Volar Palmar Hand Fingers Skin and Superficial Fascia

Volar (Palmar) Hand Fingers Skin and Superficial Fascia

Palmar Aponeurosis

Finger and Thumb Motions

Intrinsic Hand Muscles - Thenar

Abductor Pollicis Brevis

Flexor Pollicis Brevis Opponens Pollicis

Abductor Pollicis Brevis Flexor Pollicis Brevis

Flexor Pollicis Brevis Opponens Pollicis

Adductor Pollicis - Transverse head - Oblique head

Intrinsic Hand Muscles - Hypothenar

Abductor Digiti Minimi Flexor Digiti Minimi Brevis

Opponens Digiti Minimi

Intrinsic Hand Muscles - Deep

Lumbricales There are 4, associated with the tendons of the flexor digitorum longus

Interossei View shows palm of hand. View shows dorsum of hand.

Extensor Expansions (“hoods”) The dorsal expansion has a central core that anchors back to the carpus of the hand, and collateral slips that run into the palmar plates of the fingers

Index Finger Extensor Expansion - Radial Side Note 1 st lumbrical and 1 st dorsal interosseous

Boutonniere Deformity Mechanism of injury (MOI), and how the injury presents

Nerves of the Hand u Median – Palmar cutaneous branch – Recurrent branch and branches to lumbricales – Sensory branches (common palmar digital branches, proper palmar digital branches) u Ulnar – Dorsal branch – Motor branches – Sensory branches (common palmar digital branches, proper palmar digital branches)

Median n Palmar cutaneous branch Recurrent branch Common palmar digital branch Proper palmar digital branch Ulnar n. Dorsal branch (not visible) Common palmar digital branch Proper palmar digital branch

Nerves (proximal to distal) Median n Ulnar nerve - Palmar cutaneous branch - Recurrent branch - Common palmar digital br. - Proper palmar digital br. - Dorsal branch (cutaneous) - Common palmar digital br. - Proper palmar digital br.

Median and Ulnar nn. entrapment Tunnel of Guyon is enclosed by the pisohamate ligament The carpal tunnel and its contents were discussed previously

Nerve Entrapment Syndromes at Hand (distribution of pain/paresthesia follows the nerve) Any nerve can be entrapped, at a variety of different locations, and the problem presents differently…

“Ulnar Claw” (results from Ulnar n. injury proximal to wrist) Rule of disrupted (denervated) muscle balance: at rest, segment will deviate toward the innervated side, explain

Arterial Anastomosis of the Hand Deep Palmar Arch (continuation of radial aa. ) u Princeps pollicis a. u Radialis indicis a. u Palmar metacarpal branches Superficial Palmar Arch (continuation of ulnar a. ) u Common palmar digital branches u Proper palmar digital branches

Radial a. • • Superficial palmar branch Deep dorsal branch (deep palmar arch) FYI: shown are the: • Princeps pollicis a. • Radialis Indicis a. • Palmar Metacarpal aa. Ulnar a. (superficial palmar arch) • Common Palmar Digital aa. • Proper Palmar Digital aa. Note: tunnel of Guyon