Professional Documents
Culture Documents
Dr. Ahmed Fathalla Ibrahim
Dr. Ahmed Fathalla Ibrahim
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
SUPERFICIAL FASCIA
PALM: characteristics: 1. Contains: cutaneous nerves & vessels 2. Contains: Palmaris brevis (increases the hollow of palm to get a firmer grip
DEEP FASCIA
PALM: thickened at 3 sites: Palmar aponeurosis: Definition Description Function Clinical anatomy: Dupuytrens contracture
PALMAR APONEUROSIS
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DEFINITION: It is a thickening of deep fascia in the middle of the palm DESCRIPTION: It is triangular in shape: Apex: directed proximally, continuous with tendon of palmaris longus Base: directed distally, divided into 4 slips for the medial 4 fingers 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: DUPUYTRENS CONTRACTURE: shortening of the medial part of aponeurosis resulting in flexion of the little & ring fingers
DEEP FASCIA
Flexor retinaculum: Definition Attachments Relations Functions Clinical anatomy: Carpal tunnel syndrome
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
FLEXOR RETINACULUM
1. 2. 3. 4. 5. 6. 1. 2. RELATIONS: Superficial: from lateral to medial: Superficial palmar branch of radial artery Palmar cutaneous branch of median nerve Tendon of palmaris longus Palmar cutaneous branch of ulnar nerve Ulnar vessels Ulnar nerve Deep: Structures passing through carpal tunnel Tendon of FPL & its synovial sheath (radial bursa) Tendons of FDS & FDP & their common synovial sheath (Ulnar bursa) 3. Tendon of FCR & its synovial sheath ( in a special compartment) 4. Median nerve
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
DEEP FASCIA
Fibrous flexor sheaths Definition Attachments Function
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
INTRINSIC MUSCLES
1. 2. 3. 4. 1. 2. 3. THENAR MUSCLES: Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Adductor pollicis HYPOTHENAR MUSCLES: Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi
INTRINSIC MUSCLES
INTRINSIC MUSCLES
1. THENAR MUSCLES 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) Have general insertion (proximal phalanx of thumb) EXCEPT opponens pollicis (1st metacarpal) HYPOTHENAR MUSCLES Have general origin (medial side of flexor retinaculum & medial 2 carpal bones: pisiform & hamate Have general insertion (proximal phalanx of little finger) EXCEPT opponens digiti minimi (5th metacarpal bone)
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INTRINSIC MUSCLES
1. 2. 1. 2. 1. 2. 1. 2. LUMBRICALS Origin: tendons of FDP Insertion: tendons of ED PALMAR INTEROSSEI Origin: metacarpal bone Insertion: proximal phalanx DORSAL INTEROSSEI Origin: adjoining sides of 2 metacarpal bone Insertion: proximal phalanx PALMARIS BREVIS Origin: Palmar aponeurosis Insertion: skin of medial border of hand
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