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  • Dr. Ahmed Fathalla Ibrahim

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    The document summarizes the anatomy of the skin, fascia, muscles, blood vessels, and nerves of the palm and hand. It describes the characteristics and functions of the palmar aponeurosis, flexor retinaculum, fibrous flexor sheaths, thenar and hypothenar muscles, arterial arches, and nerve innervation. The intrinsic muscles of the hand originate on bones and fascia and insert on phalanges, allowing fine manipulation. The superficial and deep palmar arches form from the ulnar and radial arteries to supply the hand. The median and ulnar nerves innervate specific muscles.

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    10-Palm of Hand

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    The document summarizes the anatomy of the skin, fascia, muscles, blood vessels, and nerves of the palm and hand. It describes the characteristics and functions of the palmar aponeurosis, flexor retinaculum, fibrous flexor sheaths, thenar and hypothenar muscles, arterial arches, and nerve innervation. The intrinsic muscles of the hand originate on bones and fascia and insert on phalanges, allowing fine manipulation. The superficial and deep palmar arches form from the ulnar and radial arteries to supply the hand. The median and ulnar nerves innervate specific muscles.

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    © All Rights Reserved
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    104 views22 pages

    Dr. Ahmed Fathalla Ibrahim

    Uploaded by

    mrpraveenm
    The document summarizes the anatomy of the skin, fascia, muscles, blood vessels, and nerves of the palm and hand. It describes the characteristics and functions of the palmar aponeurosis, flexor retinaculum, fibrous flexor sheaths, thenar and hypothenar muscles, arterial arches, and nerve innervation. The intrinsic muscles of the hand originate on bones and fascia and insert on phalanges, allowing fine manipulation. The superficial and deep palmar arches form from the ulnar and radial arteries to supply the hand. The median and ulnar nerves innervate specific muscles.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    of 22

    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

    1. 2. 3.

    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

    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

    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)

    2. 1. 2.

    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

    ARTERIAL ARCHES IN HAND


    SUPERFICIAL PALMAR ARCH DEEP PALMAR ARCH Formation Site Surface anatomy Branches

    1. 2. 3. 4.

    SUPERFICIAL PALMAR ARCH


    1. 2. FORMATION: Direct continuation of ulnar artery (mainly) 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: Radialis indicis: supplies lateral side of index Princeps pollicis: supplies both sides of thumb

    1. 2.

    DEEP PALMAR ARCH


    1. 2. FORMATION: Direct continuation of radial artery (mainly) 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

    NERVES IN HAND Cutaneous innervation

    NERVES IN HAND Muscular innervation


    1. 1. 2. 3. 4. ULNAR NERVE: SUPERFICIAL BRANCH: Palmaris brevis DEEP BRANCH: Adductor pollicis Hypothenar muscles Interossei Medial two lumbricals

    NERVES IN HAND Muscular innervation


    1. 2. 3. 4. MEDIAN NERVE: Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Lateral two lumbricals

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