HAND
Deep Fascia
-Flexor retinaculum
-Palmar aponeurosis
-Palmaris brevis m.
-fibrous digital sheaths
-synovial sheaths; ulnar bursa (common flx. bursa)
radial bursa (bursa of FPL)
Vinculum: provide
blood supply to
tendons
Potential spaces: can
become infected
(grow/widen w/infection…)
Pulp space infection (felon)
Flexor tendon infection
Cat bite infection with ascending lymphangitis
Depuyen’s contracture: contracture of flexor
retinaculum.
During this surgery – what is at risk? If injured what would occur?
Where are they from, where do they go?
Thenar mm.: Abductor
thenar, Flexor thenar,
opponens pollicis.
Innervated by median n.
Hypothenar mm.:
Abductor digiti minimi,
Flexor digiti minimi,
Opponens digiti minimi.
Lumbrical mm.: 4 of
them. On digits 2 &3,
innervated by median
nerve.
Remember: 2LOAF:
2 lumbricals and O,A,F
of thenar grp.
Innervated by median
n.
Thumb movements:
Flex & Extend
Abduct & Adduct
Superficial Palmar Arch
Arteries of the Hand
Deep Palmar Arch and Dorsum
Veins
Ulnar Nerve
Median Nerve
Radial Nerve
Tunnel of Guyon
Bones, I can’t
do this with
my left hand!
What nerve is injured?
What muscles produce this posture?
Cord levels? Dermatomes levels/nerves?
Klumpke
Palsy
Klumpke palsy may produce several
abnormal postures. Classically, it produces
flexion and supination of the elbow,
extension of the wrist, hyperextension of
the metacarpophalangeal joints, and flexion
of the interphalangeal joints with the “claw
hand” posture. This presentation is rarely
seen in the newborn period. Klumpke
syndrome usually manifests in the newborn
period as weakness restricted to or mainly
involving the hand.
In many occasions,
there are no reflex or spontaneous
movements of the intrinsic hand muscles.