Hand and Wrist

Anatomy Team 434

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 OBJECTIVES
—t the end of the lecture, students should
A
be able to:
1)—
Describe the anatomy of the deep fascia of the wrist & hand (flexor &
extensor retinaculae & palmar aponeurosis).
2)List the structures passing superficial & deep to flexor retinaculum.
—
3)Describe the anatomy of the insertion of long flexor & extensor tendons.
—
4)Describe the anatomy of the small muscles of the hand (origin, insertion
—
action & nerve supply)
 Retinacula
Formed of: Flexor Retinaculum (Anterior) & Extensor
Retinaculum (posterior) formed of of —
bands of Deep Fascia at the
wrist

Founcation:Hold the long flexor and extensor tendons in

position at the wrist.

Medially Attachments: Laterally

Both retinacula attached to Flexor Retinaculum to Tubercle
Pisiform & Hook of Hamate of Scaphoid & Trapezium.

Extensor Retinaculum to Distal

end of Radius

Structures Superficial to Flexor Retinaculum

From Medial to Lateral: (these structures above flexor retinaculum)
1. Tendon of Flexor carpi ulnaris.
2. Ulnar nerve.
3. Ulnar artery.
4. Palmar cutaneous branch of ulnar nerve.
5. Palmaris longus tendon.
6. Palmar cutaneous branch of median nerve.
Carpal Tunnel

Formed from: Concave anterior surface of the Carpus

covered by Flexor Retinaculum

Contents (From Medial to Lateral):(important)

● Tendons of flexor digitorum superficialis
and profundus
● Median nerve
● Flexor Pollicis Longus
● Flexor carpi radialis

Carpal Tunnel syndrome

Causes:
•Compression of the median nerve within the carpal tunnel

Manifestations:
● Burning pain (pins and needles ) in the lateral three and
half fingers.
● No paresthesia over the thenar eminence. N
● Weakness or atrophy of the thenar muscles (Ape Hand).
● Inability to Oppose the thumb.
Palmar Aponeurosis
Features:Thickened deep fascia ,Triangular in shape , occupies the central
area of the palm.

Apex:attached to the distal border of flexor retinaculum

receives the insertion of palmaris longus tendon.

Base:divides at the bases of the fingers into four slips that pass into the fingers.

Functions: attached to the overlying skin and improves the grip. Gives origin to palmaris brevis.
— Protects the underlying tendons, vessels & nerves.

Palmaris Brevis

Origin Insertion Nerve supply Action

Flexor retinaculum & Skin of Ulnar (Superficial) Corrugation of skin

Palmaris retinaculum Palm Branch to improve Grip
Short Muscles of Thumb & Little Finger

1)Hypothenar Eminence (3) 2)Thenar Eminence (3)

Abductor Flexor
Opponens
Abductor Flexor
Opponens
3)Adductor
Muscle digiti digiti
digiti minimi
pollicis pollicis
pollicis Pollicis
minimi minimi brevis brevis

Oblique Head:
Flexor Palmar surface FR Flexor Flexor Ant. bases of 2nd
Pisiform
Origin retinaculu of 5th Scaphd& retinaculu retinaculu &3rd meta
m metacarpal Trapez m m Trans Head:
3rd meta

Lateral Medial side of

Insertion Base of Prox ph Base of Prox ph part of 1ST base of prox.ph
Met of thumb

Deep branch of
NS All by Deep branch of Ulnar All from Median N
Ulnar

Pulls the 5th

metacarpal
Action Abduction Flexion
forward
Abduction Flexion Opposition Adduction
(Cup the palm)

the origin of Opponens digiti minimi not correct (flexor retinaculum)

Insertion of Flexor Digitorum Superficialis & Profundus Movements of Thumb

Flexor digitorum superficialis:

Each tendon:
1. divides into two halves pass
around the Profundus Tendon
2. The two halves meet on the
posterior aspect of Profundus
tendon — (partial decussation of
fibers).
3. Reunion of the two halves. —
4. Further Division into two slips
attached to the Borders of
Middle Phalanx.
1. Flexion & Extension.
1. Abduction & Adduction
Flexor digitorum Profundus:Inserted into the Base of the Distal Phalanx. 1. Opposition
Fibrous Flexor (Digital) Sheath

— Strong Fibrous Sheath, which covers the anterior surface of the fingers
A
and attached tothe sides of the phalanges.

— Its Proximal end is opened Its Distal end is closed

—he Sheath with the anterior surfaces of the phalanges & the
T
interphalangeal joints form an Osteofibrous blind Tunnel for the long
flexor tendons of the fingers.

Synovial Flexor Sheaths

Common Synovial sheath (Ulnar Bursa): Contains tendons of Flexor Digitorum
Superficialis & Profundus

—he Medial part of the sheath extends

T The Lateral part of the sheath stops
—
distally(without interruption) on the
tendons of the little finger. on the middle of the palm.

The distal ends of the long flexor tendons to(Index, Middle & Ring) fingers acquire
—
Digital Synovila Sheaths

Flexor Pollicis Longus tendon has its own synovial sheath (Radial Bursa)
—

Function of Synovial Sheaths:(very important)

—llow the long tendons to move smoothly with a minimum of friction beneath the
a
flexor retinaculum and the fibrous flexor sheaths.
 Lumbrical Muscles(4) Palmar interossei(4) Dorsal
interossei(4)
Origin Tendons of flexor digitorum 1st (in thumb): Base of 1stmetacarpal. Contiguous sides of
profundus Other three: shafts of Metacarpals
Ant. Surface of Shafts of 2nd , 4rd & 5th
metacarpals.

Insertion EXT. EXP of medial four fingers Proximal phalanges of thumb ,index, Proximal Phalange of
ring, & little fingers and Extensor index, ring ,mid
expansion finger & EX

NS 1ST & 2ND Median N

Ulner n. deep Branch
3RD & 4TH Ulnar N. Deep branch

Action Flex metacarpophalangeal joints Adduction of fingers toward center Abduction of fingers
and extend interphalangeal joints of the 3rd one. away from the 3rd
of fingers Except thumb one.
 Action of Lumbricals & Interossei

writing position

Extensor Expansion
—
Formed from the expansion of the tendons of
extensor dig. at the PIJ, the expansion
The tendon splits into three parts:
—
— One Central: inserted into the base of Middle phalanx.
— Two laterals: inserted into the base of the Distal phalanx.
The Expansion Receives the insertions of:
—
— Corresponding Interosseous muscle (on each side).
— Lumbrical muscle (on the lateral side).
 MCQ

Q1)Which one of the following thenar muscles has an ulnar nerve supply?
A. Abductor pollicis brevis
B. adductor pollicis
C. flexor pollicis brevis
Q2)Which of the following group of muscles oppose the action of Palmar
interossei?
A. Lumbrical muscles
B. Dorsal interossei
C. Hypothenar eminence
Q3)Compression of the flexor retinaculum will most likely affect which of the
following nerves?
A. Median nerve 1) B
B. Ulnar nerve 2) B
C. Thoracodorsal nerve 3) A
Q4)The common synovial sheath continues from the palm to the index finger? 4) F (medial
A. T part, minimus)
B. F

For extra questions:

http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/
musculoskeletal_system/forearm_questions.html