Anatomy - Upper Limb

1. Palm
• Skin
• superficial fascia- Palmaris brevis
• Deep fascia
Flexor retinaculum
Palmar aponeurosis
fibrous flexor sheath
• Synovial sheaths of long flexor tendon
Ulnar bursa
Radial bursa
Digital synovial sheath
vincula longa & brevia
• Intrinsic muscles-
• Thenar
• Hypothenar
• Lumbricals
• Interossei
• Arteries of hand
• Superficial palmar arch
• Deep palmar arch
• Nerves
• Fascial spaces of hand
• Pulp spaces of digits

2. CUTANEOUS NERVE SUPPLY

3. PALMARIS BREVIS
SUPERFICIAL FASCIA OF PALM
SUPERFICIAL TRANSVERSE METATARSAL LIGAMENT

4. DEEP FASCIA OF PALM

5. Flexor retinaculum
• Attachment
• Relations
• Applied-carpal tunnel syndrome

6. Attachments of Flexor Retinaculum

7. Relations of Flexor Retinaculum

8. CARPAL TUNNEL SYNDROME
Cause
• Tenosynovitis of flexor tendons
• Myxedema
• Retention of fluid in pregnancy
• Fracture dislocation of lunate
• osteoarthritis
Features
Sensory
• feeling of burning pain in lateral three and
half digits especially at night
Motor
• weakness of thenar muscles
• ape thumb deformity
• Positive Tinel’s sign and Phalen;s test

10. PALMAR APONEUROSIS
• Features- apex, base, medial and
lateral border
• Function- improves grip and protects
tendons, nerves & blood vessels
• Applied- Dupuytren’s contracture

11. DUPUYTRENS CONTRACTURE

12. FIBROUS FLEXOR SHEATH

13. Fibrous flexor sheath

14. TRIGGER FINGER

15. SYNOVIAL SHEATH OF LONG FLEXOR TENDONS
• Ulnar bursa
• Radial bursa
• Digital synovial sheath
• Functions

16. Vincula

17. INTRINSIC MUSCLES OF PALM
1. PALMAR INTEROSSEI
2. DORSAL INTEROSSEI
3. LUMBRICALS
4.THENAR MUSCLES-
• Abductor pollicis brevis
• Flexor pollicis brevis
• Opponens pollicis
• Adductor pollicis
5.HYPOTHENAR MUSCLES-
• Abductor digiti minimi
• Flexor digiti minimi
• Opponens digiti minimi
• Palmaris brevis

19. INTEROSSEI

20. LUMBRICALS

21. INSERTION OF LUMBRICAL AND INTEROSSEI

22. THENAR MUSCLES- ADDUCTOR POLLICIS

23. THENAR MUSCLES-

24. THENAR MUSCLES-

25. HYPOTHENAR MUSCLES-

26. THENAR MUSCLES-
• Abductor pollicis brevis
• flexor pollicis brevis
• opponens pollicis
HYPOTHENAR MUSCLES-
• Abductor digiti minimi
• Flexor digiti minimi
• Opponens digiti minimi
• Palmaris brevis

27. NERVES AND BLOOD VESSELS OF
FOREARM AND HAND

28. NERVES
• ULNAR
• MEDIAN
(ant interosseous)
• RADIAL
(post interosseous)
ARTERY
• BRACHIAL
• ULNAR
(Ant & post interosseous)
• RADIAL

29. MEDIAN NERVE (5)
MUSCULAR BRANCH
• ABDUCTOR POLLICIS BREVIS
• FLEXOR POLLICIS BREVIS
• OPPONENS POLLICS
• 1 &2 LUMBRICALS
CUTANEOUS BRANCH
• 3- PROPER PALMAR DIGITAL NERVE
• 2- COMMON DIGITAL NERVE
ULNAR NERVE (15)
MUSCULAR BRANCH
• ADDUCTOR POLLICS
• HYPOTHENAR MUSCLES
• 3 & 4 LUMBRICALS
• INTEROSSEI
CUTANEOUS BRANCH
• 1- PROPER PALMAR DIGITAL NERVE
• 1- COMMON DIGITAL NERVE
NERVES IN HAND

30. NERVES AND BLOOD VESSELS IN FOREARM

31. ULNAR
• Muscular
• Ant & post ulnar collateral
• Common interosseous
• Ulnar carpal
• Terminal
RADIAL
• Muscular
• Radial recurrent
• Palmar carpal
• Superficial palmar branch
BLOOD VESSELS IN FOREARM

32. BLOOD VESSELS IN HAND

33. PALMAR ARCHES IN HAND
• Superficial
• Common digital
• Proper digital
• Cutaneous
• Deep
• Palmar metacarpal
• Perforating
• Recurrent

34. DORSUM OF HAND
Skin
Superficial fascia
Deep fascia
Extensor tendons of hand
Dorsal digital expansion
Anatomical snuff box
Arteries
Nerves

35. CUTANEOUS NERVE

37. SUPERFICIAL FASCIA

38. EXTENSOR RETINACULUM

40. EXTENSOR TENDONS OF DORSUM OF HAND

42. ANATOMICAL SNUFF-BOX

43. ANATOMICAL SNUFF-BOX

45. SENSORY SUPPLY OF BACK OF UPPER LIMB-RADIAL NERVE

46. SPACES OF HAND
A. PALMAR SPACES
• Midpalmar
• Thenar
• Pulp
B. DORSAL SPACES
• Dorsal subcutaneous
• Dorsal subaponeurotic
C. SPACE OF PARONA

53. WRIST DROP

54. HAND MEDIAN NERVE (5)
MUSCULAR BRANCH
• ABDUCTOR POLLICIS BREVIS
• FLEXOR POLLICIS BREVIS
• OPPONENS POLLICS
• 1 &2 LUMBRICALS
CUTANEOUS BRANCH
• 3- PROPER PALMAR DIGITAL NERVE
• 2- COMMON DIGITAL NERVE

57. ULNAR NERVE (15)
MUSCULAR BRANCH
• ADDUCTOR POLLICIS
• HYPOTHENAR MUSCLES
• 3 & 4 LUMBRICALS
• INTEROSSEI
CUTANEOUS BRANCH
• 1- PROPER PALMAR DIGITAL NERVE
• 1- COMMON DIGITAL NERVE