1 / 23

PALM OF THE HAND

PALM OF THE HAND. Dr. Ahmed Fathalla Ibrahim. THE SKIN. Flexure creases (lines of palm) Papillary ridges (fingerprints): improve grip & increase surface area Abundant sweat gland. SUPERFICIAL FASCIA. Contains: cutaneous nerves & vessels Contains: Palmaris brevis. DEEP FASCIA.

ganit
Download Presentation

PALM OF THE HAND

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. PALM OF THE HAND Dr. Ahmed Fathalla Ibrahim

  2. THE SKIN • Flexure creases (lines of palm) • Papillary ridges (fingerprints): improve grip & increase surface area • Abundant sweat gland

  3. SUPERFICIAL FASCIA • Contains: cutaneous nerves & vessels • Contains: Palmaris brevis

  4. DEEP FASCIA • PALM: thickened at 3 sites: Palmar aponeurosis: • Definition • Description • Function • Clinical anatomy: Dupuytren’s contracture

  5. PALMAR APONEUROSIS • DEFINITION: It is a thickening of deep fascia in the middle of the palm • DESCRIPTION: It is triangular in shape: • Apex:directed proximally,continuous with tendon of palmaris longus • Base:directed distally, divided into 4 slips for the medial 4 fingers • Margins: send septa to metacarpal bones separating the structures under the aponeurosis from thenar & hypothenar muscles • FUNCTION: It protects the underlying tendons, vessels & nerves • CLINICAL ANATOMY: DUPUYTREN’S CONTRACTURE: shortening of the medial part of aponeurosis resulting in flexion of the little & ring fingers

  6. DEEP FASCIA Flexor retinaculum: • Definition • Attachments • Relations • Functions • Clinical anatomy: Carpal tunnel syndrome

  7. FLEXOR RETINACULUM • DEFINITION: It is a thickening of deep fascia that lies over the front of the carpal bones converting the carpal groove (formed by carpal bones) into a tunnel • ATTACHMENTS: • Lateral:by 2 laminae: superficial (to tubercles of scaphoid & trapezium) & deep (to the medial lip of the groove on the trapezium) • Medial: to pisiform & hook of hamate

  8. FLEXOR RETINACULUM • RELATIONS: • Superficial:from lateral to medial: • Superficial palmar branch of radial artery • Palmar cutaneous branch of median nerve • Tendon of palmaris longus • Palmar cutaneous branch of ulnar nerve • Ulnar vessels • Ulnar nerve • Deep:Structures passing through carpal tunnel • Tendon of FPL & its synovial sheath (radial bursa) • Tendons of FDS & FDP & their common synovial sheath (Ulnar bursa) • Tendon of FCR & its synovial sheath ( in a special compartment) • Median nerve

  9. FLEXOR RETINACULUM • FUNCTION: It keeps the flexor tendons in position during movement of wrist joint • CLINICAL ANATOMY (CARPAL TUNNEL SYNDROME): Compression of median nerve under the flexor retinaculum

  10. DEEP FASCIA Fibrous flexor sheaths • Definition • Attachments • Function

  11. FIBROUS FLEXOR SHEATH • DEFINITION: It is a thickening of deep fascia in front of the fingers • ATTACHMENTS: • Proximal: to the slips of palmar aponeurosis • Distal: to the base of distal phalanx • On either side: to the side of phalanx • FUNCTION: It holds the long flexor tendons during flexion of the fingers

  12. INTRINSIC MUSCLES • LATERAL GROUP: FOUR THENAR MUSCLES • MEDIAL GROUP: THREE HYPOTHENAR MUSCLES PALMARIS BREVIS • CENTRAL GROUP: FOUR LUMBRICALS FOUR PALMAR INTEROSSEI FOUR DORSAL INTEROSSEI • ALL MUSCLES ARE SUPPLIED BY C8 & T1 SPINAL SEGMENTS THROUGH MEDIAN & ULNAR NERVES

  13. INTRINSIC MUSCLES

  14. THENAR MUSCLES THENAR MUSCLES • Abductor pollicis brevis • Flexor pollicis brevis • Opponens pollicis • Adductor pollicis N.B.: • Muscles # 1, 2, 4 are inserted into the proximal phalanx of thumb: act on MP & CM joints of thumb • Muscle # 3 is inserted into 1st metacarpal bone: opposition of CM joint of thumb (abduction + flexion + medial rotation)

  15. HYPOTHENAR MUSCLES HYPOTHENAR MUSCLES • Abductor digiti minimi • Flexor digiti minimi • Opponens digiti minimi N.B.: • Muscles # 1, 2 are inserted into the proximal phalanx of little finger: act on MP joint of little finger • Muscle # 3 is inserted into 5th metacarpal bone: rotates 5th metacarpal bone

  16. LUMBRICALS • Origin: tendons of FDP • Insertion: tendons of ED • Action:Writing position (flexion of MP & extension of IP joints of medial 4 fingers

  17. INTEROSSEI • PALMAR INTEROSSEI • Origin: metacarpal bone • Insertion: proximal phalanx • Action:Adduction of fingers (PAD) • DORSAL INTEROSSEI • Origin: adjoining sides of 2 metacarpal bone • Insertion: proximal phalanx • Action:Abduction of fingers (DAB)

  18. PALMARIS BREVIS • Origin: Palmar aponeurosis • Insertion: skin of medial border of hand • Action:deepening the hollow of palm to get a firmer grip

  19. ARTERIAL ARCHES IN HAND • SUPERFICIAL PALMAR ARCH • DEEP PALMAR ARCH • Formation • Site • Surface anatomy • Branches

  20. SUPERFICIAL PALMAR ARCH • FORMATION: • Direct continuation of ulnar artery (mainly) • Superficial branch of radial artery • SITE:between palmar aponeurosis & long flexor tendons • SURFACE ANATOMY:level with the distal border of the fully extended thumb • BRANCHES:digital branches to the medial three & half fingers • N.B.: Radial artery gives 2 branches that supplies the lateral one & half fingers: • Radialis indicis: supplies lateral side of index • Princeps pollicis: supplies both sides of thumb

  21. DEEP PALMAR ARCH • FORMATION: • Direct continuation of radial artery (mainly) • Deep branch of ulnar artery • SITE:between long flexor tendons & metacarpal bones • SURFACE ANATOMY:lies one inch proximal to superficial palmar arch • BRANCHES: • Branches sharing in anastomosis around wrist joint • Articular & muscular branches

  22. ULNAR NERVE IN THE HAND • MUSCULAR BRANCHES: • Palmaris brevis • Adductor pollicis • Hypothenar muscles • Interossei • Medial two lumbricals • CUTANEOUS BRANCHES: Palmar digital to medial 1 ½ fingers

  23. MEDIAN NERVE IN THE HAND • MUSCULAR BRANCHES: • Abductor pollicis brevis • Flexor pollicis brevis • Opponens pollicis • Lateral two lumbricals • CUTANEOUS BRANCHES: Palmar digital to lateral 3 ½ fingers

More Related