1.
anatomical "snuff box": borders:
lateral (palmar) - tendons of extensor pollicis brevis and abductor pollicis longus
medial (dorsal) - tendon of extensor pollicis longus
floor - scaphoid, trapezium, styloid process of radius
contents:
radial a.
clinical significance:
assess scaphoid fracture (tenderness)
2.
carpal tunnel: borders:
bony arch formed by carpals
flexor retinaculum (transverse carpal ligament)
contents:
median n.
4 tendons of flexor digitorum superficialis
4 tendons of flexor digitorum profundus
tendon of flexor pollicis longus
3.
carpals: 8 bones in the wrist:
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
4.
compartments of the hand: thenar eminence - recurrent branch of median n.
midpalmar eminence - ulnar n./median n.
hypothenar eminence - deep branch of ulnar n. (digit 5 and medial 1/2 of digit 4)
5.
deep extensor compartment: 5 muscles ALL innervated by the posterior interosseous n.:
supinator - supination
abductor pollicis longus (attaches to lateral side of base of metacarpal 1) - aBduction of CMC joint of thumb and accessory extension of thumb
extensor pollicis brevis (attaches to proximal phalanx of thumb) - extension of MCP joint of thumb, as well as extension of CMC joint of thumb
extensor pollicis longus (attaches to distal phalanx of thumb) - extension of IP joint of thumb, as well as extension of CMC and MCP joints of thumb
extensor indicis - extension of digit 2 (index)
6.
deep flexor compartment: 3 muscles:
flexor digitorum profundus (lateral 1/2 by anterior interosseous branch of median n., medial 1/2 by ulnar n.) (4 tendons that attach to distal phalanges of digits 2-5) - flexes DIP joints, as well as MCP joints and wrist joint
flexor pollicis longus (anterior interosseous branch of median n.) (attaches to base of distal phalanx of thumb) - flexes IP joint of thumb, as well as MCP joint of thumb
pronator quadratus (anterior interosseous branch of median n.) - pronation
7.
extensor expansion (hood): tendons of extensor digitorum and extensor pollicis longus expand over proximal phalanx, makes a "hood" which then divides into a central band and 2 lateral bands
attachment for lumbricals, and dorsal/palmar interossei
8.
extensor forearm: functions: extension/deviation of wrist, extension of digits, supination
innervations:
radial n.
deep radial n.
posterior interosseous n.
9.
extensor retinaculum: contains extensor muscle tendons in wrist
10.
flexor forearm: functions: flexion/deviation of wrist, flexion of digits, pronation
innervations:
median n. - superficial and intermediate mm.
anterior interosseous branch of median n. - deep muscles
ulnar n. - 1 + 1/2 muscles of flexor forearm
11.
flexor retinaculum (transverse carpal ligament): contains flexor muscle tendons in wrist
12.
hypothenar eminence: (deep branch of ulnar n.) opponens digiti minimi, flexor digiti minimi, abductor digiti minimi - muscles medial to palmar aponeurosis
13.
intermediate flexor compartment: 1 muscle with 4 tendons that attach to middle phalanges of digits 2-5:
flexor digitorum superficialis (median n.) - attaches radius and ulna and flexes the PIP joints, as well as MCP joints and wrist joint
14.
interosseous muscles (interossei): 4 (bipennate) dorsal - aBduction of digits 2-4 at MCP joints
3 (+1 thumb) palmar - aDduction of digits (1),2,4,5 at MCP joints
15.
interosseous spaces: 4 spaces containing palmar and dorsal interosseous mm. (ulnar n.)
16.
lateral epicondylitis (common extensor tendonitis): inflammation of the muscle attachment to the lateral epicondyle of the humerus, associated with repeated use of the wrist extensors; also called Tennis Elbow
17.
lumbricals: ("bye bye" mm.) - 4 "worm-shaped" mm. that originate in the tendons of the flexor digitorum profundus and insert into radial side of the extensor hood
1st and 2nd - median n.
3rd and 4th - ulnar n.
flex at MCPs and extend at PIPs/DIPs
18.
medial epicondylitis (common flexor tendonitis): inflammation of the muscle attachment to the medial epicondyle of the humerus, associated with repeated use of the wrist flexors; also called Golfer's Elbow
19.
median n.: from lateral and medial cords
crosses anterior to elbow, through cubital fossa
supplies all superficial flexors except flexor carpi ulnaris
anterior interosseous n. (branch) supplies all deep flexors except ulnar 1/2 of flexor digitorum profundus
through carpal tunnel in hand:
motor: LLOAF (OAF - recurrent branch)
sensory: lateral 3 1/2 fingers palmar side and distal phalanges on extensor side
20.
median n. in hand: "LLOAF" muscles:
Lumbrical of digit 1
Lumbrical of digit 2
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
21.
mid palmar space: contains flexor digitorum superficialis and flexor digitorum profundus tendons, as well as the lumbricals of the hand (median n. and ulnar n.)
22.
NOT in carpal tunnel: tendon of palmaris longus
radial a. (deep blood supply)
tendon of flexor carpi radialis
tendon of flexor carpi ulnaris
ulnar a. and n. (superficial blood supply)
23.
palmar aponeurosis: strong thick fascia that covers and protects the flexor tendons in the palm - connects to palmaris longus tendon
24.
palmar carpal ligament: contains tendons in wrist
25.
pronation: rotation of the hands and forearms so that the palms face downward - pronator quadratus, pronator teres
26.
radial n.: from posterior cord
spiral groove of humerus
crosses elbow anterior to lateral epicondyle
supplies extensors of arm, forearm, wrist and digits (radial n., deep radial n., posterior interosseous n.)
sensory:
arm - posterior and lower lateral
forearm - posterior
hand - dorsum of hand/lateral 3 1/2 digits up to middle phalanges
27.
superficial extensor compartment: 7 muscles that ALL originate from lateral epicondyle and supracondylar ridge:
brachioradialis (radial n.) - accessory flexion of elbow joint at forearm midpronation
extensor carpi radialis longus (radial n.) - extension and aBduction of wrist
extensor carpi radialis brevis (deep branch of radial n.) - extension and aBduction of wrist
extensor digitorum (posterior interosseous n.) - extension of digits 2-5, as well as wrist
extensor digiti minimi (posterior interosseous n.) - extenstion of digit 5 (pinky)
extensor carpi ulnaris (posterior interosseous n.) - extension and aDduction of wrist
anconeus (radial n. via branch to medial head of triceps brachii) - aBduction of ulna in pronation and accessory extension of elbow
28.
superficial flexor compartment: 4 muscles that ALL originate from medial epicondyle at common flexor tendon:
flexor carpi radialis (median n.)- flexion/aBduction of wrist
palmaris longus (median n.) (inserts at palmar aponeurosis of hand) - flexion of wrist joint and opposition of shearing forces on skin of the palm during gripping
flexor carpi ulnaris (ulnar n.)- flexion/aDduction of wrist
pronator teres (median n.) - pronation
29.
supination: rotation of the hands and forearms so that the palms face upward - supinator, biceps brachii (most powerful - inserts at radial tuberosity)
30.
synovial sheaths: flexor digitorum profundus and flexor digitorum superficialis sheaths of digits 2,3,4 - stop at MCP joints
flexor digitorum profundus and flexor digitorum superficialis sheaths of digit 5 (pinky) - continuous with common flexor sheath (ulnar bursa) in palm and wrist
flexor pollicis longus tendon sheath (radial bursa) of digit 1 (thumb) - continuous with flexor pollicis longus tendon sheath (radial bursa) in palm and wrist
31.
thenar eminence: (recurrent branch of median n.) opponens pollicis (deep), abductor pollicis brevis, flexor pollicis brevis - muscles lateral to palmar aponeurosis
32.
thenar space: adductor pollicis (ulnar n.)
33.
ulnar n.: from medial cord
crosses behind medial epicondyle
covered by flexor carpi ulnaris
supplies 1 1/2 muscles in forearm: flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus
superficial to flexor retinaculum in hand:
motor: deep branch to all muscles of hand except LLOAF
sensory: superficial cutaneous branch to medial 1 1/2 digits
