Download MBBS Anatomy PPT 8 Hand Split Notes

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Learning objectives

q Surface anatomy of Hand

q Bony landmarks

q Compartments and Spaces of hand

q Flexor Retinaculum & Structures passing below

& above FR

q Intrinsic muscles of hand

q Superficial & Deep Palmar Arches

q Dorsum of hand & Dorsal venous Arch

q Nerves in hand

q Applied anatomy

Surface Anatomy

Surface Anatomy

Wrist Bones




Wrist Bones

She
Looks
Too
Pretty
Try
To
Catch
Her

Hand Bones

Anatomical Snuff Box

Compartments & Spaces


The Skin
PALM: characteristics:
Flexure creases (lines of palm)
Papillary ridges (fingerprints): improve grip & increase

surface area

Fibrous bands connecting it to palmar aponeurosis & dividing

subcutaneous fat into small loculi (water-cushion

withstanding considerable pressure)

Abundant sweat gland

Superficial Fascia
PALM: characteristics:
Contains: cutaneous nerves & vessels
Contains: Palmaris brevis (increases the hollow of palm to

get a firmer grip

Deep Fascia

Palmar Aponeurosis
It is a thickening of deep fascia in the middle of the palm
DESCRIPTION: It is triangular in shape:
Apex: directed proximally, continuous with tendon of palmaris

longus

Base: directed distally, divided into 4 slips for the medial 4 fingers
Margins: send septa to metacarpal bones separating the structures

under the aponeurosis from thenar & hypothenar muscles

FUNCTION: It protects the underlying tendons, vessels & nerves
CLINICAL ANATOMY: DUPUYTREN'S CONTRACTURE:

shortening of the medial part of aponeurosis resulting in flexion of

the little & ring fingers


Deep Fascia
Flexor retinaculum:
Definition
Attachments
Relations
Functions
Clinical anatomy:

Carpal tunnel

syndrome

Flexor Retinaculum
It is a thickening of deep fascia that lies over the front of the

carpal bones converting the carpal groove (formed by carpal

bones) into a tunnel

ATTACHMENTS:
Lateral: by 2 laminae: superficial (to tubercles of scaphoid &

trapezium) & deep (to the medial lip of the groove on the

trapezium)

Medial: to pisiform & hook of hamate

Flexor Retinaculum
RELATIONS:
Superficial: from lateral to medial:
Superficial palmar branch of radial artery
Palmar cutaneous branch of median nerve
Tendon of palmaris longus
Palmar cutaneous branch of ulnar nerve
Ulnar vessels
Ulnar nerve
Deep: Structures passing through carpal tunnel
Tendon of FPL & its synovial sheath (radial bursa)
Tendons of FDS & FDP & their common synovial sheath (Ulnar bursa)
Tendon of FCR & its synovial sheath ( in a special compartment)
Median nerve

Flexor Retinaculum
FUNCTION: It keeps the flexor tendons in position during

movement of wrist joint

CLINICAL ANATOMY (CARPAL TUNNEL SYNDROME):

Compression of median nerve under the flexor retinaculum


Deep Fascia
Fibrous flexor

sheaths

Definition
Attachments
Function

Fibrous Flexor Sheath
DEFINITION: It is a thickening of deep fascia in front of the

fingers

ATTACHMENTS:
Proximal: to the slips of palmar aponeurosis
Distal: to the base of distal phalanx
On either side: to the side of phalanx
FUNCTION: It holds the long flexor tendons during flexion of

the fingers

Intrinsic Muscles Of Hand

Situated totally within the hand
Divided into 4 groups:-
?Thenar
?Hypothenar
?Lumbricals
?Interossei muscles

Intrinsic Muscles

LATERAL GROUP:

FOUR THENAR MUSCLES

MEDIAL GROUP:

THREE HYPOTHENAR MUSCLES

PALMARIS BREVIS
CENTRAL GROUP:

FOUR LUMBRICALS
FOUR PALMAR INTEROSSEI
FOUR DORSAL INTEROSSEI

ALL MUSCLES ARE SUPPLIED BY C8 & T1 SPINAL

SEGMENTS THROUGH MEDIAN & ULNAR NERVES
Intrinsic Muscles
Thenar Muscles:
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis
Adductor Pollicis

Hypothenar Muscles:
Abductor Digiti Minimi
Flexor Digiti Minimi
Opponens Digiti Minimi

The Thenar Group

?Abductor Pollicis

Brevis

?Flexor Pollicis Brevis

?Opponens Pollicis

?Adductor Pollicis

Muscles

ABDUCTOR POLLICIS BREVIS

Origin Scaphoid & Trapezium &

Flexor Retinaculum

Insertion Lateral side of base of

proximal phalanx of thumb

Action Abducts thumb

Innervation median nerve (C8 and

T1

Flexor Pol icis Brevis

Origin S-Tubercle of Trapezium

D-Capitate & Trapezoid bones
Insertion Lateral side of base

of proximal phalanx of thumb
Action Flexes thumb
InnervationRecurrent branch of

median nerve (C8 and T1)
Opponens Pol icis

Origin Flexor retinaculum and

Tubercles of Trapezium
Insertion Lateral side of 1st

metacarpal
Action Draws 1st metacarpal

laterally to oppose thumb toward

center of palm
Innervation Recurrent branch of

median nerve (C8 and T1)

Adductor Pol icis

It has 2 heads that are separated by a

gap through which the radial artery

passes
Origin: Oblique head ? capitate &

bases of 2nd and 3rd metacarpals,
Transverse head ? anterior surface of

body of 3rd metacarpal bone
Insertion: medial side of base of

proximal phalanx of thumb
Innervation: ulnar nerve
Action: adducts thumb towards middle

digit

The Hypothenar Group

Hypothenar muscles

1. Opponens Digiti
Minimi
2.Abductor Digiti Minimi
3.Flexor Digiti Minimi

Brevis
4.Palmaris Brevis

Opponens Digiti Minimi

Origin Hook of hamate

and flexor retinaculum
Insertion Medial border

of 5th metacarpal
Action Brings little finger

(5th digit) into opposition

with thumb
InnervationDeep branch

of ulnar nerve (C8 and T1)
Abductor Digiti Minimi

The most superficial of the

hypothenar muscles forming

the hypothenar eminence
Origin : Pisiform bone
Insertion: Medial side of

base of proximal phalanx of

5th digit
Action:

Abducts 5th digit

Flexor Digiti Minimi Brevis

Origin Hook of hamate

and flexor retinaculum
Insertion Medial side of

base of proximal phalanx

of little finger
Action

Flexes proximal

phalanx of little (5th) finger
Innervation

ulnar

nerve

Palmar Brevis

It lies in the fascia deep to the

skin of the hypo thenar em

inence
A relatively unimportant mu scle

except that it covers and

protects the ulnar nerve and

artery
Origi n: Flexor retinaculum and

palmar aponeurosis
Inserti on: Skin on the medial side

of the palm
Acti on: Wrinkles the skin on the

medial side of the palm and

deepens the hollow of the palm, as

in cupping of the hand, thereby

aiding the grip

INTEROSSEI MUSCLES

Interosseous Muscles

They are located between the

metacarpal bones

Arranged in 2 layers: 4 Palmar

and 4 Dorsal

Located between bones 1. Dorsal

interossei 1 to 4

Origin: Adjacent sides of 2 metacarpal

bones

Insertion : Extensor expansion's and

bases of proximal phalanges of digit 2

to 4

Action: Abducts digits and assist

lumbricals

2. Palmar interossei 1 to 4

Origin : Palmar surfaces of 2nd, 3th , 4th

and 5th metacarpal bones

Insertion: Extensor expansion of digits

and bases of proximal phalanges of

digits 2, 4, and 5

Action: Adducts digits and assist

lumbricals


Lumbrical Muscles

They are named as such because

of their elongated worml i ke

form

1.Lumbri cal s 1 and 2
Ori gi n : lateral 2 tendons of flexor

digitorum profundus

2.Lumbri cal s 3 and 4
Ori gi n: medial 3 tendons of flexor

digitorum profundus

Insertion: lateral sides of extensor

expansions of digits 2 to 5
Acti on: To flex digits at MCP joints

and extend IP joints

ARTERIAL ARCHES IN HAND
SUPERFICIAL PALMAR

ARCH

DEEP PALMAR ARCH
Formation
Site
Surface anatomy
Branches

Superficial Palmar Arch
FORMATION:
Direct continuation of ulnar artery (mainly)
Superficial branch of radial artery
SITE: between palmar aponeurosis & long flexor tendons
SURFACE ANATOMY: level with the distal border of the fully

extended thumb

BRANCHES: digital branches to the medial three & half fingers
N.B.: Radial artery gives 2 branches that supplies the lateral one &

half fingers:

Radialis indicis: supplies lateral side of index
Princeps pollicis: supplies both sides of thumb

Deep Palmar Arch
FORMATION:
Direct continuation of radial artery (mainly)
Deep branch of ulnar artery
SITE: between long flexor tendons & metacarpal bones
SURFACE ANATOMY: lies one inch proximal to superficial

palmar arch

BRANCHES:
Branches sharing in anastomosis around wrist joint
Articular & muscular branches


NERVES IN HAND

Cutaneous innervation

Nerves In Hand

Muscular innervation
ULNAR NERVE:
? Superficial Branch:
Palmaris brevis

? Deep Branch:
Adductor pollicis
Hypothenar muscles
Interossei
Medial two lumbricals

Ulnar nerve

Is responsible for the innervations

of the following.

1. Flexor carpi ulnaris
2. Flexor digitorum profundus

Nerves In Hand

Muscular innervations
MEDIAN NERVE:
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Lateral two lumbricals


Median nerve

Is responsible for the innervations of

the following soldiers.

- 1. Flexor carpi radialis
- 2 .Flexor digitorum superficialis
- 3. Flexor digitorum profundus
- 4. Flexor pollicis longus
- 5. Palmaris longus
- Gives humans the ability to oppose

the thumb joint

Radial Nerve

- Is responsible for the innervations of

the following muscles

- 1. Extensor Carpi Radialis Longus
- 2. Extensor Carpi Radialis Brevis
- 3. Extensor Digitorum
- 4. Extensor Carpi Ulnaris
- 5. Abductor Pollicis Longus
- 6. Extensor Digiti Minimi
- 7. Extensor Pollicis Brevis
- 8. Extensor Pollicis Longus

Arteries:
1. Deep palmar arch
2. Superficial palmar arch
3. Common palmar digital

arteries

The Radial artery supplies blood to:
- 1. Flexor carpi radialis
- 2. Extensor carpi radialis longus
- 3. Extensor carpi radialis brevis
- 4. Flexor pollicis longus
The Ulnar artery supplies blood to:
- 1. Flexor carpi radialis
- 2. Flexor carpi ulnaris
- 3. Extensor carpi ulnaris
- 4. Flexor digitorum superficialis
- 5. Flexor digitorum profundus
- 6. Palmaris longus




Waste Management

- 1. Cephalic vein
- 2. Basillic vein
- 3. Superficial dorsal venous

arch (network)

- 4. Deep dorsal venous arch

(network)

Clinical Concerns

Carpal tunnel

Ganglion cyst

- The transverse carpal ligament in the wrist - Is a fluid fil ed cyst that develops

puts pressure on the medial nerve

out of a joint.

- - possible cause: overuse, hormonal

- - possible cause: joint trauma

- http://www.youtube.com/watch?v=SGyKQ - http://www.youtube.com/watch?v=

chSEJ4

mJ6oj3lkqm8

De Quervain's Tenosynovitis

-irritation of the sheath around the tendon
- affects the tendons on the thumb side of the wrist
- possibly caused by repetitive actions, over use
- http://www.youtube.com/watch?v=q87zSRYHa1o

1. Nerve damage that impairs the flexion of distal

interphalangeal joints of index and middle fingers also

produces which of the following conditions ?

a) Atrophy of Hypothenar eminence

b) Loss of adduction of thumb

c) Similar impairment of flexion of distal I.P joint of little finger

d) Weakness in pronation of forearm

2.A man is unable to hold a postcard between his index and

middle fingers because of an injury to which of the

following nerves ?

a) Superficial branch of ulnar nerve

b) Deep branch of ulnar nerve

c) Recurrent branch of median nerve

d) Posterior interosseous nerve
3. All of the following muscles form the

boundry of the anatomical snuff box,

EXCEPT :

a) Brachioradialis

b) Abductor pollicis longus

c) Extensor pollicis longus

d) Extensor pollicis brevis

4. Which is the longest metacarpal bone ?

a) Second metacarpal

b) Third metacarpal

c) Fourth metacarpal

d) Fifth metacarpal

5. After falling on his outstretched hand a patient

complains of tenderness in the space between

Extensor pollicis brevis and extensor pollicis

longus tendons. Which bone is most likely

fractured by the injury ?

a) Scaphoid

b) First metacarpal

c) Radial styloid process

d) Trapezium

6. Which is the most frequently fractured carpal

bone ?

a) Lunate

b) Scaphoid

c) Capitate

d) Trapezium

7. A middle aged woman suffering from myxedema, suddenly

woke up one night by a severe bout of pain in her right wrist

and middle finger. The pain seems to move up her forearm.

After a thorough neurological check up her physician

diagnosed her condition as Carpal Tunnel Syndrome.Which

nerve is involved in this syndrome ?

a) Median nerve

b) Palmar cutaneous branch of median nerve

c) Ulnar nerve

d) Anterior interosseous nerve

8. Examination of a patient reveals paralysis of the Abductor pollicis

brevis muscle. All of the following can be sites of lesion that

resulted in this paralysis , EXCEPT :

One answer only.

a) Lower trunk of brachial plexus

b) Lateral root of median nerve

c) Medial root of median nerve

d) Recurrent branch of median nerve

9. A patient exhibits weakness of Pinch grip ;

other thumb movements are normal. There is no

sensory loss in the hand. The probable cause is

da mage to :

a) Posterior interosseous nerve

b) Anterior interosseous nerve

c) Deep branch of ulnar nerve

d) Median nerve proximal to flexor retinaculum

10. In carpal tunnel syndrome which of the

follwoing conditions occur due to motor deficit ?

a) Claw hand

b) Pointing index finger

c) Benediction hand

d) Simian hand

Rx PG MCQ

This post was last modified on 05 April 2022