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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.

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PALM OF THE HAND

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  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

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