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HAND ANATOMY
Dorsum Of Hand
• Skin• Cutaneous innervation
Terminal branches of Radial Nerve Dorsal branch ulnar nerve
• Dorsal Venous network, arch proximal to MCHDrain 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
• 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
• 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
• 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