azaizah hand1

8/3/2019 azaizah hand1

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Done by : Mohamed Hosen Ahmad azaizah


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Bones & joints

Muscle & tendonsNerves

Arteries & veins


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27 bones:

8 carpals (wrist

bone) 5 metacarpals (palm

bone)

14 digitalbones


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Metacarpalbones divide

into:

Base, shaft & head

The 14 phalanges aredivided to:

Proximal, Middle & distal

Except the thumb which

contain only the proximal& distal


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1. Wrist: the distal end of theradius articulates with lunate,scaophoid & triquetrum toform the wrist joint

2. Intercarpal joints:articulation between the

individual bones of theproximal row carpus andindividual distal raw carpus,midcarpal joint bw

proximal&distal raws.


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3. Carpometacarpal joints:Thebase of

metacarpals articulate with the distal

raw of the carpal bones.

1st metacarpal & Trapezium

2nd metacarpal, trapezoid, trapezium

& capitate

3rd metacarpal & capitate

4th

metacarpal, hamate & capitate 5th metacarpal & hamate

4. Metacarpophalangeal joint:The head

of the metacarpals articulate with the

base of theproximal phalanges.

5. Interphalangeal joint:which are 9

joints articulate between the phalnges,

DIP & PIP, except the thumb.


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The muscles of the hand subdivided into :

1. Intrinsic muscles are located within the hand itself.

1. Thenar

2. Hypothenar

3. lumbrical.

4. Interossei

2. Extrinsic muscles are located proximally in theforearm and inserted to the hand skeleton by longtendons.

1. Extensor

2. Flexor


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Wrist muscles: Extensor carpi radualis longus

Extensor carpi radualis brevis

Extensor carpi ulnarisDigit muscles: Extensorpollicis brevis

Extensorpollicis longus

Abductorpollicis longus

Extensor digitorum

Extensor digiti minimi

Extensor indicis(extends metacarpophalngeal joint of theindex)


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They can be divided into:1- Muscles with primary action at wrist which is extension

Extend & abduct the hand @ wrist joint

Extend & adduct the hand @ the wrist joint


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2- primary action is at the digits

Extends the MCP of the thumb Extends the distal phalanx

Abducts and extends thumb

Extends the fingers @ the MCP, Extend little finger @ the MCPextends the IP joints of the second through fifth digits

P.S : all of the extrinsic extensor group innervated by the radial nerve .


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Superficial muscles:

Flexor carpi ulnaris

Flexor carpi radialis

Palmaris longus

Intermediate muscles:

Flexor digitorum superficialis

Deep muscles:

Flexorpollicis longus

Flexor digitorum profounds


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There are 3 layers of extrinsic flexors:

1- the superficial muscle: theirprimary action at the wrist orpalm.

Adduct & flex abduct

2- the intermediate muscle : Flexes the middle phalanx of the fingers and assist inflextion of the proximal phalanx and hand.

3- the deep muscles : primary action at the digits.

Flexorpolicis longus :flexes distal phalanx of the thumb

Flexor digitorum profunds :flexes distal phalanx of the fingers then assist in flexion

of the middle and proximal phalanges and wrist

P.S : all the extrinsic flexor are innervated by the median nerve exept theFCU and of F.D.P by ulnar nerve.


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Situated totally within the hand.

Divided into 4 groups:

1. Thenar

Opponens pollicis

Adductorpollicis Flexorpollicis brevis

Abductorpollicis brevis

2. Hypothenar

Opponens digiti minimi Abductor digiti minimi

Flexor digiti minimi

3. Lumbrical

4. Interossei


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The thenar group consists of :

.

Opponens

pollicis

Abduction of the thumb. Pulls the thumb medially

and forward across thepalm.


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Flexes MCP joint of the thumb. Adduction of the thumb.

p.S : all the muscle of the thenar areinnervated by median nerve except(Adducter.P) by deep branch of the ulnarnerve .


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The hypothenar group consists of:

Flexes the MCP joint of the little finger Abducts, assists in opposition

pull the 5th metacarpal forward & medially

all the muscle of this group innervated by the deep branch of the ulnar.


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The lumbrical muscles contribute to:

Flexion of the MCP joints & Extension of the interphalangealjoints.

p.s Nerve to Lumbricals I, II,(lateral)MedianNerve to Lumbricals III, IV: deep branch of

the Ulnar


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The interossei group consists of:

3 palmar muscles adduct thefingers to the hand axis(toward the

center of the 3rd finger).

4 dorsal muscles abduct the fingersfrom the center of the 3rd finger .

Innervated by the deep branch ofthe ulnar nerve.


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The hand is innervated by 3 nerves:

Each one has a sensory and motor

components.

1. Median nerve

2. Ulnar nerve

3. Radial nerve


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Originates from the lateral and

medial cords of the brachial

plexus (C5-T1).

Palmar cutaneous branch

provides sensation at the thenareminencegoes above FR .

The rest of M.N goes below the flexorretinoculum

to the carpal tunnel; and gives:

Recurrent motor branch

innervates the thenar andlumbrical muscles.

Sensory digital branches provide

sensation to the lateral 3 and a

half fingers(on the palmer side and only thedistal ascpect on the dorsum of the hand )


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Innervates the muscles involved in the powergrasping function of the hand.

It originates at the medial cord of the brachialplexus (C8-T1).

Motor branches(in forearm)innervate:

Flexorcarpi ulnaris Flexordigitorum profundus only 1/2

Palmar cutaneous branch provides sensation atthe hypothenar eminence.

Then Above the F.R and lateral to the pisiform :

Deep branches goes around the hook of hamate&supply ; all interossi muscles ,hypothenar andthe 3&4 lumbrical

Superficial branches sensory for 1 and a halffingers(on both sides palmer and dorsal ) .


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Innervating the wristextensors

Originates from theposterior cord of thebrachial plexus (C6-8).

At the elbow, motor

branches innervate thebrachioradialis andextensor muscles

Superficial & deepterminal branches

the deep branches doesnt reach

the hands and gives

post.interossous nerve for the

extensors of the hand and

abduector pollicis longus; the

superficial inervates the dorsum

of 3 and a half fingers.


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The superficial palmar arch: is formed mainly by the ulnar

artery with a contribution of the radial artery, the arch gives raise

to commonpalmar digital arteries wich supply the palm & each

divide into a pair ofproper palmardigital arteries, which supply

the finger.

Deep palmer arch: is formed mainly by the radial artery with a

contribution from a branch of the ulnar artery . It give raise to

palmar metacarpal arteries which supply the palm and anastomose

with the common palmar digital arteries to the superficial palmararch.


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Veins generally follow the deeparterial system as venae

comitantes.

A superficial venous systemalso exists at the dorsum ofthe hand

Contributes to the cephalic

and basilic vein in the upperextremity.


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Dorsal digital veins : pass along thesides of the fingers and are joined toone another by obliquecommunicating branches. Those fromthe adjacent sides of the fingers unite

to form3

dorsal metacarpal veins. Dorsal metacarpal veins: which end

in dorsal venous network of handopposite the middle of themetacarpus.

Dorsal venous network of hand It isfound on the back of the hand andgives rise to veins such as thecephalic and the basilic veins.


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Palmar metacarpal veins: drains the metacarpal regionof the palm, eventually draining into the deeppalmar

venous arch & then to the radial veins which drain thelateral aspect of the arm.

Properpalmar digital: which drain into the commonpalmar digital veins then drain to the superficial palmar

venous arch and eventually draining to the ulnar veinswhich drain the medial aspect of the arm.


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transverse carpal ligament,anterior annular ligament

dense connective tissue crossesover the carpal bones, forming abony tunnel

1 scaphoid 2 trapezium

3 pisiform

4 hamate

The flexorretinaculum forms aspace between it and the

unerlying carpal bones called thecarpal tunnel.


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median nerve

tendons of flexor

digitorum superficialis

tendons of flexor

digitorum profundus

tendon of flexorpollicis

longus

tendon of flexor carpi

radialis


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The palmar aponeurosis (palmar fascia) invests the muscles of the palm,and consists of central, lateral, and medial portions.

The central portion occupies the middle of the palm, is triangular inshape, and of great strength and thickness.

It covers the palmar aspect of the metacarpals and interosseous muscles

Its base divides below into four slips, one for each finger. Each slip gives

off superficial fibers to the skin of the palm and finger, those to the palmjoining the skin at the furrow corresponding to the metacarpophalangealarticulations, and those to the fingers passing into the skin at thetransverse fold at the bases of the fingers.

Its apex is continuous with the lower margin of the transverse carpalligament, and receives the expanded tendon of the Palmaris longus.

By this arrangement short channels are formed on the front of the headsof the metacarpal bones; through these the Flexor tendons pass. The

intervals between the four slips transmit the digital vessels and nerves,and the tendons of the Lumbricales.


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Thank You

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