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    عاصم مروان
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    The hand has complex fascial structures including the palmar aponeurosis and flexor retinaculum. The palmar aponeurosis is a thick fibrous sheet that covers the middle palm and inserts into the fingers. The flexor retinaculum forms the carpal tunnel, enclosing the median nerve and tendons. There are 20 small intrinsic muscles of the hand arranged into lateral, medial, and intermediate groups that control thumb and finger movement. The median and ulnar nerves provide motor and sensory innervation to the hand muscles and skin. Arterial blood supply relies on the superficial and deep palmar arches.

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    7- hand

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    The hand has complex fascial structures including the palmar aponeurosis and flexor retinaculum. The palmar aponeurosis is a thick fibrous sheet that covers the middle palm and inserts into the fingers. The flexor retinaculum forms the carpal tunnel, enclosing the median nerve and tendons. There are 20 small intrinsic muscles of the hand arranged into lateral, medial, and intermediate groups that control thumb and finger movement. The median and ulnar nerves provide motor and sensory innervation to the hand muscles and skin. Arterial blood supply relies on the superficial and deep palmar arches.

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    22 views30 pages

    7 - Hand

    Uploaded by

    عاصم مروان
    The hand has complex fascial structures including the palmar aponeurosis and flexor retinaculum. The palmar aponeurosis is a thick fibrous sheet that covers the middle palm and inserts into the fingers. The flexor retinaculum forms the carpal tunnel, enclosing the median nerve and tendons. There are 20 small intrinsic muscles of the hand arranged into lateral, medial, and intermediate groups that control thumb and finger movement. The median and ulnar nerves provide motor and sensory innervation to the hand muscles and skin. Arterial blood supply relies on the superficial and deep palmar arches.

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    of 30

    - The Hand

    Dr. mohamed dief allah


    Lecturer of anatomy & embryology
    Kasr alainy, Cairo university
    THE HAND

    Palm of the hand


    Dorsum of the hand
    Deep fascia of palm of the hand
    1. Palmar aponeurosis
    2. Flexor retinaculum
    3. Fibrous flexor sheath of the fingers
    Palmar Aponeurosis

    Definition:
    This is thick and strong fibrous sheet that covers the middle part of the palm

    Netter atlas of Anatomy


    Shape and attachments:

    Shape:
    - It is triangle
    The apex:
    - directed proximal and receives the insertion of
    Palmaris longus tendon
    Base:
    - directed distal and is divided at the roots of the
    medial 4 fingers into 4 slips.
    Flexor Retinaculum of Wrist
    **Definition:
    It is a thickened band of deep fascia in front of the carpus
    and converts its anterior concavity into the carpal tunnel.
    attachments

    ❑ Function : prevents displacement of long


    flexor tendons during contraction

    Netter atlas of Anatomy


    Structures passing SUPERFICIAL (arranged from medial to lateral)

    ❑ Tendon of Palmaris Longus


    ❑ Ulnar nerve.
    ❑ Ulnar vessels.
    ❑ Palmar cutaneous br. of
    ✓ ulnar nerve.
    ✓ median nerve.
    Structures passing DEEP (in the carpal tunnel)

    ❑ Median nerve
    ❑ Tendons of
    ➢ fl. digit. superficialis.
    ➢ fl. digit. profundus.
    ➢ flexor pollicis longus
    ➢ flexor carpi radialis
    ❑ Common synovial
    sheath of tendons
    ---What is carpal tunnel syndrome?
    Fibrous flexor sheaths

    These are dense plates of fibrous tissue which arch across the flexor tendons in the fingers.
    Synovial Sheaths of Flexor Tendons

    ❑ Definition:
    These are tubular sacs which surround the terminal
    parts of the tendons before its insertion

    ❑ Function:
    to provide a sort of lubrication for it.

    Clinical anatomy by region (Snell)


    1- Ulnar bursa:
    This is a common synovial sheath for 2- Radial bursa:
    the 8 tendons of flexor digitorum it surrounds tendon of Flexor
    superficialis & profundus. pollicis longus

    Netter atlas of Anatomy


    Clinical Anatomy:
    Dupuytren contracture of the hand
    is a deformity in the hand in which the medial part of the palmar aponeurosis undergoes fibrosis
    producing progressive shortening and flexion of the little and ring fingers.
    Pulp space:
    - It is the space which lies over the palmar surface of the terminal (distal) phalanx, It is
    divided into separate loculi that contain subcutaneous fat.
    - Its infection is very painful due to accumulation of pus in narrow spaces under tension

    Netter atlas of Anatomy


    Fascial Compartments of Palm
    Each margin of the palmar aponeurosis sends a septa into the depth of the palm
    divided It into facial compartments.

    Lateral compartment:
    Medial compartment:
    contains the thenar muscles
    contains hypothenar muscles
    1st

    5th

    3rd
    Clinical anatomy by region (Snell)

    Intermediate compartment:
    deep to the palmar aponeurosis
    Muscles of the hand
    ▪Intrinsic muscles of the hand are 20 small muscles arranged in 3 groups:

    I.Lateral group short muscles of thumb III. Intermediate II.Medial group short muscles
    4 compartment of little finger
    12 4
    ➢ 3 Thenar muscles
    ➢ 4 Lumbricals ➢ 3 Hypothenar muscles
    ➢ Adductor pollicis deep to them ➢ 4 Palmar interossei ➢ Palmaris brevis superficial
    ➢ 4 Dorsal interossei. to them.
    I. Lateral group [short muscles of thumb]

    3 Thenar muscles 1 Adductor pollicis


    (form the thenar eminence) deep to them.
    1.Abductor pollicis brevis.
    2.Flexor pollicis brevis.
    3.Opponens pollicis.

    Lippincott Williams & Wilkins Atlas of Anatomy, 1st Edition


    ❑ Nerve supply:
    3 thenar Muscles → lateral terminal branch of Median Nerve.
    Adductor pollicis →deep terminal branch of Ulnar Nerve.

    ❑ Action:
    .Abductor pollicis brevis  Abducts the thumb.
    .Flexor pollicis brevis  Flexes the thumb.
    .Opponens pollicis  Opposition of thumb
    .Adductor pollicis  Adducts the thumb.
    II. Medial group [short muscles of little finger

    3 Hypothenar muscles : 1 Palmaris brevis


    superficial to them.
    1.Abductor digiti minimi.
    2.Flexor digiti minimi.
    3.Opponens digiti minimi.

    Lippincott Williams & Wilkins Atlas of Anatomy, 1st Edition


    Palmaris brevis
    superficial to hypothenar Ms.

    Origin:
    From palmar aponeurosis & flexor retinaculum.
    .Insertion:
    Skin of the medial border of the hand.
    .Action:
    Deepen the hollow of the palm to improve grip of the palm
    during holding a rounded object.
    II. Medial group [short muscles of little finger

    ▪Nerve supply:
    3 hypothenar muscles → ulnar nerve.
    Palmaris brevis → ulnar nerve.
    ▪Action:
    .Abductor digiti minimi  Abducts the little finger.
    .Flexor digiti minimi  Flexes the little finger.
    .Opponens digiti minimi  Pulls the 5th metacarpal bone forwards & rotates it laterally to
    deepen the hollow of the palm during gripping.

    Clinical anatomy by region (Snell)


    Intermediate group
    Lumbricals
    Action: Putting the hand in writing position (Flexion of the M/P joints & Extensions of the
    I/P joints of the medial 4 fingers).
    Action of intermediate compartment
    palmar interossei= adduction dorsal interosseii= abduction
    Nerve supply of the
    hand

    Motor supply Sensory supply


    Motor supply of the hand

    Median nerve
    • 3 thenar
    • 1st & 2nd lumbricals
    Ulnar nerve supply
    i) The superficial branch: supplies palmaris brevis
    ii) The deep terminal branch: supplies 14 muscles
    • 4 Interossei (palmar & dorsal)
    • 3 Hypothenar
    • Abductor digiti minimi.
    • Flexor digiti minimi.
    • Opponens digiti minimi.
    • 2 Lumbricals: 3rd & 4th.
    • 1 Adductor pollicis.
    Sensory supply of the hand
    Arteries of palm of the hand

    Superficial palmar arch Deep palmar arch


    It is the termination of the ulnar artery and is It is the termination of the radial artery and is
    completed by the superficial palmar branch of the completed by the deep branch of the ulnar artery
    radial artery
    Thank you

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