Dr. Carters Wichita State Gross Anatomy Class Clinical Anatomy The Hand

Front 1

What is the Hypothenar eminence?

Back 1

on the thumb side

Front 2

Why is the skin on the palm of the hand different than backside?

Back 2

Cause it is attached to the palmar aponeurosis

Front 3

How many metatarsals are there?

Back 3

5

Front 4

How many phalanges are there in the fingers?

Back 4

2 in the thumb and 3 in the fingers

Front 5

How many carpal bones are in the wrist?

Back 5

8 which are in 2 rows

Front 6

What are the thenar muslces?

Back 6

Short muscles of the hand

Front 7

bring thumb toward thumb is what?

Back 7

adduction

Front 8

Humans are the only primatess that can do what?

Back 8

opposition

Front 9

what is the short adductor of the thumb?

Back 9

adductor pollicis brevis

Front 10

what hand muscle does not everyone have?

Back 10

Palmaris brevis

Front 11

What are the hypothenar muscles?

Back 11

abductor digiti minimi, flexor digiti

Front 12

What are the PAD muscles?

Back 12

Adductors of the fingers
there are 3 muscles

Front 13

What are the DAB muscles?

Back 13

abductors of the fingers and there are 4 of them

Front 14

how many lumbrical muscles are there?

Back 14

4

Front 15

Where do the lumbricals originate?

Back 15

on the tendons of the flexor digitiorium profundus

Front 16

What is included in the dorsal surface of the hand?

Back 16

Extensor tendons
Knuckles (heads of metacarpals)
Anatomical snuff box

Front 17

What is contained in the anatomical snuff box?

Back 17

radial artery and the styloid process of the radius

Front 18

What is the anatomical snuff box bounded by?

Back 18

tendons of the abductor pollicis longus, extensor pollicis brevis (laterally), and the extensor pollicis longus (medially)

Front 19

What is located on the palmer or ventral side of the hand?

Back 19

Palmar and digital creases
Thenar eminence of the thumb
Hypothenar eminence of 5th digit
Abundance of sweat glands and absence of hair
Well-patterened ridges on the ventral surface of the distal phalanges (finger prints) to prevent slippage of grasped objects

Front 20

How many metacarpals are there?

Back 20

5

Front 21

How many phalanges are there?

Back 21

14

Front 22

Digits 2-5 all have what?

Back 22

three phalanges (proximal, middle and distal)

Front 23

The first digit has what?

Back 23

has two phalanges (proximal and distal)

Front 24

How many articulatons are there?

Back 24

4
Carpometacarpal joints and intermetacarpal joints
metacarpalphalangeal (MP)joints
Proximal interphalangeal (PIP) joints
Distal interphalangeal (DIP) joints

Front 25

What are the 3 short muscles of the thenar eminence that are muscles of the thumb?

Back 25

abductor pollicis brevis
flexor pollicis brevis
opponens pollicis

Front 26

What is the other thumb muscle that is NOT a thenar muscle?

Back 26

adductor pollicis

Front 27

All thenar muscles arise from what?

Back 27

the flexor retinaculum and the trapezium

Front 28

All thenar muscles insert on what?

Back 28

shaft of the 1st metacarpal

Front 29

Where does the adductor pollicis insert?

Back 29

at the base of the proximal phalanx but arises by two heads.

Front 30

What are the two heads of the adductor pollicis?

Back 30

Transverse head of from the shaft of the 3rd metacarpal and oblique head from the bases of the 1st, 2nd and 3rd metacarpals

Front 31

Where is the adductor pollicis found between?

Back 31

Between the thumb and the index finger in the webbing

Front 32

What innervates the three thenar muscles? (abductor pollicis brevis, extensor pollicis brevis and the opponens pollicis)

Back 32

Reccurrent branch of the median nerve

Front 33

What is the only thenar muscle that is not innervated by the recurrent branch of the median nerve

Back 33

the deep head of the flexor pollicis brevis which when present is innervated by the ulnar nerve

Front 34

What other muscle of the thumb is supplied by the roots of the ulnar nerve?

Back 34

The adductor pollicis

Front 35

What do the hypothenar muscles consist of?

Back 35

Palmaris Brevis
Abductor digiti minimi
Flexor digiti minimi brevis
opponens digiti minimi

Front 36

Where does the palmaris brevis muscle originate from?

Back 36

flexor retinaculum and palmar aponeurosis

Front 37

Where does the abductor digiti minimi originate from?

Back 37

pisiform bone

Front 38

Where does the flexor digiti minimi brevis and opponens digiti minimi originate?

Back 38

flexor retinaculum and the hook of the hamate

Front 39

Where do the hypothenar muscles insert at except for the opponens digiti minimi?

Back 39

they insert at the base of the proximal phalanx of the 5th digit

The opponens digiti minimi inserts on the shaft of the 5 metacarpal

Front 40

The hypothenar muscles are supplied by what nerve?

Back 40

By the deep branch of the ulnar nerve except the palmaris brevis which is innervated by the ulnar nerve or its superficial branch

Front 41

What are the interossei muscles divided into?

Back 41

dorsal and palmar
3 on the PAD (palmar)
4 on the DOOR (Dorsal)

Front 42

Where are the interossei muscles located?

Back 42

in the space between the metacarpal bones

Front 43

What interossei muscle inserts on the 3rd digit?

Back 43

none!

Front 44

how many dorsal interossei insert on the 3rd digit?

Back 44

2

Front 45

The dorsal interossei muscles do what?

Back 45

abduct the 2nd, 3rd and 4th digits

Front 46

The palmar interossei muscles do what?

Back 46

adduct the 2nd, 4th and 5th digits

Front 47

The interossei muscles may do what?

Back 47

ASSIST!!!! in flexion of the metacarpal joints or with extension of the PIP (proximal interpharangeal joint) and DIP (distal interphalangeal joint)
These muscles cross over the MP joints

Front 48

How many Lumbrical muscles are there?

Back 48

4

Front 49

Where do the lumbricals arise from?

Back 49

the flexor digitorum profundus tendons

Front 50

What nerve are the medial (3rd and 4th) lumbricals innervated by?

Back 50

Ulnar nerve

Front 51

What nerve innervates the lateral lumbricals (1st and 2nd)?

Back 51

by the Median nerves

Front 52

What is the primary function of the lumbricals?

Back 52

to extend the interphalangeal joints, while their secondary function is to flex the MP joints

Front 53

Why are the abundent dense connective tissues of the hand an overwhelming influence on hand function?

Back 53

Dense connective tissues require long periods of time to heal. For this reason, injury to these tissues impair manual dexterity in work and leisure activities.

Front 54

Skin on the palmar surface of the hand is attached to what?

Back 54

palmar aponeurosis

Front 55

Where does the palmaris longus tendon go to?

Back 55

Palmar Aponeurosis

Front 56

What muscles are innervated by the recurrent branches of the median nerve?

Back 56

Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis

Front 57

Which lumbricals are innervated by seperate branches of the median nerve?

Back 57

1st and the 2nd

Front 58

How many muscles in the hand are innervated by the Median nerve and its branches?

Back 58

5

Front 59

What muscles of the hand are innervated by the Ulnar nerve?

Back 59

All the other muscles of the hand

Front 60

what muscle is the abductor of the little finger?

Back 60

Abductor digiti minimi

Front 61

What is the Palmar Aponeurosis?

Back 61

a thickening of the deep fascia in the central area of the palm. This structure is strong and overlies the long flexor tendons and the other soft tissues. Proximally, it is continuous with the flexor retinaculum, while distally it divides into 4 longitudinal bands that attach to the bases of the proximal phalanges and fuse with the fibrous digital sheaths of each of the 4 fingers. The tendon of the Palmaris longus inserts into this aponeurosis

Front 62

What is still being investigated by the scientific community?

Back 62

the anatomy of the palmar fascial spaces

Front 63

describe the fascial components of the palm

Back 63

fromt he lateral border of the palmar aponeurosis a lateral fibrous septum extends deeply to the 1st metacarpal. A lateral or thenar compartment is therefore formed lateral to this septum. Similarily, from the medial border of the aponeurosis, a fibrous medial septum extends dorsally (the rest on page 50)

Front 64

What is the Flexor retinaculum?

Back 64

a heavy thickening of the anteriro antebrachial fascia at the level of the wrist.

Front 65

What is the flexor retinaculum?

Back 65

it is a heavy thickening of the anterior antebrachial fascia at the level of the wrist.

Front 66

What course deep to the flexor retinaculum?

Back 66

The median nerve and all the flexor tendons, EXCEPT the palmaris longus tendon

Front 67

Together with the carpal bones, what do they and the flexor retinaculum form?

Back 67

A carpal tunnel

Front 68

What is the extensor retinaculum?

Back 68

A thickening of the posterior antebrachial fascia. As it passes from the lateral border of the radius to the medial border of the ulna and the triquetrum and the pisiform, it sends septa into the underlying bone, thus separating the space deep to it into six typical compartments

Front 69

What nerve and how many tendons pass under the flexor retinaculum?

Back 69

9 tendons and the median nerve

Front 70

What extensor tendons pass under the extensor retinaculum?

Back 70

All of them

Front 71

What is the clinical components of the hand?

Back 71

they are independently seperated so that infection cannot spread!

Front 72

What tendons pass deep to the flexor retinaculum?

Back 72

Tendons of the flexor digitorum superficialis and flexor digitorum profundus

Front 73

What sheeth does the does the flexor digitorum superficialis and the flexor digitorum profundus pass through?

Back 73

the osteofibrous flexor digital sheaths

Front 74

The long and short tendons to each tendon lie within the same fibrous sheath what are they enclosed in?

Back 74

Each seperate one has its own synovial membrane so that they can slide freely over each other.

Front 75

Close to the base of the proximal phalanx the tendon of the flexor digitorum superficialis does what?

Back 75

It splits and twists to surround the tendon of the flexor digitorum profundus, which passes through the opening between the two halves. Soon after, the two halves reach their insertions at the margins of the middle phalanx. The tendons of the deep flexor, after passing through the openings in the tendons of the superficial flexor, pass distally to their insertions at the base of the distal vinculum

Front 76

Small blood vessels from the periosteum of the phalanges pass through what?

Back 76

The long and short vincula to supply each of the long flexor tendons.

Front 77

What are the lumbricals attached to and not attached to?

Back 77

tendons of the flexor digitorum profundus and not that of the superficialis

Front 78

What does each extensor tendon sheath consist of?

Back 78

outer fibrous layer and an inner synovial membrane

Front 79

Unlike the flexors what does the extensor have that is different?

Back 79

They do not share a common extensor sheath

Front 80

What are the extensors compartmentalized by?

Back 80

the extensor retinaculum

Front 81

What is there on the dorsum of the hand?

Back 81

there is an intertendinous connection between the four tendons of the extensor digitorum

Front 82

The tendons of the extensor digitorum insert where?

Back 82

at the bases of the proximal, middle and distal phalanges in a unique manner.

Front 83

At the base of the proximal phalanges what does the tendon do?

Back 83

the tendons expand to form aponeuroses to which the tendons of the lumbricals and the interossei insert

Front 84

What is the vincula tendinum?

Back 84

Two strands of connective tissue which attaches the tendon to the osteofibrous sheath on the anterior surface of the phalanx

Front 85

What passes through the long and short vincula to supply each of the long flexor tendons?

Back 85

Small blood vessels

Front 86

What are the lumbricals attached to?

Back 86

the tendons of the flexor digitorum profundus

Front 87

The tendon sheaths that surround the flexor and extensor tendons of the hand consist of what?

Back 87

of an outer fibrous layer and an inner synovial membrane

Front 88

On the dorsum of the hand there is an intertendinous connection between what?

Back 88

The four tendons of the extensor digitorum

Front 89

The intertendinous connection between the 4 tendons of the extensor digitorum expand to form what?

Back 89

Aponeurosis to which the tendons of the lumbricals and the interossei insert

Front 90

The expanded tendon of insertion thus formed is known as what?

Back 90

extensor hood or the dorsal digital expansion

Front 91

What is the distal prolongation of the extensor hood known as?

Back 91

The extensor aponeurosis

Front 92

Towards the base of each middle phalanx each extensor aponeurosis splits to form what?

Back 92

To form a wide central band (the main tendon) and two lateral bands.

Front 93

Where does the central band insert at?

Back 93

the base of each middle phalanx while the lateral bands unite on the dorsum of each middle phalanx to insert jointly at the base of each distal phalanx

Front 94

What digit is not consistant with in people as to cutaneous innervation?

Back 94

the 4th digit

Front 95

Why does the palmer branch of the median nerve not get carpal tunnel?

Back 95

because it passes over it

Front 96

Cutaneous innervation of the hand is provided by what?

Back 96

radial, ulnar, and the median nerves

Front 97

The anterior interosseous nerve supplies what in the hand?

Back 97

all the extrinsic flexors except the flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus which are innervated by the ulnar nerve

Front 98

What does the radial nerve and the posterior interosseous nerves innervate?

Back 98

all the extensor muscles

Front 99

What does AFOL stand for?

Back 99

Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Lumbricals 1 and 2

Front 100

What innervates the AFOL?

Back 100

the recurrent branch of the median nerve

Front 101

All the intrinsic muscles of the hand are innervated by the ulnar nerve except what?

Back 101

AFOL

Front 102

Arterial blood supply to the hand is provided mainly by what?

Back 102

the superficial palmar arch

Front 103

The superficial palmer arch is what?

Back 103

a continuation of the ulnar artery and the deep palmar arch

Front 104

What is the deep palmar arch a continuation of?

Back 104

the radial artery

Front 105

The superficial palmar arch gives off what?

Back 105

common digital arteries which then divide to form the proper palmar digital arteries.

Front 106

The deep palmar arch gives off what?

Back 106

palmar metacarpal arteries which communicate with the common digital arteries

Front 107

At the creases of the palm the skin is firmly bound to what?

Back 107

subcutaneous tissue beneath

Front 108

An incision across a crease results in what?

Back 108

much scar tissue and remarkable reduction in range of motion

Front 109

What is Dupuytren's contracture?

Back 109

Its when the palmar aponeurosis becomes abnormally thickened by fibrous bands that extend from it to the base of the phalanges. As the bands pull the fingers into flexion, the aponeurosis becomes contracted so that the flexed MP joints cannot be straightened

Front 110

What cause Dupuytren's contracture?

Back 110

the condition is not very well known but there appears to be a hereditary predisposition

Front 111

Injury to the median nerve in the forearm or at the wrist produces paralysis of what?

Back 111

the thenar muscles

Front 112

How do you know if the thenar muscles have become paralyzed?

Back 112

Loss of opposition of the thumb

Front 113

What muscles of the hand can mimic opposition if the thenar muscles have become paralyzed?

Back 113

abductor pollicis longus together with the adductor pollicis and the deep intrinsic flexor

Front 114

What is the apehand deformity?

Back 114

when the median nerve is severed and the thenar muscles are no longer innervated and they atrophy and become flattened

Front 115

If injury to the ulnar nerve occurs what happens?

Back 115

may include loss of sensation in the 5th finger and the ulnar half of the 4th finger; impaired abduction and the adduction of the 5th finger and paralysis of the adductor pollicis, the 3rd and 4th lumbricals and the interossei

Front 116

What is claw hand?

Back 116

subsequent atrophy of the muscles of the hand that the ulnar nerve supplies produces a characteristic furrow between the metacarpals

Front 117

The radial nerve does not supply what?

Back 117

DO NOT supply any of the intrinsic hand muscles

Front 118

What is wrist drop?

Back 118

injury to the radial nerve produces the inability of the arm and forearm to extend the wrist