2. THE SKIN
• PALM: characteristics:
1. Flexure creases (lines of palm)
2. Papillary ridges (fingerprints):
improve grip & increase surface area
3. Fibrous bands connecting it to palmar
aponeurosis & dividing subcutaneous
fat into small loculi (water-cushion
withstanding considerable pressure)
4. Abundant sweat gland
3. SUPERFICIAL FASCIA
• PALM: characteristics:
1. Contains: cutaneous nerves & vessels
2. Contains: Palmaris brevis (increases
the hollow of palm to get a firmer grip
4. DEEP FASCIA
• PALM: thickened
at 3 sites:
Palmar aponeurosis:
• Definition
• Description
• Function
• Clinical anatomy:
Dupuytren’s
contracture
5. PALMAR APONEUROSIS
• DEFINITION: It is a thickening of deep fascia in the
middle of the palm
• DESCRIPTION: It is triangular in shape:
1. Apex: directed proximally, continuous with tendon
of palmaris longus
2. Base: directed distally, divided into 4 slips for the
medial 4 fingers
3. Margins: send septa to metacarpal bones
separating the structures under the aponeurosis
from thenar & hypothenar muscles
• FUNCTION: It protects the underlying tendons,
vessels & nerves
• CLINICAL ANATOMY: DUPUYTREN’S
CONTRACTURE: shortening of the medial part of
aponeurosis resulting in flexion of the little & ring
fingers
7. FLEXOR RETINACULUM
• DEFINITION: It is a thickening of deep fascia
that lies over the front of the carpal bones
converting the carpal groove (formed by
carpal bones) into a tunnel
• ATTACHMENTS:
1. Lateral: by 2 laminae: superficial (to
tubercles of scaphoid & trapezium) & deep
(to the medial lip of the groove on the
trapezium)
2. Medial: to pisiform & hook of hamate
8. FLEXOR RETINACULUM
• RELATIONS:
• Superficial: from lateral to medial:
1. Superficial palmar branch of radial artery
2. Palmar cutaneous branch of median nerve
3. Tendon of palmaris longus
4. Palmar cutaneous branch of ulnar nerve
5. Ulnar vessels
6. Ulnar nerve
• Deep: Structures passing through carpal tunnel
1. Tendon of FPL & its synovial sheath (radial bursa)
2. Tendons of FDS & FDP & their common synovial
sheath (Ulnar bursa)
3. Tendon of FCR & its synovial sheath ( in a special
compartment)
4. Median nerve
9. FLEXOR RETINACULUM
• FUNCTION: It keeps the flexor tendons
in position during movement of wrist
joint
• CLINICAL ANATOMY (CARPAL TUNNEL
SYNDROME): Compression of median
nerve under the flexor retinaculum
11. FIBROUS FLEXOR SHEATH
• DEFINITION: It is a thickening of deep
fascia in front of the fingers
• ATTACHMENTS:
1. Proximal: to the slips of palmar
aponeurosis
2. Distal: to the base of distal phalanx
3. On either side: to the side of phalanx
• FUNCTION: It holds the long flexor
tendons during flexion of the fingers
12. INTRINSIC MUSCLES
• LATERAL GROUP:
FOUR THENAR MUSCLES
• MEDIAL GROUP:
THREE HYPOTHENAR MUSCLES
PALMARIS BREVIS
• CENTRAL GROUP:
FOUR LUMBRICALS
FOUR PALMAR INTEROSSEI
FOUR DORSAL INTEROSSEI
• ALL MUSCLES ARE SUPPLIED BY C8 & T1 SPINAL
SEGMENTS THROUGH MEDIAN & ULNAR NERVES
15. INTRINSIC MUSCLES
• THENAR MUSCLES
1. Have general origin (lateral side of flexor
retinaculum & lateral 2 carpal bones: scaphoid &
trapezium) EXCEPT adductor pollicis (transverse
head: 3rd metacarpal bone, oblique head: 2nd & 3rd
metacarpal + 2nd & 3rd carpal bones: trapezoid &
capitate)
2. Have general insertion (proximal phalanx of thumb)
EXCEPT opponens pollicis (1st metacarpal)
• HYPOTHENAR MUSCLES
1. Have general origin (medial side of flexor
retinaculum & medial 2 carpal bones: pisiform &
hamate
2. Have general insertion (proximal phalanx of little
finger) EXCEPT opponens digiti minimi (5th
metacarpal bone)
16. INTRINSIC MUSCLES
• LUMBRICALS
1. Origin: tendons of FDP
2. Insertion: tendons of ED
• PALMAR INTEROSSEI
1. Origin: metacarpal bone
2. Insertion: proximal phalanx
• DORSAL INTEROSSEI
1. Origin: adjoining sides of 2 metacarpal bone
2. Insertion: proximal phalanx
• PALMARIS BREVIS
1. Origin: Palmar aponeurosis
2. Insertion: skin of medial border of hand
17. ARTERIAL ARCHES IN HAND
• SUPERFICIAL
PALMAR ARCH
• DEEP PALMAR
ARCH
1. Formation
2. Site
3. Surface anatomy
4. Branches
18. SUPERFICIAL PALMAR ARCH
• FORMATION:
1. Direct continuation of ulnar artery (mainly)
2. Superficial branch of radial artery
• SITE: between palmar aponeurosis & long flexor
tendons
• SURFACE ANATOMY: level with the distal border of
the fully extended thumb
• BRANCHES: digital branches to the medial three &
half fingers
• N.B.: Radial artery gives 2 branches that supplies
the lateral one & half fingers:
1. Radialis indicis: supplies lateral side of index
2. Princeps pollicis: supplies both sides of thumb
19. DEEP PALMAR ARCH
• FORMATION:
1. Direct continuation of radial artery (mainly)
2. Deep branch of ulnar artery
• SITE: between long flexor tendons &
metacarpal bones
• SURFACE ANATOMY: lies one inch
proximal to superficial palmar arch
• BRANCHES:
1. Branches sharing in anastomosis around
wrist joint
2. Articular & muscular branches
