slideshow: hand
TRANSCRIPT
The Hand
The hand is a complex biological tool that
permits a wide range of movements that facilitate
grip, pinch, grasp, and fine precision control of
objects
The hand is a complex biological tool that
permits a wide range of movements that facilitate
grip, pinch, grasp, and fine precision control of
objects
These movements are controlled by a series of
highly specialised muscles that are either extrinsic or
intrinsic
Extrinsic muscles are those which originate at the distal humerus or in the forearm and the tendons insert in
the hand
Extrinsic muscles on the volar (or palmar) aspect
include
Flexor Pollicis Longus
Flexor Digitorum Profundus
Flexor Digitorum Superficialis
Flexor Pollicis Longus
Flexor Digitorum Profundus
Flexor Digitorum Superficialis
The tendons of these muscles pass through
the carpal tunnel,Found at the proximal
part of hand just beyond the wrist joint
The Carpal Tunnel
Region on the volar aspect of the hand
Found at the junction between the forearm and hand
The Flexor Retinaculum is a fibrous band of tissue that forms
the roof of the carpal tunnel
The Flexor Retinaculum is a fibrous band of tissue that forms
the roof of the carpal tunnel
It is attached to the carpal bones
It gives rise to a number of muscles within the hand
CT reconstruction of Right Wrist
Radius
Ulna
CT reconstruction of Right Wrist
Radial attachment of the Flexor Retinaculum
Scaphoid(tubercle)
Radial attachment of the Flexor Retinaculum
Trapezium(ridge)
Ulnar attachment of the Flexor Retinaculum
Pisiform
Ulnar attachment of the Flexor Retinaculum
Hamate(hook)
Bony attachments of Flexor Retinaculum
Bony attachments of Flexor Retinaculum
Tendons of Long Flexors
Tendon of Flexor Digitorum Superficialis splits in two and inserts onto either side of the middle phalanx
Tendon of Flexor Digitorum Superficialis splits in two and inserts onto either side of the middle phalanx
It flexes the proximal interphalangeal joint
Tendon of Flexor Digitorum Profundus inserts onto the distal phalanx
Tendon of Flexor Digitorum Profundus inserts onto the distal phalanx
It flexes the distal interphalageal joint
Intrinsic muscles are those which originate and
insert within the hand itself
Intrinsic muscles may be classified as follows;
Thenar Muscles
Adductor Pollicis
Hypothenar Muscles
Lumbricals
Interossei Muscles
Thenar Muscles
control movements of the thumb
3 Thenar Muscles
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis
3 Thenar Muscles
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis
All supplied by the median nerve
Thenar Muscles
Opponens Pollicis
Arises fromFlexor RetinaculumTubercle of Trapezium
Rotates CMC & MCP joints of thumb
Opponens Pollicis
Arises fromFlexor RetinaculumTubercle of Trapezium
Supplied by median nerve
Rotates CMC & MCP joints of thumb
Abductor Pollicis Brevis
Arises from Flexor Retinaculum Scaphoid Tubercle
Abductor Pollicis Brevis
Abducts thumb at MCP, CMC joints
Arises from Flexor Retinaculum Scaphoid Tubercle
Flexor Pollicis Brevis
Arises fromFlexor Retinaculum Tubercle of Trapezium
Flexor Pollicis Brevis
Flexes MCP joint of thumb
Arises fromFlexor Retinaculum Tubercle of Trapezium
Adductor Pollicis
Supplied by deep branch of ulnar nerve
Also acts on thumb, but is not part of the thenar muscles
Adductor Pollicis
Arises from Oblique head: bases of 2nd and 3rd metacarpals, capitate, trapezoidTransverse head: anterior surface of body of 3rd metacarpal
Supplied by deep branch of ulnar nerve
Adductor Pollicis
Arises from Oblique head: bases of 2nd and 3rd metacarpals, capitate, trapezoidTransverse head: anterior surface of body of 3rd metacarpal
Adducts CMC joint of thumb
Hypothenar Muscles
control movements of the Little Finger
3 Hypothenar muscles
Abductor Digiti Minimi
Flexor Digiti Minimi Brevis
Opponens Digiti Minimi
3 Hypothenar muscles
Abductor Digiti Minimi
Flexor Digiti Minimi Brevis
Opponens Digiti Minimi
All supplied by the deep branch of the ulnar nerve
Abductor Digiti Minimi
Abducts the little finger
Flexor Digiti Minimi Brevis
Flexes the little finger
Opponens Digiti Minimi Opposes the Carpometacarpophalangeal jointsMetacarpophalangeal joints of the little finger
Interossei Muscles
Interossei Muscles
There are two sets of Interossei
Palmar Interossei
Interossei Muscles
There are two sets of Interossei
Palmar Interossei
Dorsal Interossei
Interossei Muscles
Palmar Interossei
ADDuct the fingers
Interossei Muscles
Dorsal Interossei
ABduct the fingers
Useful Pnemonic
PAD and DAB
Useful Pnemonic
PADPalmar InterosseiADDuct the fingers
DABDorsal InterosseiABduct the fingers
PAD and DAB
The lumbricals are interesting muscles as they
arise from the tendons of flexor digitorum profundus
attach to the dorsal expansion of the digits
There are 4 lumbricals
Lumbricals
1st Lumbrical
The lumbricals have a dual nerve supply
Lumbricals
The lumbricals have a dual nerve supply
Lateral two are by Median nerve
Lumbricals
The lumbricals have a dual nerve supply
Lateral two are by Median nerve
Medial two are by Ulnar nerve
Lumbricals
Nerves
All Intrinsic muscles of the hand are supplied
by the Ulnar Nerve
EXCEPT
The lateral 2 lumbricals and thenar muscles
L
O
A
F
Useful pnemonic for muscles in the hand
supplied by the median nerve is
Useful pnemonic for muscles in the hand
supplied by the median nerve is
Lateral 2 lumbricals
O
A
F
Useful pnemonic for muscles in the hand
supplied by the median nerve is
Lateral 2 lumbricals
Opponens Pollicis
A
F
Useful pnemonic for muscles in the hand
supplied by the median nerve is
Lateral 2 lumbricals
Opponens Pollicis
Abductor Pollicis Brevis
F
Useful pnemonic for muscles in the hand
supplied by the median nerve is
Lateral 2 lumbricals
Opponens Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Summary of Muscles in the Hand
Abductor Digiti MinimiOrigin Pisiform, pisohamate
ligament, flexor retinaculumInsertion Ulnar aspect base of proximal
phalanx of little fingerAction Abducts little (5th) finger
Nerve Supply Deep branch of ulnar nerve (C8 and T1) (C8, T1)
Blood Supply Ulnar artery
Anterior Hand
Anterior Hand
Abductor Pollicis BrevisOrigin Flexor retinaculum and
scaphoid tubercleInsertion Radial sesamoid of proximal
phalanx of thumb & tendon of extensor pollicis longus
Action Abduction of thumb at MCP, CMC
Nerve Supply Recurrent branch of median nerve (C8 and T1) (C8, T1)
Blood Supply Superficial palmar branch of the radial artery
Anterior Hand
Flexor Digiti MinimiOrigin Hook of hamate and flexor
retinaculumInsertion Ulnar aspect base of proximal
phalanx of little fingerAction Flexes metacarpophangeal
joint little fingerNerve Supply Deep branch of ulnar nerve (C8
and T1) (C8, T1)Blood Supply Ulnar artery
Flexor Pollicis BrevisOrigin Flexor retinaculum and
tubercle of trapeziumInsertion Lateral side of base of
proximal phalanx of thumbAction Flexes MCP joint thumbNerve Supply Recurrent branch of median
nerve (C8 and T1) (C8, T1)Blood Supply Superficial palmar branch of
the radial artery
Anterior Hand
Adductor PollicisOrigin Oblique head: bases of 2nd
and 3rd metacarpals, capitate, trapezoidTransverse head: anterior surface of body of 3rd metacarpal
Insertion Ulnar aspect base of proximal phalanx of thumb and tendon of extensor pollicis longus
Action Adducts CMC joint of thumb
Nerve Supply Deep branch of ulnar nerve (C8 and T1) (C8, T1)
Blood Supply Deep palmar arterial arch
Anterior Hand
Anterior Hand
Opponens Digiti MinimiOrigin Hook of hamate and flexor
retinaculumInsertion Ulnar border 5th metacarpal
Action Opposes CMC and MCP joints of little finger
Nerve Supply Deep branch of ulnar nerve (C8 and T1) (C8, T1)
Blood Supply Ulnar artery
Anterior Hand
Opponens PollicisOrigin Flexor retinaculum and
tubercle of trapeziumInsertion Radial border 1st metacarpalAction Opposes CMC & MCP joints of
thumbNerve Supply Recurrent branch of median
nerve (C8 and T1) (C8, T1)Blood Supply Superficial palmar branch of
the radial artery
Palmar InterosseiOrigin Anterior shaft of 2,4,5
metacarpalsInsertion Proximal phalanges and dorsal
expansion of ulnar side of index and radial side of ring and little fingers
Action Adducts fingers to axis of middle finger
Nerve Supply Deep branch ulnar nerve C8, T1
Blood Supply Branches from deep palmar arch
Anterior Hand
Dorsal InterosseiOrigin Bipennate from shafts of all
metacarpalsInsertion Proximal phalanges and dorsal
expansion of radial side of index and middle fingers and ulnar side of middle and ring fingers
Action Abducts fingers away from axis of middle finger
Nerve Supply Deep branch ulnar nerve C8, T1
Blood Supply Dorsal metacarpal arteries
Posterior Hand
LumbricalsOrigin Four tendons of flexor
digitorum profundus, Radial two are unipennate, Ulnar two are bipennate
Insertion Extensor expansion radial side 2-5 digits
Action Flex MCP joints and extend interphalangeal joints of fingers
Nerve Supply Radial 2; median nerve Ulnar 2; ulnar nerve
Blood Supply Dorsal metacarpal arteries
Anterior Hand