalangeal joints

Back 22

THE TENDON FROM EXTENSOR DIGITORUM JOINS WITH THE TENDONS OF THE INTEROSSEOUS MUSCLES TO FORM AN EXPANSION (slides) OR HOOD OVER EACH OF THE METACARPOPHALANGEAL JOINTS.

Front 23

tendons of interosseus muscles form ? tendons angling from the primary tendon of which muscle?

Back 23

THE TENDONS OF THE INTEROSSEOUS MUSCLES FORM "WING" TENDONS ANGLING FROM THE PRIMARY TENDON OF EXTENSOR DIGITORUM.

FROM THIS EXPANSION (HOOD) THE TENDON CONTINUES DISTALLY TO THE DISTAL END OF THE PROXIMAL PHALANX WHERE IT SPLITS INTO TWO LATERAL BANDS AND ONE CENTRAL BAND. THE CENTRAL BAND WILL RECEIVE "WING" TENDONS FROM THE LUMBRICALS.

Front 24

the central of the tendon will attach to the base of which phalanx

Back 24

THE CENTRAL BAND OF THE TENDON WILL ATTACH TO THE BASE OF THE MIDDLE PHALANX, WHILE THE LATERAL BANDS WILL CONTINUE DISTALLY.

Front 25

the lateral bands of the extensor hood will unite to form what tendon? that will attach tot he base of the distal phalanx

Back 25

THE LATERAL BANDS WILL UNITE TO FORM THE TERMINAL TENDON THAT WILL ATTACH TO THE BASE OF THE DISTAL PHALANX.

Front 26

thenar eminence is made up of what 3 muscles and innervated by ?

Back 26

ABDUCTOR POLLICIS BREVIS
FLEXOR POLLICIS BREVIS
OPPONENS POLLICIS
-median nerve

Front 27

abductor pollicis brevis

Back 27

ORIGIN: FLEXOR RETINACULUM AND THE TUBERCLES OF THE SCAPHOID AND TRAPEZIUM
INSERTION: LATERAL SIDE, BASE OF PROXIMAL PHALANX OF THE FIRST DIGIT (THUMB)
ACTION: ABDUCTS THUMB AND HELPS IN OPPOSITION

Front 28

flexor pollicis brevis

Back 28

ORIGIN: FLEXOR RETINACULUM AND TUBERCLE OF THE TRAPEZIUM
INSERTION: LATERAL SIDE OF 1ST METACARPAL BONE
ACTION: FLEXES THUMB

Front 29

opponens pollicis

Back 29

ORIGIN: FLEXOR RETINACULUM AND TUBERCLE OF THE TRAPEZIUM
INSERTION: LATERAL SIDE OF 1ST METACARPAL BONE
ACTION: OPPOSES THUMB AND ROTATES IT MEDIALLY

Front 30

hypothenar eminence

Back 30

-PALMARIS BREVIS
-ABDUCTOR DIGITI MINIMI
-FLEXOR DIGITI MINIMI (BREVIS)
O-PPONENS DIGITI MINIMI

Front 31

palmaris brevis

Back 31

VERY SMALL MUSCLE THAT OFTEN IS MISSING.
ORIGIN: FLEXOR RETINACULUM AND PALMAR APONEUROSIS
INSERTION: SKIN ON THE MEDIAL SIDE OF THE PALM
ACTION: WRINKLES SKIN ON MEDIAL SIDE OF PALM AND DEEPENS THE HOLLOW OF THE PALM, AIDS IN GRIP
INNERVATION: ULNAR NERVE

Front 32

abductor digiti minimi

Back 32

ORIGIN: PISIFORM BONE
INSERTION: MEDIAL SIDE OF BASE OF THE PROXIMAL PHALANX OF THE FIFTH DIGIT.
ACTION: ABDUCTS DIGIT 5 (LITTLE FINGER)

Front 33

flexor digiti minimi brevis

Back 33

ORIGIN: HOOK OF HAMATE AND THE FLEXOR RETINACULUM
INSERTION: MEDIAL SIDE OF BASE OF THE PROXIMAL PHALANX OF THE FIFTH DIGIT
ACTION: FLEXES PROXIMAL PHALANX OF DIGIT 5

Front 34

OPPONENS DIGITI MINIMI

Back 34

ORIGIN: HOOK OF HAMATE AND THE FLEXOR RETINACULUM
INSERTION: MEDIAL BORDER OF THE FIFTH METACARPAL
ACTION: DRAWS FIFTH METACARPAL ANTERIORLY AND ROTATES IT LATERALLY TO BRING THE FIFTH DIGIT IN OPPOSITION WITH THE THUMB

Front 35

the palm-abductor pollicis

Back 35

ORIGIN:
OBLIQUE HEAD: CAPITATE AND BASES OF 2nd AND 3rd METACARPALS
TRANSVERSE HEAD: JUST BODY OF 3rd METACARPAL
INSERTION: MEDIAL SIDE OF BASE OF PROXIMAL PHALANX OF THE FIRST DIGIT (THUMB)
ACTION: ADDUCTS THUMB (FIRST DIGIT)
INNERVATION: ULNAR N.
Note: NOT muscle of thenar eminence!

Front 36

the palm-lumbricals

Back 36

ORIGIN:
LUMBRICALS 1 & 2 (digits 2&3): LATERAL TWO TENDONS OF FLEXOR DIGITORUM PROFUNDUS
LUMBRICALS 3 & 4 (digits 4&5): MEDIAL THREE TENDONS OF FLEXOR DIGITORUM PROFUNDUS
INSERTION: LATERAL SIDES (WINGS) OF EXTENSOR TENDON DISTAL TO THE METACARPOPHALANGEAL JOINT
ACTION: FLEX THE METACARPOPHALANGEAL JOINT AND EXTEND THE INTERPHALANGEAL JOINTS (Wave bye-bye)
INNERVATION: Lateral 2 by median; medial 2 by ulnar. (The ½ exception)

Front 37

palmer interosseus (the palm deeper)

Back 37

Can see two heads of adductor pollicis.

PALMAR INTEROSSEI (3 of them – PAD)
ORIGIN: PALMAR SURFACES OF 2ND, 4TH, & 5TH METACARPALS
INSERTION: EXTENSOR EXPANSIONS (Wings) AND BASES OF THE PROXIMAL PHALANGES OF DIGITS 2, 4, & 5
ACTION: ADDUCTS DIGITS 2-5. EXTENDS THE INTERPHALANGEAL JOINTS AND FLEXES THE METACARPOPHALANGEAL JOINT

Note: No need for 3rd digit to have an adductor since it doesn’t move.

Front 38

dorsal interossei of palm

Back 38

(4 of them – DAB)
ORIGIN: ADJACENT SIDES OF TWO METACARPAL BONES
INSERTION: EXTENSOR EXPANSIONS AND BASES OF THE PROXIMAL PHALANGES OF 2ND - 4TH DIGITS
ACTION: ABDUCTS DIGITS 2-4. EXTENDS THE INTERPHALANGEAL JOINTS AND FLEXES THE METACARPOPHALANGEAL JOINT

Front 39

lumbricals and interossei actions

Back 39

EXTEND INTERPHALANGEAL JOINT(S)
FLEX METACARPO-PHALANGEAL JOINT
DORSAL-ABDUCT (DAB)
PALMAR-ADDUCT (PAD)

Front 40

lumbricals and interossei of palm contd

Back 40

Fine motor control – fine muscles – suspect ulnar N in fine motor issues. Use long muscles in arm for strength.

MOVEMENT OF THE EXTENSOR EXPANSION (HOOD) OVER THE METACARPOPHALANGEAL JOINT (KNUCKLE)

POSITION OF THE LONG FLEXORS - VARIATION IN LUMBRICAL ORIGIN

Front 41

dorsal carpal arch

Back 41

DORSAL CARPAL ARCH
DORSAL CARPAL BRANCH OF ULNAR ARTERY
DORSAL CARPAL BRANCH OF RADIAL ARTERY

More of a mesh than an arch. (A third arch linking radial & ulnar.)

Front 42

superficial palmar arch

Back 42

(from ulnar with a small branch from radial)
PRIMARILY A CONTINUATION OF THE ULNAR ARTERY
SUPERFICIAL PALMAR BRANCH OF RADIAL ARTERY ANASTOMOSES WITH THE SUPERFICIAL PALMAR ARCH

Front 43

deep palmar arch

Back 43

(from radial with a small branch from ulnar)
PRIMARILY A CONTINUATION OF THE RADIAL ARTERY
ANASTOMOSIS WITH THE DEEP PALMAR BRANCH OF THE ULNAR ARTERY

Front 44

deep and superficial metacarpal arteries join together to form ?

Back 44

Deep & superficial metacarpal arteries join together to form common metacarpal arteries.

DIGITAL ARTERIES (bifulcation of common metacarpal arteries)
COMMON PALMAR DIGITAL ARTERIES
PROPER PALMAR DIGITAL ARTERIES

Front 45

ulnar nerve know exceptions

Back 45

MOTOR TO MUSCLES OF THE HAND EXCEPT FOR 1-1/2 MUSCLES
EXCEPTIONS
THENAR EMINENCE (3 muscles)
LAT. 2 LUMBRICALS

Front 46

recurrent branch of the median nerve

Back 46

motor branch TO MUSCLES OF THE THENAR EMINENCE

Front 47

median nerve

Back 47

MOTOR TO THE LATERAL TWO LUMBRICALS
SENSORY TO THE PALMAR SURFACE FROM THE MIDDLE OF THE FOURTH DIGIT TO THE FIRST DIGIT, ALSO TO THE DORSAL SURFACE OF DIGITS 2, 3 AND LATERAL 1/2 OF 4

Front 48

sensory innervation by ulnar nerve

Back 48

1) MOTOR TO THE INTRINSIC MUSCLES OF THE HAND EXCEPT FOR THE MUSCLES OF THE THENAR EMINENCE AND THE LATERAL TWO LUMBRICALS
2) SENSORY TO PALMAR, MEDIAL, AND DORSAL SURFACE OF THE HAND FROM THE MIDDLE OF THE FOURTH DIGIT TO THE FIFTH DIGIT

Front 49

radial nerve sensory info

Back 49

SENSORY TO THE DORSUM OF THE HAND NOT SUPPLIES BY EITHER THE ULNAR OR MEDIAN NERVES
ALL OF THE DORSUM OF DIGIT 1
ON THE DORSUM OF THE HAND, FROM THE WRIST TO THE PROXIMAL INTERPHALANGEAL JOINT OF DIGITS 2, 3, AND MEDIAL HALF OF 4, AND ALL OF THE DORSUM OF DIGIT 1 (THE THUMB).