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80 Cards in this Set
- Front
- Back
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What spinal cord levels are at the shoulder muscles?
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C5: Abductors and lateral rotators
C6-8: Adductors and medial rotators |
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What spinal cord levels are at the elbow muscles?
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C5,6: Flexors
C7,8: Extensors |
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What spinal cord levels are in the forearm muscles?
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C6: Supinators
C7,8: Pronators |
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What spinal cord levels are in the wrist muscles?
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C6,7 Flexors and extensors
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What spinal cord levels are in the digit muscles
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C7,8: Long flexors and long extensors
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What spinal cord levels are in the hand muscles?
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C8,T1: Intrinsic muscles of the hand
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What are the flexors of the elbow and what nerve innervates them?
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1.Biceps Brachii-musculocutaneous group
2. Brachialis-musculocutaneous 3. Brachioradialis-Radial |
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What are the extensors of the elbow joint and what nerves innervate them?
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Triceps brachii-Radial
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What are the supinators of the elbow joint and what nerves innervate them?
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Supinator-deep raidal nerve
Biceps brachii-musculocutaneous |
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What are the pronators of the elbow and what nerves innervate them?
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Pronator Teres-Median
Pronator Quadratus-anterior osseous nerve (branch of median nerve) |
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What muscles act upon the radialunlar joint?
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Supinator
Pronator Teres Pronator Quadratus |
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What actions are the wrists capable of?
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Flexion/Extension
Radial/Ulnar Deviation (Abduction and Adduction) |
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What are the joints of the hand?
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Distal Radio-Ulnar
Radiocarpal Carometacarpal (CMC) Metacarpophalangeal (MCP) Interphalangeal (IP)-May be proximal or distal |
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What carpal bones articulate with which forearm bone?
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The Scaphoid and Lunate articulate with the Radius
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Name the bones of the wrist going from proximal to distal and medial to lateral.
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Pisiform-Triquetrum-Lunate-Schapoid
Hamate-Captiate-Trapezoid-Trapezium |
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Where is the saddle-type joint?
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Between the thumb and the trapezium and allows for the numerous movement between these bones.
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What is abduction of the digits?
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Fingers splayed apart
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What is the difference between abduction and flexion of the thumb?
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Abduction/Adduction occurs in the sagittal plane whereas flexion/extension occurs in the coronal plane.
Abduction-Adduction-Extension-Flexion-Opposition |
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What is the opposition of the thumb?
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The movement that allows it to touch the digits
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What is the most common injury in the arm?
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A foosh fracture or falling on an outstretched hand. This illustrates that the upper limb is not meant to be weight bearing.
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What is a Colles' fracture?
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A fracture of the distal radius where the distal segment is displaced dorsally giving the dinner fork shape (ie dinner fork deformity) this is a common injury in the elderly
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What is the flexor retinaculum?
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It is the transverse carpal ligament that is on the anterior side of the wrist. This goes medially from the pisiform and the hook of the hamate and attaches on the scaphoid tubercle and the ridge of the tapezium. This is a continuation of the antebrachial fascia and forms the roof of the carapl tunnel
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The distal tendon of the palmaris longus evolves into what structure?
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The Palmar aponeurosis which begins at the flexor retinaculum and fans out blending in with the digits. It covers soft tissue and overlies flexor tendons protecting the palm from penetrating injuries
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What is Dupuytren's Contracture?
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A fibrosis of the palmar fascia and the palmar aponeurosis which is painless. This pressure pulls on the longitudinal bands on the 4th and 5th fingers causing partial flexion at MCP and PIP joints. This can only be fixed by a surgical cut of the fibrotic CT.
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What is the distal attachment of the flexor carpi ulnaris?
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The pisiform, hook of the hamate, and the 5th metacarpal bone
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What nerve and artery runs under the flexor carpi ulnaris?
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The Ulnar artery and nerve
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What does the superficial ulnar branch of the hand innervate?
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The sensory innervation 1.5 medial digits
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What does the superficial branch of the ulna artery give rise to?
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The Superficial Palmar Arch
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What does the Deep branch of the Ulnar Nerve innervate
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1. Lumbricals 3 & 4
2. Hypothenar muscles 3. PADS & DABS |
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What muscles does the Ulnar Nerve innervate in the forearm?
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The Flexor Carpi Ulnaris (which it runs underneath) and the medial half of the Flexor Digits Profundis.
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What are the motor innervations of the median nerve?
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1. The Recurrent branch of the median nerve-innervates the thenar group
2. Common palmar digital->Palmar Digital Branches-innervates the first and second lumbricals and includes sensory fibers too along the lateral sides of each digit. |
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What is the distal insertion of the flexor carpi radialis?
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The second metacarpal
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What artery runs below the flexor carpi radialis?
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The radial artery
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The radial artery branches after it passes through the wrist-What structures does it contribute to?
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The superficial and the deep palmar arches
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What is the carpal tunnel?
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A fibro-osseous tunnel created by the concave nature of the bones roofed by the flexor retinaculum/transverse carpal ligament.
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What anchors the components of the carpal tunnel?
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The common flexor synovial tendon sheath-this allows for smooth movement
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What are the components of the carpal tunnel?
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Medial nerve (superficial)
4 tendons of FDS 4 tendons of FDP Flexor Pollicis Longus tendon |
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What is superficial and medial to the carpal tunnel?
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Guyon's Tunnel
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What is the most common compressed nerves of the body?
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The median nerve in carpal tunnel syndrome
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What causes Carpal Tunnel Syndrome?
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This is the most common compression neuropathy caused by activities and medical conditions that increase contents and pressure within the tunnel = nerve compression
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What are the risk factors for Carpal Tunnel Syndrome?
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Obesity
Female Gender Coexisting conditions (DM, pregnancy, rheumatoid arthritis, hypothyroidsim, connective tissue diseases, preexisting median mononeuropathy) Genetic Predisposition |
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What are the symptoms of Carpal Tunnel Syndrome?
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Discomfort
Parathesia Long term compression can lead to thenar muscle weakness and atrophy/motor issues |
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What tests for Carpal Tunnel Syndrome?
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Tinel Test-firm percussion over the medial nerve just proximal to or on top of the carpal tunnel
Phalen Maneuver-placing backs of hands against each other this hyperflexion will be painful within one minute |
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What is the difference between fibrous and synovial tendon sheaths?
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The fibrous sheaths are strong ligaments that enclose the synovial sheath and the flexor tendons in the palm. The synovial sheaths are deep and provides for fluid movement of the tendons.
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What is the classic alignment of the synovial sheaths?
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See image
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Flexor tendon sheath infections are known as...?
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Tenosynovitis develops due to trauma with direction inoculation (laceration) and can spread to all synovial sheaths that are continuous.
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What are the signs of tenosynovitis?
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Tenderness along the course of the flexor sheath
Symmetric enlargement of the affected digit Slightly flexed finer at rest Pain along the tendon with passive extension |
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Where is the extensor retinaculum?
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The dorsum of the wrist holding the extensor tendons to the wrist.
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What are the extensor expansion hoods?
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The flattening of the extensor digitis tendons that surround the phalanges and the base of the metacarpals. These have median and lateral bands
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What comprises the expansion hood?
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The median bands, lateral bands, and the hood anchoring portion.
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What is the purpose of intertendinous connections?
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Restricts the independent movement of the fingers
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Where are the intertendinous connections?
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Just proximal to the MCP joints
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Where do the lumbricals originate?
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They come off the tendons of FDP
They travel anteriorly to the MCP joints then blend in posteriorly with the extensor expansion hoods |
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What are the motions associated with the lumbricals?
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They flex the MCP joints because they travel anteriorly, but they extend the IP joints because they pass posteriorly to them. This is why they are the BYE-BYE muscles.
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What is Guyon's canal?
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The canal through which the ulnar nerve and the ulnar artery pass just lateral to the pisiform.
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Where does the Ulnar nerve branch to supply innervation to the 3rd and 4th lumbricals?
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Within Guyon's Canal it separates into the superficial sensory branch and the deep motor branches
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What is Cyclists Palsy?
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Compression of Guyon's Canal which affects the sensory nerve of the medial 1.5 digits and motor nerve to lumbricals 3-4, hypothenar muscle, PADs and DABs.
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What is the presentation of Cyclists Palsy?
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Clawing of digits 4 and 5 when attempting to make a fist
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What is the anatomic snuffbox?
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When the thumb is extended fully, the tendons of EPL, EPB, and abductor pollicis longus form a small triangular depression on the dorsal lateral aspect of the wrist
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What are the boarders of the anatomical snuffbox?
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Medial: Tendon of Extensor Pollicis Longus
Lateral: Tendon of Extensor Pollicis Brevis and Abductor Pollicis Longus |
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What runs through the snuffbox?
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The floor of the Scaphoid and Trapezium and the radial artery.
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What does a scaphoid fracture have a potential to injure?
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The radial artery
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What contributes to the superficial palmar arch?
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The superficial branches of ulnar and radial arteries; however ulnar is the primary blood supply
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What contributes to the deep palmar arch?
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The deep branches of the radial and ulnar arteries; however radial is the primary contributor
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What is the blood supply of the digits?
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The common palmar digital arteries coming from both the superficial and the deep arch divide into proper palmar digital branches which run laterally on each digit.
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On a radiograph-how can you tell if it is the superficial or the deep palmar arch when they are superimposed?
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Look for the main artery supplying the arch-
If its radial-deep palmar arch Ulnar-superficial palmar arch |
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What is Allen's Test?
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Test for patency of blood supply to hand
Steps: 1. Push down on the Radial and ulnar arteries while hand is raised with a clenched fist 2. Hold Down 3. Lower hand |
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What are the intrinsic thenar muscles?
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Adductor Pollicis-Deep Branch ulnar artery
Flexor Pollicis Brevis-Recurrant branch of medial nerve Opponens Pollicis-Recurrant branch of the median nerve Abductor Pollicis Brevis-Recurrant branch |
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What is the flexor pollicis longs?
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A deep flexor considered a thenar muscle innervated by the anterior osseous nerve.
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What are the lumbrical attachments?
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The Tendons of the FDP along the metacarpals then anteriorly to the MCP joints to blend in with the extension expansion hoods of the digits.
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Where is the first lumbrical?
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Around the first digit supplied by the Median nerve
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Where are the third and fourth lumbrical?
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They are around the fourth and fifth digit innervated by the deep ulnar artery
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What are the motions of the lumbricals?
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Flex the MCP joints and extend the proximal and distal IP joints
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What is the result of losing ulnar nerve at the wrist?
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-Hyperextension of MCP joints by ED
-and flexion of the IP joints by FDP Clawed fourth and fifth digit with extension at MCP "Claw Hand" Deformity |
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What are the PADS and DABS?
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3 PADS-Palmar interossei muscles adduct the fingers
4 DABS-Dorsal interossei adbduct the fingers All are intrinsic muscles therefore innervated by the deep branch of the ulnar nerve |
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What does the paper test test?
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The PADS or intrinsic nerves of the hand therefore it tests the integrity of the ulnar nerve
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What nerve is tested by the first dorsal inter web space?
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Superficial Radial nerve
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What nerve is tested by touching the palmar surface of the distal phalanx of the fifth finger?
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Superficial ulnar nerve
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What nerve innervates the brachioradialis muscle?
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The radial nerve
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What muscles are important in the power grip?
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The extensors innervated by the radial nerve
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