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Hand PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Hand” by Dr. K. S. Ravi.

This medical PowerPoint presentation is about hand anatomy. The human hand is a complex structure composed of bones, muscles, tendons, ligaments, nerves, blood vessels, and skin. It is designed to perform various functions, including grasping, holding, manipulating, and sensing.

The main components of hand anatomy Bones, Muscles, Tendons, Ligaments, Nerves, Blood vessels, and Skin.

Tags : Hand, hand anatomy, Hand Surgery, Orthopedics, Orthopedics PowerPoint presentation

Published on : May 29, 2023 | Views : 1919 | Downloads : 2

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Slide 1-

Hand Dr. K. S. Ravi MBBS, MD(JIPMER), MAMS Department of Anatomy AIIMS Rishikesh
Slide 2-

Learning objectives Surface anatomy of Hand Bony landmarks Compartments and Spaces of hand Flexor Retinaculum & Structures passing below & above FR Intrinsic muscles of hand Superficial & Deep Palmar Arches Dorsum of hand & Dorsal venous Arch Nerves in hand Applied anatomy
Slide 3-

Surface Anatomy
Slide 4-

Surface Anatomy
Slide 5-

Wrist Bones
Slide 6-

Wrist Bones She Looks Too Pretty Try To Catch Her
Slide 7-

Hand Bones
Slide 8-

Anatomical Snuff Box
Slide 9-

Compartments & Spaces
Slide 10-

The Skin PALM: characteristics: Flexure creases (lines of palm) Papillary ridges (fingerprints): improve grip & increase surface area Fibrous bands connecting it to palmar aponeurosis & dividing subcutaneous fat into small loculi (water-cushion withstanding considerable pressure) Abundant sweat gland
Slide 11-

Superficial Fascia PALM: characteristics: Contains: cutaneous nerves & vessels Contains: Palmaris brevis (increases the hollow of palm to get a firmer grip
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Deep Fascia
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Palmar Aponeurosis 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
Slide 14-

Deep Fascia Flexor retinaculum: Definition Attachments Relations Functions Clinical anatomy: Carpal tunnel syndrome
Slide 15-

Flexor Retinaculum 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
Slide 16-

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
Slide 17-

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 Fascia Fibrous 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: 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
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Intrinsic Muscles Of Hand Situated totally within the hand Divided into 4 groups:- Thenar Hypothenar Lumbricals Interossei muscles
Slide 21-

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
Slide 22-

Intrinsic Muscles Thenar Muscles: Abductor Pollicis Brevis Flexor Pollicis Brevis Opponens Pollicis Adductor Pollicis Hypothenar Muscles: Abductor Digiti Minimi Flexor Digiti Minimi Opponens Digiti Minimi
Slide 23-

The Thenar Group Abductor Pollicis Brevis Flexor Pollicis Brevis Opponens Pollicis Adductor Pollicis Muscles
Slide 24-

ABDUCTOR POLLICIS BREVIS Origin Scaphoid & Trapezium & Flexor Retinaculum Insertion Lateral side of base of proximal phalanx of thumb Action Abducts thumb Innervation median nerve (C8 and T1
Slide 25-

Flexor Pollicis Brevis Origin S-Tubercle of Trapezium D-Capitate & Trapezoid bones Insertion Lateral side of base of proximal phalanx of thumb Action Flexes thumb Innervation Recurrent branch of median nerve (C8 and T1)
Slide 26-

Opponens Pollicis Origin Flexor retinaculum and Tubercles of Trapezium Insertion Lateral side of 1st metacarpal Action Draws 1st metacarpal laterally to oppose thumb toward center of palm Innervation Recurrent branch of median nerve (C8 and T1)
Slide 27-

Adductor Pollicis It has 2 heads that are separated by a gap through which the radial artery passes Origin: Oblique head – capitate & bases of 2nd and 3rd metacarpals, Transverse head – anterior surface of body of 3rd metacarpal bone Insertion: medial side of base of proximal phalanx of thumb Innervation: ulnar nerve Action: adducts thumb towards middle digit
Slide 28-

The Hypothenar Group Hypothenar muscles Opponens Digiti Minimi Abductor Digiti Minimi Flexor Digiti Minimi Brevis Palmaris Brevis
Slide 29-

Opponens Digiti Minimi Origin Hook of hamate and flexor retinaculum Insertion Medial border of 5th metacarpal Action Brings little finger (5th digit) into opposition with thumb Innervation Deep branch of ulnar nerve (C8 and T1)
Slide 30-

Abductor Digiti Minimi The most superficial of the hypothenar muscles forming the hypothenar eminence Origin : Pisiform bone Insertion: Medial side of base of proximal phalanx of 5th digit Action: Abducts 5th digit
Slide 31-

Flexor Digiti Minimi Brevis Origin Hook of hamate and flexor retinaculum Insertion Medial side of base of proximal phalanx of little finger Action Flexes proximal phalanx of little (5th) finger Innervation ulnar nerve
Slide 32-

Palmar Brevis It lies in the fascia deep to the skin of the hypo thenar em inence A relatively unimportant mu scle except that it covers and protects the ulnar nerve and artery Origi n: Flexor retinaculum and palmar aponeurosis Inserti on: Skin on the medial side of the palm Acti on: Wrinkles the skin on the medial side of the palm and deepens the hollow of the palm, as in cupping of the hand, thereby aiding the grip
Slide 33-

INTEROSSEI MUSCLES Interosseous Muscles They are located between the metacarpal bones Arranged in 2 layers: 4 Palmar and 4 Dorsal Located between bones 1. Dorsal interossei 1 to 4 Origin: Adjacent sides of 2 metacarpal bones Insertion : Extensor expansion's and bases of proximal phalanges of digit 2 to 4 Action: Abducts digits and assist lumbricals 2. Palmar interossei 1 to 4 Origin : Palmar surfaces of 2nd, 3th , 4th and 5th metacarpal bones Insertion: Extensor expansion of digits and bases of proximal phalanges of digits 2, 4, and 5 Action: Adducts digits and assist lumbricals
Slide 34-

Lumbrical Muscles They are named as such because of their elongated worml i ke form Lumbri cal s 1 and 2 Ori gi n : lateral 2 tendons of flexor digitorum profundus Lumbri cal s 3 and 4 Ori gi n: medial 3 tendons of flexor digitorum profundus Insertion: lateral sides of extensor expansions of digits 2 to 5 Acti on: To flex digits at MCP joints and extend IP joints
Slide 35-

THE PULLEY SYSTEM The pulley system is critical to flexion of the finger. The retinacular system for each of the fingers contains 5 annular pulleys and 4 cruciform pulleys. The thumb has 2 annular pulleys and 1 oblique pulley. The system supplies mechanical advantage by maintaining the flexor tendons close to the joint's axis of motion. In doing so, the pulleys prevent bowstringing. .
Slide 36-

THE PULLEY SYSTEM OF THE THUMB PULLEY SYSTEM OF THE THUMB
Slide 37-

ARTERIES Radial and ulnar arteries and their branches provide all the blood to the hand Radial Artery Smaller of the 2 terminal branches of the brachial artery superficial palmar branch  superficial palmar arterial arch princeps pollicis artery – supplies the thumb radialis indicis – supplies lateral side of digit 2 deep palmar arterial arch – formed mainly by the radial artery which joins the deep branch of the ulnar artery palmar metacarpal arteries – arise from the deep palmar arch, run distally and join the common palmar digital arteries which arise from the superficial palmar arterial arch
Slide 38-

DORSAL ARTERY OF HAND Dorsal carpal branch of ulna & radius Dorsal carpal arch Dorsal metacarpal artery Dorsal digital artery Middle & distal phalanges Palmar proper digital arteries
Slide 39-

ARTERIES B. Uln ar Artery Enters the palm on the lateral side of the ulnar nerve superficial to the flexor retinaculum - passes lateral to the pisiform bone deep palmar branch deep palmar arterial arch, passes deep through the hypothenar muscles and anastomoses with the radial artery superficial palmar arterial arch formed mainly by the ulnar artery located distal to the deep palmar arch gives rise to the three common digital arteries that anastomoses with the palmar metacarpal arteries from the deep palmar arch each common digital artery divides into a pair of proper palmar digital arteries which run along the sides of the 2nd to 4th digits
Slide 40-

VEINS Veins generally follow the deep arterial system as venae comitantes. A superficial venous system also exists at the dorsum of the hand and contributes to the cephalic and basilic veins in the upper extremity.
Slide 41-

ULNAR NERVE Ulnar (C(7)8-T1): through Guyon's canal, past hook. of hamate :Sensory :Motor Medial palm & 1 1/2 digits via: palmar, palmar digital branches Medial dorsal hand & 1 1/2 digits via: dorsal, dorsal digital, & proper digital branches Nerve divides at hypothenar eminence [Superficial Branch @[lateral to pisiform Palmaris brevis Deep (Motor) Branch [around hook of [hamate Adductor pollicis THENAR MUSCLES [Flexor pollicis brevis [FPB] [with median HYPOTHENAR MUSCLES [Abductor digiti minimi [ADM [Flexor digiti minimi brevis[FDMB [Opponens digiti minimi [ODM INTRINSIC MUSCLES [Dorsal interossei [DIO] [abduct DAB [Volar interossei [VIO] [adduct PAD ([Lumbricals [medial two (3,4
Slide 42-

MEDIAN NERVE Median (C(5)6-T1) : runs through carpal tunnel, then (cutaneous branches off at (risk in Carpal Tunnel release :Sensory :Motor Palmar Cutaneous Branch Dorsal distal phalanges of 3 1/2 digits: via proper palmar digital branches Volar wrist capsule Volar 3 1/2 digits and lateral palm: via palmar & palmar digital branches (multiple variations (of thumb sensory innervation Motor Recurrent (Thenar motor) Branch: Usually branches off median before carpal tunnel THENAR [Abductor pollicis brevis [APB Opponens pollicis [Flexor pollicis brevis [FPB (Joint innervation with ulnar nerve) INTRINSIC ([Lumbricals [lateral two (1,2
Slide 43-

RADIAL NERVE (:Radial (C5-T1 :Sensory Motor Dorsal 3 1/2 digits and hand: via superficial branch (dorsal digit (branches Dorsal wrist capsule NONE (in hand)
Slide 44-

FLEXOR ZONE OF HAND ZONE I II BOUNDARIES FDS insertion to distal tip Midpalm COMMENT Injuries amenable to repair (e.g. ( Jersey finger Called “No man's land” because fibroosseous tunnel . high rate of complications to FDS insertion III IV Transverse Carpal ligament to fibro- osseous tunnel Transverse carpal ligament (carpal ( tunnel Injuries often associated with Median nerve or arterial arch . injuries. Explore and repair all Uncommon site of injury. Repair usually requires carpal tunnel release and repair. Median nerve at . risk V Proximal to the TCL Injuries require end-to-end repair Thumb I Similar to finger Thumb II Thumb IP to distal tip Thumb CMC to IP Thumb III Thenar eminence Similar to finger Repair may require lengthening or graft procedure
Slide 45-

ARTERIAL ARCHES IN HAND SUPERFICIAL PALMAR ARCH DEEP PALMAR ARCH Formation Site Surface anatomy Branches
Slide 46-

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
Slide 47-

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
Slide 48-

NERVES IN HANDCutaneous innervation
Slide 49-

Nerves In Hand Muscular innervation ULNAR NERVE: Superficial Branch: Palmaris brevis Deep Branch: Adductor pollicis Hypothenar muscles Interossei Medial two lumbricals
Slide 50-

Ulnar nerve Is responsible for the innervations of the following. 1. Flexor carpi ulnaris 2. Flexor digitorum profundus
Slide 51-

Nerves In Hand Muscular innervations MEDIAN NERVE: Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Lateral two lumbricals
Slide 52-

Median nerve Is responsible for the innervations of the following soldiers. 1. Flexor carpi radialis 2 .Flexor digitorum superficialis 3. Flexor digitorum profundus 4. Flexor pollicis longus 5. Palmaris longus Gives humans the ability to oppose the thumb joint
Slide 53-

Radial Nerve - Is responsible for the innervations of the following muscles 1. Extensor Carpi Radialis Longus 2. Extensor Carpi Radialis Brevis 3. Extensor Digitorum 4. Extensor Carpi Ulnaris 5. Abductor Pollicis Longus 6. Extensor Digiti Minimi 7. Extensor Pollicis Brevis 8. Extensor Pollicis Longus
Slide 54-

Arteries: 1. Deep palmar arch 2. Superficial palmar arch 3. Common palmar digital arteries
Slide 55-

The Radial artery supplies blood to: 1. Flexor carpi radialis 2. Extensor carpi radialis longus 3. Extensor carpi radialis brevis 4. Flexor pollicis longus The Ulnar artery supplies blood to: 1. Flexor carpi radialis 2. Flexor carpi ulnaris 3. Extensor carpi ulnaris 4. Flexor digitorum superficialis 5. Flexor digitorum profundus 6. Palmaris longus
Slide 56-

Recurrent Interosseous Artery supplies: -Extensor digitorum -Extensor digiti minimi
Slide 57-

Posterior Interosseous Artery Supplies: - Abductor pollicis longus -Extensor pollicis brevis -Extensor pollicis longus
Slide 58-

Waste Management 1. Cephalic vein 2. Basillic vein 3. Superficial dorsal venous arch (network) 4. Deep dorsal venous arch (network)
Slide 59-

Clinical Concerns Carpal tunnel Ganglion cyst The transverse carpal ligament in the wrist puts pressure on the medial nerve - possible cause: overuse, hormonal http://www.youtube.com/watch?v=SGyKQchSEJ4 Is a fluid filled cyst that develops out of a joint. - possible cause: joint trauma http://www.youtube.com/watch?v=mJ6oj3lkqm8
Slide 60-

De Quervain’s Tenosynovitis -irritation of the sheath around the tendon - affects the tendons on the thumb side of the wrist - possibly caused by repetitive actions, over use - http://www.youtube.com/watch?v=q87zSRYHa1o
Slide 61-

1. Nerve damage that impairs the flexion of distal interphalangeal joints of index and middle fingers also produces which of the following conditions ? a) Atrophy of Hypothenar eminence b) Loss of adduction of thumb c) Similar impairment of flexion of distal I.P joint of little finger d) Weakness in pronation of forearm 2.A man is unable to hold a postcard between his index and middle fingers because of an injury to which of the following nerves ? a) Superficial branch of ulnar nerve b) Deep branch of ulnar nerve c) Recurrent branch of median nerve d) Posterior interosseous nerve
Slide 62-

3. All of the following muscles form the boundry of the anatomical snuff box, EXCEPT : a) Brachioradialis b) Abductor pollicis longus c) Extensor pollicis longus d) Extensor pollicis brevis 4. Which is the longest metacarpal bone ? a) Second metacarpal b) Third metacarpal c) Fourth metacarpal d) Fifth metacarpal
Slide 63-

5. After falling on his outstretched hand a patient complains of tenderness in the space between Extensor pollicis brevis and extensor pollicis longus tendons. Which bone is most likely fractured by the injury ? a) Scaphoid b) First metacarpal c) Radial styloid process d) Trapezium 6. Which is the most frequently fractured carpal bone ? a) Lunate b) Scaphoid c) Capitate d) Trapezium
Slide 64-

7. A middle aged woman suffering from myxedema, suddenly woke up one night by a severe bout of pain in her right wrist and middle finger. The pain seems to move up her forearm. After a thorough neurological check up her physician diagnosed her condition as Carpal Tunnel Syndrome.Which nerve is involved in this syndrome ? a) Median nerve b) Palmar cutaneous branch of median nerve c) Ulnar nerve d) Anterior interosseous nerve 8. Examination of a patient reveals paralysis of the Abductor pollicis brevis muscle. All of the following can be sites of lesion that resulted in this paralysis , EXCEPT : One answer only. a) Lower trunk of brachial plexus b) Lateral root of median nerve c) Medial root of median nerve d) Recurrent branch of median nerve
Slide 65-

9. A patient exhibits weakness of Pinch grip ; other thumb movements are normal. There is no sensory loss in the hand. The probable cause is damage to : a) Posterior interosseous nerve b) Anterior interosseous nerve c) Deep branch of ulnar nerve d) Median nerve proximal to flexor retinaculum 10. In carpal tunnel syndrome which of the follwoing conditions occur due to motor deficit ? a) Claw hand b) Pointing index finger c) Benediction hand d) Simian hand Rx PG MCQ
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THANK YOU