anatomy of the hand - anatomie appliquée à la chirurgie ... · pdf fileanatomy...

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ANATOMY of the HAND

DIU d’anatomie appliquée à la chirurgie plastique

www.tetraplegia.info

Marc REVOLUniversité Paris Diderot

2010

www.anato.info

bones nerves regionsmuscles vessels

www.tetraplegia.infowww.anato.info


1. Scaphoid2. Lunate3. Triquetrum4. Pisiform5 Trapezium


5. Trapezium6. Trapezoid7. Capitate8. Hamate9. Metacarpals (M1 to M5)10.Phalanges



Flexor retinaculum and carpal tunnel





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Extrinsic m.


Intrinsic m.


Extrinsic m.

FDSFDPFPLEDCEIPEDM

flexor


Intrinsic m.EDMEPLEPBAPL

extensor


Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM



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Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM



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Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM



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Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM



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Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM



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Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m.

FDSFDPFPLEDCEIPEDM




Extrinsic m. InterosseousLumbrical


Intrinsic m.LumbricalThenar musclesHypothenar muscles






Extrinsic m.

Proximal attachments


Intrinsic m.

12 3 4 5

Dorsal interossei

Palmar interossei

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Extrinsic m.

Distal attachmentsDeep insertions

Superficial insertions


Intrinsic m.


Extrinsic m.

Deep insertionsDistal attachments


Intrinsic m.

capsular

bony


Extrinsic m.



Intrinsic m.


Extrinsic m.

Superficial insertions



Intrinsic m.


Extrinsic m.


Intrinsic m.

Schmidt HM, Lanz U. Surgical anatomy oo the hand.(Thieme, Stuttgart 2004)


Extrinsic m.


Intrinsic m.

Variations are common ++++


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Extrinsic m.

MP flexion IP extension


Intrinsic m.






Extrinsic m.


Intrinsic m.

DOYLE JR, BOTTE MJ. Surgical anatomy of the hand and upper extremity (Lippincott. Philadelphia, 2003)


Extrinsic m.lumbrical


Intrinsic m.



Extrinsic m.


Intrinsic m. Lumbricals arise fromflexor tendons and insert into the extensorapparatus



Extrinsic m.


Intrinsic m.

Variations are common +++

A. Martinage(Thèse. Nice, septembre 2006)

www.anato.infoSchmidt HM, Lanz U. Surgical anatomy oothe hand.(Thieme, Stuttgart 2004)

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Extrinsic m.


Intrinsic m.

APB


Extrinsic m.


Intrinsic m.

Opponens pollicis


Extrinsic m.

FPB


Intrinsic m.FPB


Extrinsic m.


Intrinsic m.

Adductor pollicis


Extrinsic m.


Intrinsic m.

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Extrinsic m.

Antepulsion

APL

EPB

APB

Opp


Intrinsic m.

Retropulsion

Abduction Adduction

EPL Add

FPB

FPB






Extrinsic m.


Intrinsic m.

Palmaris brevis

DOYLE JR, BOTTE MJ. Surgical anatomy of the hand and upper extremity (Lippincott. Philadelphia, 2003)


Extrinsic m.

H l f

Similar to the interossei of the « mixed » type


Intrinsic m.

Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi

pisiforme

Hamulus of the hamatum

Pisohamate ligamentTransverse

carpal ligament





1. Radial artery2. Ulnar artery3. Palmar branch of anterior interosseous

a.4. Palmar radiocarpal arch5. Superficial palmar branch of radial a.

and superficial palmar arch6. Dorsal radiocarpal arch7. Deep palmar arch8. Palmar radiocarpal arch9 Dorsal radiocarpal arch


9. Dorsal radiocarpal arch10. Deep branch of ulnar artery11. 12, 13, 14. Common palmar digital

arteries15. Recurrent branches from the deep

palmar arch16. Perforating branches17. 18, 19. palmar metacarpal arteries20. Princeps pollicis artery21. Radial indicis artery

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Superficial palmar arch

www.tetraplegia.infowww.anato.info PDA : Proper palmar digital artery

CPDA : Common palmar digital artery


Deep palmar arch


PMA : Palmar metacarpal artery



Variations of the superficial palmar branch of the radial artery(in Schmidt & Lanz)


Variations of the superficial palmar arch


(in Schmidt & Lanz)



Variations in the origin of the common palmar digital arteries arising from the superficial palmar arch(in Schmidt & Lanz)



Variations of the deep palmar arch(in Schmidt & Lanz)

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Variations of second palmar metacarpal artery(in Schmidt & Lanz)



The arteries of the dorsal wrist









1. Dorsal carpal arch2. Dorsal metacarpal artery3. Deep palmar arch4. Palmar metacarpal artery5. Superficial palmar arch6. Common palmar digital artery7. Direct cutaneous branch

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Variations of the dorsal arteries of the thumb and the first and second dorsal metacarpal arteries(in Schmidt & Lanz)



Variations of the branches of the princeps pollicis artery(in Schmidt & Lanz)





Variations of the metacarpal ligament of the thumb(in Schmidt & Lanz)


Mesotendineum structures and vincula of the FPL tendon(in Schmidt & Lanz)


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median

ulnar


radial

ulnar

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median

ulnar


radial

ulnar


median

ulnar


radial

ulnar

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median

ulnar


radial

ulnar

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median

ulnar


radial

ulnar

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Neurovascular structures of the fingers(in Schmidt & Lanz)


median

ulnar


radial

ulnar


median

ulnar


radial

ulnar

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median

ulnar


radial

ulnar

www.anato.info Variations in the communications between the ulnar and median nerves(in Schmidt & Lanz)


median

ulnar


radial

ulnar

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median

ulnar


radial

ulnar

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median

ulnar


radial

ulnar

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palmar


dorsal


palmar


dorsal


palmar


dorsal


palmar


dorsal

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palmar


dorsal

1. Superficial palmar arch + digital nerves


palmar


dorsal


palmar


dorsal


palmar


dorsal

2. FDS + FDP + lumbricals


palmar


dorsal

3. Deep fascia


palmar


dorsal

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palmar


dorsal


palmar


dorsal

The deep palmar space is sudivided into• medial midpalmar space• lateral thenar space

By a middle palmar septum in the region of the 3rd metacarpal

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palmar


dorsal

Deep (interosseous) compartment

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palmar


dorsal

Palmar interossei


palmar


dorsal

Dorsal interossei


palmar


dorsal

Deep branch of ulnar artery


palmar


dorsal

Deep branch of ulnar nerve


palmar


dorsal


palmar


dorsal

APB

1. APB + superficial palmar branch of radial artery

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palmar


dorsal

Opponens pollicis

FPB

2. Opponens + FPB (superficial)


palmar


dorsal

FPB

FPL

3. FPB (deep) + FPL


palmar


dorsal

Adductor pollicis

4. Adductor + radial artery


palmar


dorsal


palmar


dorsal

1. Hypothenar muscles


palmar


dorsal

3. Deep branch of ulnar nerve

2. Deep branch of ulnar artery

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palmar


dorsal


palmar


dorsal


palmar


dorsal


palmar


dorsal


palmar


dorsal


palmar


dorsal

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palmar

Superficial fascia


dorsal


palmar


dorsal


palmar


dorsal


palmar

Deep fascia


dorsal


Transverse section through the middle of the right metacarpal : proximal aspect


References

Doyle JR, Botte MJ. Surgical anatomy of hand and upper extremityLippincott. Philadelphia, 2003 (720 p).

Grant’s atlas of anatomyWilliams and Wilkins. Baltimore, 9th edition, 1991 (650 p)


Gray’s anatomy. The anatomical basis of clinical practice.Elsevier Churchill Livingstone, 39th edition, 2005 (1627 p)

Manuel de chirurgie plastique, reconstructrice et esthétiqueSauramps Médical, 2ème édition, 2009 (874 p)

Schmidt HM, Lanz U. Surgical anatomy of the hand.Thieme. Stuttgart, 2004 (258 p)

www.anato.info

anatomy of the hand - anatomie appliquée à la chirurgie ... · pdf fileanatomy...

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