Region of the wrist &

the hand

Dr. Saywan K.Asaad

 Anatomical Snuffbox:
❑ The anatomical snuffbox is a triangular skin
depression on the lateral side of the wrist.

❑ It is bounded:
❖ medially by tendon of extensor pollicis longus
❖ laterally by tendons of abductor pollicis
longus & extensor pollicis brevis
❑ Its clinical importance is that:
1) scaphoid bone is most easily palpated
here
2) the pulsation of the radial artery can
be felt here.
 Structures on the Anterior Aspect of
the Wrist:
❖ The following structures pass superficial to the
flexor retinaculum from medial to lateral:
1) Ulnar nerve.

2) Ulnar artery.

3) Palmar cutaneous branch of the ulnar nerve

4) Palmaris longus tendon.

5) Palmar cutaneous branch of the median nerve

❖ The following structures pass beneath the
flexor retinaculum from medial to lateral:
1) Flexor digitorum superficialis tendons and,
posterior to these, tendons of flexor
digitorum profundus.
2) Median nerve
3) Flexor pollicis longus tendon
4) Flexor carpi radialis tendon.
 Structures on the Posterior Aspect of
the Wrist:
❖ The following structures pass superficial to the
extensor retinaculum from medial to lateral:
1) Dorsal (posterior) cutaneous branch of the ulnar
nerve
2) Basilic vein
3) Cephalic vein
4) Superficial branch of the radial nerve.
❖ The following structures pass beneath the extensor
retinaculum from medial to lateral:
1) Extensor carpi ulnaris tendon.
2) Extensor digiti minimi tendon.
3) Extensor digitorum and extensor indicis tendons.
4) Extensor pollicis longus tendon.
5) Extensor carpi radialis longus and brevis tendons.
6) Abductor pollicis longus & the extensor pollicis
brevis tendons.
HAND
 The Palmar Aponeurosis:
❖ The palmar aponeurosis is triangular-shaped
thickening of deep fascia that occupies the
central area of the palm.

❖ The apex of the palmar aponeurosis is

attached to the distal border of the flexor
retinaculum and receives the insertion of the
palmaris longus tendon
❖ The base of the aponeurosis divides at
the bases of the fingers into four slips.
❖ The function of the palmar aponeurosis
is to give firm attachment to the
overlying skin & so improve the grip, & to
protect the underlying tendons.
 Flexor Retinaculum:
• The flexor retinaculum is a thickening of deep
fascia, measuring 2-3 cm, that holds the long
flexor tendons in position at the wrist.
• It stretches across the front of the wrist and
converts the concave anterior surface of the
hand into an osteofascial tunnel, called the
carpal tunnel .
❖ It is attached medially to the pisiform
bone and the hook of the hamate and
laterally to the scaphoid and the
trapezium bones.
 The Carpal Tunnel:
❖ The carpus is deeply concave on its anterior
surface & forms a bony gutter which is
converted into a tunnel by the flexor
retinaculum.
❖ The tendons of flexor digitorum superficialis,
flexor digitorum profundus and flexor pollicis
longus pass through the tunnel in addition to
the median nerve.
❖ The median nerve passes beneath the flexor
retinaculum in a restricted space between the
flexor digitorum superficialis and the flexor
carpi radialis muscles
 Extensor Retinaculum:
❖ The extensor retinaculum is a thickening of
deep fascia that stretches across the back of
the wrist and holds the long extensor tendons
in position
 Fibrous Flexor Sheath &
Synovial Flexor Sheath
❖ The anterior surface of each finger, from the
head of the metacarpal to the base of the
distal phalanx, is provided with a strong
fibrous sheath that is attached to the sides of
the phalanges.
 Muscles of the Hand:
Muscles of the hand include:
✔ 4 lumbrical muscles
✔ 8 interossei muscles
✔ Muscles of thumb (Thenar muscles)
✔ Muscles of little finger (Hypothenar
muscles).
 Muscles of the Thumb:
abductor pollicis brevis
flexor pollicis brevis thenar eminence
opponens pollicis
Adductor pollicis.
 Muscles of the Little Finger:
abductor digiti minimi
flexor digiti minimi brevis hypothenar eminence

opponens digiti minimi

Muscles of the thumb are supplied by median
nerve, except adductor pollicis (Ulnar nerve)

Muscles of little finger are supplied by ulnar

nerve.

1st & 2nd lumbricals are supplied by median

nerve, while 3rd & 4th by ulnar nerve.

Interossei are supplied by ulnar nerve.

 Nerve
Muscle Origin Insertion Action
Supply

Flexor
Superficial Corrugates skin to
Palmaris retinaculum,
Skin of palm branch of improve grip of
brevis palmar
ulnar nerve palm
aponeurosis

First and
Flex
second, (i.e.,
metacarpo-phalan
Tendons of Extensor lateral two)
geal joints and
Lumbricals flexor expansion of median
extend
(4) digitorum medial four nerve; third
interphalangeal
profundus fingers and fourth
joints of fingers
deep branch
except thumb
of ulnar nerve
 Interossei (8)

First arises from Proximal

base of first phalanges of
metacarpal; thumb and index,
Deep
Palmar(4) remaining three ring, and little adduct fingers toward
branch of
(PAD) from anterior fingers and dorsal center of third finger
ulnar nerve
surface of shafts of extensor
second, fourth, and expansion of each
fifth metacarpals finger

abduct fingers from

Proximal
center of third finger;
phalanges of
Contiguous sides of Deep both palmar and
Dorsal(4) index, middle, and
shafts of branch of dorsal flex
(DAB) ring fingers and
metacarpal bones ulnar nerve metacarpo-phalange
dorsal extensor
al joints and extend
expansion
interphalangeal joints
 Insertion of Long Extensor
Tendons:
On the posterior surface of each finger, the
extensor tendon joins a fascial expansion called
the extensor expansion.
Near the proximal interphalangeal joint, the
extensor expansion splits into 3 parts: a central
part, which is inserted into the base of the middle
phalanx, and two lateral parts, which converge to
be inserted into the base of the distal phalanx
The extensor expansion receives the
insertion of the corresponding
interosseous muscle and the lumbrical
muscle
THANK YOU