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ANATOMY OF THE HAND BY Dr. J. M. Hassanain.  Hand function is an important feature in humans over other primates who lack fine control and precision.

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Presentation on theme: "ANATOMY OF THE HAND BY Dr. J. M. Hassanain.  Hand function is an important feature in humans over other primates who lack fine control and precision."— Presentation transcript:

1 ANATOMY OF THE HAND BY Dr. J. M. Hassanain

2  Hand function is an important feature in humans over other primates who lack fine control and precision

3 EMBRYOLOGY OF THE UPPER LIMB  Limb buds first appear as small elevations on ventro lateral body end of fourth week.

4 Each limb bud : Mesenchyme derived from somatic mesoderm which is covered by a layer of ectoderm

5  Distal end of bud form flipper like limbs.  Later bones develop and myoblast aggregate to develop muscle mass.

6  Upper limb rotates laterally 90 degrees  Specific dermatone ( which is skin area supplied by a single spinal nerve )

7 ANATOMY  Bony skeleton  Muscles and soft tissues  Vessels and nerves

8 BONY SKELETON  Wrist joint composed of multiple carpal bone articulating with the radius proximally and five metacarpals distally

9  Proximal row of carpal bone (radial to ulnar) scafoid, lunate, traquetral, pisiform  Distal row trapezium, trapazoid, capitate, hamate

10 BONES OF THE HAND  5 Metacarpals  Thumb is no. 1  Little finger is no. 5

11 PHALANGES  All fingers have 3 phalanges proximal middle distal  Except thumb has 2 proximal distal

12  Most of tendon in the hand originate in muscles arising from the forearm  Flexor on volar aspect of forearm must arise from common flexor tendor (medial epicondyle )

13  Extensors on dorsal aspect of the forearm arise from common extensor tender on lateral epicondyl

14  In the hand ulnar side hypo thenar muscles acting on the little fingers:  Abductor digitiminimi  Flexor digitiminimi brevis  Opponens digitiminimi

15  Radial side thenar muscle acting on the thumb  Flexor, adductor pollices  Abductor pollices brevis  Opponen pollices brevis

16  Long flexors fl. digitorum superficialus fl. digitorum profundus  Act on all the fingers

17 Intrinsic  Lumbrical  Dorsal  Ventral interrosies

18 Vascular Supply of Hand  Radial artery :  Superficial palmer branch  superficial palmer arch,which arises above the wrist  Common palmer digital  Deep palmer branches  Deep palmer arch  palmer metacarpal arteries which joins the common digital  Ulnar artery  superficial palmer branch joins on side of pisiform of superficial palmer branch

19 VENOUS DRAINAGE OF HAND  Via : Dorsal digital vein  dorsal venous arch  Basillic vein in front of forearm

20 Peripheral nerve entrapment  There is a disproportion between volume of the peripheral nerve and space within the extremity through which it passes

21 Applied Anatomy of Ulnar Nerve  Arises directly from the medial cord of brachial plexus (C8-T1)  Lies between axillary artery laterally and axillary vein medially

22  At inferior border of subscapularis muscle nerve receives fiber of C7 ( lat. root of ulnar nerve )  Descend in arm post. to pectoralis major muscle ( posterio medial to brachial artery)

23  8 cm above medial epicondyl with branch of superior ulnar collateral artery diverge medially from brachial artery to pierce medial intramuscular septum

24  Together descend on medial head of triceps  Nerve passes in ulner groove dorsal aspect of medial epicondyl  It innervates fl. carpi ulnaris cm above medial epicondyl

25 Potential points of compression in the arm  Ulnar nerve fibers ( medial cord ) 1 st rib as nerve passes between rib & clavicle  8 cm proximal to medial condyl as nerve pierce intramuscular septum ( arcade of Struther )  Hypertrophy of medial head of triceps may force nerve anteriorly, as triceps contract, nerve get compressed

26 Ulnar Nerve at Elbow &Forearm  In cubital fossa ulnar nerve passes through fibro-osseous tunnel  As it leaves the canal it lies between the flexor corpi ulnanis and flexor digitorum profundus till middle of forearm

27  In distal 1/3 lies just radial to the flexor corpi ulnaris  Straight line drawn from medial epicondyl to radial margin of pisiform marks the line of the nerve

28 Supply of ulnar nerve in forearm  Muscular branch to fl. Digitorum profundus ( i.e. ulner ½ ) 3 cm distal to medial epicondyl  Palmer cutanous branch  Dorsal cutanous branch

29 Ulnar nerve enters hand  From under fl corpi ulnaris muscle, nerve and artery  Radial to pisiform, superficial to transverse carpel lig. and dorsal to superficial palmer lig.  Ulnar nerve divide to : deep terminal branch superficial palmer branch

30 Muscle supplied by ulnar nerve  Flexor corpi ulnaris  Flexor digitorum profundus ( medial 2 tendons )  Flexor digiti minimi  2,3,4 th web space interossei  3 rd & 4 th lumbricle  Adductor pollicis  1 st dorsal interosseous

31 Sensory Supply of Ulnar Nerve  Dorsal cutanous branch of ulnar : skin dorsoulnar side of hand, little finger and ulnar ½ of index finger  Medial cutanous nerve of forearm : C8-T1 skin over biceps elbow crease middle 1/3 of arm palmer skin down to forearm

32 Anatomical Sites of Compression  Points in elbow and forearm  Anconeus epitrochlearis muscle  Fibrous arcade between 2 heads of fl. carpi ulnaris

33 Site of compression in hand &wrist  Palmaris brevus muscle  Fibrous origin of fl digitiminmi  Ulnar artery aneurysm or thrombosis  Distal ulnar tunnel ganglia

34 MEDIAN NERVE  Arises from lateral & medial cords of brachial plexus  Contain fibers C5 –T1  Forms antrolat to 3 rd portion of axillary artery in upper 1/3 of arm

35  In the arm it descends post. to pectoralis major muscle, lateral to brachial artery, antromedial to brachialis muscle, posteromedial to biceps  In mid portion of arm, median nerve crosses ant to brachial artery to lie on its medial side to enter the cubital fosse

36  The nerve enters forearm between humeral and ulnar head of pronater teres  Then runs between fl digitorum superficialis and fl digitorum profundus, later emerges 5 cm above wrist radial to tendon of palmaris longus

37 MEDIAN NERVE IN THE WRIST  It enters the wrist dorsal to transverse carpal lig through the carpal tunnel

38 Boundaries Of Carpal Tunnel  Dorsally: radio carpal lig.  Radially: scaphoid & trapezium  Palmorly: transverse carpal lig.  Ulnary: hood of hamate & pisiform

39 After exiting carpal tunnel  Median nerve splits to two parts  Common digital nerve to thumb  Proper digital nerve to radial side of index  Ulnar division of median nerve; common digital to 2 nd & 3 rd web

40 Muscle supplied by median nerve  Forearm  Pronator teres  Flexor digitorum superficialis  Flexor carpi radialis  Palmaris longus  Flexor digitorum profundus  Flexor pollicis longus  Pronator quadratus

41 HAND  Flexor pollicis brevis  Abductor pollicis brevis  Opponens pollicis  First lumbrtical  Second lumbrical

42 Anatomical compression points of the median nerve  ARM:  Pectoralis minor muscle  Anomalous axillary arch muscles  Anomalous vascular arches in the axilla  Deltopectoral fascia  Supracondyloid process  Ligament of Struthers

43 FOREARM  Lacertus fibrosus  Pronator teres muscle  Flexor digitorum superficialis arch  Anomalous muscles  Ulnar collateral or radial artery branches

44 HAND / WRIST  Carpal tunnel  Palmar cutaneous branch within the transverse retinacular ligament

45 RADIAL NERVE  Arises from the post cords of the brachial plexus behind 3 rd part of axillary artery  Neural element of C5 – C8  Proximal 1/3 of arm nerve descends behind brachial artery ant to subscapularis,teres major,latissmus dorsi muscle and long head of triceps

46  At junction of upper and middle 1/3 of arm deviates dorsolaterally between medial and long head of triceps lying adjacent to spiral groove of humerus

47  10 cm above lat humeral epicondyl lying between the brachialis and brachioradialis then lies between brachialis and extensor carpi radialis ant to tip of lat epicondyl dividing into : Superficial Deep branches

48 Radial Nerve In Forearm  Superficial branch ant to supinator muscle proximal 1/3 then deep to brachioradialis  The sup branch pierces the fascia on the brachioradialis on the ulnar side of tendons 7cm above wrist  On the dorsoradial side of wrist it divides into 5 dorsal digital nerves and only one branch to extensor carpi radilalis brevus muscle

49  Post interosseous nerve (deep terminal branch of radial nerve ) innervates extensor muscle of wrist  It is seperated from the radium by deep head of supinator  After leaving the supinator it lies between the abductor pollies and other extensors of forearm

50  In distal forearm it penetrates the extensor pollies brevus to lie in the interosseous membrane  Distally it divides to give sensory innervation to the wrist

51 Muscles supplied by radial nerve  Triceps : long head medial head lateral head  Anconeus  Brachioradialis  Extensor carpi longus  Extensor carpi radialis brevis

52 Muscles supplied by radial nerve  Extensor carpi ulnaris  Extensor digitorum communis  Extensor digiti minimi  Abductor pollicis longus  Extensor pollicis longus  Extensor pollicis brevis  Extensor indicis proprius

53 Anatomical compression points of the radial nerve  ARM:  Accessory subscapularis teres latissimus  Lateral head of the triceps muscle  Lateral intermuscular septum

54  FOREARM:  Posterior interosseous nerve within radial tunnel  Fibrous bands attached to radiocapitelar joint  Extensor carpi radialis brevis muscle  Arcade of Frohse  Fibrous bands within the supinator muscle

55  Superficial radial nerve  Between brachioradialis muscle & radial shaft  Between brachioradialis and extensor carpi radialis longus tendons

56 THANK YOU  THE END


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