DEN 015L - General Anatomy 1

STUDENT’S ACTIVITY
SHEET
DENTISTRY / FIRST YEAR

Session 22

LESSON TITLE: WRIST AND HAND Materials:

Modules, pen, notebook LEARNING OUTCOMES:
Upon completion of this lesson, the dental student can:
1. Identify the bones of the wrist and hand region;
2. Identify the ligaments located on the References:
metacarpophalangeal and interphalangeal Snell, R., 2012. Clinical Anatomy By Regions. 9th ed. regions;
Baltimore, Md.: Wolters Kluwer/Lippincott Williams & Wilkins
3. Identify the extensor tendon expansion;
4. Locate accurately the intrinsic muscles of the hand;
5. Name the tendons that pass through the extensor tunnels of the wrist;
6. Identify the boundaries of the anatomic snuffbox.

LESSON PREVIEW
Last time, we talked about the upper arm and forearm regions. We started discussing the cutaneous innervation of both
the upper arms and forearm followed by the vascular supply and venous drainage. Muscular anatomy was also discussed
and we have known that both regions are compartmentalized in terms of muscular location. In the upper arm, we have the
anterior fascial compartment comprised of the biceps brachii, coracobrachialis, and brachialis which all have common
innervation and vascular supply as well, musculocutaneous nerve, and brachial artery, respectively. Next for the upper
arm, we have the posterior compartment, which contains the three heads of the triceps brachii muscle, with the radial
nerve as the muscular innervation and the profunda brachii and ulnar collateral arteries. In the forearm, the ulna and
radius bones can be located. It also has compartments, anterior, lateral, and posterior. The anterior has the superficial
groups consisting of the pronator teres, flexor carpi radialis, palmaris longus, and flexor carpi ulnaris. The intermediate
group has the flexor digitorum superficialis and the deep group has the flexor digitorum profundus, and the pronator
quadratus. Muscular innervation is coming from the median nerve, except for the flexor carpi ulnaris and medial part of the
flexor digitorum profundus which are supplied by the ulnar nerve. Vascular supply comes from ulnar and radial arteries.
The lateral compartment has the brachioradialis, and extensor carpi radialis longus; innervated by the radial nerve, and
the vascular supply from the radial and brachial arteries. The posterior compartment also has a superficial group. It
contains the extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, and
anconeus, having a proximal attachment on the lateral epicondyle of the humerus. The deep portion has the supinator,
abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, and extensor indicis. Nerve supply to these
muscles is from the deep branch of the radial nerve. Its vascular supply is from the anterior and posterior interosseous
arteries.

This session will wrap everything up in the upper limb section. We will be discussing the most distal region of the upper
limb; the wrist and hand regions. Same pattern as from the previous two sessions, we would tackle bones, muscular
anatomy, nerve and vascular supply, as well as the joints that are formed within the wrist and hand through the junctions
of bones.

So, brace yourself for new knowledge and I welcome you to the wrist and hand section of the course!
 MAIN LESSON
Wrist Joint
The wrist (radiocarpal) joint is a condyloid (ellipsoid) type of synovial joint. The position of the joint is indicated
approximately by a line joining the styloid processes of the radius and ulna, or by the proximal wrist crease. The wrist
(carpus), the proximal segment of the hand, is a complex of eight carpal bones, articulating proximally with the forearm via
the wrist joint and distally with the five metacarpals.

ARTICULATION OF WRIST JOINT

The ulna does not participate in the wrist joint. The distal end of the radius and the articular disc of the distal radioulnar
joint articulate with the proximal row of carpal bones, except for the pisiform. The latter bone acts primarily as a
sesamoid bone, increasing the leverage of the f l exor carpi ulnaris (FCU). The pisiform lies in a plane anterior to the other
carpal bones, articulating with only the triquetrum.

JOINT CAPSULE OF WRIST JOINT

The fibrous layer of the joint capsule surrounds the wrist joint and is attached to the distal ends of the radius and ulna
and the proximal row of carpals (scaphoid, lunate, and triquetrum). The synovial membrane lines the internal surface of
the fibrous layer of the joint capsule and is attached to the margins of the articular surfaces. Numerous synovial folds are
present.

LIGAMENTS OF WRIST JOINT

The fibrous layer of the joint capsule is strengthened by strong dorsal and palmar radiocarpal ligaments. The palmar
radiocarpal ligaments pass from the radius to the two rows of carpals. They are strong and directed so that the hand
follows the radius during supination of the forearm. The dorsal radiocarpal ligaments take the same direction so that the
hand follows the radius during pronation of the forearm.

The joint capsule is also strengthened medially by the ulnar collateral ligament, which is attached to the ulnar styloid
process and triquetrum. The joint capsule is also strengthened laterally by the radial collateral ligament, which is
attached to the radial styloid process and scaphoid.

MOVEMENTS OF WRIST JOINT

The movements at the wrist joint may be augmented by additional smaller movements at the intercarpal and midcarpal
joints. The movements are flexion-extension, abduction–adduction (radial deviation–ulnar deviation), and circumduction.
The hand can be flexed on the forearm more than it can be extended; these movements are accompanied (actually, are
initiated) by similar movements at the midcarpal joint between the proximal and the distal rows of carpal bones. Adduction
of the hand is greater than abduction. Most adduction occurs at the wrist joint. Abduction from the neutral position occurs
at the midcarpal joint. Circumduction of the hand consists of successive fl exion, adduction, extension, and abduction.

MUSCLES MOVING WRIST JOINT

Movement at the wrist is produced primarily by the “carpi” muscles of the forearm, the tendons of which extend along the
four corners of the wrist to attach to the bases of the metacarpals. The FCU does so via the pisohamate ligament, a
continuation of the FCU tendon if the pisiform is considered a sesamoid bone within the tendon.
- Flexion of the wrist joint is produced by the FCR and FCU, with assistance from the flexors of the fingers and thumb, the
palmaris longus and the APL.
- Extension of the wrist joint is produced by the ECRL, ECRB, and ECU, with assistance from the extensors of the fingers
and thumb.
- Abduction of the wrist joint is produced by the APL, FCR, ECRL, and ECRB; it is limited to approximately 15° because of
the projecting radial styloid process.
- Adduction of the wrist joint is produced by simultaneous contraction of the ECU and FCU.

Intercarpal Joints
The intercarpal (IC) joints, interconnecting the carpal bones, are plane synovial joints, which may be summarized as
follows:
- Joints between the carpal bones of the proximal row.
- Joints between the carpal bones of the distal row.
- The midcarpal joint, a complex joint between the proximal and distal rows of carpal bones.
- The pisotriquetral joint, formed from the articulation of the pisiform with the palmar surface of the triquetrum.

JOINT CAPSULE OF INTERCARPAL JOINTS

A continuous, common articular cavity is formed by the IC and carpometacarpal joints, with the exception of the
carpometacarpal joint of the thumb, which is independent. The wrist joint is also independent. The continuity of the
articular cavities, or the lack of it, is significant in relation to the spread of infection and to arthroscopy, in which a flexible
fi beroptic scope is inserted into the articular cavity to view its internal surfaces and features. The fibrous layer of the joint
capsule surrounds the IC joints, which helps unite the carpals. The synovial membrane lines the fibrous layer and is
attached to the margins of the articular surfaces of the carpals.

LIGAMENTS OF INTERCARPAL JOINTS

The carpals are united by anterior, posterior, and interosseous ligament.

MOVEMENTS OF INTERCARPAL JOINTS

The gliding movements possible between the carpals occur concomitantly with movements at the wrist joint, augmenting
them and increasing the overall range of movement. Flexion and extension of the hand are actually initiated at the
midcarpal joint, between the proximal and the distal rows of carpals. Most flexion and adduction occur mainly at the wrist
joint, whereas extension and abduction occur primarily at the midcarpal joint. Movements at the other IC joints are small,
with the proximal row being more mobile than the distal row.

Carpometacarpal and Intermetacarpal Joints

The carpometacarpal (CMC) and intermetacarpal (IM) joints are the plane type of synovial joint, except for the CMC
joint of the thumb, which is a saddle joint.

ARTICULATIONS OF CARPOMETACARPAL AND INTERMETACARPAL JOINTS

The distal surfaces of the carpals of the distal row articulate with the carpal surfaces of the bases of the metacarpals at the
CMC joints. The important CMC joint of the thumb is between the trapezium and the base of the 1st metacarpal; it has a
separate articular cavity. Like the carpals, adjacent metacarpals articulate with each other; IM joints occur between the
radial and ulnar aspects of the bases of the metacarpals.

JOINT CAPSULE OF CARPOMETACARPAL AND INTERMETACARPAL JOINTS

The medial four CMC joints and three IM joints are enclosed by a common joint capsule on the palmar and dorsal
surfaces. A common synovial membrane lines the internal surface of the fibrous layer of the joint capsule, surrounding a
common articular cavity. The fibrous layer of the CMC joint of the thumb surrounds the joint and is attached to the
margins of the articular surfaces. The synovial membrane lines the internal surface of the fibrous layer. The looseness of
the capsule facilitates free movement of the joint of the thumb.

LIGAMENTS OF CARPOMETACARPAL AND INTERMETACARPAL JOINTS

The bones are united in the region of the joints by palmar and dorsal CMC and IM ligaments and by interosseous IM
ligaments. In addition, the superficial and deep transverse metacarpal ligaments (the former part of the palmar
aponeurosis), associated with the distal ends of the metacarpals, play a role in limiting movement at the CMC and IM
joints as they limit separation of the metacarpal heads.

MOVEMENTS OF CARPOMETACARPAL AND INTERMETACARPAL JOINTS

The CMC joint of the thumb permits angular movements in any plane (flexion–extension, abduction–adduction, or
circumduction) and a restricted amount of axial rotation. Most important, the movement essential to opposition of the
thumb occurs here. Although the opponens pollicis is the prime mover, all of the hypothenar muscles contribute to
opposition.

Almost no movement occurs at the CMC joints of the 2nd and 3rd digits, that of the 4th digit is slightly mobile, and that of
the 5th digit is moderately mobile, flexing and rotating slightly during a tight grasp. When the palm of the hand is “cupped”
(as during pad-to-pad opposition of thumb and little finger), two thirds of the movement occur at the CMC joint of the
thumb, and one third occurs at the CMC and IC joints of the 4th and 5th fingers.

Metacarpophalangeal and Interphalangeal Joints

The metacarpophalangeal joints are the condyloid type of synovial joint that permit movement in two planes:
flexionextension and adduction–abduction. The interphalangeal joints are the hinge type of synovial joint that permits
flexionextension only.

ARTICULATIONS OF METACARPOPHALANGEAL AND INTERPHALANGEAL JOINTS

The heads of the metacarpals articulate with the bases of the proximal phalanges in the MP joints, and the heads of the
phalanges articulate with the bases of more distally located phalanges in the IP joints.

JOINT CAPSULES OF METACARPOPHALANGEAL AND INTERPHALANGEAL JOINTS

A joint capsule encloses each MC and IP joint with a synovial membrane lining a fi brous layer that is attached to the
margins of each joint.

LIGAMENTS OF METACARPOPHALANGEAL AND INTERPHALANGEAL JOINTS

The fibrous layer of each MC and IP joint capsule is strengthened by two (medial and lateral) collateral ligaments. These
ligaments have two parts:
- Denser “cord-like” parts that pass distally from the heads of the metacarpals and phalanges to the bases of the
phalanges - Thinner “fan-like” parts that pass anteriorly to attach to thick, densely fibrous or fibrocartilaginous plates, the
palmar ligaments (plates), which form the palmar aspect of the joint capsule.

The fan-like parts of the collateral ligaments cause the palmar ligaments to move like a visor over the underlying
metacarpal or phalangeal heads.

The strong cord-like parts of the collateral ligaments of the MP joint, being eccentrically attached to the metacarpal heads,
are slack during extension and taut during flexion. As a result, the fingers cannot usually be spread (abducted) when the
MP joints are fully flexed. The interphalangeal joints have corresponding ligaments, but the distal ends of the proximal and
middle phalanges, being flattened anteroposteriorly and having two small condyles, permit neither adduction nor
abduction.

The palmar ligaments blend with the fibrous digital sheaths and provide a smooth, longitudinal groove that allows the long
flexor ligaments to glide and remain centrally placed as they cross the convexities of the joints. The palmar ligaments of
the 2nd–5th MP joints are united by deep transverse metacarpal ligaments that hold the heads of the metacarpals
together.
In addition, the dorsal hood of each extensor apparatus attaches anteriorly to the sides of the palmar plates of the MP
joints.

MOVEMENTS OF METACARPOPHALANGEAL AND INTERPHALANGEAL JOINTS

Flexion–extension, abduction–adduction, and circumduction of the 2nd–5th digits occur at the 2nd–5th MP joints.
Movement at the MP joint of the thumb is limited to flexion-extension. Only flexion and extension occur at the IP joints.

CHECK FOR UNDERSTANDING MAGLINTE, JULIENE LAILANIE Y. I.

BONES OF THE WRIST AND HAND DDM2-A3
Answers:
1. Distal phalanges 5. Hook of hamate 9. Triquetrum 13. Trapezium
2. Middle phalanges 6. Hamate 10. Lunate 14. Tubercle
3. Proximal phalanges 7. Capitate 11. Scaphoid 15. Trapezoid
4. Metacarpal bones 8. Pisiform 12. Tubercle 16. Sesamoid bones

II. METACARPOPHALANGEAL AND INTERPHALANGEAL LIGAMENTS

Answers:
1. Flexor digitorum profundus 5. Palmar carpometacarpal 9. Joint capsule
tendons ligaments 10. Collateral ligaments
2. Palmar ligaments (volar 6. Hook of hamate 11. Cut margins of digital
phases) 3. Deep transverse 7. Pisiform fibrous sheath
metacarpal ligaments 8. Trapezium 12. Flexor digitorum
4.Palmar metacarpal ligaments superficial tendons (cut)

III. SUPERFICIAL PALMAR DISSECTION:

Answers: deep antebrachial fascia
1. Palmar digital nerves continuous with extensor
from superficial branch retinaculum 13. Palmar
of ulnar nerve to 5th branch of median nerve
digit and medial half of 14. Thenar muscles 15.
4th digit Recurrent branch of
6. Ulnar artery 7.
2. Palmaris brevis muscle median nerve to thenar
Superficial branch of
3. Palmar aponeurosis muscles
ulnar nerve 8. Deep
4. Hypothenar muscles palmar branch of ulnar
5. Palmaris brevis muscle artery and deep branch 16. Minute fasciculi attach
of ulnar nerve 9. palmar aponeurosis to
Pisiform bone 10. dermis 17. Palmar
Palmar branch of ulnar aponeurosis
nerve 18. Transverse fasciculi
19. Palmar digital arteries
and nerves 20. Superficial
11. Palmaris longus
transverse metacarpal
tendon 12. Palmar carpal
ligaments
ligament thickening of
IV. DEEP PALMAR DISSECTION

Answers: radial artery and nerve 19. Pisiform (transverse carpal over adductor
1. Insertion of flexor recurrent branch of bone 20. Common ligament) 29. pollicis
digitorum profundus median nerve to flexor sheath (ulnar Thenar muscles 30. muscle
tendon 2. Insertion thenar muscles 11. bursa) containing Proper palmar 39. 1st dorsal
of flexor digitorum (Synovial) flexor superfiialis and digital nerves of intercrosscous
superficialis tendon tendon sheath of profundus flexor thumb muscle 40. Probe in
3. Midpalmar space fingers tendons 21. Flexor 31. (Synovial) dorsal extension of
(deep to flexor 12. 2nd, 3rd, and 4th carpi ulnaris tendon tendinous sheath of thenar space deep
tendons and lumbrical muscles 22. Ulnar artery with flexor policis longus to adductor pollicis
lumbrical muscles) (in facial sheath) 13. venae comitantes muscle (radial muscle 41. Thenar
4. Probe in Superficial pulmur and ulnar nerve 23. bursa) 32. Probe in space (deep to
midpalmar space arterial and veous Radial artery and 1st lumbrical fascial flexor tendons and
5. 5th finger arches 14. Common venae comitantes sheath 33. Common 1st lumbrical muscle)
(synovial) tendinous flexor sheath (ulnar 24. Flexor carpi palmar 42. Septum
sheath 6. Common bursa) 15. Median radialis tendon 25. digital artery 34. separating thenar
flexor sheath (ulnar nerve 16.Palmar Tendinous sheath of Proper palmar from midpalmar
bursa) 7. digital nerves to 5th flexor policis longus digital arteries 35. space 43. Common
Hypothenar muscles finger and medial muscle (radial Septa form palmar palmar
8. Common palmar half of 4th finger 17. bursa) 26. Median aponeurosis forming digital artery 44.
digital branches of Superficial branch of nerve 27. Palmanis canals 36. Palmar Proper palmar
median nerve (cut) ulnar nerve longus tendon and aponeurosis digital arteries and
9. Ulnar artery palmar carpal nerves 45. Anular
ligament 37. Proper palmar and cruciform parts
18. Deep palmar digital nerves of of fibrous sheath
10. Superficial branch of ulnar 28. Flexor thumb 38. Fascia over (synovial)
palmar branch of artery and deep retinaculum flexor tendon
branch of ulnar sheaths
V. FLEXOR AND EXTENSOR TENDONS IN FINGERS

Answers:
1. Triangular 9. Lumbrical m. 17. Dorsal 25. Vinculum breve 33. Lumbrical
aponeurosis 2. 10. Interosseous expansion (hood) 26. Collateral muscle
Insertion of m. slip to lateral 18. Long extensor ligaments 34. Palmar
extensor tendon to band 11. Lateral tendon 27. Insertion of ligament
base of middle bands 12. Insertion 19. Metacarpal lumbrical muscle to (palmar plate)
phalanx of extensor tendon to 20. Interosseous extensor tendon 28. 35. Flexor
3. Slips of long base of distal mm. Attachment of digitorum
extensor tendon to phalanx 21. Lumbrical m. interosseous m. to superficialis
lateral bands 4. 13. Insertion of 22. Flexor base of proximal tendons (cut)
Dorsal expansion extensor tendon digitorum profundus phalanx and joint 36. Collateral
(hood) to distal phalanx tendon 23. Flexor 29. Insertion of ligaments
5. Long 14. Insertion of digitorum deep portion of 37. Flexor
extensor tendon extensor tendon superficialis tendon extensor tendon to digitorum
6. Inrterosseou to middle phalanx proximal phalanx profundos tendon
24. Vincula longa
s mm. 15. Lateral band and joint capsule (cut)
7. Metacarpal 8. 16. Slips of long 30. Collateral
38. Palmar
Portion of extensor tendon ligament
ligament
interosseous tendon to 31. Extensor
(palmar plate)
passing to base of lateral bands tendon 32.
proximal phalanx Interosseous muscles
and joint capsule
VI. INTRINSIC MUSCLES OF THE HAND

Answers:
1. Deep 9. Median 17. Superficial 25. Branches from 33. Ulna deep
transverse nerve palmar branch of branch of 34. Radius ulnar nerve to
metacarpal 10. Pisiform radial artery 18. 3rd 35. Palmar and 4th lumbrical
ligaments bone 11. Palmar Flexor interosseous muscles and to all
2. Common carpal arterial arch retinaculum muscles interosseous
palmar digital 12. Ulnar transverse (unipennate) muscles 37.
arteries 3. Palmar artery and palmar carpal Tendinous clips 26. Lumbrical to
metacarpal arteries carpal branch ligament extensor
4. Deep palmar 13. Ulnar nerve (reflected) 19. muscles (reflected) expansions
(arterial arch) 14. Pronator Opponens pollicis
5. Opponents quadratus muscle muscle 20.
27. Dorsal interosseous muscles
digiti minimi muscle 15. Radial artery Branches of
(bipennate)
6. Flexor digiti and palmar carpal median nerve to
28. Abductor
minimi brevis muscle branch 16. Radius thenar muscles and
pollicis brevis
(cut) 7. Deep palmar to 1st and 2nd
muscle
branch of ulnar artery lumbrical muscles
29. Radial artery
and deep branch of 21. Abductor
30. Radius
ulnar nerve pollicis brevis
muscle (cut) 31. Ulna
8. Abductor digiti
22. Flexor 32. Abductor digiti minimi muscle
minimi muscle (cut)
pollicis brevis
muscle 23.
Adductor pollicis
muscle 24. 1st
dorsal
interosseous
muscle
VII. SUPERFICIAL RADIAL DISSECTION

Answers: anatomical snuffbox

1. Muscular fascia 14.Trapezium bone
over 1st dorsal 15. Abductor
interosseous muscle 6. Dorsal carpal pollicis longus tendon
2. 1st dorsal branch of radial artery 7.
interosseous muscle Extensor retinaculum 8. 16. 1st metacarpal
3. Radial artery 4. Superficial branch of bone 17. Extensor
Extensor carpi radialis radial nerve 9. pollicis brevis tendon
longus tendon 10. 18. Extensor pollicis
5. Extensor carpi longus tendon
radialis brevis tendon 11. Dorsal digital
branches of radial nerve
12. Scaphoid bone 13.
Radial artery in
VIII. SUPERFICIAL DORSAL DISSECTION

Answers: 1. Probe in Superficial branch of

dorsal subaponeurotic radial nerve
space between opened 9. Dorsal venous network 13. Dorsal branches of
dorsal fascia of hand and of hand proper palmar digital
dorsal interosseous 10. Dorsal metacarpal nerves
fascia 2. Communicating 5. Cephalic vein 6.
veins
branches of radial and Posterior antebrachial
11. Intercapitular veins 12. Dorsal digital nerves and
ulnar nerves 3. Extensor cuteneous nerve (from
veins
retinaculum (thickening radial nerve 7. Basilic vein
of antebrachial fascia) 4. 8. Dorsal branch of ulnar
nerve
IX. DEEP DORSAL DISSECTION

Answers:
1. Dorsal 6. Extensor 11. Superficial 16. Dorsal 21. Dorsal
branched of palmar pollicis longus tendon branch of radial nerve branch of ulnar nerve metacarpal arteries
digital branches of 7. Extensor 12. Lateral 17. Dorsal carpal 22. Dorsal digital
median nerve and of pollicis brevis tendon antebrachial branch of ulnar branches of dorsal
palmar digital 8. Abductor cutaneous nerve artery branch of ulnar
arteries to dorsum pollicis longus tendon (terminal part of 18. Extensor nerve to 5th and
of middle and distal 9. Radial artery musculocutaneou carpi ulnaris tendon
ulnar half of 4th
phalanges of 2nd , 3rd, in anatomic snuffbox s nerve) 13. Medial 19. Dorsal carpal
fingers
and radial half of 10. Extensor antebrachial (arterial) arch 20.
4th fingers digitonum, extensor cutaneous nerve Dorsal metacarpal
2. Dorsal digital digiti minimi and 14. Posterior arteries
branches of extensor indicis antebrachial
superficial branch of cutaneous nerve
tendons (cut)
radial nerve to 1st, (branch of radial
2nd, 3rd, and radial nerve)
half of 4th fingers 3. 15. Extensor
Dorsal digital retinaculum
arteries
4. Extensor carpi
radialis brevis
tendon
5. Extensor carpi
radialis longus
tendon
X. EXTENSOR TENDONS AT THE WRIST

Answers:
1. Dorsal 5. Extensor carpi 9. Extensor digitorum 13. Extensor retinaculum
interosseous muscles radialis longus 10. Extensor digiti 14. Abductor digiti minimi
2. Radial artery in 6. Extensor carpi minimi muscle
anatomical snuffbox 3. radialis brevis 11. Extensor carpi 15. Intertendinous
Extensor pollicis brevis 4. 7. Extensor pollicis ulnaris 12. Plane of cross connections
Abductor pollicis longus longus section shown below 16. Transverse fibers
8. Extensor indicis of extensor expansions
(hoods)

XI. CROSS SECTION OF THE MOST DISTAL PORTION OF THE FOREARM

Answers:
1. Extensor carpi ulnaris 6. Extensor carpi radialis brevis
2. Extensor digiti minimi 7. Extensor carpi radialis longus
3. Extensor digitorum and extensor indicis 8. Extensor pollicis brevis
4. Extensor retinaculum 9. Abductor pollicis longus
5. Extensor pollicis longus

XII. FINGERS
Answers:
1. Body of nail 6. Articular cavity 11. Flexor digitorum 16. Synovial 21. Lunula
2. Nerves 7. Palmar ligament superficialis tendon membrane 22. Nail bed
3. Arteries (plate) 12. Centaral tendon 17. Epiphysis 23. Distal phalanx
4. Septa 8. Flexor digitirum 13. Lateral tendon 18. Nail matrix 5. Distal anterior profundus
tendon 14. Middle phalanx 19. Nail root closed space (pulp) 9. Synovial (flexor 15. Articular
20. Eponychium
tendon) sheath of cartilage (cuticle) finger
10. Fibrous tendon sheath
of finger
RATIONALIZATION
I. BONES OF THE WRIST AND HAND

Answers:
1. 5. 9. 13.
2. 6. 10. 14.
3. 7. 11. 15. 4. 8. 12. 16.

II. METACARPOPHALANGEAL AND INTERPHALANGEAL LIGAMENTS

Answers:
1. 5. 9.
2. 6. 10.
3. 7. 11.
4. 8. 12.

III. SUPERFICIAL PALMAR DISSECTION:

Answers:
1. 6. 11. 16.
2. 7. 12. 17.
3. 8. 13. 18.
4. 9. 14. 19. 5. 10. 15. 20.

IV. DEEP PALMAR DISSECTION

Answers:
1. 10. 19. 28. 37.
2. 11. 20. 29. 38.
3. 12. 21. 30. 39.
4. 13. 22 31. 40.
5. 14. 23. 32. 41.
6. 15. 24. 33. 42.
7. 16. 25. 34. 43.
8. 17. 26. 35. 44. 9. 18. 27. 36. 45.

V. FLEXOR AND EXTENSOR TENDONS IN FINGERS

Answers:
1. 9. 17. 25. 33.
2. 10. 18. 26. 34.
3. 11. 19. 27. 35.
4. 12. 20. 28. 36,
5. 13. 21. 29. 37.
6. 14. 22. 30. 38.
7. 15. 23. 31. 39. 8. 16. 24. 32. 40.

VI. INTRINSIC MUSCLES OF THE HAND

Answers:
1. 9. 17. 25. 33.
2. 10. 18. 26. 34.
3. 11. 19. 27. 35.
4. 12. 20. 28. 36,
5. 13. 21. 29. 37.
6. 14. 22. 30. 38.
7. 15. 23. 31. 39. 8. 16. 24. 32. 40.

VII. SUPERFICIAL RADIAL DISSECTION

Answers:
1. 6. 11. 16.
2. 7. 12. 17.
3. 8. 13. 18.
4. 9. 14. 5. 10. 15.

VIII. SUPERFICIAL DORSAL DISSECTION

Answers:
1. 5. 9. 13.
2. 6. 10.
3. 7. 11. 4. 8. 12.

IX. DEEP DORSAL DISSECTION

Answers:
1. 6. 11. 16. 21.
2. 7. 12. 17. 22.
3. 8. 13. 18.
4. 9. 14. 19. 5. 10. 15. 20.

X. EXTENSOR TENDONS AT THE WRIST

Answers:
1. 5. 9. 13.
2. 6. 10. 14.
3. 7. 11. 15. 4. 8. 12. 16.

XI. CROSS SECTION OF THE MOST DISTAL PORTION OF THE FOREARM

Answers:
1. 6.
2. 7.
3. 8.
4. 9.
5.

XII. FINGERS
Answers:
1. 6. 11. 16. 21.
2. 7. 12. 17. 22.
3. 8. 13. 18. 23.
4. 9. 14. 19. 5. 10. 15. 20.

LESSON WRAP-UP

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track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.