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Forearm, Wrist and Hand Anatomy

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Presentation on theme: "Forearm, Wrist and Hand Anatomy"— Presentation transcript:

1 Forearm, Wrist and Hand Anatomy
Alastair Stephens Dan Waite

2 Label the carpal bones of the wrist.
Scaphoid Lunate Triquetral Pisiform Hamate Capitate Trapezoid Trapezium What can a fracture of the scaphoid result in? H C Td Tm T The blood flow can be disrupted as it runs distal to proximal and this can lead to avascular necrosis. S P L

3 What are the boundaries of the cubital fossa?
Inter-epicondylar line Superior border Aponeurosis of biceps Covers roof of fossa and protects the median nerve Brachioradialis Lateral border Pronator teres Medial border

4 What are the boundaries of the anatomical snuffbox?
What can be palpated in the anatomical snuffbox? EPL Radial artery Radial styloid process Scaphoid Trapezium Base of 1st metacarpal Cephalic vein passes over snuffbox EPB & AP

5 What is the carpal tunnel formed by?
The retinaculum attaches to pisiform, hook of hamate, scaphoid tubercle and trapezium tubercle Passes ~2cm distal to distal wrist crease HH TT What passes through the carpal tunnel? P ST Flexor digitorum superficialis (x4) Flexor digitorum profundus (x4) Flexor pollicis longus Median nerve

6 What are the sensory distributions of the hand
What are the sensory distributions of the hand? Where do you test for each nerve? Ulnar Median Radial Ulnar nerve on the 5th digit Median nerve on the 2nd digit Radial nerve over the first dorsal interosseous * * *

7 What is the innervation to these compartments?
Anterior Forearm Posterior Forearm Hand Everything is radial nerve Everything is median nerve Except: Flexor carpi ulnaris (ulnar) Flexor carpi profundus to digits 4 and 5 (ulnar) Everything is ulnar nerve Except: Thenar muscles (median) Lumbrical to digits 2 and 3 (median) Ulnar nerve Radial nerve Median nerve

8 What movements occur at the radio-ulnar joints?
Proximal radio-ulnar joint Nursemaid’s elbow Pronation: Median Nerve Pronator teres and pronator quadratus Supination: Musculocutaneous Nerve and Radial Nerve Biceps and Supinator Radial tuberosity Avulsion fracture by biceps Distal radio-ulnar joint

9 What 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.

10 What’s the difference between Ulnar Claw and Hand of Benediction?
Name Nerve damaged Typical presentation Digits affected Muscle Involved Ulnar Claw Ulnar nerve lesion at the wrist At rest Digits 4 and 5 The 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 Benediction Median nerve lesion at the wrist or elbow Attempting to make a fist Digits 2 and 3 The 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.

11 Right 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 Palsy Compression 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 compression Recurs at the right lung apex Horner’s Syndrome Compression of the cervical sympathetic chain

12 Thank you. Any questions?

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