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Dr. Ahmed Fathalla Ibrahim. THE SKIN PALM: characteristics: 1.Flexure creases (lines of palm) 2.Papillary ridges (fingerprints): improve grip & increase.

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Presentation on theme: "Dr. Ahmed Fathalla Ibrahim. THE SKIN PALM: characteristics: 1.Flexure creases (lines of palm) 2.Papillary ridges (fingerprints): improve grip & increase."— Presentation transcript:

1 Dr. Ahmed Fathalla Ibrahim

2 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

3 SUPERFICIAL FASCIA PALM: characteristics: 1.Contains: cutaneous nerves & vessels 2.Contains: Palmaris brevis (increases the hollow of palm to get a firmer grip

4 DEEP FASCIA PALM: thickened at 3 sites: Palmar aponeurosis: Definition Description Function Clinical anatomy: Dupuytren’s contracture

5 PALMAR APONEUROSIS DEFINITION: It is a thickening of deep fascia in the middle of the palm DESCRIPTION: It is triangular in shape: 1.Apex: directed proximally, continuous with tendon of palmaris longus 2.Base: directed distally, divided into 4 slips for the medial 4 fingers 3.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: DUPUYTREN’S CONTRACTURE: shortening of the medial part of aponeurosis resulting in flexion of the little & ring fingers

6 DEEP FASCIA Flexor retinaculum: Definition Attachments Relations Functions Clinical anatomy: Carpal tunnel syndrome

7 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

8 FLEXOR RETINACULUM RELATIONS: Superficial: from lateral to medial: 1.Superficial palmar branch of radial artery 2.Palmar cutaneous branch of median nerve 3.Tendon of palmaris longus 4.Palmar cutaneous branch of ulnar nerve 5.Ulnar vessels 6.Ulnar nerve Deep: Structures passing through carpal tunnel 1.Tendon of FPL & its synovial sheath (radial bursa) 2.Tendons of FDS & FDP & their common synovial sheath (Ulnar bursa) 3.Tendon of FCR & its synovial sheath ( in a special compartment) 4.Median nerve

9 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

10 DEEP FASCIA Fibrous flexor sheaths Definition Attachments Function

11 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

12 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

13 INTRINSIC MUSCLES THENAR MUSCLES:THENAR MUSCLES: 1.Abductor pollicis brevis 2.Flexor pollicis brevis 3.Opponens pollicis 4.Adductor pollicis HYPOTHENAR MUSCLES:HYPOTHENAR MUSCLES: 1.Abductor digiti minimi 2.Flexor digiti minimi 3.Opponens digiti minimi

14 INTRINSIC MUSCLES

15 THENAR MUSCLES 1.Have general origin (lateral side of flexor retinaculum & lateral 2 carpal bones: scaphoid & trapezium) EXCEPT adductor pollicis (transverse head: 3 rd metacarpal bone, oblique head: 2 nd & 3 rd metacarpal + 2 nd & 3 rd carpal bones: trapezoid & capitate) 2.Have general insertion (proximal phalanx of thumb) EXCEPT opponens pollicis (1 st metacarpal) HYPOTHENAR MUSCLES 1.Have general origin (medial side of flexor retinaculum & medial 2 carpal bones: pisiform & hamate 2.Have general insertion (proximal phalanx of little finger) EXCEPT opponens digiti minimi (5 th metacarpal bone)

16 INTRINSIC MUSCLES LUMBRICALS 1.Origin: tendons of FDP 2.Insertion: tendons of ED PALMAR INTEROSSEI 1.Origin: metacarpal bone 2.Insertion: proximal phalanx DORSAL INTEROSSEI 1.Origin: adjoining sides of 2 metacarpal bone 2.Insertion: proximal phalanx PALMARIS BREVIS 1.Origin: Palmar aponeurosis 2.Insertion: skin of medial border of hand

17 ARTERIAL ARCHES IN HAND SUPERFICIAL PALMAR ARCH DEEP PALMAR ARCH 1.Formation 2.Site 3.Surface anatomy 4.Branches

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

19 DEEP PALMAR ARCH FORMATION: 1.Direct continuation of radial artery (mainly) 2.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

20 NERVES IN HAND Cutaneous innervation

21 NERVES IN HAND Muscular innervation ULNAR NERVE: SUPERFICIAL BRANCH: 1.Palmaris brevis DEEP BRANCH: 1.Adductor pollicis 2.Hypothenar muscles 3.Interossei 4.Medial two lumbricals

22 NERVES IN HAND Muscular innervation MEDIAN NERVE: 1.Abductor pollicis brevis 2.Flexor pollicis brevis 3.Opponens pollicis 4.Lateral two lumbricals


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