1. By: Breona, Haley, Katherene, Kelsea
Hand
By: Breona, Haley, Katherene, Kelsea

3. Distal wrist crease
Proximal wrist crease

4. Palmaris longus tendon
Flexor carpi radialis tendon

5. Anatomical Snuff Box

6. Tendon of Extensor Pollicis Longus
Tendon of extensor pollicis brevis

7. Tendon of Abductor Pollicus Longus

8. Extensor Digitorum Tendon

9. Thenar eminence
Hypothenar eminence

10. Easy way to remember: “So Long To Pinky, Here Comes The Thumb”
Wrist bones
Easy way to remember: “So Long To Pinky, Here Comes The Thumb”

11. Metacarpal bones

12. Phalangeal bones

13. Joints

14. Articular Cartilage
Articular cartilage (hyaline) covers bones at joints, absorbing stress placed on bones from compression.
Articular cartilage
Marieb, Elaine N., & Hoehn, K. (2013). Human anatomy & physiology. Boston: Pearson.

15. Synovial Joints in the Hand
Articular cartilage covers surface of bones at joint
Minimizes stress of compression on joints
Articular capsule
External fibrous layer strengthens joint
Continuous with periosteum of bone
Internal synovial membrane makes synovial fluid
Joint cavity filled with synovial fluid reduces friction
Ligament
Joint cavity filled with synovial fluid
Articular cartilage
Fibrous layer
Articular capsule
Synovial
membrane
Perisoteum
Marieb, Elaine N., & Hoehn, K. (2013). Human anatomy & physiology. Boston: Pearson.

16. Ligaments: Palmar aponeurosis
Large, fan-shaped ligament
Covers flexor tendons on palmar side of hand
Form 4 bands that attach to the base of phalanges
Palmar aponeurosis
Marieb, Elaine N., & Hoehn, K. (2013). Human anatomy & physiology. Boston: Pearson.
Marieb, Elaine N., & Hoehn, K. (2013). Human anatomy & physiology. Boston: Pearson.

17. anterior view, right hand
Common flexor sheath
anterior view, right hand
Elongated bursa filled with synovial fluid
Deep to flexor retinaculum
Covers tendons of Flexor digitorum superficialis and Flexor digitorum profundus
Reduces friction so tendons can slide past each other
Common flexor sheath
Marieb, Elaine N., & Hoehn, K. (2013). Human anatomy & physiology. Boston: Pearson.
Moore, K., Agur, A., & Dalley II, A., Phd. (2015). Essential clinical anatomy. Philadelphia: WoltersKluwer.

18. Ligaments: Flexor retinaculum Extensor retinaculum
Holds down tendons of anterior muscles
Extensor retinaculum
Holds down tendons of posterior muscles
Extensor retinaculum
Flexor retinaculum

19. Muscles Extensors = dorsal side, “stretcher”
Flexors = palmar side, “bender”
Opponens = oppose
Brevis = short
Longus = long
Carpi = wrist
Superficialis = Superficial
Digitorum = fingers
Digiti = finger
Digiti minimi = little finger
Pollicis = thumb
Indicis = index finger
Interossei = between bones
Profundus = deep

20. Abductor pollicis longus
Nerve: Posterior Interosseous nerve
Roots: C7, C8
Origin: Posterior surface of proximal ½ of ulna, radius, and interosseous membrane
Insertion: Base of 1st metacarpal
Action: Abducts and extends thumb
Synergist: Abduction: Abductor pollicis brevis
Extension: Extensor pollicis (longus and brevis)
Antagonist: Adduction: Adductor pollicis
Flexion: Flexor pollicis (longus and brevis)

21. Flexor pollicis longus
Nerve: Median
Roots: C8, T1
Origin: Anterior surface of radius, interosseous membrane
Insertion: Distal phalanx of thumb
Action: Flexes all digits of pollex
Synergist: Flexion: Flexor pollicis brevis
Antagonist: Extension: Extensor pollicis (longus and brevis)

22. Extensor pollicis longus
Nerve: Posterior Interosseous nerve
Roots: C7, C8
Origin: Posterior surface of middle ⅓ ulna and interosseous membrane
Insertion: Dorsal surface of distal phalanx
Action: Extends interphalangeal, metacarpophalangeal, and carpometacarpal joints of thumb
Synergist: Extension: Extensor pollicis brevis, abductor pollicis longus
Abduction: Abductor pollicis (longus and brevis)
Antagonist: Flexion: Flexor pollicis (longus and brevis)
Adduction: Adductor pollicis

23. Extensor pollicis brevis
Nerve: Posterior Interosseous Nerve
Roots: C7, C8
Origin: Posterior surface of distal ⅓ of radius and interosseous membrane
Insertion: Dorsal surface of the base proximal phalanx
Action: Extends proximal phalanx, metacarpophalangeal, and carpometacarpal joints of thumb
Synergist: Extension: Extensor pollicis longus
Antagonists: Flexion: Flexor pollicis (longus and brevis)

24. Extensor indicis Nerve: Radial Nerve, Posterior Interosseous Branch
Roots: C7, C8
Origin: Posterior surface of ulna and interosseous membrane
Insertion: Into extensor hood of index finger
Action: Extends 2nd digit and assists with hand extension
Synergist: Extension: Extensor digitorum
Antagonists: Flexion: Flexor digitorum (superficialis and profundus), Flexor digiti minimi brevis

25. Opponens digiti minimi
Nerve: Ulnar nerve, deep branch
Roots: C8, T1
Origin: Hamalus (hook) of the hamate bone and
flexor retinaculum
Insertion: Ulnar side of 5th metacarpal bone
Action: Brings little finger into opposition with the
thumb at CMC joint
Synergist: Abductor digiti minimi,
Flexor digiti minimi brevis
Opponens digiti minimi

26. Abductor digiti minimi
Nerve: Ulnar nerve, deep branch
Roots: C8, T1
Origin: Pisiform bone and tendon of flexor carpi ulnaris
Insertion: Base of proximal phalanx of the little finger
Action: Abducts little finger at MCP joint
Synergist: Dorsal interossei 2 - 4
Antagonist: Palmar interossei 2, 4-5, Extensor indices

27. Flexor digiti minimi brevis
Nerve: Ulnar nerve, deep branch
Roots: C8, T1
Origin: Hamalus (hook) of the hamate bone and
flexor retinaculum
Insertion: Base of proximal phalanx of the little finger
Action: Flexes little finger at MCP joint
Synergist: Flexor digitorum (superficialis and profundus)
Antagonist: Extensor digitorum, Extensor digiti minimi

28. Abductor pollicis brevis
Nerve: Median nerve
Roots: C8 and T1
Origin: Flexor retinaculum and tubercles of trapezium and scaphoid bones
Insertion: Base of proximal phalanx of thumb: dorsal digital expansion of thumb
Action: Abducts thumb at CMC and MCP joints
Synergist: Abductor brevis
Antagonist: Adductor pollicis, palmar interossei

29. Flexor pollicis brevis
Nerve: superficial head: median nerve
Roots: C8, deep branch of ulnar nerve
Origin: Superficial head: flexor retinaculum and tubercle of trapezium
Deep head: trapezoid and capitate bones
Insertion: Radial side of proximal phalanx of thumb
Action: flexes proximal phalanx of thumb at MCP joint, flexes metacarpal bone and rotates it medially at CMC joint
Synergist: Pollex flexion: Flexor pollicis longus, Adductor pollicis
Antagonist: Pollex extension: Extensor pollicis (longus and brevis), Abductor pollicis longus

30. Adductor Pollicis
Nerve: Deep branch of ulnar nerve of 2nd and 3rd metacarpal bones.
Root: (C8,T1)
Origin: Oblique head: capitate bone and bases of 2nd and 3rd metacarpal bones transverse head: Palmar surface of the 3rd metacarpal bones
Insertion: Ulnar side of base of proximal phalanx of thumb
Action: Adducts the thumb at CMC and MCP joints
S: Palmar interossei metacarpal bones A: Abductor pollicis (longus and brevis)

31. Opponens Pollicis Nerve: Median nerve Roots: C8 and T1
Origin: Flexor retinaculum and the tubercles of the scaphoid and trapezium bones
Insertion: Whole length of lateral border of metacarpal bone of thumb.
Action: opposes thumb to other fingers
Synergist: abductor pollicis brevis, flexor pollicis brevis

32. Lumbricals (4 muscles) Latin word meaning worm-like Action:
*Left, Palmar side
Latin word meaning worm-like
Action:
Extends 2nd - 5th fingers at IP joints
Flexes 2nd - 5th fingers at MCP joints

33. Dorsal Interossei Mnemonic: DAB
Action: Abducts 2nd - 5th fingers at MCP joints
*Left, Dorsal side

34. Palmar Interossei Mnemonic: PAD
Action: Adducts thumb, 2nd, 4th, and 5th fingers at MCP joints
*Left, Palmar side

35. Flexor Digitorum Superficialis
Nerve: Median
Roots: C7, C8, T1
Origin: Humero-ulnar head: medial epicondyle of humerus and coronoid process
Radial head: oblique line of radius
Insertion: Body of middle phalanges (digits 2-5)
Action: Flexes PIP joints and MCP joints (digits 2-5)
Synergist: Flexion: Flexor digitorum profundus
Antagonists: Extensor (digitorum and digiti minimi)

36. Flexor Digitorum Profundus
Nerve: Lateral fibers:Median & medial fibers: Ulnar
Roots: C8, T1
Origin: Proximal ¾ of medial and anterior surfaces of ulnar, interosseous membrane
Insertion: Base of distal phalanges (digits 2-5)
Action: Flexes DIP joint (digits 2-5), assist with wrist flexion
Synergist: Flexion: Flexor digitorum superficialis
Wrist Flexion: Palmaris longus, Flexor Carpi
radialis, Flexor carpi ulnaris, Flexor digitorum
superficialis
Antagonists: DIP extension: Extensor digitorum & digiti
minimi
Wrist extension: Extensor carpi radialis
longus & brevis, Extensor carpi ulnaris

37. *Right, Palmar side

38. *Right, Palmar side

39. *Right, Dorsal side

40. *Right Hand

41. Carpal Tunnel Syndrome
The carpal tunnel is an area deep to the flexor retinaculum which the median nerve and tendons travel through. Carpal tunnel syndrome occurs when excess pressure is put on the median nerve at the carpal tunnel, caused by either the narrowing of the carpal tunnel or the enlargement of surrounding structures.
Causes:
overuse/frequent repetition of wrist or finger flexion
sleeping on flexed wrist,
other diagnoses that may cause inflammation at carpal tunnel (i.e. rheumatoid arthritis)
Symptoms:
tingling
numbness
weak thumb/grip
pain in fingers

42. Carpal Tunnel Syndrome, cont.
Prevention:
Stretching
Taking breaks and resting
Maintaining correct posture & wrist position
Keeping hands warm
Using tools designed to keep wrist in proper alignment
Treatment:
Rest
Splinting of wrist
Corticosteroids and NSAIDs to relieve swelling
Stretching and strengthening (after symptoms have abated)
Carpal tunnel release surgery: cutting carpal ligament to relieve pressure on median nerve
"Carpal Tunnel Syndrome Fact Sheet", NINDS, Publication date July 2012.
Moore, K., Agur, A., & Dalley II, A., Phd. (2015). Essential clinical anatomy. Philadelphia: WoltersKluwer.

43. Arteries Ulnar artery Radial artery Superficial palmar arch
Deep palmar arch
*Left, Palmar side

44. Veins Dorsal Venous Arch Cephalic Vein Basilic Vein *Right,
Dorsal side