Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Human Anatomy ppt lectures Topic 8 Hand Split Notes. - anatomy ppt free download human anatomy ppt lectures, medicine notes ppt, anatomy handwritten notes pdf, mbbs 1st year anatomy notes pdf download, best anatomy notes pdf, human anatomy notes pdf, anatomy easy notes pdf, anatomy notes online, anatomy short notes, Anatomy ppt, Powerpoint Presentations and lecture notes.
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