wrist and hand 山东大学医学院解剖教研室李振华. surface anatomy of wrist and hand...

SDU. SDU. LIZHENHUALIZHENHUA

Wrist and Hand

山东大学医学院解剖教研室李振华


Surface anatomy of wrist and hand

Anatomical “snuff box” 鼻烟壶

Medial: tendon of the extensor pollicis longs

Lateral: tendons of the abductor pollicis longus and extensor pollicis brevis

Proximal: styloid process of radius

Floor: scaphoid and trapezium bones

Radial a. crosses the floor of the snuff, so may fell the radial pulse in this fossa


Anatomical “snuff box”


Deep fascia of the wrist

Palmar carpal ligament 腕掌侧韧带 Flexor retinaculum 屈肌支持带

Thickening of deep fascia in the hand Attached laterally to scaphoid and trapezium a

nd medially to pisiform and hamate Ulnar carpal canal 腕尺侧管

Formed by the distal part of palmar carpal ligament and flexor reticulum

Transmit the ulnar a., v. and n. Radial carpal canal 腕桡侧管

The radial end of flexor reticulum is attached to the tubercles of scaphoid and trapezium

Transmit tendon of flexor carpi radialis


★Carpal tunnel

Composition: Formed by flexor retinaculum and carpal groove

Structures passing through the carpal tunnel Median n. The tendons of flexor digitorum superficialis a

nd flexor digitorum profundus enclosed by common flexor synovial sheath

The tendon of flexor pollicis longus enclosed by synovial sheath for flexor pollicis longus


Carpal tunnel

Common flexor synovial sheath

Synovial sheath for flexor pollicis longus


Carpal tunnel

Median n.

common flexor synovial sheath Tendon of flexor pollicis longus enclosed by synovial sheath for flexor pollicis longus

Tendons of flexor digitorum superficialis

Tendons of flexor digitorum profundus


Posterior region of wrist 腕后区

Extensor retinaculum 伸肌支持带 Thickening of deep fascia of forearm a

wrist Attached laterally to radius and mediall

y to styloid process of ulna and triquetral bone

Forms six fibrous compartments for extensor tendons passing from forearm into hand


Posterior region of wrist 腕后区 ① tendons of abductor pollicis longus and extensor pollicis brevis and their synovial sheaths;

② tendons of extensor carpi radialis longus and brevis and their synovial sheaths;

③ tendon of extensor pollicis longus and its synovial sheath; ④ tendons of extensor digitorum, extensor indicis and their synovial sheaths;

⑤ tendon of extensor digiti minimi and its synovial sheaths; ⑥ tendon of extensor carpi ulnaris and its synovial sheaths


Palm of hand 手掌

Deep fascia of the palm Superficial layer

Thenar fascia 鱼际筋膜 Hypothenar fascia 小鱼际筋膜 Palmar aponeurosis 掌腱膜

thick triangular membrane Deep layer

palmar interosseous fascia 骨间掌侧筋膜


Osseofascial compartments of palm 手掌骨筋膜鞘

Lateral compartment 外侧鞘 Medial compartment 内侧鞘 Intermediate compartment 中间鞘

Laeral intermuscular septumMedial intermuscular septum

Palmar aponeurosis

Palmar interosseous fascia

Adductor pollicis

Hypothenar fascia

Thenar fascia


Intermediate compartment 中间鞘 Boundaries

Palmar aponeurosis Laeral and medial intermus

cular septum Palmar interosseous fascia

Contents superficial palmar arch, a.,

v.,n. tendons of flexor digitorum

superficialis and profundus Lumbricales common flexor sheath


Fascia spaces 筋膜间隙 Thenar space 鱼际间隙 : located between the fascia of the adductor pollicis and flexor te

ndon of the index finger. Proximal: blind Distally: continuous with the back of the index finger by the fist lumbrical canal

Midpalmar space 掌中间隙 : lies posterior to common flexor sheath Proximal: continous with the posterior space of the antebrachial flexor through the carpl canal Distally: continuous with the appropriate lumbrical canals

Midpalmar space

Thenar space

Palmar intermediate septum


Muscles of hand

Lateral group － thenar (4) Medial group － hypothenar (3) Intermedial group

Lumbricals 蚓状肌 (4) Palmar interossei 骨间掌侧肌 (3) Dorsal interossei 骨间背侧肌 (4)


Muscles of hand

Lateral group － thenar 鱼际 (4) Abductor pollicis brevis 拇短展肌 Flexor pollicis brevis 拇短屈肌 Opponens pollicis 拇对掌肌 Adductor pollicis 拇收肌

Action: flex, abduct, adduct and oppose thumb

Nerve supply: median n. except adductor pollicis which is supplied by ulnar n.


Muscles of hand

Medial group － hypothenar 小鱼际 (3) Abductor digiti minimi 小指展肌

Flexor digiti minimi brevis 小指短屈肌

Opponens digiti minimi 小指对掌肌

Action: flex, abduct , and oppose little

finger Nerve supply: ulnar n.


Muscles of hand

Intermedial group

Lumbricals 蚓状肌 (4) Action: flex fingers at MP joint

s; extend fingers at IP joints Nerve supply: first two lumbric

als supplied by median n., and 3rd and 4th lumbricals supplied by ulnar n.


Muscles of hand

Intermedial group Palmar interossei (3) 骨间掌侧肌

adduct fingers towards middle finger at MP joints

Dorsal interossei (4) 骨间背侧肌 abduct fingers away from middl

e finger at MP joints Nerve supply: ulnar n.


Arteries of upper limb

Superficial palmar arch 掌浅弓 Formed by ulnar artery and superficial

palmar branch of radial artery The curve of arch lies across the pal

m, level with the distal border of fully extended thumb

Gives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries


Arteries of upper limb

Deep palmar arch 掌深弓 Formed by radial artery and deep palm

ar branch of ulnar artery The curve of arch lies across upper part

of palmar at level with proximal border of extended thumb

Gives rise to three palmar metacarpal arteries to joint the distal ends of the corresponding common palmar digital arteries


Nerves of hand Median n. 正中神经

Muscular branches: supply thenar except adductor pollicis, first two lumbricales

Cutaneus branches: supply skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsum

Recurrent branch


Nerves of hand Ulnar n. 尺神经

Muscular branches supply hypothenar muscles, interossei, 3rd and 4th lumbricales and adductor pollicis

Cutaneus branches supply skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar two and one-half fingers

Radial n. 桡神经 Skin of radial side of dorsum of hand Posterior aspect of radial two and on

e-half fingers


Dorsum of hand 手背Fascia of the dorsal hand The superficial fascia

Dorsal venous rete of hand Superficial lymph vessels Superficial branches of radial n. and do

esal branch of ulnar n. Deep fascia － the dorsal fascia of han

d Superficial layer--dorsal aponeurosis

手背腱膜 Deep layer--dorsal interosseous fascia

骨间背侧筋膜


Dorsum of hand 手背Two spaces The dorsal subcutaneous space 手背皮下间隙 The dorsal subaponeurotic space 手背腱膜下间隙

Superficial fascia

Dorsal aponeurosisDorsal interosseous fascia

Dorsal subcutaneous space

Dorsal subaponeurotic space


Fingers 手指

Pulp space of the fingers 指髓间隙 The deep fascia of the pulp of each finger fuses with

the periosteum of the terminal phalanx just distal to the insertion of the long flexor tendons and closes off a facial compartment known as the pulp space.

Each pulp space is subdivided by the presence of numerous septa, which pass from the deep fascia to the periosteum.

Through the pulp space, which is filled with fat, runs the terminal branches of the digital artery that supplies the diaphysis of the terminal phalanx..

The pulp space is limited proximally by the firm adherence of skin and the distal flexion crease to the underlying tissue; this prevents pulp infection from spreading proximally along the finger.


Fingers 手指 Vessels

Proper palmar digital a.

Nerves ： Proper palmar digital n.

wrist and hand 山东大学医学院 解剖教研室 李振华. surface anatomy of wrist and hand...

Documents

wrist and hand 山东大学医学院解剖教研室李振华. surface anatomy of wrist and hand...