Anatomy of the Hand Quiz

Forearm and Hand Anatomy

• Instructors: Dr. Jose Gomez (Assistant Professor, Gross Anatomy), Dr. Andreanna White (Instructor, Gross Anatomy)
• Contact Information: Provided in the slides for both instructors
• Learning Objectives:
  • Identify forearm and hand bones, noting their unique characteristics
  • Differentiate types of joints and permitted movements
  • Distinguish between extrinsic and intrinsic hand muscles, identifying their origins, insertions, actions, and innervations
  • Define the anatomical snuffbox and its contents
  • Identify radial, ulnar, and median nerve courses through the forearm and hand
  • Understand how nerve damage in different body regions can present differently
  • Describe arterial and venous blood flow in the forearm and hand
  • Identify lymphatic drainage pathways
  • Recognize clinical signs/symptoms of nerve damage
  • Link clinical correlates (e.g., Colles' and Smith fractures, elbow stress injuries) with their anatomical underpinnings
• Recommended Reading: Gray's Anatomy for Students, 4th Edition: Chapter 7 “Upper Limb”, Pages: 680, 681, 761 - 809
• Pre-Lab Osteology Quiz: Required to understand the lecture and related activities, and may be part of the examination

Osteology of the Forearm and Hand

• Pre-lab quiz needed for this section
• The material is examinable.

Muscles of the Forearm and Hand

• Forearm Muscles: These muscles are bellied within the forearm, with insertions also in the forearm. Function in supination or pronation
• Examples: Supinator, Pronator Quadratus, Brachioradialis
• Extrinsic Muscles of the Hand: Located proximally outside of the hand. Tendons insert within the hand.
• Intrinsic Muscles of the Hand: Originate and insert within the hand itself.

Extrinsic & Intrinsic Muscles of the Hand

• Extrinsic Muscles: Located in the forearm. Tendons insert in the hand.
• Intrinsic Muscles: located in the hand. Origin and insertion are both in the hand.

Summary of Muscles

• Details of different forearm and hand muscles, their actions, and innervation.
  • Specific muscle names, functions, and innervations are listed in the summary table.
• Anatomical Snuffbox:
  • Boundaries: Abductor pollicis longus and extensor pollicis brevis tendons, the extensor pollicis longus tendon, and the scaphoid and trapezium bones.
  • Roof: Superficial branch of radial nerve and cephalic vein.
  • Contents: Radial artery.

Tissue Layers of the Forearm

• Superficial Fascia: Loose connective and adipose tissue. Contains cutaneous nerves, superficial veins and lymphatics
• Deep Fascia: Dense connective tissue. Encloses muscles, neurovasculature and lymphatics

Fascial Compartments of the Forearm

• Interosseous Membrane: Dense fibrous connective tissue. Divides the forearm into anterior and posterior compartments.

Fascial Compartments of the Forearm (continued)

• Anterior Compartment: Containing flexors and pronators.
• Posterior Compartment: Containing extensors and supinators.
• Nerve innervation details are given for both superficial and deep anterior compartments

Anterior Compartment of the Forearm

• List of muscles including their actions and innervation

Superficial Anterior Compartment

• List of muscles including their origins, insertions, innervations and actions

Deep Anterior Compartment

• Provides detailed information concerning the origin, insertion, innervation and action of the muscles.

Posterior Compartment

• List of muscles including their actions and innervation.

Posterior Compartment (continued)

• Detailed information for the origin, insertion, innervation, and action of specific muscles.

Fascia of the Wrist

• Flexor Retinaculum (Transverse/Palmar Carpal Ligament): Thickening of the antebrachial fascia. Forms a tunnel housing various structures.
• Extensor Retinaculum: Structure that protects tendons within the posterior of the wrist
• Tendon Sheaths: Tubular structures reducing friction on tendons

Flexor Retinaculum & the Carpal Tunnel

• Description of the Flexor Retinaculum: Location, boundaries, structures that traverse within the tunnel.
• Contents of the Carpal Tunnel: Includes median nerve, flexor tendon compartments.

Carpal Tunnel

• Details of anatomical structure.

Anatomical Snuffbox

• Detailed description of Boundaries and Contents: Provides precise boundaries and contains critical structures of the anatomical snuffbox region of the wrist.

Fascia of the Hand

• Provides detailed information on palmar aponeurosis.

Bowstringing

• Visually depicts the issue occurring when tendons become overstretched.

Trigger Finger

• Describes a mechanism of injury causing a trigger finger, and reasons for it
• Presents the typical cause

Dupuytren's Contracture

• Describes the disease affecting the palmar fascia.
• Presents the typical symptoms, progression and implications of the condition

Dorsal Digital Expansions

• Illustration and description of the structures.

Mallet Finger- “Baseball Finger”

• Mechanism of injury: describes the mechanism causing a mallet finger, a medical condition
• Presentation: details the presentations of the condition

Intrinsic Muscles of the Hand

• Listing of different intrinsic muscle groups and their locations in the hand. Detailed table of thenar and hypothenar muscles

Thenar Compartment of the Hand

• Details of the location and action of each muscle in the Thenar muscle group

Adductor Pollicis

• Information concerning location and action of this muscle

Hypothenar Compartment of the Hand

• Detailed anatomical descriptions of this compartment of the hand's intrinsic muscle group

Central Compartment of the Hand: Lumbricals

• Detailed analysis of this intrinsic muscle group, its origins, insertions, nerve innervation and actions.

Palmar Interossei – Deep Layer

• Description of the origin, insertion, innervation and action

Dorsal Interossei – Deep Layer

• Description of the origin, insertion, innervation and action.

Interossei Muscles (continued) and Action

• Displays visual guides demonstrating the action of Interossei muscles (Abduction and Adduction)

The Neurovascular System of the Forearm and Hand & Associated Clinical Injuries

• Introduction
• Brief overview of the area.

Arteries of the Forearm

• Diagrammatic representation and explanation regarding the arteries.

Arteries of the Forearm (continued)

• Overview of branches (radial, ulnar, etc.) and their connections

Arteries of the Hand

• Superficial and Deep Palmar Arches
• Description

Arteries of the Hand (continued)

• Details of how the radial and ulnar arteries form palmar arches and supply digital arteries.

Veins of the Forearm

• Identifying the superficial veins

Veins of the Hand

• Identifying the superficial veins

Lymphatic Drainage of Upper Limb

• Details of superficial and deep lymphatic drainage

Superficial Lymphatics of the Upper Limb

• Details of lymphatic vessels

Lymphatic drainage flow Diagram

• Overview of lymphatic drainage pathways.

Nerves of the Forearm

• Identification of the three main forearm nerves
• Overview of the nerves.

Ulnar Nerve Pathway in the Forearm

• Description of The Ulnar Nerve's course and location.

Ulnar Nerve Innervation

Detailed description of the branches of the ulnar nerve in the hand (Palmar & Dorsal Cutaneous, Superficial, and Deep).

Clinical Implications of Ulnar Nerve Injuries

• Discussion of Ulnar Claw from damage at wrist or elbow

Clinical Implications of Ulnar Nerve Injuries - Avulsion Fracture

• Describes a specific type of injury that can involve the ulnar nerve.

Median Nerve Pathway in the Forearm

• Details of Median Nerve pathway, location and actions.

Median Nerve Innervation

• Details of the four main branches of the median nerve, in the hand.

Median Nerve: Sensory Territory

• Details of sensation areas supplied by the median nerve

Sensory Innervation of Nerves of the Hand

• Visual explanation of areas of sensory innervation by each nerve

Supracondylar Fracture of the Humerus

• Mechanism(s) and clinical implications of injuries.

Hand of Benediction

• Resultant physical deformity when a patient is unable to make a complete fist.

Supracondylar Fracture of the Humerus Cont'd

• Details of potential losses and retained functions in fractures.

Median Nerve Injury

• Mechanism of injury, Functional losses and retained functions - detailed analysis of the condition and its effects

Median Nerve Injury: Carpal Tunnel Syndrome

• Describes the mechanism and symptoms of carpal tunnel syndrome

Innervation to the Palm

• The nerves that supply different regions of the palm. Details of both Ulna and Median nerve

Radial Nerve Pathway in the Forearm

• Tracing the path of the radial nerve. Includes its branches and their locations

Radial Nerve Injury

• Mechanism of Injury, and the Symptom: "Wrist Drop"

Fractures of the Radius: Distal “Colles Fracture"

• Information about Colles fracture mechanism, treatment, presentation, and associated potential complications/injuries

Fractures of the Radius: Distal “Smith's Fracture"

• Provides information concerning the mechanism, presentation, and/or associated implications

Movements Created by Each Nerve

• Illustration and detailed description of the movements related to each nerve

Common Carpal Fractures

• Overview of common carpal fractures (including scaphoid and hamate)

Repetitive Stress Injuries of the Elbow

• Details on lateral and medial epicondylitis

Swan Neck Deformity vs. Boutonniere Deformity

• Illustrations of the two deformities, distinguishing their presentations.

Heberden's & Bouchard's Nodes

• Overview of the bony growths and conditions.

Thank you for your attention and participation