Bone and Muscles of the Hand

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This ppt explain about the bony structure that made up our hand and also extrinsic and intrinsic hand muscles that move our wrist and hand joint.

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Bone and Muscles of the Hand

  1. 1. COLLEGE OF ALLIEDCOLLEGE OF ALLIED HEALTH AND SCIENCESHEALTH AND SCIENCES ANATOMYANATOMY MUSKULOSKELETALMUSKULOSKELETAL UPPER LIMB (PART 5)UPPER LIMB (PART 5) Carpals, Metacarpals andCarpals, Metacarpals and PhalangesPhalanges By : HERMIZAN BIN HALIHANAFIAH
  2. 2. HANDHAND IntroductionIntroduction  Gross motor skills and fine motor skills.Gross motor skills and fine motor skills.  5 Digits / fingers5 Digits / fingers  Thumb – pollexThumb – pollex  Index finger – digitus indicisIndex finger – digitus indicis  Middle finger – digitus tertiusMiddle finger – digitus tertius  Ring finger – digitus annulusRing finger – digitus annulus  Little finger – digitus minimiLittle finger – digitus minimi
  3. 3. HandHand  Hand composed by a bony framework :Hand composed by a bony framework :  8 carpals bones8 carpals bones  5 metacarpals5 metacarpals  14 phalanges14 phalanges
  4. 4. Carpal BonesCarpal Bones  The names reflect on their shapeThe names reflect on their shape  Divide in two rows; proximal and distal rowDivide in two rows; proximal and distal row  Proximal row:Proximal row:  From lateral to medialFrom lateral to medial  Scaphoid, lunate, triquetrum and pisiformScaphoid, lunate, triquetrum and pisiform  Distal rowDistal row  From lateral to medialFrom lateral to medial  Trapezium, trapezoid, capitate and hamateTrapezium, trapezoid, capitate and hamate
  5. 5. 8 bones of Carpals8 bones of Carpals  A – Scaphoid (boatlike)A – Scaphoid (boatlike)  B – Lunate (moon-shaped)B – Lunate (moon-shaped)  C – Triquatrum (three-cornered)C – Triquatrum (three-cornered)  D – Pisiform (pea-shaped)D – Pisiform (pea-shaped)  E – Trapezium (four sided figure)E – Trapezium (four sided figure)  F – TrapezoidF – Trapezoid  G – Capitate (head-shaped)G – Capitate (head-shaped)  H – Hamate (hooked)H – Hamate (hooked) Try this pneumonic!!: She Look Too Pretty, Try To Catch Her
  6. 6. CapitateCapitate  Largest carpal boneLargest carpal bone  Rounded projectionRounded projection  Head articulate with lunate boneHead articulate with lunate bone LunateLunate  Large hook-projection on its anteriorLarge hook-projection on its anterior
  7. 7. ScaphoidScaphoid  70 % fractures involve the scaphoid70 % fractures involve the scaphoid  Fall on outstretched hand – force isFall on outstretched hand – force is transmitted from the capitate throughtransmitted from the capitate through the scaphoid to the radiusthe scaphoid to the radius
  8. 8. Carpal TunnelCarpal Tunnel  Concave space formed by the pisiform and hamate (on theConcave space formed by the pisiform and hamate (on the ulnar side), and the scaphoid and trapezium ( on the radialulnar side), and the scaphoid and trapezium ( on the radial side) plus the flexor retinaculum (deep fascia)side) plus the flexor retinaculum (deep fascia)  Long flexor tendons of the digits and thumb (flexorLong flexor tendons of the digits and thumb (flexor digitorum superficialis, flexor digitorum profundus, flexordigitorum superficialis, flexor digitorum profundus, flexor pollicis longus) and the median nerve pass through thepollicis longus) and the median nerve pass through the carpel tunnelcarpel tunnel  Narrowing of the carpel tunnel may give rise to a conditionNarrowing of the carpel tunnel may give rise to a condition calledcalled carpal tunnel syndromecarpal tunnel syndrome ..
  9. 9. Anatomy of Carpal Tunnel
  10. 10. Carpal Turnel SyndromeCarpal Turnel Syndrome
  11. 11. Flexor RetinaculumFlexor Retinaculum  TheThe flexor retinaculumflexor retinaculum ((transverse carpaltransverse carpal ligamentligament, or, or anterior annular ligamentanterior annular ligament ) is a) is a strong, fibrous band, which arches over thestrong, fibrous band, which arches over the carpus.carpus.  Converting the deep groove on the front of theConverting the deep groove on the front of the carpal bones into a tunnel, thecarpal bones into a tunnel, the carpal tunnelcarpal tunnel  Flexor tendons of the digits and the medianFlexor tendons of the digits and the median nerve pass.nerve pass.
  12. 12. Flexor Retinaculum
  13. 13. Extensor RetinaculumExtensor Retinaculum  TheThe extensor retinaculumextensor retinaculum ((dorsal carpaldorsal carpal ligamentligament) is an anatomical term for the fascia) is an anatomical term for the fascia that holds the tendons of the extensor musclesthat holds the tendons of the extensor muscles in place.in place.  It is located on the back of the forearm, justIt is located on the back of the forearm, just proximal to the hand.proximal to the hand.
  14. 14. Extensor Retinaculum
  15. 15. Joints of the Carpal BonesJoints of the Carpal Bones  Intercarpal /midcarpalIntercarpal /midcarpal jointjoint  Articulation betweenArticulation between carpals bone.carpals bone.  Planar jointPlanar joint  Biaxial movement –Biaxial movement – gliding movement( backgliding movement( back – forth , side – side)– forth , side – side)
  16. 16. MetacarpalsMetacarpals  Divide into:Divide into:  Proximal baseProximal base  Intermediate shaftIntermediate shaft  Distal headDistal head
  17. 17.  It consists of five cylindrical bones which areIt consists of five cylindrical bones which are numbered from the radial (lateral ) to the ulnarnumbered from the radial (lateral ) to the ulnar (medial) side.(medial) side. 1.1. First metacarpal boneFirst metacarpal bone 2.2. Second metacarpal boneSecond metacarpal bone 3.3. Third metacarpal boneThird metacarpal bone 4.4. Fourth metacarpal boneFourth metacarpal bone 5.5. Fifth metacarpal boneFifth metacarpal bone MetacarpalsMetacarpals
  18. 18. MetacarpalsMetacarpals Proximal base Intermediate Shaft Distal Head
  19. 19. Joints of the MetacarpalsJoints of the Metacarpals  Carpometacarpal jointsCarpometacarpal joints  Proximal based of metacarpals articulate with distalProximal based of metacarpals articulate with distal row of carpal bones.row of carpal bones.  11stst metacarpal articulate with trapezium bonesmetacarpal articulate with trapezium bones  The second metacarpal articulates primarily with theThe second metacarpal articulates primarily with the trapezoid and secondarily with the trapezium andtrapezoid and secondarily with the trapezium and capitate.capitate.  The third metacarpal articulates primarily with theThe third metacarpal articulates primarily with the capitate,capitate,  The fourth metacarpal articulates with the capitateThe fourth metacarpal articulates with the capitate and hamate.and hamate.  The fifth metacarpal articulates with the hamate.The fifth metacarpal articulates with the hamate.
  20. 20.  CarpometacarpalCarpometacarpal  The 1The 1stst CMC (between trapezium and 1CMC (between trapezium and 1stst metacarpal) is a saddle jointmetacarpal) is a saddle joint  Also known as a trapeziometacarpal jointAlso known as a trapeziometacarpal joint (TMC)(TMC)  Produce triaxial diarthrosisProduce triaxial diarthrosis  The rest CMC – condyloid jointThe rest CMC – condyloid joint  Produce biaxial diarthrosisProduce biaxial diarthrosis Joints of the MetacarpalsJoints of the Metacarpals
  21. 21.  Metacarpophalangeal jointMetacarpophalangeal joint  Distal head of metacarpals articulate withDistal head of metacarpals articulate with proximal phalanges.proximal phalanges.  Condyloid jointCondyloid joint  Produce biaxial diarthrosis ; flexion –Produce biaxial diarthrosis ; flexion – extension / abduction - adductionextension / abduction - adduction Joints of the MetacarpalsJoints of the Metacarpals
  22. 22. PhalangesPhalanges  14 bones14 bones  Numbered 1-5 same with metacarpalsNumbered 1-5 same with metacarpals  Each phalanx consist:Each phalanx consist:  Proximal baseProximal base  Intermediate shaftIntermediate shaft  Distal headDistal head  2 phalanges in thumb, 3 the other fingers.2 phalanges in thumb, 3 the other fingers.
  23. 23.  Phalanges can divide into:Phalanges can divide into:  Proximal phalanxProximal phalanx  Middle phalanxMiddle phalanx  Distal phalanxDistal phalanx  Except thumb; only proximal and distal part.Except thumb; only proximal and distal part. PhalangesPhalanges
  24. 24. Joint of the PhalangesJoint of the Phalanges  Interphalangeal jointInterphalangeal joint  Joint between phalangesJoint between phalanges  Proximal and distal IPProximal and distal IP except thumbexcept thumb  Hinge jointHinge joint  Permits monoaxialPermits monoaxial diarthrosis ; flexion anddiarthrosis ; flexion and extensionextension
  25. 25. Movement of Hand and DigitsMovement of Hand and Digits  ulnar and radial deviation at RCulnar and radial deviation at RC  Wrist flexion and extension at RCWrist flexion and extension at RC  Flexion and extension digit at MCPFlexion and extension digit at MCP  Abduction and adduction digits at MCPAbduction and adduction digits at MCP  Abduction and adduction thumb at 1Abduction and adduction thumb at 1stst CMCCMC  Opposition and reposition thumb at 1Opposition and reposition thumb at 1stst CMCCMC  Flexion and extension digits at IPFlexion and extension digits at IP
  26. 26. Wrist MovementWrist Movement
  27. 27. Thumb MovementThumb Movement Thumb opposition Thumb adduction Thumb abduction
  28. 28. Adduction / abduction digits at MCPAdduction / abduction digits at MCP
  29. 29. Thumb extension / flexion atThumb extension / flexion at MCP / CMCMCP / CMC
  30. 30. Flexion Digit at PIP / DIPFlexion Digit at PIP / DIP
  31. 31. Muscles of the Forearm Move theMuscles of the Forearm Move the Wrist, Hand, Thumb and FingersWrist, Hand, Thumb and Fingers  Group of muscles that act on the digits are known asGroup of muscles that act on the digits are known as extrinsic hand musclesextrinsic hand muscles because originate outsidebecause originate outside the hand and insert within it.the hand and insert within it.  There is 2 groups of forearm muscles:There is 2 groups of forearm muscles:  Anterior compartment (flexor muscles)Anterior compartment (flexor muscles)  Posterior compartment (extensor muscles)Posterior compartment (extensor muscles)
  32. 32. Extrinsic Hand MusclesExtrinsic Hand Muscles
  33. 33. Anterior compartment ofAnterior compartment of Forearm MusclesForearm Muscles  Muscle of the forearm originate on theMuscle of the forearm originate on the humerushumerus  Insert on the carpals, metarcarpals, andInsert on the carpals, metarcarpals, and phalangesphalanges  Act as flexorAct as flexor  Divide into superficial or deep muscles.Divide into superficial or deep muscles.
  34. 34. Posterior compartment ofPosterior compartment of Forearm MusclesForearm Muscles  Muscle of the forearm originate on theMuscle of the forearm originate on the humerushumerus  Insert on the carpals, metarcarpals, andInsert on the carpals, metarcarpals, and phalangesphalanges  Act as extensorAct as extensor  Divide into superficial or deep muscles.Divide into superficial or deep muscles.
  35. 35. Forearm MusclesForearm Muscles  Superficial anterior compartment musclesSuperficial anterior compartment muscles  Deep anterior compartment musclesDeep anterior compartment muscles  Superficial posterior compartment musclesSuperficial posterior compartment muscles  Deep posterior compartment musclesDeep posterior compartment muscles
  36. 36. Superficial Anterior CompartmentSuperficial Anterior Compartment MusclesMuscles  Arrange in following order from lateral to medial:Arrange in following order from lateral to medial: 1.1. Flexor carpi radialisFlexor carpi radialis 2.2. Palmaris longusPalmaris longus 3.3. Flexor carpi ulnarisFlexor carpi ulnaris 4.4. Flexor digitorum superficialis – deep to theFlexor digitorum superficialis – deep to the other 3 muscles and is a largest superficialother 3 muscles and is a largest superficial muscle in the forearm.muscle in the forearm.
  37. 37. From lateral – medial : Flexor Carpi Radialis, Palmaris Longus, Flexor Carpi Ulnaris, Flexor Digitorum Superficialis
  38. 38. Deep Anterior CompartmentDeep Anterior Compartment MusclesMuscles  Arrange in following order from lateral toArrange in following order from lateral to medial:medial: 1.1. Flexor pollicis longusFlexor pollicis longus 2.2. Flexor digitorum profundusFlexor digitorum profundus
  39. 39. Deep Flexor Muscles: From lateral to Medial : Flexor Pollicis Longus, Flexor Digitorum Profundus (deep to flexor digitorum superficialis)
  40. 40. Superficial Posterior CompartmentSuperficial Posterior Compartment MusclesMuscles  Arrange in following order from lateral toArrange in following order from lateral to medial:medial: 1.1. Extensor carpi radialis longusExtensor carpi radialis longus 2.2. Extensor carpi radialis brevisExtensor carpi radialis brevis 3.3. Extensor digitorumExtensor digitorum 4.4. Extensor digiti minimiExtensor digiti minimi 5.5. Extensor carpi ulnarisExtensor carpi ulnaris
  41. 41. From lateral – medial : extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
  42. 42. Deep Posterior CompartmentDeep Posterior Compartment MusclesMuscles  Arrange in following order from lateral toArrange in following order from lateral to medial:medial: 1.1. Abductor pollicis longusAbductor pollicis longus 2.2. Extensor pollicis brevisExtensor pollicis brevis 3.3. Extensor pollicis longusExtensor pollicis longus 4.4. Extensor indicisExtensor indicis
  43. 43. From lateral to medial : abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis.
  44. 44. Flexor Carpi RadialisFlexor Carpi Radialis  Origin – medial epicodyle ofOrigin – medial epicodyle of humerushumerus  Insertion –base of SecondInsertion –base of Second and third metacarpalsand third metacarpals  ActionAction  Flexion and abductionFlexion and abduction hand (radial deviation) athand (radial deviation) at wrist jointwrist joint  Nerve innervations – medianNerve innervations – median nerve
  45. 45. Palmaris longusPalmaris longus  Origin – medial epicondyle ofOrigin – medial epicondyle of humerushumerus  Insertion – flexor retinaculumInsertion – flexor retinaculum and palmar aponeurosisand palmar aponeurosis (deep fascia in center of palm)(deep fascia in center of palm)  ActionAction  Weakly flexes hand at wristWeakly flexes hand at wrist jointjoint  Nerve innervations – medianNerve innervations – median nervenerve
  46. 46. Flexor Carpi UlnarisFlexor Carpi Ulnaris  Origin – medial epicondyleOrigin – medial epicondyle of humerus, proximalof humerus, proximal posterior of ulnaposterior of ulna  Insertion – pisiform, hamate,Insertion – pisiform, hamate, and base of fifth metacarpal.and base of fifth metacarpal.  Action – flexion andAction – flexion and adduction hand (ulnaradduction hand (ulnar deviation) at wrist joint.deviation) at wrist joint.  Nerve innervations – ulnarNerve innervations – ulnar nervenerve
  47. 47. Flexor digitorum superficialisFlexor digitorum superficialis  Origin – medial epicondyle of humerus, coronoid process ofOrigin – medial epicondyle of humerus, coronoid process of ulna, ridge along lateral margin of anterior surface of radius.ulna, ridge along lateral margin of anterior surface of radius.  Insertion – middle phalanx of each fingers (2Insertion – middle phalanx of each fingers (2ndnd – 5– 5thth digits)digits)  ActionAction  Flexion the proximal interphalangeal joints of 2Flexion the proximal interphalangeal joints of 2ndnd throughthrough 55thth digitsdigits  Assist flexion metacarpophalangealAssist flexion metacarpophalangeal  Assist wrist flexionAssist wrist flexion  Nerve innervations – Medial nerveNerve innervations – Medial nerve
  48. 48. Flexor digitorum superficialisFlexor digitorum superficialis
  49. 49. Flexor Pollicis LongusFlexor Pollicis Longus  Origin – anterior surface of radiusOrigin – anterior surface of radius and interosseous membrane,and interosseous membrane, medial epicondyle of humerusmedial epicondyle of humerus  Insertion – base of distal phalanxInsertion – base of distal phalanx of thumbof thumb  Action – flexes distal phalanx ofAction – flexes distal phalanx of thumb at interphalangeal joint.thumb at interphalangeal joint.  Nerve innervations – MedianNerve innervations – Median nervenerve
  50. 50. Flexor Digitorum ProfundusFlexor Digitorum Profundus  Origin - anterior medial surface of proximal body of ulnaOrigin - anterior medial surface of proximal body of ulna  Insertion – base of distal phalanx of each finger (2Insertion – base of distal phalanx of each finger (2ndnd – 5– 5thth ))  ActionAction  Flexion distal interphalangeal joint of 2Flexion distal interphalangeal joint of 2ndnd – 5– 5thth digitsdigits  Assist flexion proximal interphalangeal and MCPAssist flexion proximal interphalangeal and MCP  Assist wrist flexionAssist wrist flexion  Nerve innervations – index and middle (median nerve),Nerve innervations – index and middle (median nerve), ring and digiti minimi (ulnar nerve)ring and digiti minimi (ulnar nerve)
  51. 51. Flexor Digitorum ProfundusFlexor Digitorum Profundus
  52. 52. Flexor Digitorum Profundus (FDP) & Superficialis (FDS)  Flexor digitorum superficialis (FDS) insert into middle phalanx.  Flexor digitorum profundus (FDP) runs deep to the FDS until the level of the MP joint where FDS bifurcates.  FDP inserts at the base of the distal phalanx and acts primarily to flex the DIP joint as well as all other joints flexed by FDS.
  53. 53. Extensor Carpi Radialis LongusExtensor Carpi Radialis Longus  Origin – lateralOrigin – lateral supracondylar ridge ofsupracondylar ridge of humerushumerus  Insertion – dorsal surfaceInsertion – dorsal surface of base second metacarpalof base second metacarpal  Action – extend and abductAction – extend and abduct hand at wrist jointhand at wrist joint  Nerve innervations – RadialNerve innervations – Radial nervenerve
  54. 54. Extensor Carpi Radialis BrevisExtensor Carpi Radialis Brevis  Origin – lateral epicondyle ofOrigin – lateral epicondyle of humerushumerus  Insertion – dorsal surface ofInsertion – dorsal surface of base third metacarpalbase third metacarpal  Action - Extend and adductAction - Extend and adduct hand at wrist jointhand at wrist joint  Nerve innervations – RadialNerve innervations – Radial nervenerve
  55. 55. Extensor digitorumExtensor digitorum  Origin – lateral epicondyle of humerusOrigin – lateral epicondyle of humerus  Insertion – dorsum of distal and middle phalanges of eachInsertion – dorsum of distal and middle phalanges of each fingers (2fingers (2ndnd - 5- 5thth digits).digits).  ActionAction  Extends proximal of each finger at metacarpophalangealExtends proximal of each finger at metacarpophalangeal jointjoint  Extends distal and middle phalanges of each fingers atExtends distal and middle phalanges of each fingers at interphalangeal joint.interphalangeal joint.  Assists in Extends hand at wrist jointAssists in Extends hand at wrist joint  Nerve innervation – Radial nerveNerve innervation – Radial nerve
  56. 56. Extensor digitorumExtensor digitorum
  57. 57. Extensor digiti minimiExtensor digiti minimi  Origin – lateral epicondyle ofOrigin – lateral epicondyle of humerushumerus  Insertion – tendon of extensorInsertion – tendon of extensor digitorum on fifth phalanx.digitorum on fifth phalanx.  ActionAction  Extends proximal phalanx of littleExtends proximal phalanx of little finger at metacarpophalangealfinger at metacarpophalangeal  Extend the interphalangeal ofExtend the interphalangeal of little finger.little finger.  Nerve supply – Radial nerveNerve supply – Radial nerve
  58. 58. Extensor Carpi UlnarisExtensor Carpi Ulnaris  Origin – lateral epicondyleOrigin – lateral epicondyle of humerus and posteriorof humerus and posterior border of ulnaborder of ulna  Insertion –base of fifthInsertion –base of fifth metacarpalmetacarpal  Action – extends andAction – extends and adducts hand at wrist joint.adducts hand at wrist joint.  Nerve innervations – RadialNerve innervations – Radial nervenerve
  59. 59. Abductor Pollicis LongusAbductor Pollicis Longus  Origin – posterior surface of middleOrigin – posterior surface of middle of radius and ulna andof radius and ulna and interosseous membraneinterosseous membrane  Insertion – base of firstInsertion – base of first metacarpalsmetacarpals  ActionAction  Abducts and extends thumb atAbducts and extends thumb at carpometacarpal jointcarpometacarpal joint  Abducts hands at wrist jointAbducts hands at wrist joint  Nerve innervations – Radial nerveNerve innervations – Radial nerve
  60. 60. Extensor pollicis brevisExtensor pollicis brevis  Origin – posterior surface of middle of radius andOrigin – posterior surface of middle of radius and interosseous membrane.interosseous membrane.  Insertion – base of proximal phalanx of thumbInsertion – base of proximal phalanx of thumb  ActionAction  Extends proximal phalanx of thumb atExtends proximal phalanx of thumb at metacarpophalangeal jointmetacarpophalangeal joint  Extends1Extends1stst metacarpal of thumb at carpometacarpalmetacarpal of thumb at carpometacarpal jointjoint  Assists in radial deviation at wrist jointAssists in radial deviation at wrist joint  Nerve innervations – Radial nerveNerve innervations – Radial nerve
  61. 61. Extensor pollicis brevisExtensor pollicis brevis
  62. 62. Extensor Pollicis LongusExtensor Pollicis Longus  Origin – posterior surface of middle of ulna andOrigin – posterior surface of middle of ulna and interosseous membraneinterosseous membrane  Insertion – base of distal phalanx of thumbInsertion – base of distal phalanx of thumb  ActionAction  extend distal phalanx of the thumb at interphalangealextend distal phalanx of the thumb at interphalangeal jointjoint  Assist in extension of thumb at metacarpophalangealAssist in extension of thumb at metacarpophalangeal and carpometacarpal joint.and carpometacarpal joint.  Assist radial deviation and extension hand at wristAssist radial deviation and extension hand at wrist joint.joint.  Nerve innervations - Radial nerveNerve innervations - Radial nerve
  63. 63. Extensor pollicis longusExtensor pollicis longus
  64. 64. Extensor IndicisExtensor Indicis  Origin – posterior surface of ulna,Origin – posterior surface of ulna, interosseous membraneinterosseous membrane  Insertion – tendon of entensorInsertion – tendon of entensor digitorum of index fingerdigitorum of index finger  Action – extend distal and middleAction – extend distal and middle phalanx at IP joint, extendphalanx at IP joint, extend proximal phalanx at MCPproximal phalanx at MCP  Deep radial nerveDeep radial nerve
  65. 65. Surface anatomy of hand The tendons that are palpated with thumb abducted and extended form an anatomic snuff- box
  66. 66. Surface anatomy of hand  Flexor Tendons:  Flexor carpi radialis, flexor carpi ulnaris, and palmaris longus primarily flex the wrist
  67. 67. Intrinsic Hand MusclesIntrinsic Hand Muscles  Has a origins andHas a origins and insertions within theinsertions within the handhand  Produce weak butProduce weak but intricate and preciseintricate and precise movements of themovements of the digits (Fine motordigits (Fine motor skills)skills)
  68. 68. Intrinsic Hand MusclesIntrinsic Hand Muscles  The intrinsic muscle of the hand divided into 3The intrinsic muscle of the hand divided into 3 groups:groups:  Thenar musclesThenar muscles  Hypothenar musclesHypothenar muscles  Intermediate musclesIntermediate muscles
  69. 69. Thenar MusclesThenar Muscles  Thenar (lateral aspect of palm)  Abductor pollicis brevis  Opponens pollicis  Flexor pollicis brevis  Adductor pollicis  Move the thumb (pollex)  This 4 muscles form the thenar eminence, lateral rounded contour on the palm. (ball of the thumb)
  70. 70. Abductor PollicisAbductor Pollicis BrevisBrevis OriginOrigin  Flexor retinaculumFlexor retinaculum  ScaphoidScaphoid  TrapeziumTrapezium  InsertionInsertion  Lateral side of proximalLateral side of proximal phalanx of thumbphalanx of thumb  ActionAction  Abduct of thumb at CMCAbduct of thumb at CMC joint.joint.  Median NerveMedian Nerve
  71. 71. Opponens PollicisOpponens Pollicis  OriginOrigin  Flexor retinaculumFlexor retinaculum  TrapeziumTrapezium  InsertionInsertion  Lateral side of 1Lateral side of 1stst metacarpalmetacarpal (thumb)(thumb)  ActionAction  Opposition thumb at CMC joint.Opposition thumb at CMC joint.  Median nerveMedian nerve
  72. 72. Flexor Pollicis BrevisFlexor Pollicis Brevis  OriginOrigin  Flexor retinaculumFlexor retinaculum  TrapezoidTrapezoid  TrapeziumTrapezium  CapitateCapitate  InsertionInsertion  Lateral side of proximal phalanxLateral side of proximal phalanx of thumb.of thumb.  ActionAction  Flexion thumb at CMC andFlexion thumb at CMC and MCP joint.MCP joint.  Median and ulnar nervesMedian and ulnar nerves
  73. 73. Adductor PollicisAdductor Pollicis  OriginOrigin  Oblique head – Capitate and 2Oblique head – Capitate and 2ndnd and 3and 3rdrd metacarpalsmetacarpals  Transverse head – 3Transverse head – 3rdrd metacarpalmetacarpal  InsertionInsertion  Medial side of proximal phalanx ofMedial side of proximal phalanx of thumbthumb  Action – adduct thumb at CMC andAction – adduct thumb at CMC and MCPMCP  Ulnar NerveUlnar Nerve
  74. 74. Hypothenar Muscles  Medial aspect of palm  Abductor digiti minimi  Flexor digiti minimi brevis  Opponens digiti minimi  Move the digiti minimi  This 3 muscles form the hypothenar muscles (medial rounded contour in the palm) – ball of the little finger
  75. 75. Abductor digiti minimiAbductor digiti minimi  OriginOrigin  Tendon flexor carpi ulnarisTendon flexor carpi ulnaris  PisiformPisiform  InsertionInsertion  Medial side of proximal phalanxMedial side of proximal phalanx of little fingers.of little fingers.  ActionAction  Abduction little finger at MCPAbduction little finger at MCP  Assist flexion little finger atAssist flexion little finger at MCPMCP
  76. 76. Flexor digiti minimiFlexor digiti minimi brevisbrevis  OriginOrigin  Flexor retinaculumFlexor retinaculum  HamateHamate  InsertionInsertion  Medial side of proximalMedial side of proximal phalanx of little fingersphalanx of little fingers  Action – flexion little finger atAction – flexion little finger at MCP, assist opposition little fingerMCP, assist opposition little finger at CMCat CMC  Ulnar nerveUlnar nerve
  77. 77. Opponens DigitiOpponens Digiti MinimiMinimi  OriginOrigin  Flexor retinaculumFlexor retinaculum  HamateHamate  InsertionInsertion  Medial side of entire lengthMedial side of entire length fifth metacarpals (little finger)fifth metacarpals (little finger)  ActionAction  Opposition little finger atOpposition little finger at CMCCMC  Ulnar nerveUlnar nerve
  78. 78. Intermediate MuscleIntermediate Muscle  Midpalmar / intermediate (11 muscles)  Lumbricals  Palmar interossei  Dorsal interossei  Acts on all the digits  Important muscles for movements in skilled activities (playing piano , writing, typing, precision handling etc)
  79. 79. Lumbricals  Consists of 4 musclesConsists of 4 muscles  OriginOrigin  Lateral and adjacent side of tendons of flexorLateral and adjacent side of tendons of flexor digitorum profundus of each fingers (2digitorum profundus of each fingers (2ndnd – 5– 5thth ))  InsertionInsertion  Lateral side of tendon of extensor digitorum onLateral side of tendon of extensor digitorum on proximal phalanges of each fingers (2proximal phalanges of each fingers (2ndnd – 5– 5thth ))  ActionAction  Flexion each finger at MCP and extend each finger atFlexion each finger at MCP and extend each finger at IPIP  Median and ulnar nerveMedian and ulnar nerve
  80. 80. Lumbricals Flexor Digitorum Profundus 1st lumbricals Insertion to tendon of Extensor digitorum 4th lumbricals
  81. 81. Palmar interosseiPalmar interossei  4 muscles  Origin  Sides of shafts of metacarpals of all digits (except the middle one)  Insertion  Side of bases of proximal phalanges of all digits (except the middle finger)  Action  Adduction each finger at MCP assists in Flexion each finger at MCP  Ulnar nerves
  82. 82. Dorsal InterosseiDorsal Interossei  4 muscles4 muscles  OriginOrigin  Adjacent side of metacarpalsAdjacent side of metacarpals  InsertionInsertion  Proximal phalanx of each fingerProximal phalanx of each finger  ActionAction  Abduction Finger 2-4 at MCPAbduction Finger 2-4 at MCP  Assist Flexion Finger 2-4 at MCPAssist Flexion Finger 2-4 at MCP and extension at IP at the sameand extension at IP at the same fingerfinger  Ulnar nerveUlnar nerve
  83. 83. Carpal TunnelCarpal Tunnel  Concave space located at the palmarConcave space located at the palmar surface of the wrist.surface of the wrist.  Formed by medially by pisiform andFormed by medially by pisiform and hamate and laterally by scaphoid andhamate and laterally by scaphoid and trapezium.trapezium.  Cover by flexor retinaculum on the roofCover by flexor retinaculum on the roof side.side.
  84. 84. Carpal TunnelCarpal Tunnel  10 structures passed through this10 structures passed through this passageway.passageway.  4 flexor digitorum superficialis4 flexor digitorum superficialis  4 flexor digitorum profundus4 flexor digitorum profundus  1 flexor pollicis longus1 flexor pollicis longus  Median nerveMedian nerve
  85. 85. Thank YouThank You For YourFor Your UnbelievableUnbelievable Attention!!!Attention!!!

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