8. BONY SKELETON
♦ Wrist joint composed of multiple
carpal bone articulating with the
radius proximally and five
metacarpals distally
9. ♦ Proximal row of carpal bone
(radial to ulnar)
scafoid , lunate , traquetral , pisiform
♦ Distal row
trapezium , trapazoid , capitate ,
hamate
10. BONES OF THE HAND
♦5 Metacarpals
♦Thumb is no. 1
♦Little finger is no. 5
11. PHALANGES
♦ All fingers have 3 phalanges
proximal
middle
distal
♦ Except thumb has 2
proximal
distal
12. ♦ Most of tendon in the hand originate
in muscles arising from the forearm
♦ Flexor on volar aspect of forearm
must arise from common flexor
tendor (medial epicondyle )
13. ♦Extensors on dorsal aspect of the
forearm arise from common
extensor tender on lateral
epicondyl
14. ♦ In the hand ulnar side hypo thenar
muscles acting on the little fingers:
♦ Abductor digitiminimi
♦ Flexor digitiminimi brevis
♦ Opponens digitiminimi
15. ♦ Radial side thenar muscle acting on
the thumb
♦ Flexor, adductor pollices
♦ Abductor pollices brevis
♦ Opponen pollices brevis
16. ♦Long flexors
fl. digitorum superficialus
fl. digitorum profundus
♦Act on all the fingers
18. Vascular Supply of Hand
♦ Radial artery :
♦ Superficial palmer branch superficial palmer
arch ,which arises above the wrist
♦ Common palmer digital
♦ Deep palmer branches
♦ Deep palmer arch palmer metacarpal arteries
which joins the common digital
♦ Ulnar artery superficial palmer branch joins on
side of pisiform of superficial palmer branch
19. VENOUS DRAINAGE OF
HAND
♦ Via : Dorsal digital vein dorsal
venous arch
♦ Basillic vein in front of forearm
20. Peripheral nerve entrapment
♦There is a disproportion between
volume of the peripheral nerve
and space within the extremity
through which it passes
21. Applied Anatomy of Ulnar Nerve
♦Arises directly from the medial
cord of brachial plexus (C8-T1)
♦Lies between axillary artery
laterally and axillary vein
medially
22. ♦ At inferior border of subscapularis
muscle nerve receives fiber of C7
( lat. root of ulnar nerve )
♦ Descend in arm post. to pectoralis
major muscle ( posterio medial to
brachial artery)
23. ♦8 cm above medial epicondyl
with branch of superior ulnar
collateral artery diverge medially
from brachial artery to pierce
medial intramuscular septum
24. ♦ Together descend on medial head of
triceps
♦ Nerve passes in ulner groove dorsal
aspect of medial epicondyl
♦ It innervates fl. carpi ulnaris 0.5-1
cm above medial epicondyl
25. Potential points of compression
in the arm
♦ Ulnar nerve fibers ( medial cord )
1st rib as nerve passes between rib & clavicle
♦ 8 cm proximal to medial condyl as nerve
pierce intramuscular septum ( arcade of
Struther )
♦ Hypertrophy of medial head of triceps may
force nerve anteriorly, as triceps contract,
nerve get compressed
26. Ulnar Nerve at Elbow &Forearm
♦ In cubital fossa ulnar nerve passes
through fibro-osseous tunnel
♦ As it leaves the canal it lies between
the flexor corpi ulnanis and flexor
digitorum profundus till middle of
forearm
27. ♦ In distal 1/3 lies just radial to the
flexor corpi ulnaris
♦ Straight line drawn from medial
epicondyl to radial margin of
pisiform marks the line of the nerve
28. Supply of ulnar nerve in forearm
♦ Muscular branch to fl. Digitorum
profundus ( i.e. ulner ½ ) 3 cm distal
to medial epicondyl
♦ Palmer cutanous branch
♦ Dorsal cutanous branch
29. Ulnar nerve enters hand
♦ From under fl corpi ulnaris muscle , nerve
and artery
♦ Radial to pisiform , superficial to transverse
carpel lig. and dorsal to superficial palmer
lig.
♦ Ulnar nerve divide to :
deep terminal branch
superficial palmer branch
31. Sensory Supply of Ulnar Nerve
♦ Dorsal cutanous
branch of ulnar :
skin dorsoulnar
side of hand , little
finger and ulnar ½ of
index finger
♦ Medial cutanous nerve
of forearm : C8-T1
skin over
biceps
elbow crease
32. Anatomical Sites of Compression
♦ Points in elbow and forearm
♦ Anconeus epitrochlearis muscle
♦ Fibrous arcade between 2 heads of fl.
carpi ulnaris
33. Site of compression
in hand &wrist
♦ Palmaris brevus muscle
♦ Fibrous origin of fl digitiminmi
♦ Ulnar artery aneurysm or
thrombosis
♦ Distal ulnar tunnel ganglia
34. MEDIAN NERVE
♦ Arises from lateral & medial cords of
brachial plexus
♦ Contain fibers C5 –T1
♦ Forms antrolat to 3rd portion of axillary
artery in upper 1/3 of arm
35. ♦ In the arm it descends post. to pectoralis
major muscle, lateral to brachial artery,
antromedial to brachialis muscle,
posteromedial to biceps
♦ In mid portion of arm, median nerve crosses
ant to brachial artery to lie on its medial
side to enter the cubital fosse
36. ♦ The nerve enters forearm between humeral
and ulnar head of pronater teres
♦ Then runs between fl digitorum
superficialis and fl digitorum profundus,
later emerges 5 cm above wrist radial to
tendon of palmaris longus
37. MEDIAN NERVE IN THE WRIST
♦ It enters the wrist dorsal to transverse carpal
lig through the carpal tunnel
38. Boundaries Of Carpal Tunnel
♦ Dorsally: radio carpal lig.
♦ Radially: scaphoid & trapezium
♦ Palmorly: transverse carpal lig.
♦ Ulnary: hood of hamate & pisiform
39. After exiting carpal tunnel
♦ Median nerve splits to two parts
♦ Common digital nerve to thumb
♦ Proper digital nerve to radial side of index
♦ Ulnar division of median nerve; common
digital to 2nd & 3rd web
41. HAND
♦ Flexor pollicis brevis
♦ Abductor pollicis brevis
♦ Opponens pollicis
♦ First lumbrtical
♦ Second lumbrical
42. Anatomical compression points of
the median nerve
♦ ARM:
♦ Pectoralis minor muscle
♦ Anomalous axillary arch muscles
♦ Anomalous vascular arches in the axilla
♦ Deltopectoral fascia
♦ Supracondyloid process
♦ Ligament of Struthers
44. HAND / WRIST
♦ Carpal tunnel
♦ Palmar cutaneous branch within the
transverse retinacular ligament
45. RADIAL NERVE
♦ Arises from the post cords of the brachial
plexus behind 3rd part of axillary artery
♦ Neural element of C5 – C8
♦ Proximal 1/3 of arm nerve descends behind
brachial artery ant to subscapularis ,teres
major ,latissmus dorsi muscle and long
head of triceps
46. ♦ At junction of upper and middle 1/3 of arm
deviates dorsolaterally between medial and
long head of triceps lying adjacent to spiral
groove of humerus
47. ♦ 10 cm above lat humeral epicondyl lying
between the brachialis and brachioradialis
then lies between brachialis and extensor
carpi radialis ant to tip of lat epicondyl
dividing into : Superficial
Deep branches
48. Radial Nerve In Forearm
♦ Superficial branch ant to supinator muscle
proximal 1/3 then deep to brachioradialis
♦ The sup branch pierces the fascia on the
brachioradialis on the ulnar side of tendons
7cm above wrist
♦ On the dorsoradial side of wrist it divides
into 5 dorsal digital nerves and only one
branch to extensor carpi radilalis brevus
muscle
49. ♦ Post interosseous nerve (deep terminal
branch of radial nerve ) innervates extensor
muscle of wrist
♦ It is seperated from the radium by deep
head of supinator
♦ After leaving the supinator it lies between
the abductor pollies and other extensors of
forearm
50. ♦ In distal forearm it penetrates the extensor
pollies brevus to lie in the interosseous
membrane
♦ Distally it divides to give sensory
innervation to the wrist
51. Muscles supplied by radial nerve
♦ Triceps : long head
medial head
lateral head
♦ Anconeus
♦ Brachioradialis
♦ Extensor carpi longus
♦ Extensor carpi radialis brevis
