hand anatomy
TRANSCRIPT
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Anatomy of the Hand
KHALID AYOUB03/03/03
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TOPICS• Osteology
• Arthrology
• Extensor tendon
• Flexor tendon
• Nerve supply
• Blood supply
• Common pathological conditions
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Osteology
Carpus:
• Mostly articular
• No tendon insertion
• Intrinsic Ligaments
• Shape
P
R
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Osteology
Carpus:• Mostly articular• No tendon insertion• Intrinsic Ligaments• Shape• Ossification
P
R
P
<11
24
5
56
6
16
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ARTHROLOGY
A). Radiocarpal joint; Radius Scaphoid
Lunate
TFC Triquetrum
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ARTHROLOGY
Extrinsic Ligaments
1. Radio-scapho-lunate
(Lig. Of Testut)
2. Radial collateral
3. Palmar radiocarpal;
- Radio-scapho-capitate
- Radio- lunate
4. Radio-luno-triquetral
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ARTHROLOGY
5. Palmar Ulnocarpal : Ulno-lunate
Ulno-triquetral
6. Ulnar collateral
7. Dorsal radiocarpal = Dorsal radio-
triquetral
8. . Tranverse carpal Lig
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ARTHROLOGY
B) Distal radio-ulnar joint• Stabilised by TFCC:
1. Articular disc
2. Meniscal homologue
3. UCL
4. Palmar Ulnocarpal Lig
5. Dorsal & Ulnar RU Lig
6. Extensor carpi ulnaris sheath.
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ARTHROLOGY
C). Intercarpal Joints
Supported by Intrinsic Ligaments &
Shape
D) Pisiform articulation
E) Midcarpal Joint; Between the
proximal and distal carpal rows
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ARTHROLOGY
Distal Row
Proximal Row
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ARTHROLOGY
F) Metacarpo-Phalangeal Joint
• Ellipsoid joints
• Volar plate
• Collateral lig
• Deep transvers MC Lig
MC
PH
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ARTHROLOGY
G). Interphalangeal joint
• Hinge joint
• Volar plate
• Collateral Lig
• Accessary Lig
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EXTENSOR APPARATUS
A. Wrist• Extensor Retinaculum
• 6 compartments
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EXTENSOR APPARATUS
B. Hand• EDC
• EDM
• EI
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EXTENSOR APPARATUS
C. MP Joints
• Interosseous M.
• Common Extensor Tendon
• Sagital band
• Lateral Band/Tendon
• Transversr/Oblique I. L.
• Lumbrical M.
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EXTENSOR APPARATUS
D. Finger IP Joint
• Central slip
• Lateral slip
• Transverse Retinacular Lig
• Oblique Retinacular Lig
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Swan neck deformityCauses1. Long extensor overactivity• Mallet deformity (1o)• Exterinsic spasticity• Intrinsic tightness2. Failure of the volar stabilisation PIP J
(Mallet deformity 2o)
• Volar plate insufficiency• FDS insufficincy• Joint laxity
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Boutonniere deformity
1. Rupture of the central slip
2. Volar dislocation of the lateral band
3. More efficient pull of the lateral band on the DIP J
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Carpal Tunnel
• From distal radius to
MC bases
• Radial wall; Scaphoid,
trapezium
• Ulnar wall; triquetrum,
pisiform, hamate
• Floor: Lunate, capitate,
proximal MC
• Roof: Flexor Retinaculum
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Carpal Tunnel
Componants of the roof:
1. Deep forearm fascia
2. Transverse carpal lig: -
- Scaphoid tubercle
- Trapezium ridge
- Pisiform
- Hamate hook
3. Conjoined aponeurosis
between thenar & hypothen.
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Carpal Tunnel• Over:- Ulnar nerve and artery(Guyon)
- Palmar cutaneous br. of Median N.
- Palmar cutaneous br. of Ulnar N.
• Contents:
-Tendon X 9
- Median Nerve (on the
radiopalmar aspect of
the tunnel and dorsal
or dorsoradial to PL
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PALM
• Palmar aponeurosis
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PALM
Palmar Spaces
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PALM
• Deep Palmar abscess
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PALM
• Synovial Sheath
& Bursa
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FINGERS
• Superficial layer• Ligaments
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FINGERSCross-section
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FINGER FLEXOR
• FDS• FDP• Synovial flexor sheath
• Fibrous flexor sheath pulley system
- Annulus
- Cruciate
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FINGER FLEXOR
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NAIL
• Nail plate: - Body
- Root• Nail bed:
- Sterile matrix
- Germinal matrix• Eponychiam• Labia ungues
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MUSCLES ACTION
Muscle Function Nerve supply
EDFinger extension (MP joint)
Post. Inteross. N
Dorsal InterossFinger Abduction
Flex MP+ext IPUlnar
Palmar InterossFinger adduction Flex MP+ext IP
Ulnar
Lumbricals Flex MP+ext IP Median + Ulnar
Palmaris longus Flexion wrist/finger/ Median
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Thumb Opposition
Complex motion made by;
• Thumb Abd … APB
• Thumb pronation ….APB
• Flexion CMC & MP
Mov>>>
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Ulnar nerve • C7,8,T1• Forearm: FCU & Ulnar half FDP Palmar & Dorsal Cut branches• Wrist: In Guyon canal (on Flexor Retin.)• Hand: Superficial Br Deep Br: - Hypothenar - Inteross - Add. P - Two ulnar lumbrical
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Ulnar Nerve Dysfunction
• Low lesion: (Below elbow) Loss innervation to the hand
small muscles only
+ Preserve forearm innervation (Ulnar FDP)
= Sever ulnar Claw Hand deformity
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Ulnar Nerve Dysfunction
• High lesion (At elbow or above)
Loss innervation below elbow (including FDP)
= less sever ulnar claw hand deformity
Ulnar paradox
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Median Nerve
• Roots: C6,7,8,T1• Elbow: - PT, FCR,PL, FDS• Forearm: Anterion interosseous branch; [FDP (radial), FPL, PQ]• Wrist: Palmer cutaneous branch (5 cm
proximal to wrist crease between PL & FCR)
• Hand: -3 Thenar m. (APB, FPB,OP) - 2 radial lumbricals - 3 ½ radial fingers
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Median Nerve Dysfunction
Level of injury of main trunk
1. Below wrist >>>> APB
(Simian Hand)
2. Mid-forearm>> palm sensation
3. Upper forearm >> Pinch test>
Anterion interosseous palsy
4. Elbow and above >> Check FDS
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Redial Nerve• Roots: C5,6,7,8,T1
• Above elbow: Muscular = Br., BR, ECRL
• Elbow:
1. Superficial terminal br. = sensory to hand
2. Deep terminal br. (Post. Inteross) >>
ECRB, Supinator
• Forearm:
- Deep terminal (Post. Inteross) br. >>> ED, EDM, ECU, APL, EPB, EPL, EI
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Redial Nerve Dysfunction• Wrist >> Check sensation• Forarm: Check for post. Inteross nerve
palsy >>>>> EPL, EI, ED (no sensory loss)• Elbow and above: Wrist extension
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SENSORY DISTRIBUTION
1. Ulnar N.
2. Median N
3. Radial N.
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Blood Supply1. Ulnar A.
• Radial to FCU
• Forms the superficial palmar arch ?with superficial palmar br. of radial artery
• Gives 4 common palmar digital art.
• Fingers: dorsal to the nerve
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Blood Supply2. Radial A.
• Radial to FCR
• Beneath APL …. Floor of
ASB
• Forms the Deep palmar arch
with deep br. of ulnar ar. 1
cm proximal to Superficial
arch
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Scaphoid
• Dorsal carpal br. supply the scaphoid dorso-ditally
• Two thirds …. Throughout the length
• 20% ….. Only in the waist
• 13% …. Only in distal 1/3
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Scaphoid
• Pedicled vascularised
bone graft
• Arterial supply of
dorsal distal radius
• 1,2
intercompartmental
supraretinacular artery
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Basic Function1. Precision pinch
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Basic Function
2. Pulp pinch: Pinch Dynamometer (2-5 kg)
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Basic Function
3. Key pinch: Pinch Dynamometer (6-10 kg)
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Basic Function
4. Chuck grip:
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Basic Function
5. Hook grip
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Basic Function
6. Span grasp:
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Basic Function
7. Power grip
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Basic Function
8. Flat hand:
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