Palmar Hand: Muscles

Muscle Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis Adductor pollicis Abductor digiti minimi Flexor digiti minimi brevis (Note: there is no longus) Opponens digiti minimi Lumbricals

Innervation recurrent branch of median nerve recurrent branch of median nerve recurrent branch of median nerve deep branch of ulnar nerve deep branch of ulnar nerve

Function to oppose thumb, it draws 1st metacarpal medially to center of palm and rotates it medially abducts thumb; helps oppose it flexes thumb adducts thumb toward lateral border of palm abducts 5th finger, assists in flexion of its proximal phalanx

deep branch of ulnar nerve

flexes proximal phalanx of 5th digit

deep branch of ulnar nerve 1 and 2: median nerve 3 and 4: deep branch of ulnar

draws 5th metacarpal anterior and rotates it, bringing 5th finger into opposition with thumb flex metacarpophalangeal joints; extend interphalangeal joints of 2nd-5th fingers

Palmar Hand: Neurovasculature

Carpal Tunnel:

Palmar Hand: Clinical CorrelatesAffected structure Clinical correlate dupuytren contracture: disease of palmar fascia resulting in progressive shortening, thickening, and fibrosis of the palmar fascia and aponeurosis. Results in fourth and fifth fingers pulled into partial flexion usually occur on dorsum of hand, where fascia is thinner. tenosynovitis: inflammation, digit swells and movement becomes painful. Infection usually confined to the infected digit because the tendons have separate sheaths. Infection of little finger can spread to carpal tunnel to anterior forearm (because its synovial sheath is continuous with the common flexor sheath) any lesion that reduces the size of the carpal tunnel or increases the size of some of the structures that pass through it. Median nerve most affected. Paresthesia, hypothesia, or anesthesia may occur in lateral 3 digits. Sensation in palm is unaffected because palmar cutaneous branch does not pass through carpal tunnel. Quervain tenovaginitis stenosans: excessive friction of tendons results in thickening of sheath and stenosis of osseofibrous tunnel. Pain in wrist radiating to forearm and thumb digital tenovaginitis stenosans: enlargements of tendons proximal to tunnel forming nodules --> cannot extend finger. Snap is audible when finger is extended passively laceration leads to profuse bleeding. Need to compress brachial artery proximal to elbow to stop bleeding. raynaud syndrome when cause is unknown. May need to perform a cervicodorsal presynaptic sympathectomy to dilate digital arteries palmar wounds: incisions/wounds along medial surface of thenar eminence may injure recurrent branch of median nerve laceration of wrist. Results in paralysis and wasting of thenar muscles and first two lumbricals; cannot oppose thumb, limited adduction. Sensation lost of thumb and adjacted 2.5 fingers. motor and sensory loss to hand. Claw hand results from atrophy of interosseous msucles of the hand. Ulnar canal syndrome: hypoesthesia in medial 1.5 fingers and weakness of intrinsic hand muscles. wrist drop: hand is flexed at wrist and lies flaccid, digits remain in flexed position. Loss of sensation is minimal because deep branch is entirely muscular.

palmar fascia

fascia, tendons, and other structures Arteries nerves

hand infections

tendon and synovial sheath

carpal tunnel syndrome

APL and EPB

FDS and FDP

palmar arches ischemia of digits recurrent branch of median nerve

median nerve

ulnar nerve

radial nerve