Hand

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Hand
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Bony, soft landmarks

• 1. dorsum
• a. knuckles metacarpal bone heads
• b. skin - thinner than palm, has hair follicles,
  sebaceous sweat glands
• c. dorsal venous network

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Bony, soft landmarks

• palm
• a. skin - much thicker than dorsum, many sweat
  glands, no hair follicles or sebaceous
• b. transverse flexion creases when
  metacarpophalangeal joints flex - proximal,
  distal
• c. longitudinal flexion creases - when thumb is
  opposed - radial midpalmar
• d. thenar eminence - ball / heel of thumb
• e. hypothenar eminence - heel of hand at little
  finger

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Trisomy 21
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Fingers

• Also have digital transverse flexion creases -
  proximal, middle, distal (thumb has only 2)
• Fingerprints - improve gripping ability
• Synovial sheaths
• a. radial bursa - encloses tendon of flexor
  pollicis longus
• b. ulnar bursa - encloses four tendons each of
  flexors digitorum superficialis profundus
  medially, extends distally to surround the two
  flexor tendons to pinkie
• c. Three separate distal sheaths - surround
  flexor tendons to index, middle, ring fingers-
  from metacarpophalangeal joints to base of distal
  phalanx

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Fingers

• Fibrous digital sheaths - dense fibrous
  connective tissue
• annular bands - surround phalanges
• cruciform bands - cross over between joints
• form osteofibrous canals - through which flexor
  tendons travel (in their synovial sheaths)
• Flexor retinaculum
• Fibrous connective fascia that covers and holds
  most of the flexors of the forearm in wrist. 

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Carpal Tunnel Syndrome

• Because the median is enclosed with the tendons
  in this tunnel, anything that decrease the size
  of the tunnel (infection, arthritis, degeneration
  etc.) will compress the median nerve causing
  carpal tunnel syndrome. Its symptom includes
  tingling sensation (paresthenia), absence of
  tactile sensation (anethesia), or diminished
  sensation (hypothenia), loss strength of thumb
  (abductor pollicis brevis, flexor pollicis brevis
  and opponents pollicis), lumbricals (lateral two)
  can also be affected. 

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Blood vessels

• Ulnar artery
• a. deep branch - joins radial to form deep palmar
  arch
• b. superficial palmar arterial arch, formed
  bysuperficial palmar branch from ulnar artery
  (more like the terminal branch of ulnar, which
  mainly forms the arch) superficial palmar
  branch of radial artery. It gives off three
  branches and joint with palmar metacarpal
  branches from deep palmar arch to form
• i) three common palmar digital artery - in the
  three medial intermetacarpal spaces each then
  divides
• proper palmar digital artery - to medial side of
  index finger, radial side of little fingerand
  both sides of middle ring fingers
• proper palmar digital artery - little finger,
  ulnar side, a branch directly from the
  superficial palmar arch (or a branch off the
  ulnar artery)

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Blood vessels

• radial a. - (sits in floor of anatomical snuff
  box)
• a. superficial palmar branch - to thenar muscles,
  joins superficial palmar arch (ulnar)
• b. princeps pollicis - to thumb, then splits into
  two proper digital arteries to both sides of the
  thumb
• c. radialis indicis - to lateral index finger
• d. deep palmar arterial arch - formed by Radial
  artery (mainly). deep branch of the ulnar a. -
  three palmar metacarpal arteries - between
  metacarpals - join common palmar digitals

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Deep palmar arterial arch

• three palmar metacarpal arteries
• three perforating arteries to dorsal arch

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Dorsal arterial arch

• a. formed by dorsal carpal branch from radial and
  ulnar arteries, and terminal branches of the
  anterior and posterior interosseus arteries. It
  is also joined by the perorating arteries from
  deep palmar arch.
• b. Dorsal arch gives off three dorsal metacarpal
  arteries, each then splits into dorsal proper
  digital arteries
• c. Dorsalis pollicis and dorsalis indicis can be
  considered as direct branches from radial dorsal
  carpal artery
• d. dorsal proper digital artery - to the medial
  side of little finger, direct branch from the
  dorsal arch (or branch from the dorsal carpal
  branch from ulnar artery).

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Nerves

• 1. ulnar nerve - superficial branch of the ulnar
  nerve - enters palm on ulnar side of center
  divides - three palmar digital branches - to
  skin of little finger (both sides), medial side
  ring finger
• 2. ulnar nerve - deep branch - to muscles of fine
  movements of hand- hypothenar muscles,
  interosseous, medial lumbricals, adductor
  pollicis

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Median nerve

• Enters palm to radial side of center divides to
  3 common palmar digital branches
• a. 1st common to abductor pollicis brevis, flexor
  pollicis brevis, opponens pollicis, and 1st
  lumbrical muscle
• then it divides - 3 proper palmar digital nerve
  - to skin, both sides of thumb lateral side of
  index
• b. 2nd common - to 2nd lumbrical muscle
• divides - to 2 proper palmar digital nerve - to
  skin of medial index, lateral middle finger
• c. 3rd common palmar digital branch divides to 2
  proper palmar digital nerve. - to skin on medial
  middle, lateral ring finger

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Radial nerve

• all sensory innervation in hand (dorsal lateral
  skin fascia)

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Muscles

• Thenar / short thumb muscles

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ABDUCTOR POLLICIS BREVIS

• ORIGINFlexor retinaculum, tubercle of trapezium
  bone, and tubercle of scaphoid bone
• INSERTIONBase of proximal phalanx of thumb,
  radial side, and extensor expansion
• ACTIONAbducts the carpometacarpal and
  metacarpophalangeal joints of the thumb in a
  vertical direction perpendicular to the place of
  the palm. By virtue of its attachment into the
  dorsal extensor expansion, extends the
  interphalangeal joint of the thumb. Assists in
  opposition, and may assist in flexion and medial
  rotation of the metacarpophalangeal joint. 
• NERVEmedian nerve - C6, C7, C8, T1

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FLEXOR POLLICIS BREVIS

• ORIGIN
• Superficial head flexor retinaculum and
  trapezium bone
• Deep head trapezoid and capitate bones
• INSERTIONBase of proximal phalanx of thumb,
  radial side, and extensor expansion
• ACTIONFlexes the metacarpophalangeal and
  carpometacarpal joints of the thumb, and assists
  in opposition of the thumb toward the little
  finger. By virtue of its attachment into the
  dorsal extensor expansion, may extend the
  interphalangeal joint
• NERVE
• superficial head median nerve. - C6, C7, C8, T1
• deep head C8, T1

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OPPONEN POLLICIS

• ORIGINFlexor retinaculum and tubercle of
  trapezium bone
• INSERTIONEntire length of first metacarpal bone,
  radial side
• ACTIONOpposes (i.e., flexes and abducts with
  slight medial rotation) the carpometacarpal joint
  of the thumb, placing the thumb in a position so
  that, by flexion of the metacarpophalangeal
  joint, it can oppose the fingers. For true
  opposition of the thumb and little finger, the
  pads of these digits come in contact. Bringing
  the tips of these digits together can be donw
  without opponens action
• NERVEmedian nerve - C6, C7, C8, T1

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ADDUCTOR POLLICIS

• ORIGIN
• oblique head capitate bone, and bases of second
  and third metacarpal bones
• transverse head palmar surface of third
  metacarpal bone
• INSERTIONTransverse head into ulnar side of base
  of proximal phalanx of thumb, and oblique head
  into extensor expansion
• ACTIONAdducts the carpometacarpal joint, and
  adducts and assists in flexion of the
  metacarpophalangeal joint, so that the thumb
  moves toward the plane of the palm. Aids in
  opposition of the thumb toward the little finger.
  By virtue of the attachment of the obilique
  fibers into the extensor expansion, may assist in
  extending the interphalangeal joint.
• NERVEulnar never - C8, T1

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Muscles

• Hypothenar / short muscles of little finger

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ABDUCTOR DIGITI MINIMI

• ORIGINTendon of flexor carpi ulnaris and
  pisiform bone
• INSERTIONBy two slips one into base of proximal
  phalanx of little finger, ulnar side the second,
  into the ulnar border of the extensor expansion
• ACTIONAbducts, assists in opposition, and may
  assist in flexion of the metacarpophalangeal
  joint of the little finger by virtue of
  insertion into the extensor expansion, may assist
  in extension of interphalangeal joints
• NERVEulnar nerve - C(7), C8, T1

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FLEXOR DIGITI MINIMI BREVIS

• ORIGINhook of hamate bone, and flexor
  retinaculum
• INSERTIONbase of proximal phalanx of little
  finger, ulnar side
• ACTIONFlexes the metacarpophalangeal joint of
  the little finger and assists in opposition of
  the little finger toward the thumb
• NERVEulnar never, C(7), C8, T1

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OPPONEN DIGITI MINIMI HAND

• ORIGINhook of hamate bone, and flexor
  retinaculum
• INSERTIONentire length of fifth metacarpal,
  ulnar side
• ACTIONopposes (i.e., flexes with slight
  rotation) the carpometacarpal joint of the little
  finger, lifting the ulnar border of the hand into
  a position so that the metacarpophalangeal
  flexors can oppose the little finger to the
  thumb. Helps to cup the palm of the hand
• NERVEulnar nerve - C(7), C8, T1

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Muscles

• Short Hand muscles

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LUMBRICALS

• ORIGIN
• 1 and 2 radial surface of flexor profundus
  tendons of index and middle fingers,
  respectively.
• 3 adjacent sides of tendon of flexor digitorum
  profundus tendons of middle and ring fingers
• 4 adjacent sides of tendon of flexor digitorum
  profundus of ring and little fingers
• INSERTIONInto the radial border of the extensor
  expansion on the dorsum of the respective digits

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LUMBRICALS

• ACTIONExtend the interphalangeal joints and
  simutaneously flex the metacarpophalangeal joints
  of the second through fifth digits. The
  lumbricales also extend the interphalangeal
  joints when the metacarpophalangeal joints are
  extended. As the fingers are extended at all
  joints, the flexor digitorum profundus tendons
  offer a form of passive resistance to this
  movement. Since the lumbricales are attached to
  the flexor profundus tendons, they can diminish
  this resistive tension by contracting and pulling
  these tendons distally, and this release of
  tension decreases the contractile force needed by
  the muscles that extend the finger joints. 
• NERVEI, II median nerve, C(6), 7, C8, T1 III,
  IV ulnar nerve C(7), C8, T1

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DORSAL INTEROSSEI

• ORIGIN
• First, lateral head Proximal one half of ulnar
  border of first metacarpal bone
• First, medial head radial border of second
  metacarpal bone
• second, third, and fourth adjacent sides of
  metacarpal bones in each interspace 
• INSERTIONinto extensor expansions and to base of
  proximal phalanges as follows
• First radial side of index finger, chiefly to
  base of proxiaml phalanx
• Second radial side of middle finger
• Third ulnar side of middle finger, chiefly into
  extensor expansion
• Fourth ulnar side of ring finger
• ACTIONAbducts the index, middle, and ring
  fingers from the axial line through the third
  digit. Assists in flexion of metacarpophalangeal
  joints and extension of interphalangeal joints of
  the same fingers. The first assists in addition
  of the thumb
• NERVEulnar nerve - C8, T1

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PALMAR INTEROSSEI

• ORIGIN
• First base of first metacarpal bone, ulnar side
• Second length of second metacarpal bone, ulnar
  side
• Third length of fourth metacarpal bone, radial
  side
• Fourth length of fifth metacarpal bone, radial
  side
• INSERTIONChiefly, into the extensor expansion of
  the respective digit, with possible attachement
  to base of proximal phalanx as follows
• First ulnar side of thumb
• Second ulnar side of index finger
• Third radial side of ring finger
• Fourth radial side of little finger
• ACTIONAdduction of thumb, index , ring, and
  little finger toward the axial line through the
  third digit. Assist in flexion of
  metacarpophalangeal joints, and extension of
  interphalangeal joints of the three fingers
• NERVEulnar nerev  C8, T1