1. hand bones
    • 8 carpal bones of wrist
    • 5 metacarpal bones of palm
    • 14 phalanges
  2. proximal row of carpals
    • scaphoid
    • lunate
    • triquetrum
    • pisiform
  3. distal row of carpals
    • trapezium
    • trapezoid
    • capitate
    • hamate
  4. pisiform
    • articulates with the palmar surface of the triquetrum
    • sesamoid bone in the tendon of the flexor carpi ulnaris
  5. capitate
    • largest of carpal bones
    • in central in position
  6. radiocarpal joint
    scaphoid, lunate, and triquetrum for a convex surface that articulates with the radius
  7. intercarpal joint
    joint of carpals
  8. carpal groove
    deep concavity on the palmar surface
  9. borders of carpal groove
    • Medial - pisiform and hook of hamate
    • lateral - tubercle of the scaphoid and tubercle of the trapezium
  10. metacarpals
    base, shaft, and head
  11. carpometacarpal joint
    • bases articulate with distal row of carpals
    • (bases of metacarpals 2-5 articulate with each other to form three intermetacarpal joints)
  12. metacarpophalangeal joints
    • rounded head articulate with the bases of the proximal phalanges
    • knuckles are produced by the metacarpal heads
  13. proximal interphalangeal joint
    joint between the proximal and middle phalanges
  14. distal interphalangeal joint
    joint between the middle and distal phalanges
  15. interphalangeal joints
    • joints between phalanges
    • thumb has only one IP joint
  16. palmar aponeurosis
    • strong triangular thickening of the deep fascia in the center of the palm
    • apex is continuous with expanded tendon of palmaris longus
    • anchored to fron to flexor retinaculum
    • base divides into 4 slips, extending to each finger
  17. flexor retinaculum
    strong transverse thickening of the deep fascia at the front of the wrist deep to the palmar aponeurosis
  18. attachments of the flexor retinaculum
    • medially - pisiform and hook of hamate
    • laterally - tubercles of the scaphoid and trapezium
  19. carpal tunnel
    • made by the carpal groove convered by the flexor retinaculum. 9 flexor tendons and median nerve pass through
    • (FDP FDS FPL)
  20. Extensor retinaculum
    • thickening of the fascia on the back of the wrist
    • Latteral - anterior border of the radius
    • medial - triquetrum and pisiform
  21. 6 tunnels of extensor reinaculum
    (lateral to medial)
    • 1) abd pollici L and ext pollicis b.
    • 2) ext carpi radiali L and ext carpi radial b
    • 3) ext pollicis L
    • 4) ext digitorum and extensor indicis
    • 5) ext digiti minimi
    • 6) ext carpi ulnaris
  22. Synovial sheaths
    tubular bursae that surround tendons where they pass under reinacular. concenric layers of synovial membrane separated by capillary film of fluid
  23. syonial sheaths of the long flexor tendons
    carpal synovial sheaths and digital synovial sheaths
  24. carpal synocial sheaths
    • behind the flexor retinaculum in the caparl tunnel
    • sheath of FPL
    • common flexor sheath of FDS and FDP
    • continuous with digital sheaths of thumb and little finger
  25. digital synovial sheaths
    • behind the fibrous digital sheaths in osseofibrous tunnels
    • extends from the head of the metacarpal to the base of the distal phalanx
  26. thenar eminence
    • abductor pollicis brevis, opponens pollicis, superficial head of FPB
    • innervated by recurrent branch of median nerve
  27. deep thumb muscles
    • adductor pollicis brevis and deep head of FPB
    • innervated by the deep branch of the ulnar nerve
  28. hypotheanr eminence
    • abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
    • all innervated by deep branch of the ulnar nerve
  29. Lumbricals
    • 4 small muscle that arise from the tnedons of the flexor digitorum profundus in the palm
    • passes to radial side of the corresponding finger insert into the radial border of the extensor expansion covering the dorsal surface of thefinger
  30. 1st and 2nd lumbrical
    • each by a single head from the radial sides of the tendons of the index and middle fingers respectively
    • innervated by the digital branches of median nerve
  31. 3rd and 4th lumbricals
    • each by 2 heads
    • from the adjeacent sides of the tendons of the middle, ring and little fingers
    • innervated by the deep branch of the ulnar nerve
  32. action of lumbricals
    extend the IP joints and flex the MCP joints (with the interossei)
  33. extensor mechanism (extensor expansion, extensor apparatus)
    • complex set of CT on the dorsum of each phalanx
    • serves as a primary attachment for the extensor digitorum, extesor digiti minimim extensor indicis, lumbricals and interossei.
  34. Extensor digitorum tendon
    • attaches by a tendinous slip to the proximal phalanx
    • (extends the MCP)
  35. Central tendon
    • direct continuation of the extensor digitorum
    • attaches to dorsal side of base of middle phalanx
    • extends PIP
  36. lateral bands
    • forms from slips from central tendon
    • forms terminal tendon that attaches to the dorsal side of the distal phalanx
    • exten the DIP
  37. dorsal hood
    • surrounds the MCP joint,
    • connects the extensor digitorum tendon to the palmar plate
    • receives tendinous insertions from the lumbricals and interossei muscle
  38. olique retinacular ligaments
    • run from the fibrous digital sheath to the lateral bands
    • fibers run anterior to the PIP joint axis of rotation and posterior to the DIP joint axis
    • coordinate extension between the PIP and DIP joints
  39. Median nerve of heand
    • passes through the carpal tunnel, deep to flexor retinaculum and superficial to flexor tendons
    • distal border of retinaculum becomes enlarged and flattened and divides into terminal branches
  40. reccurent branch of medial nerve
    turns into the base of thenar eminence and supplies the abductor pollicis brevis, opponens pollicis, superificial head of flexor polilicis brevis
  41. palmar digital branches
    • supply lateral 3.5 digits
    • muscular branches to the first two lumbricals
  42. Ulnar nerve of hand
    enters hand by passing superficial to the flexor retinaculum on the radial side of the pisiform covered by tunnel of guyon and palmaris brevis muscle
  43. tunnel of guyon
    superfical part of the retinaculum that covers the ulnar artery lies lateral to the ulnar nerve
  44. superficial branch of ulnar nerve
    supplies the palmaris brevis and divides into palmar digital branches for the ulnar 1.5 fingers
  45. deep branch
    • passes deeply among and supplies the hypothenar muscles
    • supplies interossei, 3rd and 4th lumbricals, adducotr pollicis, deep head of flexor pollici brevis
  46. radial artery of hand
    • deep to tendons of the long abductor and extensors of the thumb
    • enters palm between 2 heads of 1st dorsal interosseous muscle, crosses the ulnar side and forms the deep palmar arch by anastomosing the deep branch of ulnar artery
  47. ulnar artery of hand
    • enters superficial to the flexor retinaculum lateral to the ulnar nere and pisiform
    • gives off a deep branch and continued across the palm as the superficial palmar arch
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