Transcript Document 571582

HAND ANATOMY
Dorsum Of Hand
• Skin
• Cutaneous innervation
Terminal branches of Radial Nerve
Dorsal branch ulnar nerve
• Dorsal Venous network, arch proximal to MCH
Drain from volar aspect as well
Pressure of gripping does not impede the venous
return
Radial Side Cephalic Vein
Ulnar Side Basilic Vein
Cutaneous Innervation
Palm of the Hand
• Skin – Flexion creases and papillary ridges
• Possibly improve the grip and increase the surface
area
• Sweat glands abound, No sebaceous glands
• Ulnar Nv. Little ,½ Ring and Hypothenar eminence
• Median Nv. Thumb, Index Middle, ½ Ring and Thenar
eminence
Cutaneous Innervation
Palm Fascia
• Palmar Aponeurosis
• Flexor Retinaculum, transverse carpal ligament
Radial - Scaphoid tubercle, ridge of Trapezium
Ulnar – Pisiform, hook of Hamate
• Superficial relations, ulnar to radial
Ulnar Nv., Ulnar Art., Covered by fascia giving origin
to the hypothenar ms. – Guyon’s canal
Palmar br. Ulnar nv , PL tendon, Palmar br. Median
nv, Superficial palmar br. Radial art.
Palmar Spaces
Thenar and Mid Palmar Spaces –
Located dorsal to FT and volar to
MC and Int. ms. Fascia
Midpalmar oblique Septum
Thenar Space between the thenar
eminence and third metacarpal.
Extends dorsally IbI the Int. ms.
And Add. Pollicis .Mostly contains
the first lumbrical
Midpalmar Space IbI thenar and
hypothenar space overlying the
3,4,5 MC
Hypothenar Space
Dorsal Sub aponeurotic Space
Interdigital Web Space
Radial,Ulnar bursa,Parona’s
Carpal Tunnel
Guyon’s Canal
Blood Supply
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Radial Artery
Ulnar Artery
Superficial Palmar Arch
Deep palmar Arch
Anterior carpal arch
Posterior carpal arch
Radial Artery
• Wrist - emerges medial to the brachioradialis
• Superficial palmar branch – Superficial palmar arch
• Dorsally IbI the radial carpal ligament and the APL EPB to
emerge in the snuff box
• Branches - Radial digital collateral artery
Dorsal radial carpal branch, FDMA
• Reenters palm IbI the two heads of 1st DI
• A. radialis indices and A. princeps pollicis
• Emerges IbI the transverse and oblique heads of adductor
pollicis – Deep palmar arch
• Post. Carpal Arch – DRCB, Ulnar A., Int. A. – 2, 3, 4 DMAs
Ulnar Artery and Nerve
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Deep and radial to Ulnar nv and FCU
Superficial br.- Superficial palmar arch
Deep br.- Deep palmar arch
Ulnar nv ulnar and more superficial
Superficial br. Ulnar side of little and common digital
nv to the little and ring
• Deep br. Supplies the hypothenar muscles Curves
around the hook of hamate and pierces the
opponens digiti minimi along with the deep br. Ulnar
A. to supply the 3,4th lumbricals and all interossei to
end in the Adductor pollicis
Median Nerve
• Enters the palm through the carpal tunnel
• Three branches
• Medial – Common digital to the ring and middle and
common digital to the middle and index – gives a br
to the second lumbrical
• Lateral – Radial digital to the index and the whole of
thumb – gives a br to the first lumbrical
• Recurrent br./ muscular br. – thenar muscles
Thenar Eminence
• Abductor Pollicis Brevis – arises FR and scaphoid
tubercle inserts radial side base of proximal phalanx
• Flexor Pollicis Brevis – arises FR and trapezium inserts
radial sesmoid and radial border proximal phalanx –
deep head ulnar nv
• Opponens Pollicis – arises FR and trapezium inserts
radial border metacarpal
• Adductor Pollicis – arises 3rd MC transverse head,
capitate oblique head inserts ulnar sesmoid and
ulnar side base of proximal phalanx – Ulnar nv
Hypothenar Eminence
• Abductor Digiti Minimi – arises FR and
pisiform inserts ulnar side proximal phalanx
and ext. expansion
• Flexor Digiti Minimi Brevis – arises FR inserts
base of proximal phalanx
• Opponens Digiti Minimi – arises FR and hook
of hamate inserts ulnar border 5th metacarpal
Flexor Tendons
Flexor Digitorum Profundus
Flexor Digitorum Superficialis
Chiasma
Flexor Tendons
Flexor Tendons - Zones
Extensor Retinaculum
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Ribbon like band <2.5 cm wide
Oblique across dorsal surface wrist joint
Medial attach.Radius anterolateral border
Lateral attach. Pisiform and Triquetral passes
below the styloid process ulna
• If attached to both the forearm bones the ER
would be 30 % longer in pronation
• Being oblique it is able to maintain a constant
tension throughout the motion
• Divide into six
compartments by
fibrous septa to the
bone
• Separate synovial
sheaths for all the
tendons except the
EDC and EI
• Extensor Tendons Zones
EXTENSOR
TENDONS
Dorsal Interossei - Abductors
Palmar Interossei - Adductors
MCPJ
Volar Plate
PIPJ
Volar Plate PIPJ
DIPJ
Volar Plate
Nail Anatomy
Perionychium – Nail Bed, Nail Fold, Eponychium, Paronychium,
Hyponychium
Nail Bed – Germinal matrix, sterile matrix
Nail Fold – Dorsal roof, Ventral floor – germinal matrix – Lunula
Germinal matrix produces 90% of the nail, sterile matrix adds inner layer
which keeps the nail adherent, dorsal roof gives the shine