Hand: Learning Objectives and Review Questions

True/False - Part 1

  1. The hook of the hamate provides the medial distal attachment for the flexor retinaculum.
  2. The tubercle of the trapezium is the site of attachment of the distal lateral flexor retinaculum.
  3. The superficial transverse metacarpal ligament separates the passing of the interosseous muscles from the lumbricals.
  4. The pisiform bone provides the lateral proximal attachment for the flexor retinaculum.
  5. Palmaris brevis primarily inserts into the skin and not into the palmar aponeurosis.
  6. The origin of the abductor digiti minimi arises, in part, from fibers of insertion of the flexor carpi ulnaris.
  7. The abductor policis brevis may atrophy if the median nerve is perturbed in the axilla.
  8. The flexor pollicis brevis has two heads of origin, each innervated by a different nerve.
  9. The recurrent branch of the median nerve enters the thenar eminence by passing deep to the opponens pollicis.
  10. The oppenens pollicis muscle medially rotates the thumb at the metacarpophalangeal joint.
  11. The adductor pollicis is innervated by the median nerve for the transverse head and the radial nerve for the oblique head.
  12. Flattening of the thenar eminence occurs in the case of atrophy of the adductor pollicis.
  13. The flexor digiti minimi muscle flexes the little finger at the middle interphalangeal joint.
  14. The oppenens digiti rotates the fifth metacarpal laterally and the oppenens pollicis rotates the first metacarpal medially.
  15. Unlike the reference digit of the foot being the second digit, the reference digit of the hand is the 3rd digit.
  16. The dorsal interosseous muscles are bipennate and are four in number.
  17. The third digit is not, by definition, capable of adduction. (This is true.)
  18. Unlike the dorsal interossei, which are bipennate, the palmar interossei are unipennate.
  19. All seven of the interosseous muscles are innervated by the deep branch of the radial nerve.
  20. All seven of the interosseous muscles resist extension at the metacarpophalangeal joints.
  21. The tendons of flexor digitorum split into medial and lateral slips that insert onto the base of the proximal phalanges.
  22. The four lumbricals resist extension at the proximal interphalangeal joint.
  23. The lumbrical tendons insert onto the extensor hood distal to the insertions of the interossei.
  24. In the case of ape hand, the thumb supinates into a position that aligns the palmar surface of the thumb with the palmar surface of the remaining fingers.
  25. Within Guyon's tunnel the ulnar artery is lateral to the ulnar nerve.
  26. The ulnar artery is typically the dominate artery of the superficial palmar artery on the dorsum of the hand.
  27. At the wrist the radial artery passes deep to the tendons of abductor pollicis longus and flexor pollicis longus to lie on the posterior surface of the scaphoid bone.

True/False - Part 2

  1. Abduction of the thumb is orthogonal to abduction of the index finger.
  2. The ulnar is radial to the ulnar nerve at the proximal entrance tol Guyen's canal.
  3. Common digital arteries arise from the deep palmar arch.
  4. The princips pollicis artery is generally regarded as a branch of the superficial palmar arch.
  5. A lesion of the recurrent median nerve causes atrophy of the hypothenar eminence.
  6. The insertion of extensor carpi radialis longus inserts radial (lateral) to the insertion of extensor carpi radialis brevis.
  7. Guyon's canal transmits the deep branch of the radial nerve.
  8. Guyon's canal is anterior and radial to the transverse carpal ligament (flexor retinaculum).
  9. The thenar muscles are innervated by the recurrent branch of the median nerve.
  10. Opposition of the thumb is lost, without compensation, in the case of recurrent medial nerve injury.
  11. The tendons of the interossei cross posterior to the deep transverse metacarpal ligament.
  12. The tendons of the lumbricals cross posterior to the deep transverse metacarpal ligament.
  13. The lateral bands of the extensor apparatus (hood) are largely derived from the tendons of the interossei and lumbrical mm.
  14. The pisiform bone is anterior to the triquetrum.
  15. The triangular fibrocartilage complex is part of the distal radioulnar joint.
  16. The pisiform bone is a sesamoid bone within the tendon of flexor carpi radialis.
  17. In part, the origin of the abductor digiti minimi is from the pisiform bone.
  18. The ulnar nerve enters the palm lateral to the pisiform bone and then passes the medial aspect of the hook of the hamate.
  19. The hypothenar muscles are innervated by the median nerve with the exception of the lateral head of the flexor digiti mini brevis being innervated by the ulnar nerve.
  20. The superficial branch of the ulnar nerve provides cutaneous sensation to the medial 1.5 fingers on the palmar side whereas the dorsal digital branch of the ulnar nerve innervates the nail bed of the middle finger.
  21. The third digit (middle finger), by definition, is not capable of adduction.
  22. The intrinsic muscles of the hand, and the lumbricals in particular, play a key role in preventing hyperextension at the MP joint.
  23. In the event of paralysis of the medial lumbricals and all interossei (ulnar nerve injury), the thumb can be expected to supinate and, thus, the hand appears similar to an "ape hand."
  24. The deep branch of the ulnar nerve passes deep into the palm of the hand along with the radial artery.
  25. Both the superficial and deep palrmar arches are fed by both the ulnar and radial arteries.
  26. The anterior interosseous nerve, after providing motor innervation pronator quadratus, continues onto the hand and supplies sensation to the joints of the wrist.
  27. The radial artery approaches the hand along the lateral side of flexor carpi radialis but does not enter the palm of the hand without first entering the anatomical snuff box.
  28. The radial artery leaves the anterior compartment of the forearm by passing deep to the tendon of abductor polllicis longus and along the dorsal surface of the lunate bone.
  29. Branches of the superficial radial nerve can be palpated as they cross the superficial surface of the extensor pollicis longus tendon.
  30. Variable interdependence of the finger extensor tendons can be accounted for by variability in the intertendinus connections (nothing to do with vincula).
  31. Vincula longa and brevia are continuous with the flexor tenden sheaths.
  32. Although the vinculae are known for tethering the tendons, their primary function is to transport synovial fluid from the periosteal lining of the phalanges.
  33. In the case of a "gracefull grasp," flexion of the IP joints is retarded as the long flexors begin to flex the MP joint.
  34. A graceful grasp depends on the integrity of the intrinsic muscles whereas a strong grip is largely dependent on flexor digitorum profundus.
  35. Although the long extensors are antagonistic to the long flexors, the long extensors are critical for a strong grip.
  36. When fusing the wrist as a treatment for loss of extension the wrist is fused in a flexed position.
  37. The heads of origin of the first dorsal interosseous muscle provide a passage way for the radial artery to leave the dorsum of the hand.
  38. The princeps pollicis artery passes along the medial border of the radial head of the first dorsal interosseous and the lateral border of the oblique head of adductor pollicis.
  39. In anatomical position the volar surface of the thumb is 90 degrees opposed to the volar surface of the fingers. (This relates to the previous question)
  40. The anterior border of the "anatomical snuff box" is the dorsal surface of the scaphoid bone.
  41. A lacertion of the the thenar eminence can be expected to involve the recurrent median nerve.
  42. Median nerve injury at the wrist may result in uncompensated loss of opposition of the thumb.
  43. A fracture of the hook of the hamate can end the career of a professional athlete due to injury of the median nerve.
  44. The extensor hood of the third digit receives contributions from the attachments of five tendons.
  45. The extensor hood of the second digit receives contributions from the attachments of five tendons.

Essay

  1. Discuss the Hand. Include contents, compartments, relationships, boundaries, fascial specializations, vascularization, innervation, lymphatics, muscles and movements, and compensation in the case of nerve injury.

  • Carpal Tunnel - relationships and compression symptoms
  • Tendon sheath compartments and retinaculae
  • Proximity of long and short flexor tendons near MP joint
  • Extensor hood - central band and lateral bands
    • Insertion of interossei and lumbricals
  • MP and IP joints - collateral ligaments
  • Vincula longa and breva - mesotendons (stick with Hollinshead on this)
  • Lunate dislocation - into carpal tunnel
  • Extensor digitorum profundus - grip and strength
  • Sensory innervation to the hand - there is merit to knowing this
    • nail beds, palmar fingers, dorsal hand
  • Abductors and Adductors of the wrist
    • Flexor carpi radialis - abductor
    • Flexor carpi ulnaris - adductor
    • Extensor carpi radialis longus - abductor
    • Extensor carpi ulnaris - adductor
  • Articular disk - limits adduction
  • distal radioulnar joint

You will not be held reponsible for anatomy that was unique to this lecture. Nevertheless, points that overlap with the lecture, the dissector, the text, and this posting merit your attention.

Short Answer and Definitions

  1. Hook of the hamate
  2. Pisiform bone

Top of page
Topic revision: r5 - 27 Oct 2017, LorenEvey
This site is powered by FoswikiCopyright © by the contributing authors. All material on this collaboration platform is the property of the contributing authors.
Ideas, requests, problems regarding Structural Basis of Medical Practice? Send feedback