General Anatomy Snell clinical anatomy (credits)

1. By: Dolor Jaira Ishael G

2. Short Muscle of the Little
Finger
1. Abductor digiti minimi
2. Flexor digiti minimi brevis
3. Opponens digiti minimi
Which together form the hypothenar eminence

4. Opposition of the Little Finger
Opponens digiti minimi muscle
– capable of rotating the fifth metacarpal bone to a
slight degree.
- It assist the flexor digiti minimi in flexing the
carpometacarpal joint, thereby pulling fifth metacarpal bone
forward and cupping the palm.

6. Arteries of the Palm
Ulnar Artery
-enters the hand anterior to the flexor retinaculum on the
lateral side of the ulnar nerve and the pisiform bone.
-has a deep branch that continues into the palm as the
superficial palmar arch.

8. Superficial palmar arch
- Direct continuation of the ulnar artery
- Curves laterally behind the palmar aponeurosis and in front
of the long flexor tendons
- The arch is completed on the lateral side by one of the
branches of the radial artery

10. Four Digital Arteries
- Arise from the convexity of the arch and
pass to finger.

12. Deep branch of the ulnar artery
- Arises in front of the flexor retinaculum, passes between
the abductor digiti minimi and flexor digiti minimi
- Joins the radial artery to complete the deep palmar arch

18. Radial Artery
- Leaves the dorsum of the hand by turning forward bet
the proximal ends of the first and second
mdetacarpal bone.
- Enters the palm and curves medially bet the oblique
and transverse heads of the adductor pollicis and
continues as the deep palmar arch

20. Deep Palmar arch
- Direct continuation of the radial artery
- Curves medially beneath the long flexor tendons and in front of the
metacarpal bones and the interosseous muscle.
- The arch is completed on the medial side by the deep branch of the
ulnar artery
- The curve of the arch lies at the level with the proximal border of the
extended thumb
- -send branches sup. Take part in the anatomosis around the wrist joint,
and inf, to join the digital branches of the superficial palmar arch.

22. Branches of the Radial Artery in the
Palm
-Entering the palm , gives off the
arteria radialis indicis, which supplies
the lat side of the index finger , and
the arteria princeps pollicis which
divides into two and supplies the
lateral and medial sides of the
thumb.

24. Veins of the Palm
- Superficial and deep palmar arterial
arches are accompanied by the
superficial and deep palmar venous
arches, receiving corresponding
tributaries.

26. Lymph Drainage of the Palm
-Lymph vessels of the finger pass along their borders to reach
the web. From here the vessels ascend onto the dorsum of the
hand.
-Lymph vessels on the palm form a plexus that is drained by
vessels that ascend in front of the forearm or pass around the
medial and lateral borders to join vessels on the dorsum of the
hand.

27. -Lymph from the medial side of the hand ascends in
vessels that accompany the basilic vein.
drain into
1. Supratrochlear nodes
2. Lateral axillary node

29. Lymph from the Lateral side of the hand ascend in
vessels that accompany the cephalic vein, Drain into
1.Infraclavicular node
2.Lateral axillary nodes

30. Nerves of the Palm
1.Median Nerve
2.Ulnar nerve

32. Median Nerve
-Passing behind the flexor retinaculum and through the Carpal
tunnel.
- Divides into lateral and medial branches
- Muscular branch
- recurrent around the lower border of the flexor retinaculum
and lies about one fingerbreadth distal to the tubercle of the
scaphoid; supplies the muscle of the thenar eminence ( abductor
pollicis brevis, the flexor polliciss brevis, and the opponens
pollicis) and the 1st lumbrical muscle.

34. Cutaneous Branches
- supp. the palmar aspect of the lateral three and half
finger and the distal half of the dorsal aspect of each finger.
- One of these branches also supp. The second lumbrical
muscle
Palmar cutaneous branch
- of the median nerve given off in the front of the
forearm
- crosses ant. To the flexor retinaculum and supp.
The skin over the lat. Part of the palm

35. Ulnar Nerve
- Enters the palm ant. To the flexor
retinaculum alongside the lat. Borders of the
pisiform bone.
- Crosses the retinaculum , it divides into a
1. superficial
2.deep terminal branch.

37. Superficial branch of the
Ulnar Nerve
-Descends into the palm
-lying in the subcutaneous tissue between the pisiform bone and the
hook of the hamate.
Tunnel of Guyon
-where nerve and artery lies in a fibro-osseous tunnel
- created by fibrous tissue derived from the superficial part of the
flexor ritinaculum.

39. Branches
-Muscular branch
to the palmaris brevis
-Cutaneous branches
to the palmar aspect of the medial side of the little
finger and adjacent sides of the litter and ring finger
It also supp. The distal half of the dorsal aspect of
each finger.

40. Deep Branch of the Ulnar Nerve
-runs backward between the abductor digiti minimi and flexor
digitiminimi
-winds around the lower border of the hook of the hamate,
-Laterally within the concavity of the deep palmar arch.
-behind the long flexor tendons
-Front of the metacarpal bone and interosseous muscle.

42. Branch
Muscular brances
- to the three muscle of the hypothenar eminence,namely
1. abductor digiti minimi
2. Flexor digiti minimi
3. opponens digiti minimi
- Supp. All the palmar and dorsal interossei, and the 3rd and
4th lumbrical muscle, and booth heads of the abductor policis
muscle

44. Fascial Spaces of the Palm
-Spaces filled with loose connective tissue.
- the triangular palmar aponeurosis fans out from the lower borded of
the flexor retinaculum.
-from its medial border, a fibrous septum is fascial compartment
containing the 3 hypothenar muscle.
-Lateral border of the palmar aponeurosis, a second fibrous septum passes
obliquely backward to the anterior border of the 3rd metacarpal bone
-Second septum divides the palm into the Thenar space, lies lat to the
septum

46. Midpalmar space
- medial to the septum
-Proximally closed off from the forearm by the walls of the carpal tunnel.
- Distally 2 spaces are continues with the appropriate lumbrical canal.
Thenar space
-contains the 1st lumbrical muscle
-Posterior to the long flexor tendons to the index finger
and front of the adductor pollicis muscle
Lumbrical Canal
- potential space surrounding the tendon of each lumbrical muscle
-filled with connective tissue
-Proximally continuous with one of the palmar space

47. Pulp space of the
Fingers
-Pulp of each finger fuses with the periosteum of the terminal
phlanx just distal to the insertion of the long flexor tendons
and closes off a fascial compartment.
- Filled with fat
- Subdivided by the presence of numerous septa

49. The Dorsum of the Hand
Skin
on the dorsum of the hand is thin, hairy and freely mobile on the
underlying tendons and bones.
Sensory Nerve supply
-derived from the superficial branch of the radial nerve and the
post. Cutaneous branch of the ulnar nerve

51. Superficial branch of the radial nerve
- Winds around the radius deep to the brachioradialis tendon
- Decends over the extensor retinaculum and supp. The lat.
Two thirds of the dorsum of the hand.
-divides into several dorsal digital nerves supply the thumb,
index and middle finger and the lat. Side of the ring finger

53. Post. Cutaneous Branch of the Ulnar
nerve
- Winds around the ulna deep to flexor carpi ulnaris tendon
- Descends over the extensor retinaculum
- Supp the medial side of the ring finger and the sides of the
little finger

54. Dorsal Venous Arch
Lies in the subcutaneous tissue
-proximal to the metacarpophalangeal joint and drains on the
lat side into the cephalic vein
-on the Medial side , into the basilic vein

56. Insertion of the Long Extensor
Tendons
-4 tendons of the extensor digitorum emerge from the under
the extensor retinaculum
-fan out over the dorsum of the hands
-tendons are embedded in the deep fascia, and together form
the roof of a subsfacial space

58. -Posterior is surface of each finger , the extensor tendons
joins the facial expansion called the Extensor expansion
Central part
- Which is inserted into the base of the middle phalanx, and
two lat parts, which converge to be inserted into the
base of the distal phalanx

59. The Radial Artery on the dorsum of
the hand
-winds around the lat margin of the wrist joint,beneath the
tendons of the abductor pollicis longus and extensor pollicis
brevis, and on the lateral ligament of thejoint.
-Take part in the anastomosis around the wrist joint.
-Dorsal digital arteries pass to the thumb and index finger