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3 In two layers: a superficial layer a deep layer.

4 Common origin from the supraepicondylar ridge and lateral epicondyle of the humerus Except for the brachioradialis and anconeus, extend as tendons into the hand. Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Extensor digitorum Extensor digiti minimi Base of 2nd metacarpal Base of 3rd metacarpal Base of 5th metacarpal Anconeus Supraepicondylar ridge of humerus Lateral surface of distal end of radius proximal to styloid process flexion of forearm Supraepicondylar ridge of humerus Base of 2nd metacarpal extend and abduct hand at the wrist joint Lateral epicondyle of humerus (common extensor origin) Base of 3rd metacarpal Extend and abduct hand at the wrist join Lateral epicondyle of humerus; posterior border of ulna Base of 5th metacarpal Extends and adducts hand at wrist joint Lateral epicondyle of humerus (common extensor origin) Extensor expansions of medial four digits extends medial four digits primarily at metacarpophalangeal joints, secondarily at interphalangeal joints Extensor expansion of 5th digit Lateral surface of olecranon and superior part of posterior surface of ulna Lateral epicondyle of humerus assists triceps in extending forearm stabilizes elbow joint; may abduct ulna during pronation

5 Except for the supinator muscle, all these deep layer muscles originate from the posterior surfaces of the radius, ulna, and interosseous membrane and pass into the thumb and fingers. Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis

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7 Supinator Extensor carpi radialis brevis Deep branch of radial nerve Rest Posterior interosseous nerve continuation of deep branch of radial nerve

8 Radial artery Posterior interosseous artery origin: common interosseous branch of the ulnar artery recurrent interosseous artery End by joining to dorsal carpal arch of the wrist Anterior interosseous artery origin: common interosseous branch of the ulnar artery

9 Deep branch becomes posterior interosseous nerve after emerging from between 2 heads of supinator Posterior interosseous nerve passes deep to extensor pollicis longus to reach the wrist.

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12 The carpal tunnel formed anteriorly at wrist by a deep arch formed by carpal bones lexor retinaculum carpal bones & flexor retinaculum (transverse carpal ligament) (transverse carpal ligament) Flexor digitorum/superficialis Flexor pollicis longus Median nerve Pass through the carpal tunnel

13 abductor pollicis longus & extensor pollicis brevis extensor carpi radialis longus & extensor carpi radialis brevis extensor pollicis longus through three compartments on the lateral surface of the wrist. The extensor tendons pass into the hand in six compartments defined by an extensor retinaculum : extensor digitorum & extensor indicis posterior surface of the wrist extensor carpi ulnaris & extensor digiti minimi extensor carpi ulnaris & extensor digiti minimi medial side of the wrist

14 A triangular condensation of deep fascia that covers the palm and is anchored to the skin in distal regions. Continuous with the palmaris longus tendon, when present; otherwise, anchored to the flexor retinaculum.

15 Tendons of the extensor digitorum extensor pollicis longus muscles expand over the proximal phalanges to form "extensor hoods" or "dorsal digital expansions". Tendons of the extensor digiti minimi, extensor indicis, extensor pollicis brevis join these hoods.

16 Palmaris brevis Interossei Thenar muscles Hypothenar muscles Adductor pollicis Lumbrical Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Abductor digiti minimi Flexor

17 All of the intrinsic muscles of the hand deep branch of the ulnar nerve by deep branch of the ulnar nerve Except three thenar & two lateral lumbrical muscles median nerve by median nerve

18 Superficial palmar arch Deep palmar arch

19 Cephalic vein originates from lateral side of dorsal venous network. Basilic vein Basilic vein originates from dorsal venous network medial side of dorsal venous network.

20 Ulnar nerve medial side of the palm, medial half of the dorsum of the hand, the 5th finger, and the medial half of the 4th finger, anterior surfaces of the medial one and a half digits, Median nerve thumb,index,middle fingers,lateral side of the ring [distal parts on the dorsum of the hand] Radial nerve dorsolateral side

21 Homework: 1. Which structures pass through the carpal tunnel and their anatomical relationships with each other in the tunnel? 2. The incidence of carpal tunnel syndrome in the world and/or in Turkey? 3. The risk factors, higher in whom? Any gender disperancies in its incidence? Please send answers to

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