Wrist Anatomy PDF

A white background with blue text Description automatically generated +-----------------------------------+-----------------------------------+ | ### Distal Radius and Ulna |  | | | | | - R...

A white background with blue text Description automatically generated +-----------------------------------+-----------------------------------+ | ### Distal Radius and Ulna |  | | | | | - Radius | | | | | | - Ulna notch | | | | | | - Carpal articular surface | | | | | | - Styloid process | | | | | | - Dorsal tubercle | | | | | | - Ulna | | | | | | - Head of ulna | | | | | | - Styloid process | | | | | | Radius starts to flatten out and | | | create a wider distal end to | | | accommodate the carpal surface | | | | | | Most of carpal bones will rest | | | against carpal surface | | | | | | Styloid process is where | | | collateral ligament attaches on | | | radial side | | | | | | Dorsal tubercle acts as a | | | trochlea, anchor point where | | | extensor muscle wraps around | | | | | | Ulna doesn't participate in | | | articulation of the wrist | | | | | | Styloid process attachment point | | | for a ligament that supports | | | distal radioulnar joint. | | | | | | Ligament runs from styloid | | | process to radius. | | | | | | As it rotates into pronation, | | | distance between radius and | | | styloid process stays the same. | | | | | | Articular disc sits there and | | | acts as an obstacle for the ulna | | +===================================+===================================+ | ### Bones of the hand -- Carpal | **S**ally **L**eft **T**he | | | **P**arty **T**o **T**ake | | - Distal row articulate with | **C**athy **H**ome | | metacarpal | | | | | | - Proximal row do not | | | articulate with metacarpal | | | | | | - Pisiform is a sesamoid bone | | | that sits in the tendon of | | | flexor carpiulnaris (ulna | | | side) | | | | | | - Scaphoid and trapezium has a | | | tubercle that are close | | | | | | - Scaphoid and Trapezius | | | tubercle creates a border | | | along the radius side | | | | | | - Hamate and Pisiform create | | | border on the ulna side | | | | | | - These are attachment point | | | for a ligament and forms a | | | carpal tunnel under the | | | ligament | | +-----------------------------------+-----------------------------------+ | ### Bones of the hand |  | | | | | - Head is the articulation with | | | distal end | | | | | | - Proximal, middle and distal | | | phalange | | +-----------------------------------+-----------------------------------+ | ### Wrist Joint | - Flexion and extension | | | | | - Radiocarpal Joint | - Abduction and Adduction | | | | | - Articulation with distal | - Circumduction | | radius and proximal row | | | of carpal bones (except | - No rotation (pronation and | | pisiform) | supination at radioulnar | | | joints) | | - Scaphoid, Lunate, | | | Triquetrum | - As radius moves, it brings | | | the hand with it | | - Classification: Condyloid | | | joint. Carpal bones being | To prevent rotation: | | outer rounded edges, | | | carpal surface has a | - Supported by strong ligaments | | cupping shape that rests | to ensure hand follows | | against carpal bones | forearm during supination and | | | pronation | | | | | | - Fibrous capsule -- | | | strengthened by dorsal and | | | palmar radiocarpal ligaments | | | | | | - Extracapsular ulnar and | | | radial collateral ligaments | +-----------------------------------+-----------------------------------+ | | - Collateral ligaments come off | | | the styloid process and | | | immediately follows to the | | | carpal bones (radial) | | | | | | - Ligamentous border of | | | articular disc: forms from | | | medial side of styloid | | | process and runs across and | | | binds styloid process of ulna | | | and medial border of radius. | | | Helps prevent separation of | | | the distal radioulnar | | | articulation. | | | | | | - Capitate bone is important in | | | the hand as that's where | | | ligaments attach to | | | | | | - Radiocarpal ligaments head | | | towards the proximal end, | | | some to the midpoint of | | | capitate bone. | | | | | | - There is also bones within | | | the carpal bones | | | | | | - Ligaments coming from | | | capitate and radiating | | | outwards towards other | | | carpals. RADIATE CARPAL | | | LIGAMENT | | | | | | - These bones anchor carpal | | | bones to radius to prevent | | | independent movement | +-----------------------------------+-----------------------------------+ |  | Midcarpal Joint | | | | | | - Proximal carpals to distal | | | carpals | | | | | | - Plane Joint | | | | | | Curving of carpal bones in | | | opposite direction, implying both | | | carpal bones move independently | | | | | | - Work in conjunctions with | | | radiocarpal joint, especially | | | in flexion and extension (15 | | | degrees ext, 20-25 flex). In | | | flexion, proximal row moves | | | towards palmar side and | | | distal row will move further. | | | Have an articulation of | | | proximnal and distal rows. | | | All carpal bones in the row | | | move in the same direction. | | | | | | - Abduction/adduction more | | | complex, involves motion of | | | skin to individual plane | | | joints. Midcarpal joint | | | doesn't work as a pure unit | | | and then individual carpal | | | bones move in different ways | | | with other bones. The shape | | | of the bones will prevent | | | movement in certain | | | directions. | | | | | | - During abduction/adduction, | | | the bones slightly twist. | | | Individual bones move | | | different amounts. Midcarpal | | | joint works as individual | | | plane joints. Large ROM | | | between distal row and | | | proximal row. Adduction is | | | greater ROM. | | | | | | - During abduction, the radius | | | is only articulating with | | | scaphoid and lunate | | | | | | - During adduction, triquetrium | | | comes into contact with the | | | radius but can also with the | | | ulna's articular disc. | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ |  | Interphalangeal joints will have | | | collateral ligaments. | | | | | | Collateral ligaments run side to | | | side. | | | | | | Proximal & Distal interphalangeal | | | joints have collateral ligaments. | | | | | | - Metacarpophalangeal joints | | | have collateral ligaments: | | | Cord-like part Is | | | strong/prevents dislocation | | | and fanlike part: fibres fan | | | out is weaker but good to | | | hold everything in. | | | | | | - Palmar ligament is band of | | | fibres that run horizontally | | | and are important and help | | | prevent dislocation of the | | | joints. | | | | | | - Deep transverse metacarpal | | | ligament: links each | | | metacarpal to each other, | | | prevents separation of the | | | distal ends of metacarpals. | | | Holds heads together. | | | | | | Ligaments for all joints: | | | capsule; palmar plate; collateral | | | | | | Capsule holds synovial fluid | +-----------------------------------+-----------------------------------+ | ### 1^st^ carpometacarpal joint | - Between trapezius and base of | | | 1^st^ metacarpal | | | | | | - Synovial saddle joint | | | | | | - Flexion and Extension | | | | | | - Abduction and adduction | | | | | | - Opposition | | | | | | - Thumb changes its orientation | | | | | | Pollicis is rotated 90 degrees to | | | all other digits | +-----------------------------------+-----------------------------------+ |  | Flexion of the thumb is moving | | | towards midline | | | | | | Opposition is when the metacarpal | | | rotates across and sits on top of | | | 2^nd^ metacarpal | | | | | | Opposition occurs at the thumb | | | and some occurs at the little | | | finger as it is condyloid in | | | shape. | +-----------------------------------+-----------------------------------+ | SCAPHOID FRACTURE | - Position of wrist is not | | | identical across all the | | | bones | | | | | | - When we flex/extend, no event | | | movement between scaphoid and | | | radius and lunate and radius | | | | | | - Fall onto extended wrist can | | | fracture scaphoid bone | | | | | | - Arterial supply to scaphoid | | | is via recurrent branch of | | | radial artery | | | | | | - Recurrent branch goes back | | | into the bone. Comes from the | | | distal end of scaphoid and | | | gets to the proximal end. | | | | | | - Fractures that disrupt blood | | | flow to proximal portion can | | | lead to necrosis | | | | | | - Tenderness in floor of | | | anatomical snuff box | | | | | | - Necrosis means it starts to | | | die. Tenderness in the | | | proximal end. | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ Wrist Muscles  +-----------------------------------+-----------------------------------+ | ### The forearm | Retinaculum: Connective tissue | | | band that holds multiple tendons | |  | in place | +===================================+===================================+ | ### Muscles of the forearm |  | +-----------------------------------+-----------------------------------+ | ### Muscles of the forearm -- Ant |  | | erior | | | | | | Even when they originate on the | | | medial epicondyle, they don't | | | have much action on the elbow | | | because they are attached on the | | | ulna so no contractile tissue | | | between ulna attachment and | | | humerus attachment. | | | | | | Palmaris Longus is the most | | | superficial of these 3. Some | | | people don't have palmaris | | | longus. Fused on the top of | | | retinaculum. | | | | | | FCU: Inserts via | | | pisiform(sesamoid bone) | | +-----------------------------------+-----------------------------------+ | Intermediate layers contain |  | | flexors of digits. Deep layers | | | contain deep flexor of digit and | - FLEXOR DIGITORUM | | thumb. Deep ones go further to | SUPERFICIALIS | | distal phalanx. | | | | - Crosses and bound on the | | | ulna, along beside the | | | coronoid process along | | | superior surface of the ulna | | | (ulna head) | | | | | | - Radial head originate along | | | anterior border of radius | | | | | | - Deep under retinaculum, | | | through carpal tunnel and end | | | up going to middle digits and | | | splits and there is a gap for | | | FDP | | | | | | - FLEXOR DIGITORUM PROFUNDUS | | | | | | - Originates from the forearm, | | | deep layers don't extend the | | | elbow | | | | | | - Goes towards the distal | | | phalanges | | | | | | - When force is applied through | | | deep tendon, y-shaped tendon | | | of superficialis anchors deep | | | tendon against the bone to | | | prevent tainting of skin | | | | | | - FLEXOR POLLICUS LONGUS | | | | | | - Flexes the thumb | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ | ### Muscles of the forearm -- Pos | | | terior | | +-----------------------------------+-----------------------------------+ | #### Radialis Group | Brachioradialis: Forearm muscle | | | that doesn't act on the wrist. | | Two extensors of the wrist on the | | | posterior side | Muscle fibres of Brachioradialis | | | start on the posterior | |  | compartment but wrap around on | | | the anterior compartment and goes | | | to styloid process. Action is | | | kind of like an anterior muscle | | | action. | +-----------------------------------+-----------------------------------+ |  | Action differs to other posterior | | | muscles and FLEXES the elbow. | | Not acting on the wrist | | | | Since it goes on from posterior | | | to anterior, it moves hand to mid | | | pronation and mid supination. | | | Creates shortest distance between | | | radius and supercondylar ridge. | | | | | | It will pronate a supinated | | | forearm and supinate a pronated | | | forearm until it reaches a | | | midpoint. | | | | | | Powerful flexor when in mid | | | pronation/supination. | +-----------------------------------+-----------------------------------+ | All flexors come from medial |  | | epicondyle of humerus. All of | | | extensors come from lateral | Acts on the wrist | | epicondyle of humerus. | | | | Extensors of the wrist | | - Extensor Digitorum: splits | | | into 4 tendons. Extensor | - Extensor carpi radialis | | digiti mimi often | longus wraps on the lateral | | incorporated with it. Gets | side | | separated as it goes through | | | its own portion of extensor | - Extensor carpi radialis | | retinaculum. These go through | brevis comes from lateral | | 3 tendons, extensor digitorum | part of supracondylar ridge | | goes to 4^th^ digit gives off | of humerus and runs along | | a branch that goes to the | side of the radius | | fifth digit, hence why | | | extensor digiti minimi | - There is a gap in between | | considered a separate muscle. | called posterior surface of | | | the radius and there is a | | Extensor carpi ulnaris runs down | tubercle, dorsal tubercle. | | the ulna and crossing the wrist | Extensor policus longus wraps | | joint but not the metacarpals. | around it. | | Goes under the retinaculum to | | | base of 5^th^ metacarpal | Extensor Expansion: Fingers from | | | 2-5 | +-----------------------------------+-----------------------------------+ |  | Abductor pollicus longus: | | | | | | Starts from ulna and then halfway | | | deviates across the interosseous | | | membrane along the radius. | | | | | | Wraps around the wrist near | | | distal end of radius. Runs out on | | | the palmar surface of the thumb. | | | Pul on the anterior surface of | | | base of 1^st^ metacarpal. | | | | | | Extensor Pollicis longus | | | | | | Wraps around dorsal tubercle and | | | across the thumb to distal | | | phalanx | | | | | | Extensor pollicis brevis | | | | | | Does not wrap on the anterior | | | surface, just runs on lateral | | | border of the wrist | | | | | | Extensor Indicis | | | | | | Runs under the extensor | | | retinaculum and runs on posterior | | | side of fingers. Doesn't insert | | | into a particular phalanx. So, | | | there are extensor expansions | | | which are tendons that extend | | | across in various CT that joins | | | on the bones. | +-----------------------------------+-----------------------------------+ | |  | +-----------------------------------+-----------------------------------+ | ### Anatomical Snuff Box | Formed by deep tendons going to | | | the thumb | | | | | | Extensor pollicis longus forms | | | the top. Underneath are 2 | | | tendons: Extensor pollicis brevis | | | and abductor pollicis runs with | | | the tendon and goes on the | | | anterior side of metacarpals | | | | | | Radial artery runs through it | | | | | | Scaphoid bone: If there is a | | | fracture, this is where you'll | | | palpate to feel a fracture, feel | | | the proximal part. | | | | | | Can take pulse through anatomical | | | snuff box | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ | | Abduction: moving towards thumb | | | side, deviating towards radius | | | | | | Adduction: deviating towards ulna | | | | | | Simultaneous flexors and | | | extensors on the radial side. | | | Flexion of extension would cancel | | | out but since they pull on radius | | | side, the carpal bones will move | | | towards the radius side. | +-----------------------------------+-----------------------------------+ |  | End of forearm. Radius on the | | | right | | | | | | Each muscles on the corners can | | | be used with one another to | | | produce movements | | | | | | Muscles called digiti minimi sit | | | on ulnar side of the hand. As | | | they pull on little finger, it | | | exerts force of ulnar deviation. | | | If affecting the thumb or index, | | | it will contribute to radial | | | deviation. | +-----------------------------------+-----------------------------------+ | ### Nerve Supply to forearm |  | | | | | | Posterior divisions give rise to | | | axillary and radial nerve | | | | | | Anterior compartment arises from | | | anterior division (later and | | | medial cords). | | | | | | Musculocutaenous does anterior | | | arm but does not innervate muscle | | | within the elbow. Only median and | | | ulna nerve continue down rest of | | | the arm. | +-----------------------------------+-----------------------------------+ | Neurovascular structures | Ulnar nerve runs along the | | ------------------------ | brachial artery. Brachail artery | | | runs down in middle of forearm. | | | Ulnar nerve follows brachial | | | artery | | | | | | Ulna nerve runs behind medial | | | epicondyle and forms the funny | | | bone. Gap medial epicondyle of | | | humerus and olecranon of ulna. | | | | | | Radial nerve runs between heads | | | of triceps and runs in radial | | | grove which curls around lateral | | | humerus and runs anterior side of | | | lateral epicondyle. | | | | | | While its supplying the | | | brachioradialis, it also runs | | | underneath it. Runs on anterior | | | side and then wraps on posterior | | | side. | | | | | | Radial nerve from posterior, | | | passes elbow on anterior and back | | | to posterior. | | | | | | Medial nerve runs on medial side | | | but behind elbow on posterior | | | side before returning to | | | anterior. | +-----------------------------------+-----------------------------------+ |  | Musculocutaneous: pierces the | | | corocobrachialis and runs between | | | biceps brachii and brachialis and | | | doesn't extend the elbow | | | | | | Median nerve follows axillary | | | artery. | | | | | | Median runs with the brachial | | | artery, all the way across the | | | elbow. | | | | | | Median nerve runs along the | | | medial portion of humerus and | | | crosses the elbow on the anterior | | | side and runs straight down | | | middle of anterior forearm. | +-----------------------------------+-----------------------------------+ | | Median nerve also crosses the | | | middle of the wrist which means | | | it passes through to the hand by | | | the carpal tunnel. | | | | | | Ulnar nerve | | | | | | Comes behind medial epicondyle, | | | next to olecranon. | | | | | | So anterior compartment gets | | | nearly all innervation from | | | median nerve | | | | | | Radial nerve | | | | | | Runs on anterior side of forearm | | | but as it wraps on the lateral | | | side, it runs underneath | | | brachioradialis and above | | | extensor carpi radialis longus | | | and brevis and so is protected | | | between the muscles. | +-----------------------------------+-----------------------------------+ |  | Blood supply to the forearm comes | | | from the brachial artery. | | | | | | Artery crosses the elbow through | | | cubital fossa that sits between | | | the epicondyles Median nerve also | | | runs through it | | | | | | Then after coming from the | | | cubital fossa, brachial artery | | | splits into ulna artery and | | | radial artery. | | | | | | Ulna gives rise to the common | | | interosseous artery. | | | | | | Posterior goes through | | | interosseous membrane and | | | anterior runs anterior side of | | | interosseous membrane. | | | | | | When they get to the hand, they | | | cross into the hand but different | | | pattern. Radial artery runs | | | anterior side of forearm and runs | | | behind the thumb. | | | | | | Ulna artery continues on the | | | palmar side. | +-----------------------------------+-----------------------------------+ | ### Cubital Fossa | Cubit -- "Elbow" | | | | |  | Clinical site | | | | | | - Venapuncture | | | | | | - BP readings | | | | | | - Nerve passage | | | | | | Formed between medial and lateral | | | epicondyle. | | | | | | Medial side has pronator teres, | | | lateral side has brachioradialis | | | starts high and runs anterior | | | side, creating a triangle. | | | | | | Superficial veins empty blood | | | from hand and skin. Deep veins | | | empty blood from muscles. | +-----------------------------------+-----------------------------------+ | ### Blood vessels of the hand -- | Darker ones are deep veins. Light | | Veins | are superficial. | | | | |  | | +-----------------------------------+-----------------------------------+ | ### Clinical Applications | | | | | |  | | +-----------------------------------+-----------------------------------+ | ### Surface Anatomy | | | | | |  | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ Hand Muscles +-----------------------------------+-----------------------------------+ |  | | +===================================+===================================+ | | | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ | | No extrinsic muscles on | | | dorsal/posterior side of hand | +-----------------------------------+-----------------------------------+ | ### Compartments of the Hand | | | | | | Thenar | | | | | | - Muscles affecting the thumb | | | | | | Hypothenar | | | | | | - Muscles of little finger | | | | | | Central | | | | | | - Tendons of the extrinsic | | | flexors | | | | | | - Vessels and nerves | | | | | | - Intrinsic muscles of digits | | | 2-4 | | +-----------------------------------+-----------------------------------+ |  | Pink area is the long tendon | | | | | | Long tendons run through carpal | | | tendon | | | | | | Flexors run through the carpal | | | tunnels and run with medial nerve | | | | | | Flexor carpi radialis is sitting | | | at the border | | | | | | Enclosed by Transverse Carpal | | | Ligament which is a strong and | | | thick ligament which makes a roof | | | of the carpal tunnel | +-----------------------------------+-----------------------------------+ | ### Muscles of the Hand | Crosses wrist joint and finger | | | joint and have influence over | |  | both | | | | | | Central muscles include | | | lumbircals | +-----------------------------------+-----------------------------------+ | ### Intrinsic muscles -- Superfic | Thenar group does NOT include | | ial | Abductor pollicis longus tendon | | | | |  | FPB | | | | |  | - I medial side of proximal | | | phalange., When it contracts, | | | it produces flexion across | | | the hand | | | | | | ADD | | | | | | - Pulls metacarpal closer to | | | other metacarpal | | | | | | Abductor digiti M: | | | | | | - Origin and then runs down the | | | medial side before inserting. | | | Pulls little finger outwards. | +-----------------------------------+-----------------------------------+ | | ### Deep Muscles | | | | | | Opponens Pollicis | | | | | | - Does not go to proximal | | | phalange but inserts 1^st^ | | | metacarpal | | | | | | - Fibres run towards the thumb. | | | Opponens pollicis acts at the | | | 1^st^ carpal joint and pulls | | | the outside (later border) | | | towards palmar surface of | | | thumb producing rolling | | | motion of the thumb. | | | | | | Opponens muscles affect | | | metacarpal bones | | | | | | Flexors can abductors affect the | | | proximal phalange | | | | | | Muscles fibres pull on phalanges | | | themselves to produce flexion. | | | | | | 5^th^ metacarpal will roll and on | | | the outside edge. Roll little | | | finger in. complex condyloid | | | joint. | +-----------------------------------+-----------------------------------+ | ### Central Group -- Intrinsic mu |  | | scles -- Lumbricals | | | | White lines are the long tendons | |  | of flexor digitorum profundus. | | | | | | Profundus goes to distal phalange | | | and superficial going to middle | | | phalange. Lumbricals are the 3rd | | | muscle group that goes there and | | | go to posterior side. | | | | | | Long extensor digitorum longus | | | terminates at expansion that | | | affects all joints across | | | phalanges. | | | | | | Lumbricals flex | | | metacarpophalangeal joints go to | | | posterior side. | | | | | | Since it pulls on | | | extensor-expansion, it produces | | | extension on the interphalangeal | | | joints. | +-----------------------------------+-----------------------------------+ | ### Intrinsic muscles -- Inteross | 4 Dorsal Interossei arise in | | ei | metacarpals and insert lateral | | | part of proximal phalange | | | | | | 3 palmar interossei arse from | | | metacarpals and insert on the | | | proximal phalange | | | | | | No palmar interossei next to | | | 1^st^ and 2st metacarpal as | | | that's where the adductor | | | pollicis be in. | | | | | | If acting together, they work | | | with lumbricals that leads to | | | flexion of carpometacarpal joint. | | | Goes to posterior side and leads | | | to posterior surface and produce | | | flexion of the carpometacarpal | | | joint. | +-----------------------------------+-----------------------------------+ |  | | | | | | Note: lumbricals only go into | | | extension-expansion. However, | | | Interossei go into both into | | | proximal bone and | | | extensor-expansion hence produce | | | less effect on the | | | interphalangeal joints due to | | | attachment to bones. | | +-----------------------------------+-----------------------------------+ | ### Hand movements | POWER GRIP: | | | | |  | - Wrist is extended and finger | | | are flexed. Extension means | | | increase in length over which | | | the flexors, leading to | | | increased tension on the | | | tendons. Intrinsic muscles of | | | thumb and little thumb ad | | | lumbricals are in effect. | | | Long tendons are sued for | | | increasing tension. | | | | | | HOOP GRIP | | | | | | - Tends to sue long tendons | | | only. Long flexors of fingers | | | are engaged and intrinsic | | | won't as they're prone to | | | wearout. So long flexors can | | | increase duration of carrying | | | items. | | | | | | PRECISION Grip | | | | | | - Involves fine movements of | | | thumb. Use long tendons of | | | wrist but intrinsic muscles | | | of thumb to oppose the | | | flexion of fingers. Uses more | | | intrinsic muscles. | | | | | | Medial view of holding the coin | | | | | | - Involves abduction of thumb, | | | pulling thumb out of palmar | | | surface. Abductor pollicis | | | brevis. | | | | | | POSITION OF REST | | | | | | - Clinically important | | | | | | - Slight extension of the wrist | | | and slight flexion of fingers | | | and thumb. Minimal tension of | | | muscles. | | | | | | G/H. POWER GRIP | | | | | | \- when we flex | | | metacarpophalangeal joint, we | | | change the alignment. It drops as | | | the intrinsic muscles of 5^th^ | | | digit are being engaged, pulls | | | the 5^th^ metacarpal towards the | | | palmar surface. That drags 4^th^ | | | metacarpal that is slight | | | condyloid in shape. | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | ### Anatomical Snuff Box | | | | | |  | | +-----------------------------------+-----------------------------------+ | ### Surface Anatomy |  | | | | |  | | +-----------------------------------+-----------------------------------+ | ### Nerves of the hand | | | | | | All thenar muscles are supplied | | | by Median Nerve, except Adductor | | | Pollicis (Ulnar). Median nerve | | | also supplies lumbricals1 & 2 | | | | | | Median nerve runs through carpal | | | tunnel and gives little branches | | | to thenar group. Median nerve | | | supplies superficial nerve | | | | | | All Hypothenar muscles + Adductor | | | pollicis + lumbricals 3&4 + | | | interossei (all) supplied by | | | Ulnar nerve. Ulnar nerve runs | | | outside the carpal tunnel but | | | give branches that goes to the | | | hypothenar group. Creates a deep | | | branch that innervates the deep | | | muscles. | | | | | | So it matches, profundus and | | | lumbricals. (recheck). The | | | profundus muscle it does in the | | | forearm, matches to lumbricals | | | within intrinsic muscles in hand. | | | | | | Ulnar nerve does deep. | | +-----------------------------------+-----------------------------------+ | ### Vascular structures |  | | | | | Ulna artery and radial artery |  | | come from brachial artery | | | | | | Ulna artery is the main | | | contributor to interosseous | | | artery. Slight redundancy in the | | | radial artery that supplies less | | | blood. | | | | | | Most muscles in the forearm are | | | done by ulnar artery | | | | | | Radial artery continues as the | | | deep palmar arch. Superficial | | | palmar arch comes from ulnar | | | artery. | | | | | | Superficialis palmar arch runs | | | between tendons of flexor | | | digitorum superficialis and | | | flexor digitorum profundus. Quite | | | effective in producing heat. | | | | | | These loops empty in the other | | | arteries, creating a redundancy. | | | | | | Both muscles give rise to digital | | | arteries that run down the hand. | | | | | | Radial artery gives rise to | | | dorsal carpal arch. | | | | | | All arches provide input to | | | digital arteries. Digital | | | arteries run either side of | | | finger and are called end | | | arteries. | | | | | | Specialized ability to almost | | | constrict. | | | | | | Responsible for hands going pale | | | when cold due to lack of blood | | | flow. | | | | | | Veins: | | | | | | Superficial veins empty from the | | | hand | | | | | | Palmar plexus of veins: deep and | | | superficial | | | | | | Deep will empty muscles from deep | | | muscles via ulnar and radial | | | veins. | | | | | | Skin on the palm o hand will | | | empty in superficial palmar | | | plexus and run up the forearm | | | veins. | | | | | | Cephalic vein drains blood from | | | the posterior side of the hand. | | | Dorsal venous vein goes to the | | | forearm and then translates onto | | | outer surface from posterior | | | surface. | | | | | | Median antebrachial vein runs up | | | to the medial cubital vein. | | | | | | Basilic vein drains to the | | | brachial vein | | | | | | Cephalic vein joins to the | | | axillary vein | | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ | ### Clinical Applications | | | | | | Median nerve compression | | | | | | - Carpal tunnel syndrome | | | | | | - Thenar eminence | | | | | | If there is an inflammation of | | | the synovial sheath, it will | | | increase the pressure. | | | | | | The muscles are not being used | | | then. | | | | | | Lose the ability to oppose the | | | thumb. | | | | | | Opponens muscle is the key muscle | | | being affected | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+