Presentation on theme: "Forearm, Wrist and Hand Anatomy"— Presentation transcript:
1Forearm, Wrist and Hand Anatomy Alastair StephensDan Waite
2Label the carpal bones of the wrist. Scaphoid Lunate Triquetral Pisiform Hamate Capitate Trapezoid TrapeziumWhat can a fracture of the scaphoid result in?HCTdTmTThe blood flow can be disrupted as it runs distal to proximal and this can lead to avascular necrosis.SPL
3What are the boundaries of the cubital fossa? Inter-epicondylar lineSuperior borderAponeurosis of bicepsCovers roof of fossa and protects the median nerveBrachioradialisLateral borderPronator teresMedial border
4What are the boundaries of the anatomical snuffbox? What can be palpated in the anatomical snuffbox?EPLRadial arteryRadial styloid processScaphoidTrapeziumBase of 1st metacarpalCephalic vein passes over snuffboxEPB & AP
5What is the carpal tunnel formed by? The retinaculum attaches to pisiform, hook of hamate, scaphoid tubercle and trapezium tuberclePasses ~2cm distal to distal wrist creaseHHTTWhat passes through the carpal tunnel?PSTFlexor digitorum superficialis (x4)Flexor digitorum profundus (x4)Flexor pollicis longusMedian nerve
6What are the sensory distributions of the hand What are the sensory distributions of the hand? Where do you test for each nerve?UlnarMedianRadialUlnar nerve on the 5th digitMedian nerve on the 2nd digitRadial nerve over the first dorsal interosseous***
7What is the innervation to these compartments? Anterior ForearmPosterior ForearmHandEverything is radial nerveEverything is median nerveExcept:Flexor carpi ulnaris (ulnar)Flexor carpi profundus to digits 4 and 5 (ulnar)Everything is ulnar nerveExcept:Thenar muscles (median)Lumbrical to digits 2 and 3 (median)Ulnar nerveRadial nerveMedian nerve
8What movements occur at the radio-ulnar joints? Proximal radio-ulnar jointNursemaid’s elbowPronation: Median NervePronator teres and pronator quadratusSupination: Musculocutaneous Nerve and Radial NerveBiceps and SupinatorRadial tuberosityAvulsion fracture by bicepsDistal radio-ulnar joint
9What is Froment’s sign? What is Allen’s test? Allen’s test determines if there are any vascular anomalies between the radial and ulnar arteries prior to any vascular procedures.The radial and ulnar arteries are compressed and ulnar released, noting if the whole hand becomes perfused again.Ulnar nerve damage leads to adductor pollicis brevis paralysis, leading to excess thumb flexion whilst pinching.
10What’s the difference between Ulnar Claw and Hand of Benediction? NameNerve damagedTypical presentationDigits affectedMuscle InvolvedUlnar ClawUlnar nerve lesion at the wristAt restDigits 4 and 5The lumbricals to digits 4 and 5 are paralysed. This leads to a loss of flexion at the MCP joint and a loss of extension at the IP joints. This results in the hyperextension of the MCP joints by the unopposed extensor digitorum, and the flexion of the IP joints by the unopposed flexor digitorum profundus and superficialis.Hand of BenedictionMedian nerve lesion at the wrist or elbowAttempting to make a fistDigits 2 and 3The lumbricals and flexor digitorum profundus tendons to digits 2 and 3 are paralysed. This leads to a loss of flexion at the MCP joint and the DIP joints. If the patient is asked to make a fist, they will be able to flex digit 4 and 5 but not digits 2 and 3.
11Right Lung Apex Tumour (pancoast tumour) Steve, 72, comes to his GP complaining that he’s unable to move all of the digits on his right hand except his thumb. During the consultation, the GP notices Steve has a hoarse voice and a droopy right eyelid. What is the likely diagnosis, and explain why?Right Lung Apex Tumour (pancoast tumour)Klumpke’s PalsyCompression of the C8-T1 nerve roots leads to paralysis and wasting of the small muscles of the hand (claw hand deformity)Right recurrent laryngeal nerve compressionRecurs at the right lung apexHorner’s SyndromeCompression of the cervical sympathetic chain