2 Surface anatomy of wrist and hand Anatomical “snuff box” 鼻烟壶Medial: tendon of the extensor pollicis longsLateral: tendons of the abductor pollicis longus and extensor pollicis brevisProximal: styloid process of radiusFloor: scaphoid and trapezium bonesRadial a. crosses the floor of the snuff, so may fell the radial pulse in this fossa
4 Deep fascia of the wrist Palmar carpal ligament 腕掌侧韧带Flexor retinaculum 屈肌支持带Thickening of deep fascia in the handAttached laterally to scaphoid and trapezium and medially to pisiform and hamateUlnar carpal canal 腕尺侧管Formed by the distal part of palmar carpal ligament and flexor reticulumTransmit the ulnar a., v. and n.Radial carpal canal 腕桡侧管The radial end of flexor reticulum is attached to the tubercles of scaphoid and trapeziumTransmit tendon of flexor carpi radialis
5 ★Carpal tunnelComposition: Formed by flexor retinaculum and carpal grooveStructures passing through the carpal tunnelMedian n.The tendons of flexor digitorum superficialis and flexor digitorum profundus enclosed by common flexor synovial sheathThe tendon of flexor pollicis longus enclosed by synovial sheath for flexor pollicis longus
6 Carpal tunnel Synovial sheath for flexor pollicis longus Common flexor synovial sheath
7 Carpal tunnel Tendons of flexor digitorum superficialis Median n. Tendons of flexor digitorum profundusMedian n.common flexor synovial sheathTendon of flexor pollicis longus enclosed by synovial sheath for flexor pollicis longus
9 Posterior region of wrist 腕后区 Extensor retinaculum 伸肌支持带Thickening of deep fascia of forearm a wristAttached laterally to radius and medially to styloid process of ulna and triquetral boneForms six fibrous compartments for extensor tendons passing from forearm into hand
10 Posterior region of wrist 腕后区 ① tendons of abductor pollicis longus and extensor pollicis brevis and their synovial sheaths;② tendons of extensor carpi radialis longus and brevis and their synovial sheaths;③ tendon of extensor pollicis longus and its synovial sheath;④ tendons of extensor digitorum, extensor indicis and their synovial sheaths;⑤ tendon of extensor digiti minimi and its synovial sheaths;⑥ tendon of extensor carpi ulnaris and its synovial sheaths
11 Palm of hand 手掌 Deep fascia of the palm Superficial layer Deep layer Thenar fascia 鱼际筋膜Hypothenar fascia 小鱼际筋膜Palmar aponeurosis 掌腱膜 thick triangular membraneDeep layerpalmar interosseous fascia 骨间掌侧筋膜
13 Intermediate compartment 中间鞘 BoundariesPalmar aponeurosisLaeral and medial intermuscular septumPalmar interosseous fasciaContentssuperficial palmar arch, a., v.,n.tendons of flexor digitorum superficialis and profundusLumbricalescommon flexor sheath
14 Fascia spaces 筋膜间隙Thenar space 鱼际间隙: located between the fascia of the adductor pollicis and flexor tendon of the index finger.Proximal: blindDistally: continuous with the back of the index finger by the fist lumbrical canalMidpalmar space掌中间隙: lies posterior to common flexor sheathProximal: continous with the posterior space of the antebrachial flexor through the carpl canalDistally: continuous with the appropriate lumbrical canalsPalmar intermediate septumThenar spaceMidpalmar space
15 Muscles of hand Lateral group－thenar (4) Medial group－hypothenar (3) Intermedial groupLumbricals 蚓状肌 (4)Palmar interossei 骨间掌侧肌 (3)Dorsal interossei 骨间背侧肌 (4)
16 Muscles of hand Lateral group－thenar 鱼际 (4) Abductor pollicis brevis拇短展肌Flexor pollicis brevis 拇短屈肌Opponens pollicis 拇对掌肌Adductor pollicis 拇收肌Action: flex, abduct, adduct and oppose thumbNerve supply: median n. except adductor pollicis which is supplied by ulnar n.
17 Muscles of hand Medial group－hypothenar 小鱼际 (3) Abductor digiti minimi 小指展肌Flexor digiti minimi brevis 小指短屈肌Opponens digiti minimi 小指对掌肌Action: flex, abduct , and oppose littlefingerNerve supply: ulnar n.
18 Muscles of hand Intermedial group Lumbricals 蚓状肌 (4) Action: flex fingers at MP joints; extend fingers at IP jointsNerve supply: first two lumbricals supplied by median n., and 3rd and 4th lumbricals supplied by ulnar n.
19 Muscles of hand Intermedial group Palmar interossei (3)骨间掌侧肌 adduct fingers towards middle finger at MP jointsDorsal interossei (4) 骨间背侧肌abduct fingers away from middle finger at MP jointsNerve supply: ulnar n.
20 Arteries of upper limb Superficial palmar arch 掌浅弓 Formed by ulnar artery and superficial palmar branch of radial arteryThe curve of arch lies across the palm, level with the distal border of fully extended thumbGives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries
21 Arteries of upper limb Deep palmar arch 掌深弓 Formed by radial artery and deep palmar branch of ulnar arteryThe curve of arch lies across upper part of palmar at level with proximal border of extended thumbGives rise to three palmar metacarpal arteries to joint the distal ends of the corresponding common palmar digital arteries
22 Nerves of hand Median n. 正中神经 Muscular branches: supply thenar except adductor pollicis, first two lumbricalesCutaneus branches: supply skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsumRecurrent branch
23 Nerves of hand Ulnar n. 尺神经 Radial n. 桡神经 Muscular branches supply hypothenar muscles, interossei, 3rd and 4th lumbricales and adductor pollicisCutaneus branches supply skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar two and one-half fingersRadial n. 桡神经Skin of radial side of dorsum of handPosterior aspect of radial two and one-half fingers
24 Dorsum of hand 手背 Fascia of the dorsal hand The superficial fascia Dorsal venous rete of handSuperficial lymph vesselsSuperficial branches of radial n. and doesal branch of ulnar n.Deep fascia－the dorsal fascia of handSuperficial layer--dorsal aponeurosis 手背腱膜Deep layer--dorsal interosseous fascia 骨间背侧筋膜
25 Dorsum of hand 手背 Two spaces The dorsal subcutaneous space 手背皮下间隙 The dorsal subaponeurotic space 手背腱膜下间隙Dorsal subaponeurotic spaceSuperficial fasciaDorsal aponeurosisDorsal subcutaneous spaceDorsal interosseous fascia
26 Fingers手指 Pulp space of the fingers 指髓间隙 The deep fascia of the pulp of each finger fuses with the periosteum of the terminal phalanx just distal to the insertion of the long flexor tendons and closes off a facial compartment known as the pulp space.Each pulp space is subdivided by the presence of numerous septa, which pass from the deep fascia to the periosteum.Through the pulp space, which is filled with fat, runs the terminal branches of the digital artery that supplies the diaphysis of the terminal phalanx..The pulp space is limited proximally by the firm adherence of skin and the distal flexion crease to the underlying tissue; this prevents pulp infection from spreading proximally along the finger.
27 Fingers 手指 Vessels Nerves： Proper palmar digital a. Proper palmar digital n.