1. Wrist and Hand
山东大学医学院 解剖教研室
李振华

2. Surface anatomy of wrist and hand
Anatomical “snuff box” 鼻烟壶
Medial: tendon of the extensor pollicis longs
Lateral: tendons of the abductor pollicis longus and extensor pollicis brevis
Proximal: styloid process of radius
Floor: scaphoid and trapezium bones
Radial a. crosses the floor of the snuff, so may fell the radial pulse in this fossa

3. Anatomical “snuff box”

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 hand
Attached laterally to scaphoid and trapezium and medially to pisiform and hamate
Ulnar carpal canal 腕尺侧管
Formed by the distal part of palmar carpal ligament and flexor reticulum
Transmit 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 trapezium
Transmit tendon of flexor carpi radialis

5. ★Carpal tunnel
Composition: Formed by flexor retinaculum and carpal groove
Structures passing through the carpal tunnel
Median n.
The tendons of flexor digitorum superficialis and flexor digitorum profundus enclosed by common flexor synovial sheath
The 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 profundus
Median n.
common flexor synovial sheath
Tendon 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 wrist
Attached laterally to radius and medially to styloid process of ulna and triquetral bone
Forms 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 membrane
Deep layer
palmar interosseous fascia 骨间掌侧筋膜

12. Osseofascial compartments of palm 手掌骨筋膜鞘
Lateral compartment 外侧鞘
Medial compartment 内侧鞘
Intermediate compartment 中间鞘
Laeral intermuscular septum
Medial intermuscular septum
Palmar aponeurosis
Thenar fascia
Hypothenar fascia
Adductor pollicis
Palmar interosseous fascia

13. Intermediate compartment 中间鞘
Boundaries
Palmar aponeurosis
Laeral and medial intermuscular septum
Palmar interosseous fascia
Contents
superficial palmar arch, a., v.,n.
tendons of flexor digitorum superficialis and profundus
Lumbricales
common 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: blind
Distally: continuous with the back of the index finger by the fist lumbrical canal
Midpalmar space掌中间隙: lies posterior to common flexor sheath
Proximal: continous with the posterior space of the antebrachial flexor through the carpl canal
Distally: continuous with the appropriate lumbrical canals
Palmar intermediate septum
Thenar space
Midpalmar space

15. Muscles of hand Lateral group－thenar (4) Medial group－hypothenar (3)
Intermedial group
Lumbricals 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 thumb
Nerve 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 little
finger
Nerve supply: ulnar n.

18. Muscles of hand Intermedial group Lumbricals 蚓状肌 (4)
Action: flex fingers at MP joints; extend fingers at IP joints
Nerve 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 joints
Dorsal interossei (4) 骨间背侧肌
abduct fingers away from middle finger at MP joints
Nerve supply: ulnar n.

20. Arteries of upper limb Superficial palmar arch 掌浅弓
Formed by ulnar artery and superficial palmar branch of radial artery
The curve of arch lies across the palm, level with the distal border of fully extended thumb
Gives 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 artery
The curve of arch lies across upper part of palmar at level with proximal border of extended thumb
Gives 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 lumbricales
Cutaneus branches: supply skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsum
Recurrent 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 pollicis
Cutaneus 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 fingers
Radial n. 桡神经
Skin of radial side of dorsum of hand
Posterior 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 hand
Superficial lymph vessels
Superficial branches of radial n. and doesal branch of ulnar n.
Deep fascia－the dorsal fascia of hand
Superficial 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 space
Superficial fascia
Dorsal aponeurosis
Dorsal subcutaneous space
Dorsal 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.