palm of the hand
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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Dr. Ahmed Fathalla Ibrahim
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THE SKIN
1. Flexure creases (lines of palm)2. Papillary ridges (fingerprints):
improve grip & increase surface area
3. Abundant sweat gland
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SUPERFICIAL FASCIA
1. Contains: cutaneous nerves & vessels
2. Contains: Palmaris brevis
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DEEP FASCIA• PALM: thickened
at 3 sites:Palmar aponeurosis:• Definition• Description• Function• Clinical anatomy:
Dupuytren’s contracture
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PALMAR APONEUROSIS• DEFINITION: It is a thickening of deep fascia in the
middle of the palm• DESCRIPTION: It is triangular in shape:1. Apex: directed proximally, continuous with tendon of
palmaris longus2. Base: directed distally, divided into 4 slips for the
medial 4 fingers3. 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
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DEEP FASCIAFlexor retinaculum:• Definition• Attachments• Relations• Functions• Clinical anatomy:
Carpal tunnel syndrome
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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: 1. Lateral: by 2 laminae: superficial (to
tubercles of scaphoid & trapezium) & deep (to the medial lip of the groove on the trapezium)
2. Medial: to pisiform & hook of hamate
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FLEXOR RETINACULUM• RELATIONS: • Superficial: from lateral to medial:1. Superficial palmar branch of radial artery2. Palmar cutaneous branch of median nerve3. Tendon of palmaris longus4. Palmar cutaneous branch of ulnar nerve5. Ulnar vessels6. Ulnar nerve• Deep: Structures passing through carpal tunnel1. Tendon of FPL & its synovial sheath (radial bursa)2. Tendons of FDS & FDP & their common synovial sheath (Ulnar
bursa)3. Tendon of FCR & its synovial sheath ( in a special compartment)4. Median nerve
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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
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DEEP FASCIAFibrous flexor sheaths• Definition• Attachments• Function
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FIBROUS FLEXOR SHEATH• DEFINITION: It is a thickening of deep
fascia in front of the fingers• ATTACHMENTS: 1. Proximal: to the slips of palmar
aponeurosis2. Distal: to the base of distal phalanx3. On either side: to the side of phalanx• FUNCTION: It holds the long flexor
tendons during flexion of the fingers
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INTRINSIC MUSCLES• LATERAL GROUP:LATERAL GROUP: FOUR THENAR MUSCLES• MEDIAL GROUP:MEDIAL GROUP: THREE HYPOTHENAR MUSCLESPALMARIS BREVIS• CENTRAL GROUP:CENTRAL GROUP: FOUR LUMBRICALSFOUR PALMAR INTEROSSEIFOUR DORSAL INTEROSSEI• ALL MUSCLES ARE SUPPLIED BY C8 & T1 SPINAL ALL MUSCLES ARE SUPPLIED BY C8 & T1 SPINAL
SEGMENTS THROUGH SEGMENTS THROUGH MEDIAN & ULNAR NERVESMEDIAN & ULNAR NERVES
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INTRINSIC MUSCLES
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THENAR MUSCLESTHENAR MUSCLESTHENAR MUSCLESTHENAR MUSCLES1. Abductor pollicis brevis2. Flexor pollicis brevis3. Opponens pollicis4. Adductor pollicisN.B.:• Muscles # 1, 2, 4 are inserted into the proximal proximal
phalanx of thumbphalanx of thumb: act on MP & CM joints of thumb
• Muscle # 3 is inserted into 11stst metacarpal bone metacarpal bone: opposition of CM joint of thumb (abduction + flexion + medial rotation)
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HYPOTHENAR MUSCLESHYPOTHENAR MUSCLESHYPOTHENAR MUSCLESHYPOTHENAR MUSCLES• Abductor digiti minimi• Flexor digiti minimi• Opponens digiti minimiN.B.:• Muscles # 1, 2 are inserted into the
proximal phalanx of little fingerproximal phalanx of little finger: act on MP joint of little finger
• Muscle # 3 is inserted into 55thth metacarpal metacarpal bonebone: rotates 5th metacarpal bone
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LUMBRICALSLUMBRICALS
1.1. Origin:Origin: tendons of FDP2.2. Insertion:Insertion: tendons of ED3.3. Action:Action: Writing positionWriting position (flexion
of MP & extension of IP joints of medial 4 fingers
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INTEROSSEIINTEROSSEI• PALMAR INTEROSSEIPALMAR INTEROSSEI1.Origin: metacarpal bone 2.Insertion: proximal phalanx3.Action: Adduction of fingers (PAD)(PAD)• DORSAL INTEROSSEIDORSAL INTEROSSEI1.Origin: adjoining sides of 2 metacarpal bone 2.Insertion: proximal phalanx3.Action: Abduction of fingers (DAB)(DAB)
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PALMARIS BREVIS
1.1. Origin:Origin: Palmar aponeurosis 2.2. Insertion:Insertion: skin of medial border of
hand3.3. Action:Action: deepening the hollow of
palm to get a firmer grip
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ARTERIAL ARCHES IN HAND • SUPERFICIAL
PALMAR ARCH• DEEP PALMAR
ARCH1. Formation2. Site3. Surface anatomy4. Branches
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SUPERFICIAL PALMAR ARCH• FORMATION:FORMATION:1. Direct continuation of ulnar artery (mainly)2. Superficial branch of radial artery• SITE:SITE: between palmar aponeurosis & long flexor
tendons• SURFACE ANATOMY:SURFACE ANATOMY: level with the distal border
of the fully extended thumb• BRANCHES:BRANCHES: digital branches to the medial three &
half fingers• N.B.: Radial artery gives 2 branches that supplies
the lateral one & half fingers:1.1. Radialis indicis:Radialis indicis: supplies lateral side of index2.2. Princeps pollicis:Princeps pollicis: supplies both sides of thumb
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DEEP PALMAR ARCH• FORMATION:FORMATION:1. Direct continuation of radial artery (mainly)2. Deep branch of ulnar artery• SITE:SITE: between long flexor tendons &
metacarpal bones• SURFACE ANATOMY:SURFACE ANATOMY: lies one inch
proximal to superficial palmar arch• BRANCHES: BRANCHES: 1. Branches sharing in anastomosis around
wrist joint2. Articular & muscular branches
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ULNAR NERVE IN THE HANDULNAR NERVE IN THE HAND
• MUSCULAR BRANCHES:MUSCULAR BRANCHES: 1. Palmaris brevis2. Adductor pollicis3. Hypothenar muscles4. Interossei5. Medial two lumbricals• CUTANEOUS BRANCHES: CUTANEOUS BRANCHES:
Palmar digital to medial 1 ½ fingers
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MEDIAN NERVE IN THE HANDMEDIAN NERVE IN THE HAND
• MUSCULAR BRANCHES:MUSCULAR BRANCHES:1. Abductor pollicis brevis2. Flexor pollicis brevis3. Opponens pollicis4. Lateral two lumbricals• CUTANEOUS BRANCHES: CUTANEOUS BRANCHES:
Palmar digital to lateral 3 ½ fingers