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Wrist Hand and Fingers

Wrist Hand and Fingers. Dr. S. Nishan Silva (MBBS). Surface Anatomy of Upper Limb. Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve Inflammation of tendons = compression of Median nerve Anatomical Snuffbox Lateral = E.pollicis brevis

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Wrist Hand and Fingers

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  1. Wrist Hand and Fingers Dr. S. Nishan Silva (MBBS)

  2. Surface Anatomy of Upper Limb • Carpal Tunnel • Carpals concave anteriorly • Carpal ligament covers it • Contains: long tendons, Median nerve • Inflammation of tendons = compression of Median nerve • Anatomical Snuffbox • Lateral = E.pollicis brevis • Medial = E. pollicis longus • Floor = scaphoid, styloid of radius • Contains Radial Artery (pulse) Frolich, Human Anatomy,UpprLimb

  3. Bones of the Wrist

  4. Bones of the Wrist

  5. Ligaments of Wrist (dorsal)

  6. Triangular FibrocartilageLigament(TFCC)*extends from ulnar side of distal radius & attaches to ulna @ base of ulnar styloid process*disc provides stability to wrist*major stabilizer of distal radioulnar joint

  7. Tendons of Wrist (dorsal)

  8. Wrist (dorsal)

  9. (dorsal)

  10. Hand Anatomy • Flexor digitorum superficialis (FDS) insert into middle phalanx. • Flexor digitorum profundus (FDP) runs deep to the FDS until the level of the MP joint where FDS bifurcates. • FDP inserts at the base of the distal phalanx and acts primarily to flex the DIP joint as well as all other joints flexed by FDS. (Figure 268-5).

  11. Ligaments of Wrist (palmar)

  12. Flexor retinaculum • It is attached, medially, to the pisiform and the hamulus of the hamate bone; laterally, to the tubercle of the scaphoid, and to the medial part of the volar surface and the ridge of the trapezium.

  13. Tendons of Wrist (palmar)

  14. (palmar)

  15. (palmar)

  16. (palmar)

  17. Bones of the Hand

  18. Bones of the Hand

  19. Carpal Tunnel

  20. Joints of the Upper Extremity • Radiocarpal joint • Synovial-condyloid • Distal radius with proximal row of carpals • Intercarpal joints • Synovial-plane • Carpal-metacarpal (2-5) • Synovial-plane • Trapezium-metacarpal 1 • Synovial-saddle • Metacarpal-phalangeal • Synovial-condyloid • Interphalangeal • Synovial-hinge • ALL DIARTHROSES

  21. Carpal Tunnel

  22. Anatomy Review • Muscles & Tendons • Extrinsic • Flexor tendons • Flexor carpi ulnaris • Flexor carpi radialis • Palmaris longus • Flexor pollicis longus (FPL) • Flexor digitorum profundis (FDP) • Flexor digitorum superficialis (FDS)

  23. Anatomy Review • Muscles & Tendons • Extrinsic • Extensor tendons • Abductor pollicis longus • Extensor pollicis brevis • Extensor carpi radialis longus and brevis • Extensor digitorum • Extensor digiti minimi • Extensor carpi ulnaris

  24. HAND & FINGER ANATOMY • 9 Finger Flexors • Median nerve • Transverse carpal ligament • 5 deep flexors pass through superficialis tendons and insert on distal phalanx of each finger and thumb • 4 superficial flexors insert on middle phalanx of digits 2-5 • Annular ligaments = pulleys (A1-A5) • PREVENT BOWSTRINGING

  25. Extrinsic Hand Muscles

  26. Extensor Indicis • O • Dorsal surface lower ½ body of ulna • Interosseus membrane • I • Ulnar side of index finger • N • Radial (posterior interosseus) • F • MCP and IP Ext of 2nd digit

  27. Extensor Pollicis Longus • O • Posterior 1/3 ulna • Interosseus membrane • I • Posterior surface of base of thumb distal phalanx • N • Radial (posterior interosseus) • F • CMC, MCP and IP Ext of 1st digit

  28. Extensor Pollicis Brevis • O • Dorsal 2/3 of radius • I • Dorsal surface of base of proximal 1st phalanx • N • Radial (posterior interosseus) • F • CMC & MCP Ext of thumb • CMC ABD of thumb

  29. Abductor Pollicis Longus • O • Posterior distal 2/3 of ulna • Posterior middle 1/3 of radius • Interosseus membrane • I • Radial side of base of 1st metacarpal • N • Radial (posterior interosseus) • F • CMC ABD & Ext of thumb

  30. Flexor Pollicis Longus • O • Anterior middle ½ of radius • Interosseus membrane • I • Palmar surface of base of distal 1st phalanx • N • Median (anterior interosseus) • F • IP Flexion of thumb

  31. Extensor Digiti Minimi • O • Lateral epicondyle of humerus • I • Extensor expansion of 5th digit • N • Radial (posteior interosseus) • F • MCP and IP extension of 5th digit

  32. Flexor Digitorum Superficialis • O • Medial epicondyle of humerus • Middle ½ anterior radius • I • Four tendons separating into two parts that insert into sides of bases of middle 2-5 phalanxes • N • Median • F • MCP flexion digits 2-5 • PIP flexion digits 2-5

  33. Flexor Digitorum Profundus • O • Anteriomedial surface of ulna • Interosseus membrane • I • Four tendons inserting into distal phalanges of digits 2-5 • N • Median 2-3 digits • Ulna 4-5 digits • F • DIP flexion of 2-5 digits

  34. Intrinsic Hand Muscles Thenar Eminance

  35. Abductor Pollicis Brevis • O • Scaphoid tuberosity • Trapezium ridge • Transverse carpal ligament • I • Lateral base of proximal 1st phalanx • N • Median • F • CMC & MCP ABD of thumb

  36. Flexor Pollicis Brevis • O • Superficial head – trapezium • Deep head – trapezoid, capitate and palmar ligaments of distal carpal bones • I • Base of prximal 1st phalanx on radial side • Extensor expansion • N • Superficial – median • Deep – Ulnar • F • CMC & MCP Flexion of thumb

  37. Opponens Pollicis • O • Trapezium • Transverse Carpal Ligament • I • Radial side of 1st metacarpal shaft • N • Median • F • Opposition

  38. Intrinsic Hand Muscles Hypothenar Eminence

  39. Abductor Digiti Minimi • O • Pisiform • I • Ulnar side base of 5th proximal phalanx • N • Ulnar • F • MCP ABD of 5th digit

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