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Palm and Joints of Hand

This document provides an overview of the anatomy of the wrist and hand. It discusses the bones and joints of the wrist and hand, the superficial and deep fascia including the flexor retinaculum and palmar aponeurosis. It also describes the muscles of the hand including the thenar, hypothenar, palmar and dorsal interossei, and lumbricals. Additionally, it covers the nerves of the hand and the arterial supply. Key structures like the fibrous flexor sheath, synovial sheaths, and surgical spaces of the hand are defined.

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Gaurav Thapa
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14 views33 pages

Palm and Joints of Hand

This document provides an overview of the anatomy of the wrist and hand. It discusses the bones and joints of the wrist and hand, the superficial and deep fascia including the flexor retinaculum and palmar aponeurosis. It also describes the muscles of the hand including the thenar, hypothenar, palmar and dorsal interossei, and lumbricals. Additionally, it covers the nerves of the hand and the arterial supply. Key structures like the fibrous flexor sheath, synovial sheaths, and surgical spaces of the hand are defined.

Uploaded by

Gaurav Thapa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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At the end of Session, you should

be able to define
Bones& joints of Wrist and Hand
Superficial fascia
Deep Fascia
Flexor Retinaculum
Palmar Aponeurosis
Fibrous flexor sheath
Muscles of Hand
Thenar and Hypothenar muscles
Palmar and Dorsal Interosseus
Lumbricles
Nerves of Hand

X-ray
Photograph of
Hand and
Wrist
Bones of Hand &
Wrist
Scaphoid - Boat
Shaped
Lunate - Crescent
shaped
Triquetral - 3 sided
Pisiform - Pea shaped

Trapezium - 4 sided
Trapezoid - 4 sided
Capitate - has a Head
Hamate - has a Hook
Flexor Retinaculum
Flexor Retinaculum
 Thickened part of deep fascia which covers the anterior concavity
of Carpus and converts into tunnel, Carpal Tunnel

 Attachment:
 Medially (i) Pisiform (ii) Hook of Hamate
 Laterally: (i) Tubercle of Scaphoid (II) Crest of Trapezium
 Lateral deep slip and medial superficial slip (Volar carpal ligament)

 Relations:
 Superficial to it:
 i) Tendon of Pal. Long. ii) Ulnar nerve & Vessels iii) Palmar cut. branch of
Median & Ulnar nerves.
 Deep to it:
 i) Median nerve ii) Tendons of Flex. Dig. Sup. & Prof. iii) Tendon of FPL iv) Ulnar
and Radial Bursa v) Flex. Car. Rad.
Position of Flexor Retinaculum
Palmar
Aponeurosis
Fibrous Flexor Sheath & Synovial Sheaths
of Hand

Ulnar Bursa

Radial Bursa
Fibrous flexor Sheath
Dupuytren’s Contracture
Thickening & Contraction of Ulnar side of Palmar Aponeurosis

Due to Inflammation
involving Ulnar side of
Palmar Aponeurosis .

Proximal and Middle


phalanx become flexed
and can’t be extended
(Terminal phalanx
remains unaffected).

Ring finger is commonly


involved.
Muscles of Hand
Four Thenar muscles
 Abductor Pollicis Brevis, Opponens Pollicis

 Flexor Pollicis Brevis, Adductor Pollicis

Four Hypothenar muscles


 Opponens Digiti Minimi, Flexor Digiti Minimi

 Abductor Digiti Minimi, Palmaris Brevis

Four Lumbricals

Four Palmar Interosseus

Four Dorsal Interosseus


Adductor
Pollicis
Lumbricals
Extensor Hood and
attachment of
Dorsal Interosseus
&
Lumbricals
Palmar
Interossei
(Palmar View)
Dorsal
Interossei
(Palmar View)
Arterial Supply
of the Hand
Superficial
Palmar Arch
D
e
e
p

P
a
l
m
a
r

A
r
c
h
Nerves of the Hand
Ulnar Nerve

Median Nerve

Radial Nerve
U
l
n
a
r

N
e
r
v
e

in

H
a
n
d
M
e
d
i
a
n

N
e
r
v
e

in

H
a
n
d
Ulnar Claw Complete Claw
Hand Hand
Radial Nerve in Hand
Motor function test of Ulnar and
Median Nerve in Hand

Ulnar nerve Median nerve


Surgical Spaces of Hand
Palmar Spaces

1. Pulp space of fingers


2. Midpalmar space
3. Thenar space
Dorsal Spaces

1. Dorsal subcutaneous space


2. Dorsal subaponeurotic space
The Forearm space of Parona
Digital Pulp space

Infection
of this
space is
called
“Whitlow”
Surgical Spaces of the Hand
Cross Section of the Palm showing
Mid Palmar space & Thenar space
Mid Palmar space
 Shape – Triangular
 Situation – Under the inner half of hollow of palm
 Extent
 Proximally – Inferior margin of Flexor retinaculum
 Distally – Distal palmar crease
 Communication
 Proximally – Forearm space
 Distally – Fascial sheath of 3rd , 4th lumbricals sometimes with 2nd
 Boundaries –
 Anterior – Flexor tendons of 3rd , 4th & 5th fingers, 2nd , 3rd & 4th
lumbricals Palmar aponeurosis
 Posterior – Fascia covering interossei and metacarpals
 Lateral – Intermediate palmar septum
 Medial – Medial palmar septum
 Drainage – Incision at 3rd or 4th web
Thenar space
 Shape – Triangular
 Situation – Under the outer half of hollow of palm
 Extent
 Proximally – Inferior margin of Flexor retinaculum
 Distally – Proximal transverse palmar crease
 Communication
 Fascial sheath of 1st lumbrical and sometimes 2nd
 Boundaries:
 Anterior – Short muscles of thumb, Flexor tendons of index finger, 1 st
lumbrical, Palmar aponeurosis,
 Posterior – Transverse head of adductor policis & 1st dor. Inter. Mus.
 Lateral - Lateral palmar septum
 Medial – Intermediate palmar septum
 Drainage – Incision at 1st web posteriorly
Surgical Incisions of the Hand

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