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.

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

3. 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

4. HandHand
 Hand composed by a bony framework :Hand composed by a bony framework :
 8 carpals bones8 carpals bones
 5 metacarpals5 metacarpals
 14 phalanges14 phalanges

6. 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

8. 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)
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10. 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

11. 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

12. 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 ..

13. Anatomy of Carpal Tunnel

14. Carpal Turnel SyndromeCarpal Turnel Syndrome

15. 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.

16. Flexor
Retinaculum

17. 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.

18. Extensor
Retinaculum

19. 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)

20. MetacarpalsMetacarpals
 Divide into:Divide into:
 Proximal baseProximal base
 Intermediate shaftIntermediate shaft
 Distal headDistal head

21.  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

22. MetacarpalsMetacarpals
Proximal base
Intermediate Shaft
Distal Head

23. 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.

24.  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

25.  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

26. 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.

27.  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

28. 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

30. 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

31. Wrist MovementWrist Movement

32. Thumb MovementThumb Movement
Thumb opposition Thumb adduction Thumb abduction

33. Adduction / abduction digits at MCPAdduction / abduction digits at MCP

34. Thumb extension / flexion atThumb extension / flexion at
MCP / CMCMCP / CMC

35. Flexion Digit at PIP / DIPFlexion Digit at PIP / DIP

37. 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)

38. Extrinsic Hand MusclesExtrinsic Hand Muscles

39. 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.

40. 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.

41. 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

42. 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.

44. From lateral – medial : Flexor Carpi Radialis, Palmaris Longus, Flexor
Carpi Ulnaris, Flexor Digitorum Superficialis

45. 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

46. Deep Flexor Muscles: From lateral to Medial : Flexor Pollicis Longus,
Flexor Digitorum Profundus (deep to flexor digitorum superficialis)

47. 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

48. From lateral – medial : extensor carpi radialis longus, extensor carpi radialis brevis,
extensor digitorum, extensor digiti minimi, extensor carpi ulnaris

49. 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

50. From lateral to medial : abductor pollicis longus, extensor pollicis brevis,
extensor pollicis longus, extensor indicis.

51. 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

52. 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

53. 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

54. 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

55. Flexor digitorum superficialisFlexor digitorum superficialis

56. 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

57. 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)

58. Flexor Digitorum ProfundusFlexor Digitorum Profundus

59. 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.

60. 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

61. 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

62. 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

63. Extensor digitorumExtensor digitorum

64. 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

65. 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

66. 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

67. 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

68. Extensor pollicis brevisExtensor pollicis brevis

69. 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

70. Extensor pollicis longusExtensor pollicis longus

71. 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

72. Surface anatomy of hand
The tendons that are
palpated with thumb
abducted and extended
form an anatomic snuff-
box

73. Surface anatomy of hand
 Flexor Tendons:
 Flexor carpi
radialis, flexor
carpi ulnaris,
and palmaris
longus primarily
flex the wrist

75. 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)

76. 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

77. 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)

79. 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

80. 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

81. 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

82. 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

83. 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

85. 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

86. 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

87. 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

88. 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)

89. 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

90. Lumbricals
Flexor Digitorum
Profundus
1st
lumbricals
Insertion to tendon of
Extensor digitorum
4th
lumbricals

94. 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

96. 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

98. 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.

99. 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

101. Thank YouThank You
For YourFor Your
UnbelievableUnbelievable
Attention!!!Attention!!!