Anatomy 9.pdf

 ‫‪Lectures of the Upper limb.‬‬ ‫مرسي‪.‬‬ ‫ا‪.‬د ‪/‬مرسي عبد الفتاح‬ ‫أستاذ التشريح واألجنة‪ /‬كلية الطب‪ /‬جامعة طنطا‪.‬‬  Faculty of Physical Therapy ❑Course Title: Anatomy I ❑Course Code: FM 101 ❑Department: Anatomy and embryology ❑Lecture Title...

 ‫‪Lectures of the Upper limb.‬‬ ‫مرسي‪.‬‬ ‫ا‪.‬د ‪/‬مرسي عبد الفتاح‬ ‫أستاذ التشريح واألجنة‪ /‬كلية الطب‪ /‬جامعة طنطا‪.‬‬  Faculty of Physical Therapy ❑Course Title: Anatomy I ❑Course Code: FM 101 ❑Department: Anatomy and embryology ❑Lecture Title: Muscles of the hand ❑Lecturer Name : Pr.Dr. Morsy Abdelfattah Morsy ❑ Objectives: By the end of this lecture the students will be able to: ❖ Describe the flexor retinaculum, extensor retinaculum, carpal tunnel, palmar aponeurosis and anatomical snuffbox. ❖ Identify the bones of the hand. ❖ Recognize the intrinsic muscles of the hand ❖ Describe the dorsal and palmar interosseus muscles. ❖ Describe the thenar and hypothenar muscles ❖ Describe the lumbricals muscles Bones of the Hand ❑ Carpal bones: composed of two rows (Posterior view): A-Proximal row: 1-Scaphoid. 2-Lunate. 3-Triquaterl. 4-Pisiform(not appears). B-Distal row: 1-Trapezium. 2-Trapezoid. 3-Capitate. 4-Hamate. ❑Carpal bones (8): Anterior view: Proximal row: 1-Scaphoid. 2-Lunate. 3-Triquateral. 4-Pisiform.(Appear in this view). Distal row: 1-Trapezium. 2-Trapezoid. 3-Capitate. 4-Hamate. ❑ Metacarpal bones 5 in number composed of head , shaft and base. They are: 1st. 2nd. 3rd. 4th. 3rd 5th. 2nd 1st 4th 5th ❑ Carpal tunnel and structures at the wrist: The carpal tunnel is formed anteriorly at the wrist by a deep arch formed by the carpal bones and the flexor retinaculum. The base of the carpal arch is formed medially by the pisiform and the hook of the hamate and laterally by the tubercles of the scaphoid and trapezium. ❑ Flexor retinaculum: It is a thick connective tissue ligament that bridges the space between the medial and lateral sides of the base of the arch and converts the carpal arch into the carpal tunnel. The four tendons of the flexor digitorum profundus, the four tendons of the flexor digitorum superficialis, the tendon of the flexor pollicis longus and median nerve pass through the carpal tunnel. Flexor retinaculum  The flexor retinaculum holds the tendons to the bony plane at the wrist and prevents them from 'bowing’. The median nerve is anterior to the tendons in the carpal tunnel. Flexor retinaculum ❑ Extensor Retinaculum: The extensor retinaculum is a thickening of deep fascia that stretches across the back of the wrist and holds the long extensor tendons in position. Extensor It converts the grooves on the retinaculum posterior surface of the distal ends of the radius and ulna into six separate tunnels for the passage of the long extensor tendons. The retinaculum is attached medially to the pisiform bone and the hook of the hamate and laterally to the distal end of the radius. ❑Carpal tunnel syndrome: It is caused by pressure on the median nerve within the carpal tunnel. The nerve injury may be a direct effect of increased pressure on the median nerve caused by overuse, swelling of the tendons (Rheumatoid arthritis), and cysts arising from the carpal joints. Patients typically report pain and pins-and-needles in the distribution of the median nerve. By tapping over the median nerve (in the region of the flexor retinaculum) readily produces these symptoms (Tinel's sign). Initial treatment to reduces the inflammation and removes any repetitive insults that produce the symptoms. If this does not lead to improvement of nerve conduction ,the surgical treatment is needed. ❑Anatomical snuffbox: It is triangular depression formed on the posterolateral side of the wrist and 1st metacarpal bone by the extensor tendons passing into the thumb. The base of the triangle is at the wrist and the apex is directed into the thumb. It is more apparent when the thumb is extended. The lateral border is formed by the tendons of the abductor pollicis longus and extensor pollicis brevis. The medial border is formed by the tendon of the extensor pollicis longus. The floor of the impression is formed by the scaphoid and trapezium bones. The radial artery passes on the floor of anatomical snuffbox. Terminal parts of the superficial branch of the radial nerve and cephalic vein pass in the roof of snuffbox. ❑Palmar aponeurosis: It is a triangular-shaped condensation of deep fascia that covers the palm and is anchored to the skin in distal regions. The apex of the triangle is continuous with the palmaris longus tendon, when present or it is anchored to the flexor retinaculum. Transverse fibers interconnect the more longitudinally arranged bundles that continue into the digits. Vessels, nerves, and long flexor Palmar tendons lie deep to the palmar aponeurosis aponeurosis in the palm. ❑The intrinsic muscles of the hand: These muscles of the hand are the adductor pollicis, interossei, thenar, hypothenar, palmaris brevis, and lumbrical muscles. These muscles present in the hand and do precision movements ('precision grip') with the fingers and thumb. All the intrinsic muscles of the hand are innervated by deep branch of the ulnar nerve except three thenar and two lateral lumbrical muscles, which are innervated by median nerve. ❖ Palmaris brevis: It is a quadrangular- shaped subcutaneous muscle that overlies the hypothenar muscles. Origin: It originates from the palmar aponeurosis and flexor retinaculum Palmaris Insertion: into the dermis brevis muscle of the skin on the medial margin of the hand. Nerve supply: Superficial branch of the ulnar nerve. Action: It improves grip. ❖Dorsal interossei (four muscles): Origin: Adjacent sides of metacarpals Insertion: Extensor expansion and base of proximal phalanges of index, middle, and ring fingers Nerve supply: Deep branch of ulnar nerve [C8,T1]. Action: Abduction of index, middle, and ring fingers at the metacarpophalangeal joints ❖Palmar interossei (four muscles): Origin: Sides of metacarpals Insertion: Extensor expansion of index, ring, and little fingers and the proximal phalanx of thumb Nerve supply: Deep branch of ulnar nerve [C8,T1]. Action: Adduction of the thumb, index, ring, and little fingers at the metacarpophalangeal joints ❖ Adductor pollicis: Origin: it has two heads. 1-Transverse head from 3rd metacarpal bone. 2-Oblique head from Adductor capitate and bases of 2nd & pollicis 3rd metacarpals bones. Insertion: Base of proximal phalanx of thumb Nerve supply: Deep branch of ulnar nerve [C8,T1]. Action: Adducts thumb. ❖ Lumbricals (four muscles): Origin: Tendons of flexor digitorum profundus Insertion: Extensor expansion of index, middle, ring, and little fingers. Nerve supply: Medial two by the deep branch of the ulnar nerve; lateral two by digital branches of the median nerve Action: Flex metacarpophalangeal joints while extend interphalangeal joints ❖ Thenar muscles (3 muscles): 1- Opponens pollicis: Origin: Tubercle of trapezium and flexor retinaculum Insertion: Lateral margin and Opponens adjacent palmar surface pollicis of 1st metacarpal bone. Nerve supply: Recurrent branch of median nerve [C8,T1]. Action: Medially rotates thumb. 2-Abductor pollicis brevis: Origin: Tubercles of trapezium and adjacent flexor retinaculum. Insertion: Abductor Proximal phalanx of pollicis brevis thumb. Nerve supply: Recurrent branch of median nerve [C8,T1]. Action: Abducts thumb at metacarpophalangeal joint. 3-Flexor pollicis brevis: Origin: Tubercle of the trapezium and flexor retinaculum. Insertion: Proximal phalanx of the thumb. Flexor pollicis Nerve supply: brevis Recurrent branch of median nerve [C8,T1]. Action: Flexes the metacarpophalangeal joint of the thumb. ❖ Hypothenar muscle (3 muscles): 1-Opponens digiti minimi: Origin: ▪ Hook of hamate and flexor retinaculum Insertion: ▪ Medial aspect of 5th metacarpal bone. Nerve supply: Opponens ▪ Deep branch of ulnar digiti minimi nerve [C8,T1]. Action: ▪ Laterally rotates 5th metacarpal bone. 2-Abductor digiti minimi: Origin: ▪ Pisiform bone. Insertion: ▪ Proximal phalanx of little finger. Nerve supply: ▪ Deep branch of ulnar nerve [C8,T1]. Action: Abductor ▪ Abducts little finger at digiti minimi metacarpophalangeal joint. 3-Flexor digiti minimi brevis: Origin: ▪ Hook of the hamate and flexor retinaculum. Insertion: Flexor digiti ▪ Proximal phalanx of little minimi brevis finger. Nerve supply: ▪ Deep branch of ulnar nerve [C8,T1]. Action: ▪ Flexes little finger at metacarpophalangeal joint.  MCQ Q1: Which of the following carpal bone is medial attachment of the flexor retinaculum of the hand? a. Pisiform b. Trapezium c. Scaphoid d. lunate Q2:Adductor pollicis muscle takes its nerve supply from which one of the following nerves? a. Recurrent branch of median b. Digital branch of median c. Superficial branch of ulnar d. Deep branch of ulnar Q3: Which of the following muscle is inserted into the apex of palmar aponeurosis? a. Flexor digitorum longus b. Flexor carpi ulnaris c. Palmaris longus d. Flexor pollicis longus Q4:The opponens pollicics muscle is inserted into which one of the following bones? a. 1st metacarpal b. 2nd metacarpal c. 3rd metacarpal d. 4th metacarpal Q5: The index finger is adducted by which of the following muscles? a. 1st dorsal interosseus b. 2nd dorsal interosseus c. 1st palmar interosseus d. 2nd palmar interosseus  References 1-Gray H, Anatomy of the Human Body. 20th ed. New York: Bartleby 2000. 2-Gray, s anatomy for students by Richard Drake and A. Wayne Vogel, 2019. 3-Snell R. " Clinical Anatomy by Regions ' 8th ed. Lippincott Williams and Wilkins, Philadelphia, 2008. 4-Agur A. & Dalley A. " Atlas of Anatomy" Lippincott Williams and Wilkins, Philadelphia, 2005 Thanks, with the best wishes. Prof.Dr/Morsy Abdelfattah.