Lesson-14-15 (Hand Anatomy).pdf

HAND Hand in anatomical position Dorsum of the hand Palm of the hand Dorsum of the hand Palm of the hand Fascia of the palm Synovial sheaths Flexor aspect 1. Flexor digitorum superficialis Flexor digitorum profundus 2. Flexor policis longus 3. Flexor carpi radialis Synovial sheaths Extensor aspect 1...

HAND Hand in anatomical position Dorsum of the hand Palm of the hand Dorsum of the hand Palm of the hand Fascia of the palm Synovial sheaths Flexor aspect 1. Flexor digitorum superficialis Flexor digitorum profundus 2. Flexor policis longus 3. Flexor carpi radialis Synovial sheaths Extensor aspect 1. Extensor pollicis brevis Abductor pollicis longus 2. Extensor pollicis longus 3. Extensor carpi radialis longus Extensor carpi radialis brevis 4. Extensor digitorum communis Extansor indicis proprius 5. Extensor digiti minimi 6. Extensor carpi ulnaris Compartments of the hand thenar compartment hypothenar compartment central compartment adductor compartment Central compartment Tendon of the flexor muscles of the forearm Lumbrical muscles Superficial palmar arterial arch branches of ulnar & median nerves Muscles of the Hand Thenar muscles: 1. Abductor pollicis brevis 2. Flexor pollicis brevis 3. Opponens pollicis Abductor pollicis brevis muscle O: flexor retinaculum, scaphoid, trapezium. I: proximal phalanx of the thumb N: median nerve Abductor pollicis brevis muscle Flexor pollicis brevis muscle Superficial head: O: FR & trapezium Deep head: (1. palmar interosseous muscle) O: trapezium & capitatum I: proximal phalanx Median nerve & ulnar nerve Function of the FPB muscle Opponens pollicis muscle O: FR & trapezium I: 1. Metacarpal bone Median nerve Function of the OP muscle Function of opponens pollicis m Intrinsic muscles of the hand Adductor compartment: Adductor pollicis muscle Adductor pollicis muscle Oblique head O: capitatum & base of the 2. and 3. metacarpal bones Adductor pollicis muscle Transverse head O: body of the 3. metacarpal bone I: ulnar side of the proximal phalanx N: ulnar nerve Intrinsic muscles of the hand Hypothenar muscles: 1. Abductor digiti minimi 2. Opponens digiti minimi 3. Flexor digiti minimi brevis Abductor digiti minimi muscles O: pisiform I: medial side of the proximal phalanx of the 5. digit. N: ulnar nerve Flexor digiti minimi brevis O: hamate & FR I: proximal phalanx of 5. digit. N: ulnar nerve Opponens digiti minimi muscle O: hamate & FR I: ulnar side of the 5. metacarpal bone. N: ulnar nerve F: deeping the hollow of the palm Palmaris brevis muscle O: FR & palmar aponeurosis I: skin of the medial side of the palm Ulnar nerve Protects ulnar nerve and artery Intrinsic muscles of the hand Central compartment: Lumbrical muscles Lumbrical muscles O: tendon of the flexor digitorum profundus muscle I: extansor expansions of the digits 2 to 5. Flex MCP joints &extend IP joints N: 1&2 median 3&4 ulnar Intrinsic muscles of the hand Interosseous muscle palmar interosseous (3) dorsal interosseous (4) Palmar interosseous muscles ❖O: palmar surface of the 2. 4. and 5. metacarpal bones ❖I: proximal phalanges of second, fourth and fifth digits and their extansor expansions. Dorsal interosseous muscle ▪ O: adjacent sides of two metacarpal bones ▪ I: proximal phalanges of second, third and fourth digits and their extansor expansions. Flexor retinaculum Transverse carpal ligament – laterally: scaphoid & trapezium – medially: pisiform & hamate Flexor retinaculum – Carpal Tunnel The structures passing superficial to the Flexor retinaculum palmar cutaneous branch of median nerve tendon of palmaris longus ulnar a. ulnar n. tendon of flexor carpi ulnaris (partly) The structures passing deep to the Flexor retinaculum (Carpal Tunnel) FDS, FDP, F pollicis longus, Flexor carpi radialis median n. The structures passing deep to the Flexor retinaculum (Carpal Tunnel) Carpal Tunnel syndrome Cause of the syndrome:inflam mation of the FR, anterior dislocation of the lunate bone The structures passing superficial to the Extensor retinaculum ❑laterally: radius, medially: triquatrum & pisiform o superficial branch of radial n o cephalic v o basilic v o dorsal branch of ulnar n Guyon’s Canal pisiform & hook of hamate pisohamate ligament Sensory innervation of the palmar surface of the hand Palmar cutaneous branch of median nerve Common palmar digital branch of median nerve Proper palmar digital branch of median nerve Palmar cutaneous branch Common palmar & proper palmar Digital branches of ulnar nerve Superficial branch of radial nerve Sensory innervation of the palmar surface of the hand Median nerve injury Superficial Palmar Arch ulnar artery radial artery superficial branch of radial artery common palmar digital arteries Deep Palmar Arch radial artery deep branch of ulnar artery Palmar metacarpal arteries Proper palmar digital arteries Radialis indicis artery Principal pollicis artery Blood supply of the dorsum of the hand radial artery dorsal carpal artery Dorsal metacarpal arteries Veins Wrist joint (radiocarpal Joint) ❑condyloid type of synovial j ❑distal end of radiusscaphoid &lunate bones ❑distal end of ulnatriquatrum by the aid of articular disc Wrist Joint ❑Fibrous capsule of the joint ❑synovial membrane ❑palmar radiocarpal lig→ supination of forearm ❑dorsal radiocarpal lig→ pronation of forearm ❑ulnar & radial collateral ligs Joints of the Hand Intercarpal Joints (plane)→ gliding Carpometacarpal joint of thumb (trapezium & 1th metacarpal) (saddle) Carpometacarpal joint of II, III, IV, V digits (plane) →gliding Intermetacarpal J (plane) Metacarpophalangeal Joints (condyloid) (F-E; Add-Abd; circumdiction) Interphalangeal Joint (hinge)→ flexion-extension