Anatomy of the hand

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  • Plate 439B /439A
  • Gelberman 416, 417 ,421,422 fig 29.2,29.3 ,29.4,29.5
  • Anatomy of the hand

    1. 1. ANATOMY OF THE HAND BY Dr. J . M . Hassanain
    2. 2. ♦ Hand function is an important feature in humans over other primates who lack fine control and precision
    3. 3. EMBRYOLOGY OF THE UPPER LIMB♦Limb buds first appear as small elevations on ventro lateral body end of fourth week.
    4. 4. Each limb bud :Mesenchyme derived fromsomatic mesoderm which iscovered by a layer of ectoderm
    5. 5. ♦ Distal end of bud form flipper like limbs.♦ Later bones develop and myoblast aggregate to develop muscle mass .
    6. 6. ♦ Upper limb rotates laterally 90 degrees♦ Specific dermatone ( which is skin area supplied by a single spinal nerve )
    7. 7. ANATOMY♦Bony skeleton♦Muscles and soft tissues♦Vessels and nerves
    8. 8. BONY SKELETON♦ Wrist joint composed of multiple carpal bone articulating with the radius proximally and five metacarpals distally
    9. 9. ♦ Proximal row of carpal bone (radial to ulnar) scafoid , lunate , traquetral , pisiform♦ Distal row trapezium , trapazoid , capitate , hamate
    10. 10. BONES OF THE HAND ♦5 Metacarpals ♦Thumb is no. 1 ♦Little finger is no. 5
    11. 11. PHALANGES♦ All fingers have 3 phalanges proximal middle distal♦ Except thumb has 2 proximal distal
    12. 12. ♦ Most of tendon in the hand originate in muscles arising from the forearm♦ Flexor on volar aspect of forearm must arise from common flexor tendor (medial epicondyle )
    13. 13. ♦Extensors on dorsal aspect of the forearm arise from common extensor tender on lateral epicondyl
    14. 14. ♦ In the hand ulnar side hypo thenar muscles acting on the little fingers:♦ Abductor digitiminimi♦ Flexor digitiminimi brevis♦ Opponens digitiminimi
    15. 15. ♦ Radial side thenar muscle acting on the thumb♦ Flexor, adductor pollices♦ Abductor pollices brevis♦ Opponen pollices brevis
    16. 16. ♦Long flexors fl. digitorum superficialus fl. digitorum profundus♦Act on all the fingers
    17. 17. Intrinsic♦Lumbrical♦Dorsal♦Ventral interrosies
    18. 18. Vascular Supply of Hand♦ Radial artery :♦ Superficial palmer branch superficial palmer arch ,which arises above the wrist♦ Common palmer digital♦ Deep palmer branches♦ Deep palmer arch  palmer metacarpal arteries which joins the common digital♦ Ulnar artery  superficial palmer branch joins on side of pisiform of superficial palmer branch
    19. 19. VENOUS DRAINAGE OF HAND♦ Via : Dorsal digital vein  dorsal venous arch♦ Basillic vein in front of forearm
    20. 20. Peripheral nerve entrapment♦There is a disproportion between volume of the peripheral nerve and space within the extremity through which it passes
    21. 21. Applied Anatomy of Ulnar Nerve♦Arises directly from the medial cord of brachial plexus (C8-T1)♦Lies between axillary artery laterally and axillary vein medially
    22. 22. ♦ At inferior border of subscapularis muscle nerve receives fiber of C7 ( lat. root of ulnar nerve )♦ Descend in arm post. to pectoralis major muscle ( posterio medial to brachial artery)
    23. 23. ♦8 cm above medial epicondyl with branch of superior ulnar collateral artery diverge medially from brachial artery to pierce medial intramuscular septum
    24. 24. ♦ Together descend on medial head of triceps♦ Nerve passes in ulner groove dorsal aspect of medial epicondyl♦ It innervates fl. carpi ulnaris 0.5-1 cm above medial epicondyl
    25. 25. Potential points of compression in the arm♦ Ulnar nerve fibers ( medial cord ) 1st rib as nerve passes between rib & clavicle♦ 8 cm proximal to medial condyl as nerve pierce intramuscular septum ( arcade of Struther )♦ Hypertrophy of medial head of triceps may force nerve anteriorly, as triceps contract, nerve get compressed
    26. 26. Ulnar Nerve at Elbow &Forearm♦ In cubital fossa ulnar nerve passes through fibro-osseous tunnel♦ As it leaves the canal it lies between the flexor corpi ulnanis and flexor digitorum profundus till middle of forearm
    27. 27. ♦ In distal 1/3 lies just radial to the flexor corpi ulnaris♦ Straight line drawn from medial epicondyl to radial margin of pisiform marks the line of the nerve
    28. 28. Supply of ulnar nerve in forearm♦ Muscular branch to fl. Digitorum profundus ( i.e. ulner ½ ) 3 cm distal to medial epicondyl♦ Palmer cutanous branch♦ Dorsal cutanous branch
    29. 29. Ulnar nerve enters hand♦ From under fl corpi ulnaris muscle , nerve and artery♦ Radial to pisiform , superficial to transverse carpel lig. and dorsal to superficial palmer lig.♦ Ulnar nerve divide to : deep terminal branch superficial palmer branch
    30. 30. Muscle supplied by ulnar nerve♦ Flexor corpi ulnaris♦ Flexor digitorum profundus ( medial 2 tendons )♦ Flexor digiti minimi♦ 2 ,3 ,4th web space interossei♦ 3rd & 4th lumbricle♦ Adductor pollicis♦ 1st dorsal interosseous
    31. 31. Sensory Supply of Ulnar Nerve♦ Dorsal cutanous branch of ulnar : skin dorsoulnar side of hand , little finger and ulnar ½ of index finger♦ Medial cutanous nerve of forearm : C8-T1 skin over biceps elbow crease
    32. 32. Anatomical Sites of Compression♦ Points in elbow and forearm♦ Anconeus epitrochlearis muscle♦ Fibrous arcade between 2 heads of fl. carpi ulnaris
    33. 33. Site of compression in hand &wrist♦ Palmaris brevus muscle♦ Fibrous origin of fl digitiminmi♦ Ulnar artery aneurysm or thrombosis♦ Distal ulnar tunnel ganglia
    34. 34. MEDIAN NERVE♦ Arises from lateral & medial cords of brachial plexus♦ Contain fibers C5 –T1♦ Forms antrolat to 3rd portion of axillary artery in upper 1/3 of arm
    35. 35. ♦ In the arm it descends post. to pectoralis major muscle, lateral to brachial artery, antromedial to brachialis muscle, posteromedial to biceps♦ In mid portion of arm, median nerve crosses ant to brachial artery to lie on its medial side to enter the cubital fosse
    36. 36. ♦ The nerve enters forearm between humeral and ulnar head of pronater teres♦ Then runs between fl digitorum superficialis and fl digitorum profundus, later emerges 5 cm above wrist radial to tendon of palmaris longus
    37. 37. MEDIAN NERVE IN THE WRIST♦ It enters the wrist dorsal to transverse carpal lig through the carpal tunnel
    38. 38. Boundaries Of Carpal Tunnel♦ Dorsally: radio carpal lig.♦ Radially: scaphoid & trapezium♦ Palmorly: transverse carpal lig.♦ Ulnary: hood of hamate & pisiform
    39. 39. After exiting carpal tunnel♦ Median nerve splits to two parts♦ Common digital nerve to thumb♦ Proper digital nerve to radial side of index♦ Ulnar division of median nerve; common digital to 2nd & 3rd web
    40. 40. Muscle supplied by median nerve♦ Forearm♦ Pronator teres♦ Flexor digitorum superficialis♦ Flexor carpi radialis♦ Palmaris longus♦ Flexor digitorum profundus♦ Flexor pollicis longus♦ Pronator quadratus
    41. 41. HAND♦ Flexor pollicis brevis♦ Abductor pollicis brevis♦ Opponens pollicis♦ First lumbrtical♦ Second lumbrical
    42. 42. Anatomical compression points of the median nerve♦ ARM:♦ Pectoralis minor muscle♦ Anomalous axillary arch muscles♦ Anomalous vascular arches in the axilla♦ Deltopectoral fascia♦ Supracondyloid process♦ Ligament of Struthers
    43. 43. FOREARM♦ Lacertus fibrosus♦ Pronator teres muscle♦ Flexor digitorum superficialis arch♦ Anomalous muscles♦ Ulnar collateral or radial artery branches
    44. 44. HAND / WRIST♦ Carpal tunnel♦ Palmar cutaneous branch within the transverse retinacular ligament
    45. 45. RADIAL NERVE♦ Arises from the post cords of the brachial plexus behind 3rd part of axillary artery♦ Neural element of C5 – C8♦ Proximal 1/3 of arm nerve descends behind brachial artery ant to subscapularis ,teres major ,latissmus dorsi muscle and long head of triceps
    46. 46. ♦ At junction of upper and middle 1/3 of arm deviates dorsolaterally between medial and long head of triceps lying adjacent to spiral groove of humerus
    47. 47. ♦ 10 cm above lat humeral epicondyl lying between the brachialis and brachioradialis then lies between brachialis and extensor carpi radialis ant to tip of lat epicondyl dividing into : Superficial Deep branches
    48. 48. Radial Nerve In Forearm♦ Superficial branch ant to supinator muscle proximal 1/3 then deep to brachioradialis♦ The sup branch pierces the fascia on the brachioradialis on the ulnar side of tendons 7cm above wrist♦ On the dorsoradial side of wrist it divides into 5 dorsal digital nerves and only one branch to extensor carpi radilalis brevus muscle
    49. 49. ♦ Post interosseous nerve (deep terminal branch of radial nerve ) innervates extensor muscle of wrist♦ It is seperated from the radium by deep head of supinator♦ After leaving the supinator it lies between the abductor pollies and other extensors of forearm
    50. 50. ♦ In distal forearm it penetrates the extensor pollies brevus to lie in the interosseous membrane♦ Distally it divides to give sensory innervation to the wrist
    51. 51. Muscles supplied by radial nerve ♦ Triceps : long head medial head lateral head ♦ Anconeus ♦ Brachioradialis ♦ Extensor carpi longus ♦ Extensor carpi radialis brevis
    52. 52. Muscles supplied by radial nerve ♦ Extensor carpi ulnaris ♦ Extensor digitorum communis ♦ Extensor digiti minimi ♦ Abductor pollicis longus ♦ Extensor pollicis longus ♦ Extensor pollicis brevis ♦ Extensor indicis proprius
    53. 53. Anatomical compression points of the radial nerve ♦ ARM: ♦ Accessory subscapularis teres latissimus ♦ Lateral head of the triceps muscle ♦ Lateral intermuscular septum
    54. 54. ♦ FOREARM:♦ Posterior interosseous nerve within radial tunnel♦ Fibrous bands attached to radiocapitelar joint♦ Extensor carpi radialis brevis muscle♦ Arcade of Frohse♦ Fibrous bands within the supinator muscle
    55. 55. ♦ Superficial radial nerve♦ Between brachioradialis muscle & radial shaft♦ Between brachioradialis and extensor carpi radialis longus tendons
    56. 56. THANK YOU♦ THE END

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