Surface anatomy of the wrist and hand

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1 The Wrist and Hand

2 Surface anatomy of the wrist and hand Tendons of extensor digitorum Tendon of extensor pollicis longus Tendons of extensor pollicis brevis and abductor pollicis longus Anatomical snuffbox Dorsal view

3 Skeleton of the wrist and hand Carpal bones: arranged in two rows 1. Proximal row a. b. c. d. scaphoid lunate triquetrum pisiform 2. Distal row a. b. c. d. trapezium trapezoid capitate hamate

4 Skeleton of the wrist and hand Bones of the hand 1. Metacarpals 2. Phalanges a. proximal b. middle c. distal Note: the thumb has only proximal and distal phalanges

5 Joints of the wrist and hand A. Joints of the wrist and hand 1. Radiocarpal joint 2. Intercarpal joints 3. Carpometacarpal joints

6 Joints of the wrist and hand A. Joints of the wrist and hand 1. Metacarpophalangeal (M.P.) joint 2. Proximal interphalangeal (P.I.P.) joint 3. Distal interphalangeal (D.I.P.) joint

7 Fascial structures of the hand A. Superficial fascia (thick on palm, thin on dorsum) B. Flexor retinaculum

8 Fascial structures of the hand hamulus A. Superficial fascia (thick on palm, thin on dorsum) B. Flexor retinaculum attaches to the pisiform and hamulus medially attaches to the scaphoid and trapezium laterally H T P distal row S proximal row

9 Fascial structures of the hand A. Superficial fascia (thick on palm, thin on dorsum) B. Flexor retinaculum attaches to the pisiform and hamulus medially attaches to the scaphoid and trapezium laterally forms the carpal tunnel through which pass: (the tendon of flexor carpi radialis in its own separate compartment) the tendon of flexor pollicis longus the tendons of flexor digitorum superficialis and profundus the median nerve

10 Fascial structures of the hand C. Extensor retinaculum Extensor tendons pass deep to retinaculum in six separate compartments

11 Fascial structures of the hand D. Palmar aponeurosis

12 Fascial structures of the hand palmar fascial compartments - separated from each other by CT septa 1. Central compartment (deep to palmar aponeurosis) Contents: flexor tendons digital nerves palmar arterial arches 2 fascial spaces: thenar space midpalmar space

13 Fascial structures of the hand palmar fascial compartments 2. Thenar compartment Contents: thenar muscles 3. Hypothenar compartment Contents: hypothenar muscles

14 Intrinsic muscles of the hand A. Muscles of the thumb 1. Abductor pollicis brevis 2. Flexor pollicis brevis

15 Intrinsic muscles of the hand A. Muscles of the thumb 1. Abductor pollicis brevis 2. Flexor pollicis brevis 3. Opponens pollicis

16 Intrinsic muscles of the hand A. Muscles of the thumb 1. Abductor pollicis brevis 2. Flexor pollicis brevis 3. Opponens pollicis 4. Adductor pollicis

17 Intrinsic muscles of the hand B. Hypothenar muscles 1. Palmaris brevis

18 Intrinsic muscles of the hand B. Hypothenar muscles 2. Abductor digiti minimi 3. Flexor digiti minimi brevis 4. Opponens digiti minimi flexor pollicis? brevis opponens pollicis? flexor? abductor? pollicis retinaculum brevis

19 Intrinsic muscles of the hand C. Other Intrinsic hand muscles 1. lumbricals opponens digiti? flexor digiti minimi brevis minimi? abductor digiti minimi? lumbricals

20 Intrinsic muscles of the hand C. Other Intrinsic hand muscles PAD 2. Interosseous muscles a. palmar interossei b. dorsal interossei DAB

21 Intrinsic muscles of the hand dorsal view lateral view extensor expansion flexor digitorum profundus tendon extensor expansion lumbrical extensor digitorum dorsal tendon interossei

22 Intrinsic muscles of the hand dorsal view lateral view Action of lumbricals and interossei

23 Blood supply to the hand superficial palmar arterial arch... comes primarily from the ulnar artery ulnar artery? deep palmar arterial arch... comes primarily from?radial the artery radial artery

24 Blood supply to the hand common digital arteries proper digital arteries princeps pollicis artery

25 Nerves of the hand A. Ulnar nerve 1. Cutaneous branches a. dorsal branch b. digital branches c. palmar branch

26 Nerves of the hand A. Ulnar nerve superficial branch deep branch palmar cutaneous branch

27 Nerves of the hand A. Ulnar nerve superficial branch deep branch

28 Nerves of the hand B. Median nerve digital branches

29 Nerves of the hand B. Median nerve recurrent branch palmar cutaneous branch

30 Nerves of the hand B. Median nerve digital branches palmar cutaneous branch

31 Nerves of the hand C. Radial nerve superficial radial nerve *

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