Wrist and Hand

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Wrist and Hand

• ??????? ?????
• ???

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Surface anatomy of wrist and hand

• Anatomical snuff box ???
• Medial tendon of the extensor pollicis longs
• Lateral tendons of the abductor pollicis longus
  and extensor pollicis brevis
• Proximal styloid process of radius
• Floor scaphoid and trapezium bones
• Radial a. crosses the floor of the snuff, so may
  fell the radial pulse in this fossa

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Anatomical snuff box
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Deep fascia of the wrist

• Palmar carpal ligament ?????
• Flexor retinaculum ?????
• Thickening of deep fascia in the hand
• Attached laterally to scaphoid and trapezium and
  medially to pisiform and hamate
• Ulnar carpal canal ????
• Formed by the distal part of palmar carpal
  ligament and flexor reticulum
• Transmit the ulnar a., v. and n.
• Radial carpal canal ????
• The radial end of flexor reticulum is attached
  to the tubercles of scaphoid and trapezium
• Transmit tendon of flexor carpi radialis

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?Carpal tunnel

• Composition Formed by flexor retinaculum and
  carpal groove
• Structures passing through the carpal tunnel
• Median n.
• The tendons of flexor digitorum superficialis and
  flexor digitorum profundus enclosed by common
  flexor synovial sheath
• The tendon of flexor pollicis longus enclosed by
  synovial sheath for flexor pollicis longus

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Carpal tunnel
Synovial sheath for flexor pollicis longus
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Carpal tunnel
Tendons of flexor digitorum superficialis
Median n.
Tendons of flexor digitorum profundus
common flexor synovial sheath
Tendon of flexor pollicis longus enclosed by
synovial sheath for flexor pollicis longus
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Posterior region of wrist ???

• Extensor retinaculum ?????
• Thickening of deep fascia of forearm a wrist
• Attached laterally to radius and medially to
  styloid process of ulna and triquetral bone
• Forms six fibrous compartments for extensor
  tendons passing from forearm into hand

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Posterior region of wrist ???

• ? tendons of abductor pollicis longus and
  extensor pollicis brevis and their synovial
  sheaths
• ? tendons of extensor carpi radialis longus and
  brevis and their synovial sheaths
• ? tendon of extensor pollicis longus and its
  synovial sheath
• ? tendons of extensor digitorum, extensor indicis
  and their synovial sheaths
• ? tendon of extensor digiti minimi and its
  synovial sheaths
• ? tendon of extensor carpi ulnaris and its
  synovial sheaths

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Palm of hand ??

• Deep fascia of the palm
• Superficial layer
• Thenar fascia ????
• Hypothenar fascia ?????
• Palmar aponeurosis ??? thick
  triangular membrane
• Deep layer
• palmar interosseous fascia ??????

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Osseofascial compartments of palm
??????

• Lateral compartment ???
• Medial compartment ???
• Intermediate compartment ???

Laeral intermuscular septum
Medial intermuscular septum
Palmar aponeurosis
Thenar fascia
Hypothenar fascia
Palmar interosseous fascia
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Intermediate compartment ???

• Boundaries
• Palmar aponeurosis
• Laeral and medial intermuscular septum
• Palmar interosseous fascia
• Contents
• superficial palmar arch, a., v.,n.
• tendons of flexor digitorum superficialis and
  profundus
• Lumbricales
• common flexor sheath

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Fascia spaces ????

• Thenar space ???? located between the fascia of
  the adductor pollicis and flexor tendon of the
  index finger.
• Proximal blind
• Distally continuous with the back of the index
  finger by the fist lumbrical canal
• Midpalmar space???? lies posterior to common
  flexor sheath
• Proximal continous with the posterior space of
  the antebrachial flexor through the carpl canal
• Distally continuous with the appropriate
  lumbrical canals

Palmar intermediate septum
Thenar space
Midpalmar space
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Muscles of hand

• Lateral group-thenar (4)
• Medial group-hypothenar (3)
• Intermedial group
• Lumbricals ??? (4)
• Palmar interossei ????? (3)
• Dorsal interossei ????? (4)

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Muscles of hand

• Lateral group-thenar ?? (4)
• Abductor pollicis brevis????
• Flexor pollicis brevis ????
• Opponens pollicis ????
• Adductor pollicis ???
• Action flex, abduct, adduct and oppose thumb
• Nerve supply median n. except adductor pollicis
  which is supplied by ulnar n.

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Muscles of hand

• Medial group-hypothenar ??? (3)
• Abductor digiti minimi ????
• Flexor digiti minimi brevis ?????
• Opponens digiti minimi ?????
• Action flex, abduct , and oppose little
• finger
• Nerve supply ulnar n.

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Muscles of hand

• Intermedial group
• Lumbricals ??? (4)
• Action flex fingers at MP joints extend fingers
  at IP joints
• Nerve supply first two lumbricals supplied by
  median n., and 3rd and 4th lumbricals supplied by
  ulnar n.

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Muscles of hand

• Intermedial group
• Palmar interossei (3)?????
• adduct fingers towards middle finger at MP joints
• Dorsal interossei (4) ?????
• abduct fingers away from middle finger at MP
  joints
• Nerve supply ulnar n.

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Arteries of upper limb

• Superficial palmar arch ???
• Formed by ulnar artery and superficial palmar
  branch of radial artery
• The curve of arch lies across the palm, level
  with the distal border of fully extended thumb
• Gives rise to three common palmar digital
  arteries each then divides into two proper palmar
  digital arteries

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Arteries of upper limb

• Deep palmar arch ???
• Formed by radial artery and deep palmar branch of
  ulnar artery
• The curve of arch lies across upper part of
  palmar at level with proximal border of extended
  thumb
• Gives rise to three palmar metacarpal arteries to
  joint the distal ends of the corresponding common
  palmar digital arteries

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Nerves of hand

• Median n. ????
• Muscular branches supply thenar except adductor
  pollicis, first two lumbricales
• Cutaneus branches supply skin of thenar, central
  part of palm, palmar aspect of radial three and
  one-half fingers, including middle and distal
  fingers on dorsum

Recurrent branch
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Nerves of hand

• Ulnar n. ???
• Muscular branches supply hypothenar muscles,
  interossei, 3rd and 4th lumbricales and adductor
  pollicis
• Cutaneus branches supply skin of hypothenar,
  palmar surface of ulnar one and one-half fingers,
  ulnar half of dorsum of hand, posterior aspect of
  ulnar two and one-half fingers
• Radial n. ???
• Skin of radial side of dorsum of hand
• Posterior aspect of radial two and one-half
  fingers

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Dorsum of hand ??

• Fascia of the dorsal hand
• The superficial fascia
• Dorsal venous rete of hand
• Superficial lymph vessels
• Superficial branches of radial n. and doesal
  branch of ulnar n.
• Deep fascia-the dorsal fascia of hand
• Superficial layer--dorsal aponeurosis ????
• Deep layer--dorsal interosseous fascia ??????

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Dorsum of hand ??

• Two spaces
• The dorsal subcutaneous space ??????
• The dorsal subaponeurotic space ???????

Dorsal subaponeurotic space
Superficial fascia
Dorsal aponeurosis
Dorsal subcutaneous space
Dorsal interosseous fascia
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Fingers??

• Pulp space of the fingers ????
• The deep fascia of the pulp of each finger fuses
  with the periosteum of the terminal phalanx just
  distal to the insertion of the long flexor
  tendons and closes off a facial compartment known
  as the pulp space.
• Each pulp space is subdivided by the presence of
  numerous septa, which pass from the deep fascia
  to the periosteum.
• Through the pulp space, which is filled with fat,
  runs the terminal branches of the digital artery
  that supplies the diaphysis of the terminal
  phalanx..
• The pulp space is limited proximally by the firm
  adherence of skin and the distal flexion crease
  to the underlying tissue this prevents pulp
  infection from spreading proximally along the
  finger.

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Fingers ??

• Vessels
• Proper palmar digital a.
• Nerves
• Proper palmar digital n.