Anatomy of the Hand

KHALID AYOUB
03/03/03
 TOPICS
• Osteology
• Arthrology
• Extensor tendon
• Flexor tendon
• Nerve supply
• Blood supply
• Common pathological conditions
 Osteology
Carpus:
• Mostly articular
P

• No tendon insertion
R
• Intrinsic Ligaments
• Shape
 Osteology
Carpus:
1 6
• Mostly articular <1 5
• 6 2
No tendon insertion PP 5
4
• Intrinsic Ligaments 6 1
R
• Shape
• Ossification
 ARTHROLOGY
A). Radiocarpal joint;
Radius Scaphoid
Lunate
TFC Triquetrum
 ARTHROLOGY
Extrinsic Ligaments
1. Radio-scapho-lunate
(Lig. Of Testut)
>>
2. Radial collateral
3. Palmar radiocarpal;
- Radio-scapho-capitate
- Radio- lunate
4. Radio-luno-triquetral
 ARTHROLOGY

5. Palmar Ulnocarpal : Ulno-lunate

Ulno-triquetral
6. Ulnar collateral >>

7. Dorsal radiocarpal = Dorsal radio-

triquetral
8. . Tranverse carpal Lig
 ARTHROLOGY
B) Distal radio-ulnar joint
• Stabilised by TFCC:
1. Articular disc >>
2. Meniscal homologue
3. UCL
4. Palmar Ulnocarpal Lig
5. Dorsal & Ulnar RU Lig
6. Extensor carpi ulnaris sheath.
 ARTHROLOGY
C). Intercarpal Joints
Supported by Intrinsic Ligaments &
Shape
>>
D) Pisiform articulation
E) Midcarpal Joint; Between the
proximal and distal carpal rows
 ARTHROLOGY

Distal Row
Proximal Row
 ARTHROLOGY PH

F) Metacarpo-Phalangeal Joint

• Ellipsoid joints MC

• Volar plate

• Collateral lig

• Deep transvers MC Lig

 ARTHROLOGY
G). Interphalangeal joint

• Hinge joint

• Volar plate

• Collateral Lig

• Accessary Lig
 EXTENSOR APPARATUS
A. Wrist
• Extensor Retinaculum
• 6 compartments
 EXTENSOR APPARATUS
B. Hand
• EDC
• EDM
• EI
 EXTENSOR APPARATUS
C. MP Joints
• Interosseous M.
>>
• Common Extensor Tendon
• Sagital band
• Lateral Band/Tendon
• Transversr/Oblique I. L.
• Lumbrical M.
 EXTENSOR APPARATUS
D. Finger IP Joint

• Central slip
>>
• Lateral slip

• Transverse Retinacular Lig

• Oblique Retinacular Lig

 Swan neck deformity
Causes
1. Long extensor overactivity
• Mallet deformity (1o)
• Exterinsic spasticity
• Intrinsic tightness
2. Failure of the volar stabilisation PIP J
(Mallet deformity 2o)
• Volar plate insufficiency
• FDS insufficincy
• Joint laxity
 Boutonniere deformity
1. Rupture of the central slip
2. Volar dislocation of the lateral band
3. More efficient pull of the lateral band on
the DIP J
 Carpal Tunnel
• From distal radius to
MC bases
• Radial wall; Scaphoid,
trapezium
• Ulnar wall; triquetrum,
pisiform, hamate
• Floor: Lunate, capitate,
proximal MC
• Roof: Flexor Retinaculum
 Carpal Tunnel
Componants of the roof:
1. Deep forearm fascia
2. Transverse carpal lig: -
- Scaphoid tubercle
- Trapezium ridge
- Pisiform
- Hamate hook
3. Conjoined aponeurosis
between thenar & hypothen.
 Carpal Tunnel
• Over:- Ulnar nerve and artery(Guyon)
- Palmar cutaneous br. of Median N.
- Palmar cutaneous br. of Ulnar N.
• Contents:
-Tendon X 9
- Median Nerve (on the
radiopalmar aspect of
the tunnel and dorsal
or dorsoradial to PL
 PALM
• Palmar aponeurosis
 PALM

Palmar Spaces
 PALM
• Deep Palmar abscess
 PALM

• Synovial Sheath
& Bursa
 FINGERS

• Superficial layer
• Ligaments
FINGERS
Cross-section
 FINGER FLEXOR
• FDS • Fibrous flexor sheath
• FDP pulley system
• Synovial flexor sheath - Annulus
- Cruciate
FINGER FLEXOR
 NAIL

• Nail plate: - Body

- Root
• Nail bed:
- Sterile matrix
- Germinal matrix
• Eponychiam
• Labia ungues
 MUSCLES ACTION
Muscle Function Nerve supply
Finger extension
ED Post. Inteross. N
(MP joint)
Finger Abduction
Dorsal Inteross Ulnar
Flex MP+ext IP
Finger adduction
Palmar Inteross Ulnar
Flex MP+ext IP
Lumbricals Flex MP+ext IP Median + Ulnar
Palmaris longus Flexion wrist/finger/ Median
 Thumb Opposition

Complex motion made by;

• Thumb Abd … APB Mov>>>

• Thumb pronation ….APB

• Flexion CMC & MP

 Ulnar nerve
• C7,8,T1
• Forearm: FCU & Ulnar half FDP
Palmar & Dorsal Cut branches
• Wrist: In Guyon canal (on Flexor Retin.)
• Hand: Superficial Br
Deep Br: - Hypothenar
- Inteross
- Add. P
- Two ulnar
lumbrical
 Ulnar Nerve Dysfunction
• Low lesion: (Below elbow)
Loss innervation to the hand
small muscles only
+ Preserve forearm
innervation (Ulnar FDP)
= Sever ulnar Claw Hand
deformity
 Ulnar Nerve Dysfunction
• High lesion (At elbow or
above)
Loss innervation below
elbow (including FDP)
= less sever ulnar claw
hand deformity
 Ulnar paradox
 Median Nerve
• Roots: C6,7,8,T1
• Elbow: - PT, FCR,PL, FDS
• Forearm: Anterion interosseous branch;
[FDP (radial), FPL, PQ]
• Wrist: Palmer cutaneous branch (5 cm
proximal to wrist crease between PL &
FCR)
• Hand: -3 Thenar m. (APB, FPB,OP)
- 2 radial lumbricals
- 3 ½ radial fingers
 Median Nerve Dysfunction
Level of injury of main trunk
1. Below wrist >>>> APB
(Simian Hand)
2. Mid-forearm>> palm sensation
3. Upper forearm >> Pinch test>
Anterion interosseous palsy
4. Elbow and above >> Check
FDS
 Redial Nerve
• Roots: C5,6,7,8,T1
• Above elbow: Muscular = Br., BR, ECRL
• Elbow:
1. Superficial terminal br. = sensory to hand
2. Deep terminal br. (Post. Inteross) >>
ECRB, Supinator
• Forearm:
- Deep terminal (Post. Inteross) br. >>> ED,
EDM, ECU, APL, EPB, EPL, EI
 Redial Nerve Dysfunction
• Wrist >> Check sensation
• Forarm: Check for post. Inteross nerve
palsy >>>>> EPL, EI, ED (no sensory loss)
• Elbow and above: Wrist extension
 SENSORY DISTRIBUTION
1. Ulnar N.
2. Median N
3. Radial N.
 Blood Supply
1. Ulnar A.
• Radial to FCU
• Forms the superficial
palmar arch ?with
superficial palmar br. of
radial artery
• Gives 4 common palmar
digital art.
• Fingers: dorsal to the nerve
 Blood Supply
2. Radial A.
• Radial to FCR
• Beneath APL …. Floor of
ASB
• Forms the Deep palmar arch
with deep br. of ulnar ar. 1
cm proximal to Superficial
arch
 Scaphoid
• Dorsal carpal br. supply the scaphoid dorso-
ditally
• Two thirds …. Throughout the length
• 20% ….. Only in the waist
• 13% …. Only in distal 1/3
 Scaphoid

• Pedicled vascularised
bone graft
• Arterial supply of
dorsal distal radius
• 1,2
intercompartmental
supraretinacular artery
 Basic Function
1. Precision pinch
 Basic Function
2. Pulp pinch: Pinch
Dynamometer (2-
5 kg)
 Basic Function
3. Key pinch: Pinch
Dynamometer (6-10 kg)
 Basic Function
4. Chuck grip:
 Basic Function
5. Hook grip
 Basic Function
6. Span grasp:
 Basic Function
7. Power grip
 Basic Function
8. Flat hand:
THANK YOU