Anatomy of the Hand
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1
What three skeletal groups form the skeleton of the hand?
Carpals, metacarpals, and phalanges
2
How are the digits of the hand numbered?
Numbered 1 to 5 from the thumb to the little finger
3
What are the two muscular eminences on the palmar surface of the hand?
Thenar eminence and hypothenar eminence
4
Where is the thenar eminence located relative to the hypothenar eminence?
Larger and at the base of the thumb; hypothenar is medial and at the base of the 5th digit
5
What four main types of hand activities and functions rely on manual dexterity?
Free motion, power grasping, precision handling, and pinching
6
What does the central palmar fascia thicken into centrally and in the fingers?
Fibrous palmar aponeurosis centrally and digital sheaths in the fingers
7
What structures form the boundaries of the central compartment of the palm?
Palmar aponeurosis anteriorly, and medial and lateral fibrous septa
8
What are the contents of the central compartment of the palm?
Flexor tendons and sheaths, lumbricals, superficial palmar arterial arch, and digital vessels and nerves
9
What is the deepest muscular compartment of the palm, and what muscle does it contain?
Adductor compartment, containing adductor pollicis
10
Which group of intrinsic hand muscles is chiefly responsible for thumb opposition?
Thenar muscles
11
Which four muscles are categorized as thenar muscles?
Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, and adductor pollicis
12
Which three thenar muscles form the thenar eminence?
Abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis
13
What are the proximal attachments of the abductor pollicis brevis (APB)?
Flexor retinaculum and tubercles of scaphoid and trapezium
14
What is the distal attachment of the abductor pollicis brevis?
Lateral side of the base of the proximal phalanx of the thumb
15
Which nerve innervates the abductor pollicis brevis?
Recurrent branch of the median nerve (\$C_8\text{--}T_1\$)
16
What are the primary actions of the abductor pollicis brevis?
Abducts the thumb and helps oppose it
17
What tendon passes between the two bellies of the flexor pollicis brevis (FPB)?
Tendon of the flexor pollicis longus (FPL)
18
What are the proximal and distal attachments of the flexor pollicis brevis?
Proximal: flexor retinaculum and tubercles of scaphoid and trapezium; Distal: lateral base of proximal phalanx of thumb
19
Which nerves provide dual innervation to the two heads of the flexor pollicis brevis?
Superficial head by recurrent branch of median nerve; deep head by deep branch of ulnar nerve
20
What are the actions of the flexor pollicis brevis?
Flexes the thumb at CMC and MCP joints and aids in opposition
21
What is the distal attachment of the opponens pollicis?
Lateral side of the 1st metacarpal
22
Which nerve innervates the opponens pollicis?
Recurrent branch of the median nerve (\$C_8\text{--}T_1\$)
23
What is the precise action of the opponens pollicis?
Draws the 1st metacarpal medially to center the palm and rotates it medially
24
What artery passes between the oblique and transverse heads of the adductor pollicis?
Radial artery
25
What are the proximal attachments of the two heads of the adductor pollicis?
Oblique head: bases of 2nd/3rd metacarpals and capitate; Transverse head: anterior shaft of 3rd metacarpal
26
What is the distal attachment of the adductor pollicis?
Medial side of the base of the proximal phalanx of the thumb
27
Which nerve innervates the adductor pollicis?
Deep branch of the ulnar nerve (\$C_8\text{--}T_1\$)
28
What is the primary action of the adductor pollicis?
Adducts the thumb toward the lateral border of the palm to provide grip power
29
Which three muscles comprise the hypothenar eminence?
Abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi
30
What are the proximal and distal attachments of the abductor digiti minimi (ADM)?
Proximal: pisiform; Distal: medial side of the base of the proximal phalanx of the 5th digit
31
Which nerve innervates all three hypothenar muscles?
Deep branch of the ulnar nerve (\$C_8\text{--}T_1\$)
32
What are the proximal and distal attachments of the flexor digiti minimi brevis (FDMB)?
Proximal: hook of hamate and flexor retinaculum; Distal: medial base of proximal phalanx of 5th digit
33
What is the distal attachment of the opponens digiti minimi (ODM)?
Medial border of the 5th metacarpal
34
What is the primary action of the opponens digiti minimi?
Draws the 5th metacarpal anteriorly and rotates it to oppose the thumb
35
Where is the palmaris brevis located, and what is its action?
Subcutaneous tissue of the hypothenar eminence; wrinkles hypothenar skin and deepens the hollow of the palm
36
What structure does the palmaris brevis protect?
Ulnar nerve and ulnar artery
37
What is the general action of the lumbrical muscles?
Flex the fingers at the MCP joints and extend the IP joints
38
What are the proximal attachments of the 1st and 2nd lumbricals?
Lateral two tendons of flexor digitorum profundus as unipennate muscles
39
What are the proximal attachments of the 3rd and 4th lumbricals?
Medial three tendons of flexor digitorum profundus as bipennate muscles
40
What is the distal attachment of all four lumbricals?
Lateral sides of the extensor expansions of the 2nd through 5th digits
41
Which nerve innervates the 1st and 2nd lumbricals?
Median nerve (\$C_8\text{--}T_1\$)
42
Which nerve innervates the 3rd and 4th lumbricals?
Deep branch of the ulnar nerve (\$C_8\text{--}T_1\$)
43
How many dorsal interossei muscles are there, and what is their architecture?
Four bipennate muscles located between adjacent sides of metacarpals
44
Which nerve innervates both the dorsal and palmar interossei?
Deep branch of the ulnar nerve (\$C_8\text{--}T_1\$)
45
What mnemonic describes the action of the dorsal interossei?
DAB (Dorsal Interossei Abduct)
46
What are the primary actions of the dorsal interossei?
Abduct digits 2–4 from the axial line, flex MCP joints, and extend IP joints
47
How many palmar interossei are there, and what is their architecture?
Three unipennate muscles on the palmar surfaces of the 2nd, 4th, and 5th metacarpals
48
What mnemonic describes the action of the palmar interossei?
PAD (Palmar Interossei Adduct)
49
What are the primary actions of the palmar interossei?
Adduct digits 2, 4, and 5 toward the axial line, flex MCP joints, and extend IP joints
50
What is an extensor expansion (extensor hood)?
A triangular tendinous aponeurosis formed by the flattening of the extensor digitorum tendons
51
Which common sheath do the tendons of FDS and FDP enter deep to the flexor retinaculum?
Common flexor sheath (ulnar bursa)
52
What is the tendinous chiasm (chiasma) of the finger flexor tendons?
The crossing where the FDS tendon splits to permit passage of the deeper FDP tendon
53
Where do the split halves of the FDS tendon insert?
Margins of the anterior aspect of the middle phalanx
54
Where does the FDP tendon insert distally?
Anterior aspect of the base of the distal phalanx
55
Which two main arteries supply all the blood to the hand?
Radial and ulnar arteries
56
What artery primarily forms the superficial palmar arch?
Direct continuation of the ulnar artery completed laterally by a branch of the radial artery
57
Where does the arch of the superficial palmar arch lie across the palm?
At the level of the distal border of the extended thumb
58
What artery primarily forms the deep palmar arch?
Direct continuation of the radial artery completed medially by the deep branch of the ulnar artery
59
Which arteries arise from the superficial palmar arch and travel on the lumbricals?
Common palmar digital arteries
60
Which arteries arise from the common palmar digital arteries to run along digits 2–5?
Proper palmar digital arteries
61
Which branch of the radial artery descends on the palmar aspect of the 1st metacarpal to supply the thumb?
Princeps pollicis artery
62
Which artery passes along the lateral side of the index finger to its distal end?
Radialis indicis artery
63
What is the sensory distribution of the median nerve in the hand?
Palmar skin and distal dorsal aspects of the lateral \$3\frac{1}{2}\$ digits and adjacent palm
64
Which muscles are innervated by the recurrent branch of the median nerve?
Abductor pollicis brevis, opponens pollicis, and superficial head of flexor pollicis brevis
65
Which nerve branch supplies the skin of the central palm?
Palmar cutaneous branch of the median nerve
66
What is the sensory distribution of the superficial branch of the ulnar nerve?
Skin of the palmar and distal dorsal aspects of digit 5 and the medial half of digit 4
67
What is the cutaneous distribution of the dorsal branch of the ulnar nerve?
Medial aspect of the dorsum of the hand and proximal portions of little and medial half of ring fingers
68
What is the sensory distribution of the superficial branch of the radial nerve?
Lateral half of the dorsum of the hand and thumb, and proximal dorsal aspects of digits 2, 3, and lateral half of digit 4
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