Saint Louis University

School of Medicine
ANATOMY
M.15 THE HAND
Compartments, Bones, Muscles And Tendon
Sheath, And Intrinsic Muscles Part 1
Dr. Laygo | October 22, 2018
OUTLINE
I. Surface Landmarks of the Wrist
II. Skin
III. Deep Fascia
IV. Palmar Aponeurosis
V. Movements of the Hand
VI. Intrinsic Muscles of the Hand
VII. Deep Intrinsic Muscles

SURFACE LANDMARKS OF THE WRIST

CARPAL BONES
 Radial side/Lateral 1ST row (nearest to the distal part of radius and ulna):
 Thumb (1ST DIGIT) Lateral to Medial
 Tuberosity of the scaphoid (navicular) Mnemonic Bone
 Flexor carpi radialis Scared Scaphoid (navicular of the
 Styloid process of the radius (distal part of the radius) hand)
 Palmaris longus tendon (superficial to flexor retinaculum; Lovers Lunate
likened to the appendix because it is said to be useless; Try Triquetrum
usually used as a donor for any damaged tendon) Positions Pisiform

 Ulnar side / Medial 2nd row: Lateral to medial

 Little finger (5TH DIGIT) Mnemonic Bone
 Pisiform bone (not very apparent) That Trapezium (greater
 Flexor carpi ulnaris(FCU) multangular)
They Trapezoid (Lesser
 Prominence of the flexor sublimis digitorum
multangular)
Can’t Capitate
Handle Hamate
Arrangement of bones:
Carpals
Metacarpals
Phalanges (prox, middle, distal)
Note: Count your fingers (digit) from lateral to medial while in the
anatomical position (thumb is the first digit and the little finger is the
5th digit)
 Sesamoid bones: extra bones w/c are not commonly present

JOINTS:
1. Carpometacarpal joint- between carpals and metacarpals
2. Metacarpophalangeal joint- between metacarpals and phalanges

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3. Proximal interphalangeal joint- between the proximal and middle
phalanges
4. Distal interphalangeal joint- between the middle and distal
phalanges

SKIN
A. DESCRIPTION

 Most superficial muscle

 Small muscle
 1st muscle in the palmar aspect of the hand

Flexor retinaculum & palmar

Origin
aponeurosis.
Insertion Skin of the palm
Nerve Supply Superficial branch of ulnar nerve
Corrugates the skin at the base of
hypothenar eminence
Action
Improves grip of the palm in
holding a rounded object
(ex: holding a glass of water)

 Thick and hairless C. THE NERVE SUPPLY TO THE ARM

 Bound to underlying deep fascia by numerous fibrous bands  Sensory nerve supply:
 The skin shows many flexure creases at the sites of skin  Palmar branch of median nerve
movement, which are not necessarily placed at the site of joints.  (above the flexor retinaculum)
 Sweat glands are present in large numbers  Supplies the lateral part of the palm
 Palmar branch of ulnar nerve
B. THE PALMARIS BREVIS  ( in front of flexor retinaculum)
 Supplies medial part of palm
 Lateral cutaneous nerve of the forearm/superficial
branch of the radial nerve
 Supplies skin over the base of the thenar
eminence

NOTE:
 Brevis- shorter
 Longus- longer
 Superficialis- superficial
 Profundus- deep
 Pollicis- thumb
 Digiti minimi- 5th digit
 Indicis- index finger

DEEP FASCIA
 The deep fascia of the wrist and palm is thickened to form the
flexor retinaculum and the palmar aponeurosis
 thick in farm laborers because it is being used every day
(Tagalog: Kalyo)

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 Adductor Pollicis

Oblique head: 2nd

PALMAR APONEUROSIS and 3rd metacarpal
 1st to be seen upon dissecting the anterior or palmar aspect of Origin bones ( capitate )
the hand Transverse head: anterior part
of 3rd metacarpal bone
 Triangular in shape and occupies the central part of the palm
Skin of the palm/ medial side
 Deep fascia of medial hypothenar and lateral thenar muscles 
Insertion of the base of the proximal
thin and weak (thin sensitivity)
phalanx of the thumb
 The intermediate part is thick and strong and is the palmar
Nerve Supply Ulnar nerve
aponeurosis proper.
Action Adducts thumb
 APEX is attached to the distal border of flexor retinaculum and
receives insertion of the palmaris longus muscle
 The BASE of the aponeurosis divides at the bases of the fingers
into four slips of tissues. Each slip divides into two bands: Which does not pass under the flexor retinaculum?
 One passing superficially to the skin Answer: TENDON OF PALMARIS LONGUS
 The other passing deeply to the root of the finger
 Each deep band divides into two, which diverge
around the flexor tendons and finally fuse with the
fibrous flexor sheath and the deep transverse
ligaments.
 Function: To give firm attachment to the overlying skin and so
improve the grip and to protect the underlying tendons.
MOVEMENTS OF THE HAND B. ABDUCTION
 Abduction really only occurs at the thumbs and little fingers
 There are three muscles involved in abduction
 Muscles:

 Abductor Pollicis Longus (ABPOLO)

Posterior surface of ulna and

Origin
radius
Insertion Base of first metacarpal bone
Nerve Supply Deep branch of Radial Nerve
Abducts thumb and Extends
Action
thumb
A. ADDUCTION
 Movement towards the midline of the body  Abductor Digiti Minimi
 Going towards third finger  It is close to flexor digiti minimi brevis
 Muscle: Origin Pisiform bone

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Medial side of base of
Insertion proximal phalanx of little
finger
Deep branch of Ulnar nerve
Nerve Supply
(C8 & T1)
Action Abducts little (5th) finger

 Abductor Pollicis Brevis (ABPOBRE)

Scaphoid, trapezium and
Origin
flexor retinaculum
lateral side of base of proximal
Insertion
phalanx of thumb
Nerve Supply Median nerve (C8 & T1)
Action Abducts thumb

 Muscles:
 Opponens Digiti Minimi

Origin Hook of hamate and flexor retinaculum

Insertion Medial border of 5th metacarpal
Nerve Supply Deep branch of ulnar nerve
Brings little finger into opposition with
Action
thumb

 Opponens Pollicis
Flexor retinaculum and tubercules of
Origin
scaphoid and trapezium
Insertion Lateral side of 1st metacarpal
Nerve Supply Recurrent branch of median nerve
Brings the metacarpal bone of the thumb
across the palm of the hand, and also
rotates it medially so that the pad of the
tip of the thumb faces and comes into
Action
contact with the pads of the tips of the
other fingers.
C. OPPOSITION
** draws the 1st metacarpal laterally to
 The ability to touch your thumb and pinky
oppose thumb towards center of palm

INTRINSIC MUSCLES OF THE HAND

- Found in the thenar compartment which is separated from
the other compartments by a fascia.
A. THENAR EMINENCE

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 Is the body of muscle on the palm of hand just beneath thumb.
 Thenar muscles are intrinsic muscles contained within the
thenar compartment, which is separated from other
compartments by fascia
 Thenar (thumb) muscles:
 Opponens pollicis
 Abductor pollicis brevis
 Adductor pollicis (ADPOLO)
 Flexor pollicis brevis (FLEXPOBRE)
Memory tip: “OA2F” “Oh, Ah, Ah Fuck”

 NERVE SUPPLY: MEDIAN NERVE

 The thenar muscles form the thenar eminence mound of
muscle you can see at the base of the thumb

B. HYPOTHENAR EMINENCE

 Lumbricals
 Dissect more on palmar side
 Located between metacarpals

Tendons of the flexor digitorum

Origin
profundus
Radial side of the tendinous
expansions of the extensor
Insertion
digitorum communis of the medial
4 fingers
Median nerve  1st and 2nd
lumbricals
Nerve Supply
Deep branch of ulnar nerve
3rd and 4th lumbricals
FLEX the fingers at the
metacaropophalangeal joints;
 Is the body of muscle on the palm of the human hand just Action
EXTENDS the interphalangeal
beneath the 5th phalanx joints.
 Hypothenar muscles
 Opponens digiti minimi
 Abductor digiti minimi
 Flexor digiti minimi brevis
 Memory tip: OAF (Opps Aba Father, minimi x3)
 All are innervated by the deep branch of the ULNAR NERVE

 ** Underneath the thenar and hypothenar muscles, there are

deeper muscles:
 Opponens Pollicis
 Opponens Digiti Minimi
DEEP INTRINSIC MUSCLES OF THE HAND

B. INTEROSSEOUS MUSCLES

A. LUMBICALES MUSCLES

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 The interosseous muscles are 7 in number: 4 dorsal and 3

palmar.
 Innervated by DEEP BRANCH OF ULNAR NERVE
 Two Groups:
 Four dorsal interosseous
 Muscles run between the metacarpals
 Action: ABDUCT the fingers and FLEX the
metacarpophalangeal joints and EXTEND the
interphalangeal joints ABDUCTOR MUSCLES NERVE SUPPLY
 Three palmar interosseous  radial nerve
 Located on the palmar portion of the 2 nd, 4th and 5th  except ABDUCTOR POLLICIS BREVIS (median nerve)
metacarpals
 Action: ADDUCT the fingers and FLEX the ADDUCTOR MUSCLES NERVE SUPPLY
metacarpophalangeal joints and EXTEND the  Ulnar nerve
interphalangeal joints
“BREVIS” NERVE SUPPLY
MNEMONIC FOR INTEROSSEI: PADDAB  Median nerve
PAD- Palmar interossei- adduction of the digits  Except PALMARIS BREVIS (superficial branch of ulnar nerve)
DAB- Dorsal interossei- abduction of the digits
“DIGITI MINIMI” NERVE SUPPLY
 Deep ulnar nerve
SUMMARY
“POLLICIS” NERVE SUPPLY
 Median nerve
 Except ADDUCTOR POLLICIS (ulnar nerve)

BLACK – from powerpoint

BLUE – Audio
RED – Emphasized
VIOLET – from the book
PINK – clinical correlations
GREEN – Old notes
BROWN – Reading Assignments

INTRINSIC MUSCLES OF THE HAND

THENAR HYPOTHENAR LUMBRICALS INTEROSSEI
Abductor Abductor digiti 1 and 2: 4 DORSAL
pollicis brevis minimi innervated by muscles :
MEDIAN NERVE abductors
Adductor Flexor digiti 3 and 4 : 3 PALMAR
pollicis minimi innervated by muscles
deep branch of :adductors
ulnar nerve
Opponens Opponens digiti
pollicis minimi
ANATOMY
Flexor pollicis 6 of 9 [VILLAROSA, DELA TORRE, MANOS]
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CHECKPOINT!
Questions from the lecture:
1. Which of the following is a bony landmark on the lateral side
of the wrist:
a. styloid process of radius
b. scaphoid prominence
c. pisiform bone
d. a and b
e. AOTA
2. Which of the following does not innervate the palm:
a. median
b. musculocutaneous
c. radial
d. ulnar
3. All of the following are thenar intrinsic muscles of the hand
except:
a. palmaris brevis
b. abductor pollicis
c. adductor pollicis
d. flexor pollicils brevis
e. opponens pollicis
4. Which of the following nerves supplies the hypothenar
intrinsic muscles of the hand?
a. median
b. superficial radial
c. deep radial
d. ulnar
e. musculocutaneous
5. Which of the following is true about interossei muscles?
a.four palmar interossei
b.three dorsal interossei
c.innervated by deep radial
d.flex the MCP JOINT
e.C and D
f.AOTA
***
6. A patient has a laceration on the posterior aspect of his left
forearm. What are the nerve roots of the nerve the was
possibly lacerated?
a. Anterior rami of C5-T1
b. Posterior rami of C5-C6
c. Posterior rami of C5-T1
d. Anterior rami of C8, T1
7. A patient came to you with a pain on THE lateral aspect of his
left upper forearm. Which of the following actions can trigger
the pain on this aspect?
a. left elbow flexion
b. left elbow extension
c. wrist dorsiflexion
d. wrist palmar flexion
8. T/F:The dorsal interossei are abductors.
9. T/F:Thenar muscles are innervated by the deep branch of
ulnar nerve.

Ans: D. B(partner of median nerve).A. D. D. A. C. T.F

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FINGER FLEXOR TENDONS

MUSCLES OF PRONATION
 Two muscles work together to turn the radius over the ulna and
pit the hand in a prone position: Pronator teres and pronator
quadratus.
Innerva
Muscle Origin Insertion Action
-tion
Distal ¼ of
Pronator Distal ¼
anterior Pronates Median
Quadratu surface
surface of forearm Nerve
s of ulna
radius
Medial Middle Median
Pronator epicondy lateral Pronates Nerve
Teres le of surface of forearm (C6 &
humerus radius C7)

 Extensor Hood, long extensor tendon, and lateral bands

 *Anatomical Snuffbox- located in between extensor pollicis longus
SUPINATION MUSCLES
and extensor pollicis brevis
Inner
FLEXOR TENDONS Muscle Origin Insertion Action vatio
 The muscles that flex your wrist are on the palmar side n
 Begin at the medial epicondyle of the humerus at the elbow Short head:
tip of Supinates
Tuberosity Muscul
Innerv coracoid forearm
Tendon Origin Insertion Action of radius ocutan
ation process of and,
Biceps and fascia eous
scapula when it is
Medial Brachii of forearm nerve
Flexes and Median Long Head: supine,
Flexor epicond via bicipital (C5 &
Base of 2nd radially deviates Nerve supraglenoid flexes
Carpi yle of aponeurosis C6)
metacarpal the hand (at the (C5 & tubercle of forearm
Radialis humeru
wrist) C7) scapula
s
Deep
Flexes middle
branch
phalanges at
of
proximal Lateral,
radial
Flexor Medial interphalangeal posterior
Median nerve
Digitoru epicond Middle joints. Lateral and anterior
Nerve Supinates (C5 &
m yle of Phalanges Also flexes Supinator epicondyle of surfaces of
(C7, C8, forearm C6) –
Superfici humeru of digits 2-5 proximal humerus proximal
& T1) bisects
alis s phalanges at 1/3 of the
the
metacarpophala radius
Supina
ngeal joints and
tor
hand.
muscle
Medial Distal half
Median  There are two muscles that return you to the anatomical
epicond of flexor
Palmaris Flexes hand at Nerve
yle of retinaculum position by uncrossing the radius and the ulna
Longus the wrist (C7 &
humeru and palmar
C8)
s aponeurosis
Base of the
distal
Medial
phalanx of
part:
Flexor digits 2-5; Flexes distal
ulnar
Digitoru Proxima passes phalanges at
nerve
m l ¾ of through the distal
Lateral
Profundu ulna tunnel of interphalangeal
Part:
s superficialis joints
Median
and inserts
Nerve
to the distal
phalanx

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WRISTS EXTENSORS
 The extensors of the wrist are on the dorsal side of the forearm
A majority of the wrist extensors begin at the lateral epicondyle

Muscle Origin Insertion Action Innervation

Extensor Extends and
Lateral
Carpi Base of 3rd radially Radial Nerve
epicondyle of
Radialis metacarpal deviates the (C7 & C8)
Humerus
Brevis wrist
Extensor Lateral Extends and
Carpi supracondyle Base of 2nd radially Radial Nerve
Radialis ridge of metacarpal deviates at the (C6 & C7)
Longus Humerus wrist
Extends and
Extensor Lateral
Base of 5th ulnar deviates
Carpi epicondyle of Radial Nerve
metacarpal hand at wrist
Ulnaris Humerus
joint
Extends the 5th
digit at the
Extensor Lateral Posterior
metacarpophal
Digiti epicondyle of 5th digit interosseous
angeal and
Minimi Humerus nerve
interphalangeal
joints
Extensor Extensor
digitorum expansions
of medial
Lateral Extends the Posterior
four digits;
epicondyle of four digits and interosseous
(inserts to
Humerus the wrist nerve
the base of
proximal
phalanx)
Posterior
surface of Extensor Extends 2nd Posterior
Extensor
ulna and expansion digit and helps interosseous
Indicis
interosseous of 2nd digit to extend hand nerve
membrane
Extends
Posterior
Base of proximal
Extensor surface of Posterior
proximal phalanx thumb
Pollicis radius and interosseous
phalanx of at
Brevis interosseous nerve
thumb carpometacarp
membrane
al joint
Extends distal
phalanx of
Posterior Base of
Extensor thumb at Posterior
surface of distal
Pollicis carpometacarp interosseous
middle 1/3 of phalanx of
Longus al and nerve
ulna thumb
interphalangeal
joints

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