DEPARTMENT OF ANATOMY
UPPER LIMB
Hand
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The hand is the region
of the upper limb distal
to the wrist joint.
It is subdivided into
three parts:
1. Wrist
2.Metacarpus
3.Digits (five fingers
including the thumb).
The hand has an anterior
surface (palm) and a
dorsal surface (dorsum
of hand).
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The carpal tunnel is formed anteriorly at the
wrist by a deep arch formed by the carpal bones
and the flexor retinaculum.
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The base of the carpal
arch is formed
medially by the
pisiform and the hook
of the hamate and
laterally by the
tubercles of the
scaphoid and
trapezium.
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flexor retinaculum is a
thick connective tissue
ligament that bridges
the space between the
medial and lateral sides
of the base of the arch
and converts the carpal
arch into the carpal
tunnel.
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Four tendons of the
flexor digitorum
profundus
Four tendons of the
flexor digitorum
superficialis
One tendon of the
flexor pollicis longus
Median nerve
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Carpal tunnel
syndrome is an
entrapment
syndrome caused by
pressure on the
median nerve within
the carpal tunnel.
Carpal Tunnel
syndrome
Common in computer
professionals.
Due to constant
dorsiflexion of wrist
while typing the
keyboard
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The palmar aponeurosis
is a triangular-shaped
condensation of deep
fascia that covers the
palm and is anchored to
the skin in distal
regions.
The apex of the triangle
is continuous with the
palmaris longus tendon.
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Dupuytren contracture is
a disease of the palmar
fascia resulting in
progressive shortening,
thickening, and fibrosis
of the palmar fascia and
aponeurosis.
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1. Hypothenar
compartment
2. Thenar compartment
3. Central compartment
4. Adductor
compartment
5.Interosseous
compartment
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The intrinsic muscles of the hand are located in
five compartments
All of the intrinsic muscles of the hand are
innervated by the deep branch of the ulnar
nerve except for the three thenar and two lateral
lumbrical muscles, which are innervated by the
median nerve.
Abductor Pollicis Brevis Abducts thumb
Opponens Pollicis
Flexor Pollicis Brevis
To oppose thumb
Flexes thumb
Abductor Digit Minimi
Flexor Digiti Minimi Brevis
Opponens Digiti Minimi
Abducts digit 5
Flexes proximal phalanx of digit
5
bringing digit 5 into opposition
with the thumb
Action:
Improves grip
Action:
Adducts thumb towards middle
digit
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Extension: extensor pollicis longus, extensor
pollicis brevis
Flexion: flexor pollicis longus and flexor
pollicis brevis
Abduction: abductor pollicis longus and
abductor pollicis brevis.
Adduction: adductor pollicis
Opposition: opponens pollicis.
Lumbricals
1 and 2
Flex digits at metacarpophalangeal joints and extends
interphalangeal joints
Lumbricals
3 and 4
Flex digits at metacarpophalangeal joints and extends
interphalangeal joints
Dorsal interossei
1-4
Abducts digits from axial line and
act with lumbricals to flex
metacarpo-phalangeal joints and
extends interphalangeal joints
Palmar interossei
1-3
Adducts toward axial line &
assist lumbriaclas in flexing the
same joints as above
Action of Dorsal
Interossei :
DAB : Abduction
Little finger and thumb have
no Dorsal interossei muscle
Action of Palmar
interossei :
PAD :Adduction
Middle finger and thumb have no
palmar interossei muscle
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Blood supply to the hand is by the radial and
ulnar arteries, which form two interconnected
vascular arches (superficial and deep) in the
palm.
Superficial palmar
arch:
Ulnar artery+
palmar branch of
radial artery
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Deep palmar arch:
Deep palmar
branch of ulnar
artery+ radial
artery
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To test for adequate anastomoses between
the radial and ulnar arteries, compress both
the radial and ulnar arteries at the wrist, then
release pressure from one or the other, and
determine the filling pattern of the hand.
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The hand is supplied by the ulnar, median,
and radial nerves.
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Immediately distal to the pisiform, ulnar nerve
divides into a deep branch, which is mainly motor
and a superficial branch, which is mainly sensory.
Deep branch: supplies the hypothenar
interossei, adductor pollicis, and the two medial
lumbricals.
Superficial branch: supply skin on the palmar surface of
the little finger and the medial half of the ring finger
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The ulnar nerve is most commonly injured at
two sites:
1. Elbow
2. wrist
Clawing of the hand:
Metacarpophalangeal joints of the fingers are
hyperextended and the interphalangeal joints
are flexed.
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Compression of the
ulnar nerve may occur
at the wrist where it
passes between the
pisiform and the hook
of the hamate.
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The median nerve is the most important sensory
nerve in the hand because it innervates skin on
the thumb, index and middle fingers, and lateral
side of the ring finger.
Branches:
1. Recurrent branch: innervates the three thenar
muscles
2. Palmar digital nerves: In addition to skin, the
digital nerves supply the lateral two lumbrical
muscles
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Refers to a deformity in which thumb
movements are limited to flexion and
extension of the thumb in the plane of the
palm.
Severance of median nerve paralyzes the
thenar muscles and the thumb loses much of
its usefulness.
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The only part of the radial nerve that enters
the hand is the superficial branch.
Innervates skin over the dorsolateral aspect
of the palm and the dorsal aspects of the
lateral three and one-half digits distally to
approximately the terminal interphalangeal
joints.
A 21 year old girl is brought to the
emergency department with a puncture
wound on the palmar side of her left index
finger. Preservation of which of the following
movements of her index finger will confirm
the functional integrity of the flexor
digitorum profundus muscle?
A.
Flexion of the metacarpophalangeal joint
B. Adduction
C. Abduction
D. Flexion of the distal interphalangeal joint
E. Flexion of the proximal interphalangeal
joint
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A 53-year-old African American man involved in a motor
vehicle accident sustains a severe mid-shaft fracture of the
right humerus. Vitals are Temp-100.0F, BP120/88mm/Hg, pulse- 118/min, and RR- 14/min.
Examination reveals wrist drop and no ulnar or radial
pulses in the right arm. Examination reveals decreased
sensation over the dorsal aspect of the lateral 3½ digits.
The rest of the physical exam is otherwise unremarkable.
What nerve is most likely injured given the findings in this
patient?
A.Axillary nerve
B.Musculocutaneous nerve
C.Median nerve
D.Radial nerve
E.Ulnar nerve
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The figure below represents cutaneous
innervation of wrist and hand. The area A in
the figure represents which Nerve?
1.Superficial branch of radial nerve
2.Anterior interosseous nerve
3.Palmar branch of median nerve
4.Palmar branch of ulnar nerve
5.Lateral cutaneous nerve of fore
arm