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MS Therapeutics II: Hand Anatomy
Exam II
157
Science
Graduate
10/25/2011

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Cards

Term
What is collectively called the metacarpus?
Definition
Five metacarpals
Term
What is a ray?
Definition
Each metacarpal + the phalanges associated with it
Term
Each finger has ___ IP joints. Thumb has ___ IP joints.
Definition
Finger 2 IP joints (proximal and distal)

Thumb has 1 IP joint
Term
What metacarpal is the shortest and the thickest?
Definition
1st metacarpal
Term
What metacarpal is the longest?
Definition
2nd metacarpal
Term
The palmar surface of the shaft of the metacarpal is ____ longitudinally? (concave/convex)
Definition
Concave
Term
The base of the metacarpal is the proximal end or the distal end?
Definition
Proximal end
Term
What metacarpals have a facet for articuation with the adjacent metacarpal?
Definition
2-5
Term
The head of the metacarpal is the proximal end or the distal end of the metacarpal shaft?
Definition
Distal end (knuckle)
Term
The posterior tubercle of the metacarpal is where the ___ ligaments attach.
Definition
Collateral Ligaments
Term
In anatomic position, the thumb metacarpal is rotated almost 90 degrees ____ (medially/laterally)?
Definition
Medially
Term
The palmar side of the thumb faces towards the ____ of the hand.
Definition
Midline
Term
The position of the metacarpal and trapezium is created by ?
Definition
Palmar projection of the distal pole of the scaphoid
Term
This orientation allows the thumb to sweep across the hand freely
Definition
Term
How many phalanges in a hand?
Definition
14
Term
The proximal and middle phalanx of each finger has a _____ base (convex/concave)
Definition
Concave
Term
The proximal and middle phalanx of each finger has a _____ head. (convex/concave)
Definition
Convex
Term
The distal phalanx has a ___ base and _____ distal tuberosity.
Definition
Concave base and rounded distal tuberosity
Term
How many transverse arches of the hand are there?
Definition
1. Proximal Transverse Arch
2. Distal Transverse Arch
Term
What forms the proximal transverse arch?
Definition
Distal carpal row
Term
What is the keystone of the proximal transverse arch?
Definition
Capitate
Term
Where is the distal transverse arch?
Definition
Passes through the MCP joints
Term
The distal transverse arch consists of mobile ____ metacarpals and stable ____ metacarpals (peripheral/central)
Definition
mobile peripheral metacarpals: 1, 4, 5
Stable central metacarpals: 2, 3
Term
What is the keystone of the distal transverse arch?
Definition
MCP joints of the 2nd and 3rd metacarpals
Term
What is the longitudinal arch of the hand?
Definition
Follows the shape of the 2nd and 3rd rays
Term
The proximal end (CMC) joints are firmly linked to the carpus while the distal end (phalangeal) is very mobile
Definition
Term
What is the keystone of the longitudinal arch?
Definition
2nd and 3rd MCP joints
Term
The 2nd and 3rd MCP joints serve as a keystone in both the ____ and ____ arches
Definition
Longitudinal and Distal Transverse Arches
Term
What is the CMC joint?
Definition
Articulation between the distal carpal row and the bases of the metacarpals
Term
CMC joint: ___ and ___ CMC joints are stable and rigid
___, ___, and ____ CMC joints are mobile and fold
Definition
2nd and 3rd CMC are stable/rigid
1st, 4th, and 5th, are mobile/fold
Term
Name the components of the 2nd CMC joint.
Definition
Base of the 2nd metacarpal, trapezoid, capitate, and trapezium
Term
Name the components of the 3rd CMC joint.
Definition
Base of 3rd metacarpal and capitate
Term
Name the components of the 4th CMC joint
Definition
Base of 4th metacarpal, hamate, and capitate
Term
Name the componenets of the 5th CMC joint
Definition
Base of 5th metacarpal and hamate
Term
What makes up the stability of the 2nd-5th CMC joints?
Definition
Articular Capsule
Dorsal, palmar and interosseous ligaments
Term
2nd and 3rd CMC joints are what kind of joints?
Definition
Complex saddle joints

They have a jagged interlocking articular surface and little mobility
Term
4th and 5th CMC joints...the ____ base of the metacarpal  articulates with the ____ hamate ? (convex or concave)
Definition

Convex base of the metacarpal

Concave hamate

Term
How much does the 4th CMC joint flex?
Definition
10 degrees
Term
How much does the 5th CMC joint flex?
Definition
20-25 degrees
Term
What type of joint is the 1st CMC joint? What bones comprise this joint?
Definition

Saddle Joint

Bones: Base of 1st Metacarpal and Trapezium

Term
What are the 5 different ligaments involved in 1st CMC stability?
Definition
1. Anterior Oblique
2. Ulnar Collateral
3. 1st intermetacarpal
4. Posterior oblique
5. Radial Collateral
Term
What positions is the anterior oblique ligament taut in?
Definition
ABD
extension
Opposition
Term
What positions is the ulnar collateral ligament taut in?
Definition
ABD
Ext
Opposition
Term
What positions is the 1st intermetacarpal ligament taut in?
Definition
ABD
Opposition
Term
What positions is the posterior oblique ligament taut in?
Definition
ABD
Opposition
Term
What positions is the radial collateral ligament taut in?
Definition
All EXCEPT extension
Term
the longitudinal diameter of the trapezium (palmar to dorsal) is ____ concave or convex?
Definition
concave
Term
The transverse diameter of trapezium (medial to lateral) is ___ convex or concave?
Definition
Convex
Term
The longitudinal diameter of the 1st metacarpal (palmar to dorsal) is ____ convex or concave
Definition
convex
Term
Transverse diameter of the 1st metacarpal (medial to lateral) is _____ convex or concave?
Definition
Concave
Term
Arthrokinematic of 1st CMC ABD?
Definition
Convex base of metacarpal rolls palmarly and slides dorsally on the concave trapezium
Term
Arthrokinematic of 1st CMC ADD?
Definition
Convex surface of metacarpal base rolls dorsally and slides palmarly on concave surface of trapezium
Term
Arthrokinematic of 1st CMC Flexion?
Definition
Concave surface of 1st metacarpal rolls and slides ulnarlly
Term
Arthrokinematic of 1st CMC Extension?
Definition
concave surface of 1st metacarpal rolls and slides radially
Term
Summary: ABD/ADD is convex metacarpal moving on concave trapezium (transverse diameter)

Flexion/Extension is the concave metacarpal moving on the convex trapezium (longitudinal diameter)
Definition
Term
Opposition involves ABD, flexion and 1st metacarpal medially rotating
Definition
Term
2nd- 5th MCP joint involve the articulation of the ____ head of the metacarpal and the ____ proximal surface of the proximal phalange (concave or convex?).
Definition
convex head of metacarpal Concave proximal phalange
Term
What comprises the ligamentous support of the 2nd-5th MCP joints?
Definition
Joint Capsule
Collateral ligaments--Radial and ULnar
Palmar Plate
Term
What is the proximal attachment for both the radial collateral ligament of MCP and ulnar collateral ligament of MCP?
Definition
Posterior tubercles of metacarpal head
Term
The radial collateral ligament and ulnar collateral ligament cross the MCP joint in a _____ _____ direction (direction of fiber; palmar/dorsal)
Definition
cross in oblique, palmar direction
Term
What are the two portions of the RCL and UCL of MCP?
Definition
1. Cord portion
2. Accessory Portion
Term
What is the cord portion?
Definition
thick, strong, attaches to palmar aspect of the phalanx
Term
what is the accessory portion?
Definition
fan shaped, attaches along edges of the palmar plate
Term
What is the palmar plate?
Definition
dense thick fibrocartilage
palmar to MCP joint
Term
Flexion/Extension _____ gradually from 2nd to 5th MCP (increases/decreases)
Definition
increases
Term
2nd MCP has ___ degrees of flexion; ____ degrees of hyperextension?
Definition
90 flexion
30 hyperextension
Term
5th MCP has ___ degrees of flexion; ____ degrees of hyperextension?
Definition
110-115 degrees of flexion
45 degrees of hyperextension
Term
The 2nd-5th MCP joints have approximately 20 degrees of ABD/ADD on either side of midline reference
Definition
Term
2nd-5th MCP joint arthrokinematics based on ___ phalanx moving on the ____ metacarpal head (convex/concave?)
Definition
Concave phalanx
Convex metacarpal head
Term
2nd-5th MCP Extension: base of proximal phalanx rolls ___, slides ___
Definition
rolls dorsally
Slides dorsally
Term
2nd-5th MCP Flexion: base of proximal phalanx rolls ___, slides ___
Definition
Proximal phalanx rolls palmarly
Slides palmarly
Term
2nd-5th MCP ABD: base of proximal phalanx rolls ___, slides ___
Definition

Proximal Phalanx rolls and slides radially on 2nd finger

4th and 5th fingers roll and slide ulnarly

Term
2nd-5th MCP ADD: base of proximal phalanx rolls ___, slides ___
Definition

2nd MCP: Proximal phalanx rolls and slides ulnarly

4th and 5th MCP: rolls and slides radially

Term
What is the 1st MCP joint made up of?
Definition
Convex head of metacarpal
Concave proximal phalanx of thumb
Term
In the 1st MCP joint there is usually a pair of sesamoid bones located within the palmar side of the joint capsule
Definition
Term
Is the ROM of the 1st MCP joint significantly more or less than the 2nd-5th MCP?
Definition
LESS
Term
1st MCP joint has ___ degrees of freedom
Definition
One: flexion/extension
Term
1st MCP can flex ___ degrees
Definition
60
Term
Hyperextension of 1st MCP is ____
Definition
limited
Term
1st MCP Arthrokinematics: Flexion
Definition
Concave proximal phalanx is rolling and sliding ULNARLY on convex metacarpal head
Term
1st MCP Arthrokinematics: Extension
Definition
Concave proximal phalanx rolls and slides radially on convex 1st metacarpal head
Term
How many degrees of freedom do the PIP and DIP joints have?
Definition
One
Term
PIP joint involves what?
Definition
Head of proximal phalanx
Base of middle phalanx
Term
DIP joint involves what?
Definition
Head of middle phalanx, base of distal phalanx
Term
PIP joints can flex ___ degrees. DIP joint _____.
Definition
PIP=100-120
DIP=70-90
Flexion: PIP > DIP
Term
How much hyperextension do the PIP/DIP joints allow?
Definition
PIP= minimal hyperextension
DIP= 30 degrees of hyperextension
Term
2nd through 5th PIP Arthrokinematics: Flexion
Definition
Concave base of middle phalanx rolls and slides palmarly on the proximal phalanx
Term
2nd through 5th DIP Arthrokinematics: Flexion
Definition
Concave base of distal phalanx rolls and slides palmarly on the convex head of the middle phalanx
Term
Thumb IP flexion____ deg. Hyperextension ____?
Definition
Thumb IP flexion 0-70deg
Hyperextension up to 20 degrees
Term
What are the intrinsic muscles of the thenar eminence?
Definition
Abductor pollicis brevis
Flexor pollicis brevis
Opponens Pollicis
Term
What are the intrinsic muscles of the Hypothenar eminence?
Definition

Abductor digiti minimi

Flexor digiti minimi

Opponens digiti minimi

Palmaris Brevis

Term
Other intrinsic muscles of the hand?
Definition
Adductor Pollicis (2 heads)
Lumbricals (4)
Interossei--(4) palmar, 4 dorsal
Term
Palmar interossei ___ the hand
Definition
ADD

PAD
Term
Dorsal Interossei ___  do what motion?
Definition
ABD [DAB]
Term
Median nerve motor to the hand?
Definition
FDP (lateral half)
Thenar eminence
Lumbricals 1 and 2 (lateral)
Term
Ulnar nerve motor innervation in the hand?
Definition

hypothenar eminence

lumbricles 3 and 4

FDP medial half

Interosseous Muscles (all)

Term
Joint innervation: what nerve root innervates joints of the thumb and index finger?
Definition
C6
Term
Joint innervation: what nerve root innervates joints of the middle finger?
Definition
C7
Term
Joint innervation: what nerve root innervates joints of the ring and little finger?
Definition
C8
Term
What is the fibrous digital sheath?
Definition
tunnel that guides the extrinsic flexor tendons to their insertion
Term
The fibrous digital sheath is a continuation of ____
Definition
aponeruosis of palm
Term
The fibrous digital sheath is anchored to _____?
Definition
palmar plates
Term
The sheath secretes synovial fluid to lubricate the pulleys that are embedded within the sheaths
Definition
Term
Talk about the locations of the 5 annular pulleys in the flexor digital sheath.
Definition
A1=MCP A3= PIP A5= DIP A2= shaft of the proximal phalanx A4= shaft of middle phalanx
Term
Talk about the 3 cruciate pulleys. What are they? Where can you find them?
Definition
THey are flexible fibers that crisscross the tendons in regions where digital sheaths bend during flexion

C1= between A2 and A3
C2= between A3 and A4
C3= between A4 and A5
Term
What is the function of the flexor pulleys?
Definition
hold the flexor tendons a relatively fixed distance from the joints
Term
What would happen without the flexor pulleys?
Definition
contraction of finger flexors would pull the tendons away from the axis of rotation of the joint (bowstringing)
Term
The distal attachment of the finger extensors lacks the defined insertion the flexor tendons display
Definition
Term
The extensors form a fibrous expansion of connective tissue along the entire dorsum of the finger which is referred to as?
Definition
Extensor mechanism or extensor hood
Term
Small slip of extensor digitorum tendon attaches at the base of the dorsal side of the proximal phalanx with remaining band of extensor digitorum tendon flattening out into ____ .
Definition
Central band
Term
Where does the central band attach to?
Definition
Dorsal base of middle phalanx
Term
Prior to the central band crossing the PIP, _____ diverge from the central band?
Definition
2 lateral bands
Term
The lateral bands are dorsal to the axis of rotation of the DIP and PIP and they fuse into a terminal tendon that inserts?
Definition
Into dorsal base of the distal phalanx
Term
The extensor mechanism also attaches to the palmar surface of the fingers through 2 structures
Definition
1. Dorsal hood
2. Oblique retinacular fibers
Term
Dorsal hood has 2 types of fibers
Definition
1. Transverse
2. Oblique
Term
dorsal hood transverse fiber do?
Definition
Hold extensor digitorum tendon over the dorsal surface of MCP
Term
Dorsal hood oblique fibers do?
Definition
Join with lateral and central bands
Term
What muscles attach into the extensor mechanism through the oblique fiber?
Definition
Lumbricals and Interossei
Term

What is the course of the oblique retinacular ligament?

 

When is it taut?

Definition

runs palmar to PIP and Dorsal to DIP

 

Taut: PIP extension, DIP flexion

Term
Function of the oblique retinacular ligaments?
Definition

 They help coordinate movement between the PIP and DIP

 

PIP flexion (ligament is lax) allows DIP flexion

PIP extension (tightens ligament) facilitates DIP extension

Term
How many lumbricals do we have?
Definition
4
Term
Where do the lumbricals originate from?
Definition
Tendons of the Flexor Digitorum Profundus
Term
What innervates the 2 lateral lumbricals?
Definition
Median nerve
Term
What innervates the 2 medial lumbricals?
Definition
Ulnar nerve
Term
Lumbricals attach to the ___ fibers of the dorsal hood which allows them to exert pull through central and lateral bands of extensor mechanism
Definition
oblique fibers
Term
Contraction of lumbricals produces?
Definition
flexion at MCP
extension at PIP and DIP

lumbricals are palmar to MCP and dorsal to PIP,DIP
Term
How are the interossei named?
Definition
According to their located between the shafts of the metacarpals
Term
3 palmar interossei to the fingers attach proximally on the palmar surface and to the sides of the ___, ___ and ___ metacarpals
Definition
2nd, 4th, and 5th
Term
Palmar interossei attach distally to the ___ fibers of the ____.
Definition
oblique fibers of the dorsal hood
Term
Palmar interossei ___ the 2nd 4th and 5th MCP (what motion?)
Definition
ADD
Term
Palmar interossei of the thumb attaches distally to the ulnar side of the proximal phalanx of the thumb. Function of the thumb palmar interossei?
Definition
flexes MCP joint of thumb
Term
Dorsal interossei is a ___ muscle
Definition
Bipennate
Term
Dorsal interossei has a distal attachment into the side of the base of the proximal phalanx and into the oblique fibers of the dorsal hood
Definition
Term
Dorsal interossei ___ the MCP joint of what fingers?
Definition
ABD
index middle and ring fingers
Term
Innervation of Extensor Digitorum?
Definition
Radial Nerve
Term
Innervation of extensor digiti minimi?
Definition
radial nerve
Term
Innervation of extensor indicis?
Definition
radial nerve
Term
Innervation of Extensor Pollicis Longus?
Definition
Radial Nerve
Term
Innervation of Extensor Pollicis Brevis?
Definition
Radial Nerve
Term
Innervation of Abductor Pollicis Longus?
Definition
Radial Nerve
Term
Innervation of Flexor Digitorum Superficialis?
Definition
Median nerve
Term
Innervation of lateral half of flexor digitorum profundus?
Definition
median nerve
Term
Innervation of Flexor Pollicis longus?
Definition
Median nerve
Term
Innervation of pronator quadratus?
Definition
median nerve
Term
Innervation of flexor pollicis brevis?
Definition
median nerve
Term
Innervation of abductor pollicis brevis?
Definition
median nerve
Term
innervation of opponens pollicis?
Definition
median nerve
Term
innervation of medial half of FDP?
Definition
ulnar nerve
Term
innervation of flexor digiti minimi?
Definition
ulnar nerve
Term
innervation of abductor digiti minimi?
Definition
ulnar nerve
Term
innervation of opponens digiti minimi?
Definition
ulnar nerve
Term
Innervation of palmaris brevis?
Definition
ulnar nerve
Term
inervation of lateral 2 lumbricals?
Definition
median
Term
innervation of medial 2 lumbricals?
Definition
ulnar nerve
Term
innervation palmar interossei?
Definition
ulnar nerve
Term
innervation dorsal interossei?
Definition
ulnar nerve
Term
innervation of adductor pollicis?
Definition
ulnar nerve
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