Anatomy Test 3
What movements occur at the MP joints of digits 2-5
Flexion & extension; abduction & adduction; circumduction
Clinical presentation of and reason for mallet finger
Flexion of the DIP joint - avulsion of long extensor tendon from its insertion on the distal phalanx
Which of the following muscles is innervated by the ulnar nerve? Flexor carpi ulnaris Flexor carpi radialis Palmaris longus Flexor pollicis longus
Flexor carpi ulnaris
What condition is due to avulsion of the long extensor tendon from its insertion on the distal phalanx.
Mallet finger
What are the contents of The central compartment of the hand
Long finger flexor tendons of FDS & FDP, Short muscles associated with these tendons, Arterial arches (supply structures of the hand), and Digital branches of the median & ulnar nerves
Which of the following muscles insert on the extensor expansion? Select all that apply. -Lumbricals -Dorsal Interossei -Palmar Interossei -Flexor pollicis brevis
Lumbricals, Dorsal Interossei, and Palmar Interossei
The motion that occurs at both the proximal and distal radioulnar joints
Supination & Pronation
What part of the extensor expansion runs from the proximal phalanx & fibrous digital sheaths obliquely across the middle phalanx and IP joints.
Retinacular ligament
The location where the brachial artery divides and the terminal branches
Cubital Fossa Divides into Radial Artery and Ulnar Artery
The ulnar nerve (and artery) pass from the wrist and enter the hand via what?
Ulnar (Guyon's) Canal
What are the main actions of the Palmar Interossei muscles
adducts the MP joints of 2nd, 4th, and 5th digits (reference is the middle finger), & assists the lumbricals with flexion of the MP joints & extension of the IP joints via the extensor expansion.
What are the main actions of the Adductor Pollicis muscle
adducts the thumb
The hand is capable of which of the following functions -the sensory function of touch -the functions of grasp -prehension -manipulation
all of the above
Which of the following muscles is innervated by the deep branch of the ulnar nerve? Select all that apply. -Opponens digiti minimi -Abductor digiti minimi -Dorsal Interossei -3rd and 4th lumbricals -Adductor pollicis
all of the above
Where does the flexor pollicis longus insert
base of distal phalanx of thumb
What articulates at the intercarpal joints
between adjacent carpal bones with in the proximal & distal rows
Where does the flexor digitorum superficialis insert?
bodies of the middle phalanges of medial four digits
What forms the floor of the carpal tunnel
carpal bones
Which of the following is considered a function of the hand? Select all that apply. -grasp and maniuplation of objects -expression through gestures -sexual functions -orienting objects in space
grasp and maniuplation of objects, expression through gestures, and sexual functions
What forms the medial border of the carpal tunnel
hamate & pisiform
what articulates at the proximal radioulnar joint
head of radius and radial notch of the ulna
What type of joint it is IP joints
hinge type
What is the floor of the radial tunnel
joint capsule of humero-radial joint & deep layer of supinator
What movements occur at the MP joint of the thumb
just flexion/extension
What part of the extensor expansion is formed by the ED tendon inserting into the base of the middle phalanx
central band
Which ligament becomes tight when the MP joints are in flexion limiting abduction of the joints. -palmar ligaments -collateral ligaments -transverse metacarpal ligaments
collateral ligaments
Which of the following muscles has an origin point from the lateral epicondyle of the humerus? Select all that apply. -extensor carpi radialis longus -extensor carpi radialis brevis -extensor digiti minimi -abductor pollicis longus -extensor digitorum
extensor carpi radialis brevis, extensor digiti minimi, and extensor digitorum
True or False: An anastomosis between the deep palmar branch of the ulnar artery and the radial artery form the deep palmar arterial arch
false
True or False: The median nerve travels through the cubital tunnel.
false
true or false: The ulnar nerve will provide motor innervation to the majority of the muscles of the anterior compartment of the forearm.
false
What are the main actions of the flexor carpi radialis
flexes & abducts (radial deviation) the wrist joint.
What movements occur at the IP joints
flexion and extension
What is the origin of the Opponens Digiti Minimi muscle
flexor retinaculum & hook of the hamate
What is the origins of the Flexor Digiti Minimi Brevis muscle
flexor retinaculum & hook of the hamate
What is the origin of the Abductor Digiti Minimi muscle
flexor retinaculum & pisiform
What forms the cubital anastomosis
formed by branches of the brachial artery & ulnar and radial arteries
True or False: During the movement of pronation the radius will cross over the ulna.
true
True or False: The radial nerve will divide into a superficial and deep branch at the level of the cubital fossa.
true
true or false: The radius is the laterally located long bone of the forearm
true
Hypothenar muscles have action on what structure
pinky
What bone sits of the palmar surface of the triquetrum
pisiform
What forms the ulnar border of Guyon's canal
pisiform and pisohamate ligament
Which of the following carpal bones forms the medial (ulnar) boundary of the ulnar canal? -pisiform and pisohamate ligament -hook of the hamate -palmar carpal ligament -transverse carpal ligament
pisiform and pisohamate ligament
Where does the flexor carpi ulnaris insert?
pisiform, hook of hamate, base of 5th metacarpal
What type of joints are the radioulnar joints
pivot types of synovial joint
What is the function of anular ligaments
prevents displacement of the radial head during pronation/ supination
Which muscles are supplied by the recurrent branch of the median nerve? Select all that apply. -Opponens pollicis -Abductor pollicis brevis -Dorsal Interossei -Adductor pollicisis -1st and 2nd lumbricals
Opponens pollicis andAbductor pollicis brevis
Which of the following muscles is considered a muscle of the thenar muscle? Select all that apply. -Opponens pollicis -Opponens digiti minimi -Lumbricals -Flexor pollicis brevis -Adductor pollicis
Opponens pollicis, Flexor pollicis brevis, and Adductor pollicis
What are the branches of the ulnar nerve provide sensory information in the hand
Palmar cutaneous, Dorsal cutaneous - digital branches, and Superficial branch - digital branches
What are the key ligaments of the IP joints
Palmar ligaments (volar plates) and Collateral ligaments
What are the key ligaments of the MP joint
Palmar ligaments (volar plates), Collateral ligaments, and Transverse metacarpal ligaments
1. The arteries that form the palmar and dorsal carpal arches
Palmar: Palmar carpal branch of the radial artery, palmar carpal branch of the ulnar artery, anterior interosseous artery Dorsal: dorsal carpal branch of radial artery, dorsal carpal branch of ulnar artery, posterior interosseous artery
What is the cubital fossa?
a triangular depression on the anterior aspect of the elbow
The antebrachial fascia distally stretches across the carpal groove becoming the flexor retinaculum (anterior surface) creating what?
carpal tunnel
What condition causes Progressive loss of coordination and strength in the thumb - wasting of the thenareminence
carpal tunnel syndrome
Which of the following structures of the extensor expansion is important for producing PIP extension? -central band -lateral band -terminal tendon
central band
Which of the following muscles will insert onto a metacarpal bone? Select all that apply. flexor carpi radialis flexor digitorum superficialis pronator quadratus flexor carpi ulnaris pronator teres
flexor carpi radialis and flexor carpi ulnaris
Which of the following muscles originate from the medial epicondyle of the humerus? Select all that apply. flexor carpi radialis flexor carpi ulnaris flexor digitorum profundus flexor pollicis longus palmaris longus
flexor carpi radialis, flexor carpi ulnaris, and palmaris longus
Which tendons are easily palpated as they cross the anterior aspect of the wrist? Select all that apply. flexor carpi radialis flexor digitorum profundus palmaris Longus pronator teres flexor carpi ulnaris
flexor carpi radialis, palmaris longus, and flexor carpi ulnaris
Which of the following muscles will flex the digits of the hand? pronator teres flexor carpi ulnaris flexor digitorium superficialis flexor carpi radialis
flexor digitorium superficialis
The median nerve travels between which two muscles in the anterior compartment of the forearm? pronator teres and flexor pollicis longus flexor digitorium superficialis and profundus flexor digitorium profundus and flexor pollicis longus
flexor digitorium superficialis and profundus
What is the origin of the Opponens Pollicis muscle
flexor retinaculum; tubercle of trapezium
What is the origin of the Abductor Pollicis Brevis muscle
flexor retinaculum; tubercles of scaphoid & trapezium
Which of the following structures articulate to form the proximal radioulnar joint? -head of the ulna & the ulnar notch of the radius -head of the radius & the radial notch of the ulna -distal end of the radius & articular disc with the proximal row of carpal bones
head of the radius & the radial notch of the ulna
What articulates at the distal radioulnar joint
head of ulna and ulnar notch of radius
Which of the following are considered important bony landmarks of the radius? Select all that apply. head trochlear notch styloid process carpal articular surfaces radial notch ulnar notch
head, styloid process, carpal articular surfaces, and ulnar notch
What are the barriers of the cubital fossa?
superior: imaginary line between the epicondyles lateral: brachioradialis medial: pronator teres floor: brachialis and supinator roof: fascia and skin
What occurs in the colles fracture
- fracture of the *distal radius*, possibly also involving the ulnar styloid - wrist and hand is displaced *dorsally and radially* (remember that this is the "dinner fork" or "bayonet" fracture, curves the wrist like a fork or bayonet attached to a musket) - usually caused by a fall onto an outstretched hand by an elderly patient
The muscles innervated by the posterior interosseous nerve
-Extensor Digitorium -Extensor Digiti minimi -Extensor Carpi Ulnaris -Abductor pollicis longus -Extensor pollicis brevis -Extensor pollicis longus -Extensor indicis
1. The muscles innervated by the deep branch of the ulnar nerve
-Flexor pollicis brevis (Recurrent branch Median & DBUN) -Adductor pollicis -Opponens digiti minimi -Abductor digiti minimi -Flexor digiti minimi brevis -Dorsal Interossei -Palmar Interossei -Lumbricals 3 & 4 2LOAF.5 -> Median Nerve Everything else DBUN
1. Cutaneous nerves that provide sensation to the anterior aspect of the forearm
-Lateral antebrachial cutaneous nerve (continuation of musculocutaneous) -Medial antebrachial cutaneous nerve (arises from medial cord of brachial plexus)
What innervates the Abductor Pollicis Brevis muscle
RBMN
what innervates the Opponens Pollicis muscle
RBMN
What provides motor innervation to the muscles in the hand
RBMN and DBUN
what can you use to remember what intrinsic muscles of the hand are innervated by the median nerve
2 LOAF.5
How many types of grasp taxonomies have been identified
33 types
Which compartment contains the tendons of extensor digitorium and extensor indicis? -2nd -4th -6th
4th
How many dorsal compartments are there
6
Which of the following muscles originates from the both the trapezium & scaphoid? -Opponens pollicis -Abductor pollicis brevis -Flexor pollicis brevis -Adductor pollicis
Abductor pollicis brevis and Flexor pollicis brevis
What muscles are included in the first dorsal compartment
Abductor pollicis longus and Extensor pollicis brevis
The articulations that form the radiocarpal joint and the motions that occur at this joint
Articulation: distal end of the radios & articular disc with the proximal row of carpal bones (excluding the pisiform). Motions: flexion/extension, abduction/adduction (radial dev/ulnar dev), circumduction.
Which of the following muscles originates from the pisiform? -Opponens digiti minimi -Abductor digiti minimi -Flexor digiti minimi brevis
Abductor digiti minimi
The borders of the anatomical snuff box
Anterior border: -Abductor pollicis longus -Extensor pollicis brevis Posterior border: -Extensor pollicis longus
what are the borders of the anatomical snuff box
Anterior border: Abductor pollicis longus and Extensor pollicis brevis Posterior border: Extensor pollicis longus
Where does the flexor pollicis longus originate
Anterior surface of radius & interosseous membrane.
Where does the flexor carpi ulnaris originate?
Humeral head: medial epicondyle of the humerus; Ulnar head: posterior border of ulna & olecranon
What are the main actions of the Abductor Pollicis Brevis muscle
abducts thumb; assists with opposition.
The arteries that form the cubical anastomoses
Brachial Artery: superior & inferior ulnar collateral, radial collateral, middle collateral Ulnar Artery: anterior & posterior ulnar recurrent, recurrent interosseous Radial Artery: radial recurrent
What are the specific branches that supply the cubital anastomosis
Brachial: Ulnar collaterals (superior & inferior), Radial collateral, Middle collateral Ulnar: Anterior & posterior ulnar recurrent, Recurrent interosseous Radial: Radial recurrent
These two muscles of the posterior compartment of the forearm that are not extrinsic muscles of the hand.
Brachioradialis: action on the elbow (flexion) Supinator: action on the forearm (supination)
1. The clinical manifestation (and cause) for carpal tunnel syndrome
Cause: entrapment of the median nerve in the carpal tunnel - pressure in the tunnel increases with power grip and wrist flexion/extension when tendons glide into the tunnel (FPL, FDS, FDP) Sensory (appears first): lateral 3 ½ digits (NO loss in palm because palmar cutaneous branch is before the tunnel) Motor: wasting of the thenar eminence leading to loss of coordination and strength (recurrent branch of the median nerve)
Where does the flexor digitorum superficialis originate
Humero-ulnar head: medial epicondyle of humerus & coronoid process of ulna; Radial head: superior half of anterior surface of the radius
What innervates lumbricals 3 and 4
DBUN
What innervates the Abductor Digiti Minimi muscle
DBUN
What innervates the Adductor Pollicis muscle
DBUN
What innervates the Dorsal Interossei muscles
DBUN
What innervates the Flexor Digiti Minimi Brevis muscle
DBUN
What innervates the Opponens Digiti Minimi muscle
DBUN
What innervates the Palmar Interossei muscles
DBUN
The superficial palmar arch receives contribution from what artery
Digital arteries
What are the branches of the superficial branch of the radial nerve that provide sensory information in the hand
Digital branches
What condition causes the Digits are pulled into partial flexion at the MP and PIP joints - most often impacts the 4th & 5th digits.
Dupuytren's contracture:
What condition is a disease of the palmar fascia resulting in progressive thickening of the fascia.
Dupuytren's contracture:
What tendons fan our over the dorsum of the hand and adjacent tendons are linked via intertendinous connections just proximal to MP joints
ED
What tendons cross the wrist deep to the extensor retinaculum to reach their respective insertions on the extensor expansion.
ED, EDM, & EI
What is the triangular tendinous aponeurosis that wraps around the dorsum & sides of the MP joint
Extensor Expansion
What muscles are included in the second dorsal compartment
Extensor carpi radialislongus/brevis
What muscles are included in the sixth dorsal compartment
Extensor carpi ulnaris
What muscles are included in the fifth dorsal compartment
Extensor digiti minimi
What muscles are included in the fourth dorsal compartment
Extensor digitorum and Extensor indicis
What muscles are included in the third dorsal compartment
Extensor pollicis longus
What tendons are included in the flexor tendon sheath
FDS, FDP, & FPL
What are the Ligamentous tubes that enclose the flexor tendons in their synovial sheaths from the metacarpal heads to the distal phalanx creating a "fibro-osseous tunnel"
Fibrous sheath aka the pulleys in the flexor tendon sheath
Where does the ulnar nerve divide into superficial and deep branches
Guyon's canal
Where does the pronator teres originate from
Humeral head: medial epicondyle of the humerus; Ulnar head: coronoid process of ulna.
What nerve is arising from the medial cord of the brachial plexus; supplies the skin on the medial aspect of the forearm.
Medial antebrachial cutaneous nerve
1. Compare and contrast medial epicondylitis and lateral epicondylitis
Medial: "Golfer's", flexor/Pronator group of muscles, common origin medial epicondyle, numbness and tingling over ulnar nerve distribution Lateral: "Tennis", extensor group of muscles, common origin lateral epicondyle, weak grip Both: repetitive use injuries, pain/tenderness at insertion point, radiating pain
The sensory nerve distribution in the hand
Median nerve: central palm, majority of the thenar eminence, volar aspects of index, middle, lateral ½ of ring finger & dorsal surface: distal aspects of the thumb, index, middle and ½ of ring finger.-Ulnar nerve: hypothenar eminence, and the palmar and dorsal surfaces of medial ½ of ring finger and whole pinky. -Radial nerve: lateral 2/3rd of the dorsum of the hand, the dorsum of the thumb, and the proximal parts of the dorsum of the index, middle ½ of the ring finger.
Which of the following muscles inserts on the 5th metacarpal bone? -Abductor digiti minimi -Flexor digiti minimi brevis -Opponens digiti minimi
Opponens digiti minimi
Which of the following muscles inserts on the 1st metacarpal bone? -Abductor pollicis brevis -Flexor pollicis brevis -Opponens pollicis -Adductor pollicis
Opponens pollicis
What important branch of the deep branch of the radial nerve in the forearm
PIN
What innervates the Abductor Pollicis Longus muscle
PIN
What innervates the Extensor Carpi Ulnaris muscle
PIN
What innervates the Extensor Digiti Minimi muscle
PIN
What innervates the Extensor Digitorum muscle
PIN
What innervates the Extensor Indicis muscle
PIN
What nerve is a branch of the radial nerve: supplies the skin along the midline of the forearm.
Posterior antebrachial cutaneous
What is the origin of the Extensor Pollicis Brevis muscle
Posterior surface of the distal 1/3 of the radius and the interosseous membrane.
Function of the volar plates
Prevent excessive extension of MP and IP joints
The superficial layer of the anterior compartment muscles of the forearm
Pronator Teres Flexor Carpi Radialis Palmaris Longus Flexor Carpi Ulnaris
These five muscles of the posterior compartment of the forearm have a common origin point on the lateral epicondyle of the humerus.
Pronator Teres Flexor Carpi Radialis Palmaris Longus Flexor Carpi Ulnaris Supinator
What are some syndromes caused by the Proximal median nerve injury or entrapments
Pronator teres syndrome and Anterior interosseous syndrome
The proximal and distal carpal bones of the wrist from lateral to medial.
Proximal row: Scaphoid, Lunate, Triquetrum, Pisiform Distal Row: Trapezium, Trapezoid, Capitate, Hamate
1. The clinical manifestation of an injury to the AIN nerve and the anatomical space involved
Purely Motor (3 muscles): inability to make the OK sign (loss of innervation to flexor Pollicis longus and ½ flexor Digitorum Profundus), pronation weakness (loss of Pronator quadratics)
What is the condition where sensory & motor impairments impacting the distribution of the radial nerve
Radial nerve injury or entrapments
What passes through the carpal tunnel
Tendons of FDP, FDS, and FPL and Median nerve
Which structures travel through the carpal tunnel? Select all that apply -Tendons of flexor digitorium superficialis -Tendons of flexor digitorium profundus -Tendon of flexor carpi radials -Tendon of flexor pollicis longus -Median nerve -Ulnar nerve
Tendons of flexor digitorium superficialis, tendons of flexor digitorium profundus, Tendon of flexor pollicis longus, and Median nerve
What structure is a fibro-osseous tunnel that is formed by the carpal bones posteriorly and the transverse carpal ligament anteriorly.
The carpal tunnel
What structures of the hand is located in the center of the palm. It is bordered laterally and medially by the thenar and hypothenar eminences, respectively.
The central compartment of the hand
True or False: The movements that are possible at the radiocarpal joint include: flexion/extension; radial and ulnar deviation; and circumduction.
True
Which of the following muscles inserts onto the base of the first metacarpal bone? -abductor pollicis longus -extensor pollicis longus -extensor pollicis brevis
abductor pollicis longus
Which tendons form the anterior border of the anatomical snuff box? Select all that apply. -abductor pollicis longus -extensor pollicis longus -extensor pollicis brevis -extensor Digitorium -Extensor Indicis
abductor pollicis longus and extensor pollicis brevis
Which of the following muscles is a muscle of the deep layer of the forearm? Select all that apply. -extensor carpi radialis longus -abductor pollicis longus -extensor pollicis brevis -extensor pollicis longus -extensor carpi ulnaris
abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus
What are the main actions of the Abductor Pollicis Longus muscle
abducts & extends the CM joint of the thumb; assists with extension of the wrist
What are the main actions of the Abductor Digiti Minimi muscle
abducts the 5th digit; assists with flexion of 5th digit.
What are the main actions of the Dorsal Interossei muscles
abducts the MP joints of 2nd - 4th digits, & assists the lumbricals with flexion at MP joints & extension of IP joints via the extensor expansion.
what is the key ligament of the proximal radioulnar joint
annular ligament
What structure encloses the muscles of the forearm & forms a complete sheath around the forearm; penetrated by deep nerves & vessels.
antebrachial fascia
the palmar carpal arch receives contribution from what artery
anterior interosseous artery
What innervates the flexor pollicis longus
anterior interosseous nerve
What innervates the pronator quadratus
anterior interosseous nerve
What structure gives off the medial antebrachial cutaneous nerve
arises from the medial cord of the brachial plexus;
The ulnar nerve is traveling through the cubital tunnel when transitioning from what 2 structures
arm to forearm
What joint of the forearm has an articular disk
articular disc
Cubital anastomosis: formed by branches of what arteries
brachial artery & ulnar and radial arteries
Which of the following structures forms the lateral border of the cubital fossa? imaginary line between the epicondyles brachioradialis pronator teres
brachioradialis
What is the lateral boundary of the radial tunnel
brachioradialis, ECRL and ECRB
Which of the following muscles forms part of the lateral boundary of the radial tunnel? Select all that apply. -brachioradialis -biceps -extensor carpi radialis longus -supinator -extensor carpi radialis brevis
brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis
What are the two major divisions of the radial nerve in the forearm
deep and superficial branch
What innervates the Supinator muscle
deep branch of the radial nerve
What is the cause of Cubital tunnel syndrome
entrapment of the ulnar nerve in the cubital tunnel.
What is the main actions of the Extensor Carpi Radialis Brevis muscle
extends & abducts (radial deviation) the wrist joint.
What forms the radial border of Guyon's canal
hook of the hamate
These muscles are apart of what group of hand muscles Opponens digiti minimi, Abductor digiti minimi, and Flexor digiti minimi brevis
hypothenar muscle
The ED tendons limit what motion
independent extension of the digits.
What completes the separation between the anterior and posterior surface of the forearm
interosseous membrane
What condition is Characterized by MP flexion coupled with PIP and DIP extension
intrinsic plus hand
What condition is caused by imbalances between strong (or short) intrinsic and weak extrinsic muscles of the hand.
intrinsic plus hand
What is the origin of lumbricals 1 and 2
lateral 2 tendons of FDP as unipennate muscles.
Carpal tunnel syndrome causes Sensory impairments of what structure
lateral 3 ½ digits
What cords of the brachial plexus contribute to the median nerve
lateral and medial cords
What part of the extensor expansion pass to the base of the distal phalanx; tendons of the short muscles of the hand join the ED tendon over the middle phalanx.
lateral bands
What is the origin of lumbricals 3 and 4
medial 3 tendons of FDP as bipennatemuscles.
Where does the flexor digitorum profundus orignate
medial and anterior surfaces of proximal 3/4 of the ulna & interosseous membrane
Which of the following nerves supply the skin of the anterior aspect of the forearm? Select all that apply medial antebrachial cutaneous ulnar median lateral antebrachial cutaneous
medial antebrachial cutaneous and lateral antebrachial cutaneous
Where is the cubital tunnel located
medial aspect of the elbow
What cords of the brachial plexus contribute to the ulnar nerve
medial cord
What type of joint are the intercarpal joints
plane
What type of joint is a Carpometacarpal joints
plane type
the dorsal carpal arch receives contribution from what artery
posterior interosseous artery
What is the origin of the Extensor Indicis muscle
posterior surface of the distal 1/3 of the ulna and the interosseous membrane
What is the origin of the Extensor Pollicis Longus muscle
posterior surface of the middle 1/3 of the ulna and the interosseous membrane
What is the origin of the Abductor Pollicis Longus muscle
posterior surface of the ulna, radius, and interosseous membrane
What are the main actions of the pronator teres
pronates forearm & flexes elbow
What are the main actions of the pronator quadratus
pronates forearm; deep fibers bind radius & ulna together
Which muscles are contained in the superficial layer of the anterior compartment of the forearm? Select all that apply. flexor digitorum profundus pronator quadratus pronator teres palmaris longus flexor digitorum superficialis
pronator teres and palmaris longus
What is the origin of the Brachioradialis muscle
proximal 2/3rds of the lateral supracondylar ridge of humerus.
What innervates the Brachioradialis muscle
radial nerve proper
What innervates the Extensor Carpi Radialis Longus muscle
radial nerve proper
Which of the following are considered important bony landmarks of the ulna? Select all that apply. ulnar notch radial notch coronoid process greater tubercle tuberosity styloid
radial notch, coronoid process, tuberosity, and styloid
What are the key branches of the radial artery
radial recurrent artery and carpal branches
What are some symptoms of Proximal median nerve injury or entrapments
sensory & motor impairments impacting the distribution of the median nerve
What are some of the symptoms of Cubital tunnel syndrome
sensory & motor impairments in the distribution of the ulnar nerve.
These muscles are apart of what group of hand muscles Lumbricals, Dorsal Interossei, and Palmar Interossei
short muscles
What does the Lateral antebrachial cutaneous nerve supply
skin on the lateral aspect of the forearm.
What does the medial antebrachial cutaneous nerve supply
skin on the medial aspect of the forearm.
What is the medial boundary of the radial tunnel
tendon of the biceps & brachialis
Which structures are contained in the central compartment of the hand? Select all that apply. -tendons of flexor digitorium superficialis and profundus -Radial nerve -Superficial and deep palmar arterial arches -Digital branches of the median and ulnar nerves -Tendon of flexor pollicis longus
tendons of flexor digitorium superficialis and profundus, Superficial and deep palmar arterial arches, and Digital branches of the median and ulnar nerves
What part of the extensor expansion inserts into base of distal phalanx -important extension of DIP joint.
terminal tendon
The cubital fossa is a transition zone for neurovascular structures traveling between what 2 structures
the arm & forearm
These muscles are apart of what group of hand muscles Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis, and Adductor pollicis
thenar muscles
Thenar muscles have action on what structure
thumb
Which of the following arteries contributes to the formation of the cubital anastomosis? Select all that apply. ulnar collaterals (superior and inferior) radial and middle collaterals recurrent interosseous anterior intereosseous radial recurrent
ulnar collaterals (superior and inferior), radial and middle collaterals, recurrent interosseous, and radial recurrent
What innervates the flexor carpi ulnaris
ulnar nerve
What structure travels through the cubital tunnel
ulnar nerve
What is contained within Guyon's canal
ulnar nerve and ulnar artery
What is the insertion of the Extensor Carpi Ulnaris muscle
base of the 5th metacarpal
What is the insertion of the Extensor Pollicis Longus muscle
base of the distal phalanx of thumb (dorsal aspect)
What is the insertion of the Extensor Pollicis Brevis muscle
base of the proximal phalanx of thumb (dorsal aspect)
Where does the flexor digitorum profundus insert
bases of distal phalanges of medial four digits
What structure gives off the Lateral antebrachial cutaneous nerve
continuation of the musculocutaneous nerve
Articulations between proximal & distal row of carpal bones is known as what type of joint
midcarpal joint
The location you would palpate to feel the radial pulse
Antero-Lateral Wrist between flexor carpi Radialis and the 1st dorsal compartment
What condition is Characterized by MP hyperextension coupled with PIP and DIP flexion
Intrinsic minus hand
What condition is caused by imbalances between strong extrinsic (or short) and weak intrinsic muscles of the hand
Intrinsic minus hand
What nerve is the continuation of the musculocutaneous nerve; supplies the skin on the lateral aspect of the forearm.
Lateral antebrachial cutaneous nerve
What nerves supply the skin over the anterior aspect of the forearm
Lateral antebrachial cutaneous nerve and Medial antebrachial cutaneous nerve
The deep palmar arch receives contribution from what artery
Metacarpal arteries
Which of the following joints is formed by the articulation of the the head of the metacarpal bones with the bases of the proximal phalanges. -Metacarpophalangeal joints -Interphalangeal joints -Carpometacarpal joints
Metacarpophalangeal joints
What innervates the Extensor Pollicis Brevis muscle
PIN
what innervates the Extensor Pollicis Longus muscle
PIN
What are the branches of the median nerve provide sensory information in the hand
Palmar cutaneous and Digital branches
Which branch of the median nerve arises prior to the median nerve entering the carpal tunnel? -Recurrent branch -Digital branches -Palmar cutaneous branch
Palmar cutaneous branch
What condition causes Weakness of the intrinsic muscles of the hand - clawing of 4 & 5th digits - wasting of the hypothenar eminence and over the area of the 1st dorsal interosseous
Ulnar canal syndrome
Which of the following structures pass through the ulnar canal? Select all that apply. -Ulnar nerve -Median nerve -Radial artery -Ulnar artery
Ulnar nerve and Ulnar artery
What is the origin of the Dorsal Interossei muscles
adjacent sides of two metacarpal bones (bipennate muscles)
Which of the following muscles is supplied by the PIN? Select all that apply. -extensor pollicis longus -extensor digitorium -extensor digiti minimi -extensor indicis -abductor pollicis longus
all of the above
Where does the flexor carpi radialis insert?
base of 2nd and 3rd metacarpals
What is the insertion of the Abductor Pollicis Longus muscle
base of the 1st metacarpal (lateral aspect)
What is the insertion of the Extensor Carpi Radialis Longus muscle
base of the 2nd metacarpal
What is the insertion of the Extensor Carpi Radialis Brevis muscle
base of the 3rd metacarpal
Which of the following muscles receives its blood supply from the radial recurrent artery? Select all that apply. -brachioradialis -extensor carpi radialis longus -extensor digiti minimi -extensor pollicis longus -extensor carpi radialis brevis
brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis
What type of joint is the radiocarpal joint
condyloid joint
What type of joint is the MP joint
condyloid type
What innervates the Extensor Carpi Radialis Brevis muscle
deep branch of the radialnerve
What are the movements of the wrist
flexion/extension, radial/ulnar deviation, and circumduction
Which fingers have DIP and PIP joints
digits 2-5
Where does the pronator quadratus originate
distal 1/4 of anterior surface of ulna
what articulates at the radiocarpal joint
distal end of the radius & articular disc with the proximal row of carpal bones (excluding pisiform)
Where does the pronator quadratus insert
distal ¼ of anterior surface of radius
true or false: The common interosseous artery is a branch of the radial artery
false
What is the main actions of the Extensor Carpi Radialis Longus muscle
extends & abducts (radial deviation) the wrist joint.
What are the main actions of the Extensor Carpi Ulnaris muscle
extends & adducts (ulnar deviation) the wrist joint.
What are the main actions of the Extensor Pollicis Brevis muscle
extends the CM & MP joints of the thumb; assists with extension of the wrist
what are the main actions of the Extensor Indicis muscle
extends the MP & IP joints of the index finger; assists with extension of the wrist
what are the main actions of the Extensor Pollicis Longus muscle
extends the MP & IP joints of the thumb; assists with extension of the wrist
What are the main actions of the Extensor Digiti Minimi muscle
extends the MP joints of digits & secondarily extends IP joint of the 5th digit, & extends the wrist joint
What are the main actions of the Extensor Digitorum muscle
extends the MP joints of the digits & secondarily extends IP joints, & extends the wrist joint.
Which of the following muscles will extend and radial deviate the wrist joint? -supinator -brachioradialis -extensor carpi ulnaris -extensor carpi radialis longus
extensor carpi radialis longus
What is the insertion of the Extensor Indicis muscle
extensor expansion of the 2nd digit (index finger)
What is the insertion of the Extensor Digiti Minimi muscle
extensor expansion of the 5thdigit (pinky).
What is the insertion of the Palmar Interossei muscles
extensor expansions and the bases of the proximal phalanges of digits 2, 4, & 5.
What is the insertion of the Dorsal Interossei muscles
extensor expansions and the bases of the proximal phalanges of digits 2-4
What is the insertion of the Extensor Digitorum muscle
extensor expansions of the medial four digits
Which of the following muscles inserts into the extensor expansion of the 2nd digit (index finger)? -extensor indicis -extensor digitorium -extensor digiti minimi -extensor pollicis longus
extensor indicis
Which of the following tendons is contained in the 3rd dorsal compartment? -extensor pollicis brevis -extensor digiti minimi -extensor pollicis longus
extensor pollicis longus
True or False: An infection in the tendon sheath of the thumb often presents with redness and swelling at the wrist because of the continuity of the ulnar bursa.
false
True or False: Drinking from a water bottle requires use of a precision grasp while holding a pen to write requires use of a power grasp
false
True or False: The posterior interosseous artery is a branch of the radial artery.
false
True or False: The radiocarpal joint is a condyloid joint that allows one degree of freedom: flexion/extension.
false
True or False: The superficial branch of the radial nerve is a mixed motor and sensory nerve.
false
True or False: Upon passing through the ulnar canal, the ulnar nerve divides into a superficial motor branch and a deep sensory branch.
false
What are the main actions of the flexor carpi ulnaris
flexes & adducts (ulnar deviation) the wrist joint.
What are the main actions of the flexor digitorum profundus
flexes DIP joints of digits; assists with flexion of the wrist joint
What are the main actions of the flexor pollicis longus
flexes IP (primarily) & MP joints of thumb; can assist with flexion of wrist joint
What are the main actions of the flexor digitorum superficialis
flexes PIP & MCP joints of digits; assists with flexion of the wrist joint
What is the main action of the Brachioradialis muscle
flexes elbow weakly - maximum action when the forearm is in mid-position.
What is the main actions of lumbricals 1 and 2
flexes the MP joints & extends IP joints (via extensor expansion) of digits 2 & 3
What are the main actions of lumbricals 3 and 4
flexes the MP joints & extends IP joints (via extensor expansion) of digits 4 & 5
What are the main actions of the Flexor Digiti Minimi Brevis muscle
flexes the proximal phalanx ofthe 5th digit
What are the main actions of the palmaris longus
flexes the wrist joint & tightens the palmar aponeurosis
What are the main actions of the Flexor Pollicis Brevis muscle
flexes thumb
What movements occur at the CM joint of the thumb
flexion & extension; abduction & adduction; opposition & reposition.
What movements occur at the Radiocarpal joint
flexion & extension; abduction (radialdeviation) & adduction (ulnar deviation); circumduction
what motion is the central band of the extensor expansion important for
important for extension of the PIP joint
Which of the following nerves supplies the skin of the posterolateral aspects of the forearm? -medial antebrachial cutaneous nerve -lateral antebrachial cutaneous nerve -posterior antebrachial cutaneous nerve
lateral antebrachial cutaneous nerve
What is the origin of the Extensor Carpi Ulnaris muscle
lateral epicondyle of humerus & posterior border of the ulna.
What is the origin of the Extensor Carpi Radialis Brevis muscle
lateral epicondyle of the humerus
What is the origin of the Extensor Digiti Minimi muscle
lateral epicondyle of the humerus
What is the origin of the Supinator muscle
lateral epicondyle of the humerus; "supinator ridge"
What is the origin of the Extensor Digitorum muscle
lateral epicondyle of the humerusand deep fascia of forearm.
What is the insertion of the Opponens Pollicis muscle
lateral side of the first metacarpal
What is the insertion of lumbricals 3 and 4
lateral sides of the extensor expansions of digits 4 & 5.
What is the insertion of lumbricals 1 and 2
lateral sides of the extensorexpansions of digits 2 & 3
What is the origin of the Extensor Carpi Radialis Longus muscle
lateral supracondylar ridge of the humerus.
What is the insertion of the Brachioradialis muscle
lateral surface of distal end of the radius just proximal to the radial styloid
What is the insertion of the Supinator muscle
lateral, posterior, and anterior surfaces of the proximal 1/3rd of the radius
Which of the following structures forms the medial boundary of the cubital tunnel? cubital retinaculum medial epicondyle olecranon
medial epicondyle
Where does the palmaris longus originate?
medial epicondyle of humerus
Where does the flexor carpi radialis originate from
medial epicondyle of the humerus
What innervates the flexor digitorum profundus
medial half: ulnar nerve lateral half: anterior interosseous nerve
What is the insertion of the Abductor Digiti Minimi muscle
medial side of base of the proximal phalanx of digit 5 (pinky).
What is the insertion of the Flexor Digiti Minimi Brevis muscle
medial side of base of the proximal phalanx of digit 5 (pinky).
What is the insertion of the Adductor Pollicis muscle
medial side of the base of the proximal phalanx of the thumb.
What innervates lumbricals 1 and 2
median nerve
What innervates the flexor carpi radialis
median nerve
What innervates the flexor digitorum superficialis
median nerve
What innervates the palmaris longus
median nerve
What innervates the pronator teres
median nerve
What are the three nerves that supply the skin of the hand.
median nerve, ulnar nerve, and superficial branches of the radial nerve
Where does the pronator teres insert
midway along the lateral surface. of radius
What is the origin of the Adductor Pollicis muscle
oblique head: trapezoid, capitate & bases of 2nd/3rd metacarpals; transverse head: shaft of 3rd metacarpal
Which of the following movements is possible at the carpometacarpal (CM) joint of the thumb? Select all that apply. -radial and ulnar deviation -opposition and reposition -flexion and extension -abduction and adduction -internal and external rotation
opposition and reposition, flexion and extension, and abduction and adduction
What are the key ligaments of the CM joints
palmar & dorsal carpal-metacarpal ligaments
Your patient had an injury to the ulnar nerve. Where do you anticipate your patient will have sensory loss? -central palm and the majority of the thenar eminence -palmar and dorsal surfaces of the 4th and 5th digits -lateral 2/3rds of the dorsum of the hand
palmar and dorsal surfaces of the 4th and 5th digits
Where does the palmaris longus insert?
palmar aponeurosis
What forms the roof of Guyon's canal
palmar carpal ligament
What does the antebrachial fascia continue into the hand as?
palmar fascia
The extensor expansion is Anchored on the sides to the
palmar ligaments
Which of the following ligaments provides support to the distal radioulnar joint? -palmar radio-ulnar ligaments -radial collateral ligament -dorsal radiocarpal ligaments
palmar radio-ulnar ligaments
Which of the following ligaments will prevent excessive wrist extension? Select all that apply. -ulnar collateral -dorsal radiocarpal -palmar radiocarpal -dorsal ulnocarpal -palmar ulnocarpal
palmar radiocarpal and palmar ulnocarpal
What is the insertion of the Opponens Digiti Minimi muscle
palmar surface of the 5th metacarpal
What does the pisiform sit on
palmar surface of the triquetrum
What is the origin of the Palmar Interossei muscles
palmar surfaces of 2nd, 4th, & 5th metacarpals
What is the roof of the radial tunnel
radial recurrent vessels (leash of Henry) & superficial layer of supinator.
What structure is is located from the humero-radial joint & extends distally past the proximal edge of the supinator muscle
radial tunnel
the deep branch of the radialtravels through what structure when transitioning from the cubital fossa to the forearm
radial tunnel
the interosseous membrane is located between which 2 structures
radius and ulna
What are the borders of the cubital tunnel
roof: cubital retinaculum floor: ulnar/medial collateral ligament and elbow joint capsule medial: medial epicondyle lateral: olecranon
What is the main action of the Opponens Pollicis muscle
rotates first meta-carpal to oppose the thumb.
What are the main actions of the Opponens Digiti Minimi muscle
rotates the 5th metacarpal drawing it toward the thumb in opposition
What type of joint is the CM joint of the thumb
saddle joint
What forms the lateral border of the carpal tunnel
scaphoid & trapezium
Which of the following bones are found in the proximal row of carpal bones? Select all that apply. scaphoid trapezium lunate pisiform capitate
scaphoid, lunate, and pisiform
What are the bones in the proximal row of the carpal bones from lateral to medial
scaphoid, lunate, triquetral bone, and pisiform
What occurs during accommodation
structure of the hand conforms to the structure of a surface allowing movement over surfaces.
What innervates the Flexor Pollicis Brevis muscle
superficial head = RBMN & deep head = DBUN
What is the origin of the Flexor Pollicis Brevis muscle
superficial head:flexor retinaculum & tubercle of the trapezium; deep head: tubercle of the scaphoid.
What does the superficial fascia of the forearm contain?
superficial nerves and vessels
What is the main actions of the supinator muscles
supinates the forearm
What movements occur at the Distal radioulnar joint
supination & pronation
What movements occur at the joint of the forearm
supination and pronation
The deep branch of the radial nerve supplies which of the following muscles? Select all that apply. -brachioradialis -supinator muscle -extensor carpi radialis longus -extensor carpi radialis brevis -extensor carpi ulnari
supinator muscle and extensor carpi radialis brevis
What structures travel through the cubital fossa? Select all that apply. terminal end of the brachial artery ulnar nerve proximal parts of the ulna and radial arteries biceps tendon
terminal end of the brachial artery, median nerve, proximal parts of the ulna and radial arteries, and biceps tendon
What articulates at the CM joints
the distal row of carpal bones & the bases of the metacarpal bones
antebrachial fascia of the forearm is continuous with what?
the fascia of the palm and the dorsum of the hand
What articulates at the MP joint
the head of the metacarpal bones with the bases of the proximal phalanges.
What articulates at the IP joints
the head of the phalanges with the bases of the more distal. phalanges.
What is the insertion of the Abductor Pollicis Brevis muscle
the lateral side of the base of the proximal phalanx of the thumb
What is the insertion of the Flexor Pollicis Brevis muscle
the lateral side of the base of the proximal phalanx of the thumb.
Ulnar canal syndrome causes Sensory impairments of what structure
the medial1 ½ digits
During pronation, which bone in the forearm rotates over the other
the radius rotates over the fixed ulna
What forms the floor of Guyon's canal
transverse carpal ligament
What forms the roof of the carpal tunnel
transverse carpal ligament
Which of the following structures forms the roof of the carpal tunnel? -transverse carpal ligament -extensor retinaculum -the palmar carpal ligament -palmar aponeurosis
transverse carpal ligament
The CM joint of the thumb is formed by the articulation of the base of the1st metacarpal bone with the __________. -lunate -pisiform -trapezoid -trapezium
trapezium
What articulates at the CM joint of the thumb
trapezium and the 1stmetacarpal bone.
What are the bones in the distal row of the carpal bones from lateral to medial
trapezium, trapezoid, capitate, and hamate
This function of the fibrous layer of the flexor tendon sheaths is to prevent bowstringing of the tendons as they cross multiple joints.
true
True or False: The CM joint of the thumb is a saddle joint that allows for three degrees of freedom: flexion/extension; abduction/adduction; and opposition/reposition.
true
True or False: The ability of the hand to conform to the characteristics of object surfaces is called accommodation.
true
True or False: The radioulnar joints are pivot joints that allow 1 degree of freedom: pronation/supination.
true
True or False: The tendons of the FPL, FDS, and FDP are contained in flexor tendon sheaths that consist of both a synovial layer and fibrous layer.
true
True or False: The thickening of the antebrachial fascia across the anterior aspect of the wrist forms the flexor retinaculum.
true
true or false: The cubital anastomosis is formed by the branches of the brachial, ulnar and radial arteries
true
true or flase: the median nerve gives off a deep branch called the anterior interosseous nerve.
true
Blood supply to the hand arises from multiple arches formed by the anastomoses between what arteries
ulnar and radial
Blood supply to the forearm arises from multiple branches of what arteries
ulnar and radial arteries
What is contained in the cubital fossa
ulnar artery, radial artery, accompanying veins, median nerve, divisions of radial nerve, and biceps tendon
Which of the following ligaments prevents excessive radial deviation? -radial collateral ligament -ulnar collateral ligament -palmar radiocarpal ligament
ulnar collateral ligament
What are the key branches of the ulnar artery
ulnar recurrent arteries, common interosseous artery, anterior, posterior, and recurrent interosseous artery, and carpal branches
