Forearm and Wrist Anatomy

Okay, here are 5 different options for study notes derived from the provided text:

Option 1

• Pronation is facilitated by the pronator quadratus and pronator teres muscles.
• Supination is performed by the supinator and biceps brachii muscles.
• A FOOSH injury involves falling on an outstretched hand.
• Colles' fracture is a specific type of wrist fracture resulting from a FOOSH injury.
• The carpal bones include the trapezium, trapezoid, capitate, hamate, pisiform, triquetrum, scaphoid, and lunate.
• A scaphoid waist fracture is often caused by a FOOSH injury.
• The flexor retinaculum forms the roof of the carpal tunnel.
• Contents of carpal tunnel: median nerve, FDP and FDS tendons, and flexor pollicis longus tendons.
• The ulnar nerve, ulnar artery, and radial nerve do NOT pass through the carpal tunnel.
• Carpal tunnel syndrome affects the first three digits and the radial aspect of the fourth digit.
• Tinel's test and Phalen's test may indicate carpal tunnel syndrome.
• Wrist joint complex: radiocarpal, midcarpal, and carpometacarpal joints.
• Wrist extension: ECRL, ECRB, ECU + EDC muscles.
• Wrist flexion: FCU, FCR + FDC muscles.
• Ulnar deviation: ECU and FCU muscles.
• Radial deviation: APL, FCR, ECRL, and ECRB muscles.
• The palmar aponeurosis protects underlying neurovascular structures and improves grip.
• Dupuytren's contracture is a progressive fibrosis of palmer aponeurosis.
• Digital synovial sheaths cover the flexor tendons (FDS/FDP) of the fingers and thumb
• A common synovial membrane covers the digital flexors and extends into the forearm as the ulnar bursa.
• Fibrous flexor sheaths form tunnels and prevent bowstringing of flexor tendons.
• Trigger finger is caused by repetitive finger use, leading to inflammation of flexor sheaths and nodule formation.
• Thenar muscles: flexor pollicis brevis, opponens pollicis, and abductor pollicis brevis.
• Hypothenar muscles: flexor digiti minimi, opponens digiti minimi, and abductor digiti minimi.
• Thenar muscles are innervated by median nerve (recurrent branch).
• Hypothenar muscles are innervated by ulnar nerve (deep branch).
• Dorsal interossei abduct fingers and are innervated by the ulnar nerve.
• Palmar interossei adduct fingers and are innervated by the ulnar nerve.
• Lumbricals flex the MCP joint and extend the IP joint.
• Innervation of lumbricals: Medial 2 via ulnar nerve, Lateral 2 via median nerve.
• Adductor pollicis adducts the thumb and is innervated by the ulnar nerve.
• The ulnar and radial arteries anastomose in the palm.
• Digital arteries receive blood from both deep and superficial arches.

Option 2

• Pronator quadratus and pronator teres facilitate pronation.
• Supinator and biceps brachii facilitate supination.
• FOOSH: Fall On OutStretched Hand.
• Colles' fracture is related to FOOSH injuries.
• Carpal bones: Trapezium, Trapezoid, Capitate, Hamate, Pisiform, Triquetrum, Scaphoid, Lunate.
• Scaphoid fracture often results from FOOSH.
• Flexor retinaculum defines the roof of the carpal tunnel.
• Carpal tunnel houses median nerve, FDP/FDS tendons, flexor pollicis longus tendons.
• Ulnar nerve/artery and radial nerve/artery bypass the carpal tunnel.
• Carpal tunnel syndrome impacts first three digits plus the radial side of the fourth digit.
• Tinel's/Phalen's tests can indicate carpal tunnel issues.
• Wrist complex joints: radiocarpal, midcarpal, and carpometacarpal.
• Extension: ECRL, ECRB, ECU, and EDC muscles.
• Flexion: FCU, FCR, and FDC muscles.
• Ulnar deviation involves ECU and FCU.
• Radial deviation involves APL, FCR, ECRL, and ECRB.
• Palmar aponeurosis shields neurovascular elements, boosts grip.
• Dupuytren’s contracture is a palmer aponeurosis fibrosis.
• Digital flexor tendons (FDS/FDP) are covered by synovial sheaths.
• Ulnar bursa represents a synovial membrane extension.
• Fibrous sheaths maintain flexor tendon position preventing bowstringing.
• Trigger finger due to inflamed flexor sheaths from repetitive strain.
• Thenar muscles: flexor pollicis brevis, opponens pollicis, abductor pollicis brevis.
• Hypothenar muscles: flexor/opponens/abductor digiti minimi.
• Median nerve (recurrent branch) serves thenar muscles.
• Ulnar nerve (deep branch) serves hypothenar muscles.
• Ulnar nerve innervates dorsal and palmar interossei abduction/adduction fingers.
• Lumbricals facilitate MCP flexion, IP extension; ulnar/median nerve innervation.
• Ulnar nerve serves adductor pollicis, thumb adduction muscle.
• Radial/ulnar arteries create palmar anastomosis.
• Digital arteries fed by deep/superficial arches.

Option 3

Radioulnar Joints & Forearm

• Pronation achieved via pronator quadratus and teres.
• Supination achieved via supinator and biceps brachii.
• Monteggia and Galeazzi are forearm fractures.

Wrist & Hand Injuries

• FOOSH injury results from fall on outstretched hand.
• Colles' fracture is a common wrist fracture from FOOSH.
• Scaphoid fractures often occur during FOOSH injuries.

Carpal Bones & Carpal Tunnel

• Carpal bones consist of trapezium, trapezoid, capitate, hamate, pisiform, triquetrum, scaphoid, and lunate.
• Flexor retinaculum creates the carpal tunnel.
• The carpal tunnel contains median nerve, FDP, FDS, and flexor pollicis longus.
• Ulnar nerve and artery DO NOT run through carpal tunnel.

Carpal Tunnel Syndrome

• Carpal tunnel syndrome affects digits 1-3 and radial aspect of digit 4.
• Positive Tinel’s and Phalen’s tests indicate carpal tunnel syndrome.

Wrist Joint Movements & Muscles

• Wrist complex includes radiocarpal, midcarpal, and carpometacarpal components.
• Muscles of extension: ECRL, ECRB, ECU, EDC.
• Muscles of flexion: FCU, FCR, FDC.
• Muscles for ulnar deviation: ECU, FCU.
• Muscles for radial deviation: APL, FCR, ECRL, ECRB.

Palmar Aponeurosis & Hand

• Palmar aponeurosis protects neurovascular structures and aids grip.
• Dupuytren’s contracture is fibrosis of palmar aponeurosis.

Digital Synovial Sheaths

• Flexor tendons (FDS/FDP) are covered by synovial sheaths.
• Ulnar bursa proximally extends a synovial member to forearm.

Functional Anatomy of Hand

• Fibrous flexor sheaths form tunnels and prevent bowstringing.
• Trigger finger results from inflamed flexor sheaths due to overuse.
• Thenar muscles are innervated be the median nerve (recurrent branch).
• Hypothenar muscles are innervated by the ulnar nerve (deep branch).
• Thenar muscles: flexor pollicis brevis, opponens pollicis, and abductor pollicis brevis.
• Hypothenar muscles: flexor/opponens/abductor digiti minimi.
• Innervation for lumbricals: Median N (lateral 2), ulnar N (medial 2)
• Ulnar nerve serves adductor pollicis, which facilitates thumb adduction.

Hand Vasculature

• Radial/ulnar arteries generate palmar arches.
• Digital arteries receive blood from both deep/superficial arches.

Option 4

Forearm & Wrist Anatomy/Function

• Pronation: pronator quadratus & teres. Supination: supinator & biceps brachii.
• FOOSH injury is a common mechanism for wrist injuries.
• The carpal bones are the trapezium, trapezoid, capitate, hamate, pisiform, triquetrum, scaphoid, lunate.

Carpal Tunnel

• Flexor retinaculum forms roof. Contains median nerve, FDP/FDS, & flexor pollicis longus. Ulnar nerve/vessels are OUTSIDE.
• Carpal Tunnel Syndrome: affects digits 1-3 and radial aspect of 4. Tinel's & Phalen's tests positive.

Wrist Joint & Movement

• Complex: Radiocarpal, midcarpal, carpometacarpal.
• Extension: ECRL, ECRB, ECU, EDC. Flexion: FCU, FCR, FDC. Ulnar deviation: ECU, FCU. Radial deviation: APL, FCR, ECRL, ECRB.

Hand - Palmar Aponeurosis

• Protects neurovascular structures, enhances grip. Dupuytren’s contracture involves its fibrosis.

Digital Synovial Sheaths/Fibrous Flexor Sheaths

• Synovial sheaths cover FDS/FDP tendons. Ulnar bursa extends proximally. Fibrous sheaths prevent bowstringing.
• Trigger finger: inflamed flexor sheaths, nodule formation due to repetitive use.

Intrinsic Muscles of Hand & Innervation

• Thenar muscles (median nerve recurrent branch): flexor pollicis brevis, opponens pollicis, abductor pollicis brevis.
• Hypothenar muscles (ulnar nerve deep branch): flexor, opponens, abductor digiti minimi.
• Lumbricals: flex MCP, extend IP (median N-lateral 2, ulnar N-medial 2).
• Ulnar nerve: Adductor pollicis (thumb adduction).

Hand Vasculature

• Radial/ulnar arteries form palmar anastomosis feeding digital arteries.

Option 5

Wrist and Hand Anatomy

• Forearm pronation: pronator quadratus, pronator teres. Supination: supinator, biceps brachii.
• FOOSH: common injury mechanism.
• Carpal bones: trapezium, trapezoid, capitate, hamate, pisiform, triquetrum, scaphoid, lunate.
• Flexor retinaculum → carpal tunnel.
• Contents: median nerve, FDP/FDS tendons, flexor pollicis longus. Ulnar structures bypass.
• CTS symptoms: 1st 3 digits and radial 4th. Tinel's & Phalen's tests.

Wrist Joint Actions

• Radiocarpal, midcarpal, carpometacarpal involved.
• Extension: ECRL/ECRB/ECU + EDC. Flexion: FCU/FCR + FDC. Ulnar deviation: ECU, FCU. Radial deviation: APL, FCR, ECRL, ECRB.

Hand Specific Structures

• Palmar aponeurosis: neurovascular protection, grip enhancement. Dupuytren's: fibrosis.
• Synovial Sheaths: digital flexor tendons. Ulnar bursa extends proximally.
• Fibrous Sheaths: prevent bowstringing.
• Trigger finger: inflamed sheaths, nodules. Repetitive use.

Hand Muscles

• Thenar: flexor pollicis brevis, opponens pollicis, abductor pollicis brevis. Median N (recurrent).
• Hypothenar: digiti minimi flexor/opponens/abductor. Ulnar N (deep).
• Lumbricals: MCP flexion/IP extension. Median N (lateral 2), ulnar N (medial 2).
• Thumb adduction: adductor pollicis, ulnar N.

Vasculature

• Radial/ulnar arteries → palmar anastomosis → digital arteries.