1. بسم الله الرحمن الرحيم

2. THE HAND

3. THE SKELETON OF THE HAND
The skeleton of the hand is subdivided into three segments: the carpus, metacarpus and phalanges.
The carpus: Eight carpal bones made up of two rows of four.
1- Proximal row: Scaphoid, Lunate,Triquetral, Pisiform.
2- Distal row: Trapezium, Trapezoid, Capitate and Hamate.

5. Cutaneous nerve supply
Palm of the hand:
Cutaneous branches of median nerve (lateral 2/3 of palm and lateral 3 ½ fingers)
Cutaneous branches of ulnar nerve (medial 1/3 of palm and medial 1 ½ fingers)

6. Cutaneous nerve supply
Dorsum of the hand:
Cutaneous branches of radial nerve (lateral 2/3 and lateral 3 ½ fingers except the nail bed and adjacent skin by median nerve.)
Cutaneous branches of ulnar nerve (medial 1/3 and medial 1 ½ fingers).

7. Flexor Retinaculum
It is a thick and strong fibrous band that bridges over the carpal groove (made by carpal bones).
It converts the carpal groove into an osseo-fibrous tunnel (carpal tunnel).
The retinaculum is attached medially to pisiform and hamate, while laterally is attached to scaphoid and trapezium.

11. Structures superficial to flexor retinaculum:
Ulnar nerve.
Ulnar vessels.
Palmar cutaneous branch of median nerve.
Cutaneous branch of radial nerve.
Tendon of palamaris longus.

12. Structures deep to the flexor retinaculum:
Median nerve.
Tendons of flexors of the forearm that insert into the hand with their synovial sheaths:
a. Flexor carpi radialis.
b. Flexor digitorum profundus.
c. Flexor digitorum superficialis.
d. Flexor pollicis longus.

13. Palmar aponeurosis
It is a triangular thickening of the deep fascia of the palm.
Its apex is directs upwards while the base is divided into 4 slips; each for each of the medial 4 fingers.
Function:
Protection of the underlying vessels and nerves of the palm of the hand. 

14. Muscles of the hand 1-Hypothenar group: Thenar and hypothenar muscles.
-Abductor digiti minimi. -Flexor digiti minimi. -Opponens digiti minimi.

15. 2-Thenar group: They are 4 muscles :
1,2,3- Muscles of thenar eminence (abductor pollicis brevis, flexor pollicis brevis and opponens pollicis).
4-Adductor pollicis.

16. 4-Adductor pollicis Origin. a-Transverse head. b-Oblique head.
Third metacarpal bone
b-Oblique head.
Bases of 2nd , 3rd metacarpal bones

18. Nerve supply -Hypothenar muscles and adductor pollicis:
Deep branch of ulnar nerve.
-Other thenar muscles:
Median nerve

19. Palmaris brevis Origin: Medial border of palmar aponeurosis.
Insertion: Into the skin of the medial border of the hand.
Nerve supply: Superficial branch of the ulnar nerve.
Action: It deepens the hollow of the palm to make a firmer grip.

20. Central Muscles Of The Hand
Interossei
Palmar Interossei
Dorsal Interossei
Lumbricals

21. Palmar Interossei 2nd : Origin medial side of the 2nd metacarpal
Insertion: medial side of the extensor expansion of the index finger.
3rd, 4th;
Origin lateral side of the 4th and 5th metacarpals
Insertion lateral side of the extensor expansion of ring and little fingers

22. Palmar Interossei Action:
Nerve supply:
deep branch of ulnar nerve
Action:
Flexion of metacarpo- phalageal joint of index, ring and little fingers
Adduction of the thumb , index, ring little fingers towards the midline of the hand

23. Dorsal Interossei
4 slender fleshy muscles each arises by 2 heads from the metacarpal bone
Origin:
1st : mt cpl I II
2nd II III
3rd III IV
4th IV V

24. 1st dorsal interosseous muscle

25. Dorsal Interossei Insertion : -Extensor expansions Nerve supply:
deep branch of ulnar nerve.
Action:
-Abduction of index, middle, and ring fingers towards the midline of the hand.
-Flexion of the metacarpo- phalangeal joints and
extension of interphalangeal joints of lateral four fingers (writing position).

26. Central Muscles Of The Hand
4/20/2017
THE HAND
Central Muscles Of The Hand
Lumbrical muscles
4 fleshy slender muscles originating as follows:
1st and 2nd from the lateral side of the tendons of flexor digitorum profundus for index and middle fingers respectively.
3rd from the adjacent sides of the tendons of flexor digitorum profundus for middle and ring fingers.
4rd from the adjacent sides of the tendons of flexor digitorum profundus for ring and little fingers.
THE HAND

27. Lumbricals Nerve supply: Digital branch of median nerve
Deep branch of ulnar nerve

28. Central Muscles Of The Hand
Lumbricals
Action:
Flexion of metacrpo –phalngeal joint
Extension of
inter-phalngeal joint
(writing position)

29. Some Clinical Applications

30. Arteries of the hand. Radial artery They form two arches:
1- Superficial palmar arch.
2- Deep palmar arch.

31. 1-Superficial palmar arch
It lies deep to palmar aponeurosis , at the level of fully extended thumb.
Origin: mainly from ulnar artery and completed by superficial palmar branch of radial artery. It gives 4 digital arteries.

32. 2-Deep palmar arch
-It lies 3 cm proximal to the superficial palmar arch.
Origin: mainly from radial artery, completed by deep branch of ulnar artery.
Branches: palmar metacarpal arteries.
Branches of radial artery:
1-Dorsal arch: formed by radial and ulnar arteries, on dorsum of hand.
2-Princeps pollicis: from radial artery (primary supply of thumb).
3-Radialis indicis: from radial artery, supplies radial side of index.

33. Veins of the hand
1-Superficial veins.
2-Deep veins.

35. Digital veins

36. Cephalic vein: is the lateral continuation of dorsal venous arch.
Basilic vein: is the medial continuation of dorsal venous arch.
The median cubital vein in cubital fossa.

37. Nerves of the hand
1-Median nerve
A-origin

39. course: -It enters the hand by passing deep to the flexor retinaculum
course: -It enters the hand by passing deep to the flexor retinaculum. -It divides into medial and lateral branches.

40. Branches in the hand
The 2 branches give: 1- Cutaneous branches to the skin of: Lateral 2/3 of the palm, palmar aspect of the lateral 3 1/2 fingers, the nail beds and dorsum of terminal phalanges of these fingers. 2- Muscular branches (recurrent branch): to muscles of thenar eminence and the lateral 2 lumbricals.

41. Nerve injury

42. 2-Ulnar nerve
A-Origin

43. B-course:
- It enters the hand by passing superficial to the flexor retinaculum.
- It divides into superficial and deep branches.

44. Branches in the hand 1-Superficial branch :
It gives cutaneous branches to supply the skin of medial 1/3 of palm and dorsum of the hand, & medial 11/2 fingers (palmar and dorsal aspects).
Muscular branch  palmaris brevis.
2-Deep Branch: It gives muscular branches to all muscles of the hand EXCEPT muscles of thenar eminence and the lateral two lumbricals.

45. 3-Radial nerve
A-origin

46. B-course

47. Branches in the hand Dorsum of the hand:
-Cutaneous branches of radial nerve (lateral 2/3 and lateral 3 ½ fingers except the nail bed and adjacent skin by median nerve)

49. 4/20/2017
THE HAND
THE HAND

50. Thank You

51. Anatomical snuff box
Laterally: the tendons of the abductor pollicis longus and extensor pollicis brevis.
Medially: the tendon of the extensor pollicis longus.
the floor : the scaphoid and trapezium.
The radial artery passes obliquely through the anatomical snuffbox, deep to the extensor tendons of the thumb and lies adjacent to the scaphoid and trapezium.
Sup. :Terminal parts of the superficial branch of the radial nerve and the origin of the cephalic vein from the dorsal venous arch of the hand.

53. EXTENSOR RETINACULUM  It is a thickening of the deep fascia at the back of the wrist. It is attached laterally to the anterior border of the radius and medially to the triquetral and pisiform bones. It sends septa to the back of the lower end of the radius and ulna forming 6 extensor compartments