anatomy of the hand

1. HAND AND
WRIST JOINT
Essam Eldin Abdel Hady Salama

2. Skeleton of the hand
• Composed of
• Carpus
• Metacarpus
• Phalanges

3. Carpus
Proximal row
From lateral to medial
Scaphoid
Lunate
Triquitral
Pisiform

4. Carpus
Distal row
From lateral to medial
trapezium
Trapezoid
Capitate
Hamate

5. Metacarpus
5 metacarpus
From lateral to medial;
1st,2nd ,3rd,4th,and 5th
Each one is composed of
Proximal end (base)
Shaft
Distal end (head)

6. Phalanges
14 in number
Two for the thumb (proximal
phalanx and distal or
terminal phalanx)
Three for each of the medial
four fingers (proximal
phalanx, middle phalanx and
distal or terminal phalanx)
Each phalanx is composed of
Proximal end (base)
Shaft
Distal end (head)

7. Dorsum of the hand

8. Extensor retinaculum
Attachments:
Laterally; lower part
anterior part of the
radius
Medially; triquetral and
pisiform bones

9. Structures superficial to the retinaculum
Beginning of cephalic
vein
Beginning of basilic
vein
Terminal branches of
the radial nerve

10. Structures passing deep to the retinaculum
1st compartment;
Abductor pollicis longus
Extensor pollicis brevis.
2nd compartment;
Extensor carpi radialis longus
Extensor carpi radialis longus
3rd compartment;
Extensor pollicis longus
4th compartment;
1. Extensor digitorum
2. Extensor indicis
3. Extensor part of posterior interosseous nerve
4. Extensor part of anterior interosseous artery.
5th compartment;
Extensor digiti minimi.
6th compartment;
Extensor carpi ulnaris.

11. Synovial sheath of the extensor tendons
Each tendon has its synovial
sheath except extensor
digitorum and extensor
indicic have a common
sheath
They begin just above the
retinaculum down to the
insertion
Except that of extensor
digitorum , extensor indicic
and extensor digiti minimi
which end in the middle of
the dorsum of the hand

12. Extensor expansion
Formed on the dorsum of the proximal phalanges of the medial 4 fingers by
tendon of extensor digitorum
Each is supplemented by tendons of one lumbrical, two interossei
For the indix receives the extensor indicis and that of little finger receives
extensor digiti minimi
It divides into three slips middle attached to the base of the middle phalanx
and two collateral attached to the base of the terminal phalanx

13. Palm of the hand

14. Palmar aponeurosis
Triangular thickening
in deep facial of the
palm

15. Flexor retinaculum and carpal tunnel
Attachments:
Medially to pisiform and hook of
hamate
Laterally; to tubercle of scaphoid and
crest of trapezium
Structures passing in front of the
retinaculum
Ulnar nerve
Ulnar Artery
Palmar cutaneous branch of Ulnar
nerve
Tendon of palmaris longus
Palmar cutaneous branch of median
nerve

16. Flexor retinaculum and carpal tunnel
Structures passing deep to the
retinaculum (carpal tunnel)
Tendon of flexor carbi radialis and its
synovial sheath
Tendon of flexor digitorum superficialis
Tendon of flexor digitorum profundus
Tendon of flexor pollicis longus
Median nerve
Synovial sheath of Tendon of flexor pollicis
longus
Common flexor sheath

17. Short muscles of the thumb
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
adductor pollicis

18. Short muscles of the little finger
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi

19. Short muscles of the hand
Lumbrical muscles :
Four in numbers
Arise fro lateral side of tendon of flexor
digitorum profundus and join the
extensor expiation
The first and second are supplied by the
median nerve
The third and fourth are supplied by the
deep branch of the ulnar nerve
Action; they with the interossei muscles
flex metacarpopfalgeal and extend the
interphalangeal joints (writing position)

20. Short muscles of the hand
Palmar interossei muscles :
Four in numbers
Arise from the metacarpal bone
on which it acts, and join the
extensor expiation
They are supplied by the deep
branch of the ulnar nerve.
Action; they adduct the fingers to
the middle line of the middle
finger

21. Short muscles of the hand
Dorsal interossei muscles :
Four in numbers
Arise from the adjacent sides of two
metacarpal bone,
The 1st is inserted in the proximal phalanx
of the index and the extensor expiation.
The 2tnd and 3rd reach the middle finger.
The 4th reaches the little finger
They are supplied by the deep branch of
the ulnar nerve.
Action; they abduct the fingers from the
middle line of the middle finger (fanning
of the fingers).

22. Ulnar artery
Enters the hand superficial to
the flexor retinaculum
Gives deep branch to
complete the deep palmar
arch
Curves laterally to form the
superficial palmar arch

23. Superficial palmar arch
Its formed by continuation of the
ulnar artery
It is completed by the superficial
palmar branch of the radial artery.
It lies deep to the palmar
aponeurosis in front of the branches
of median nerve, the long flexor
tendons and lumbrical muscles.
The arch gives four palmar digital
arteries which supply the medical
three and half fingers.

24. Radial artery
Above the wrist it curves backwards
to run in the floor of the anatomical
snuff box on the lateral ligament of
the wrist.
It is crossed by the tendons of
abductor pollicis longus, beginning of
the cephalic vein and terminal
branches of radial nerve.
It dips between the two heads of the
first dorsal intersseous to reach the
palm where it forms the deep palmar
arch.

25. Branches
Posterior carpal artery
First dorsal metcarpal artery
Princeps pollicis
Radialis indicis
Deep palmar arch;
It is formed by continaution of the
radial artyey
Lies on inerossi muscles infront of
bases of metacarpal bones deep to
flexor tendons and lumbricals
It is completed by deep branch of ulnar
aretry
It gives 3 palmar metacarpal arteries
3 perforating arteries
Recurrent branches

26. Median nerve
Enters the palm deep to the flexor
retinaculum
Divides into; medial and lateral
branches
It supplies;
muscles of the thenar eminence
1st and 2nd lumbricals
Lateral three and half fingers

27. Ulnar nerve
Enters the palm superficial to the
flexor retinaculum
Divides into:
Superficial branch; gives digital
branches to medial one and half
fingers
Deep branches; gives muscular to the
hypothenar muscles
3rd and 4th lumbricals
All palmar and dorsal interossei
Abductor pollicis
Articular to wrist, intermetacarpal,
carpometacarpal, and intercarpal
joints

28. Wrist joint
It is an ellipsoid synovial joint
Articular surfaces; carpal (inferior)
surface of radius
Inferior surface of the articular disc
Proximal row articular srfaces
Capsular attachment; to the
margins of the articular surfaces
Thickened by palmar, dorsal, ulnar
collateral and radial collateral
ligaments.

29. Arterial and nerve supply
Arterial supply; anterior
and posterior carpal
arches and deep palmar
arch
Nerve supply; anterior
and posterior interosseis
nerves

30. Movements of the wrist joint

31. THANK YOU
and
GOOD LUCK