ANATOMY OF THE HAND

BY
Dr. J . M . Hassanain
 Hand function is an
important feature in
humans over other
primates who lack
fine control and
precision
 EMBRYOLOGY OF THE
UPPER LIMB

Limb buds first appear as small

elevations on ventro lateral body
end of fourth week.
Each limb bud :

Mesenchyme derived from

somatic mesoderm which is
covered by a layer of ectoderm
 Distal end of bud form flipper like
limbs.
Later bones develop and myoblast
aggregate to develop muscle mass .
 Upper limb rotates laterally 90
degrees
Specific dermatone ( which is skin
area supplied by a single spinal
nerve )
 ANATOMY

Bony skeleton
Muscles and soft tissues
Vessels and nerves
 BONY SKELETON

Wrist joint composed of multiple

carpal bone articulating with the
radius proximally and five
metacarpals distally
 Proximal row of carpal bone
(radial to ulnar)
scafoid , lunate , traquetral , pisiform
Distal row
trapezium , trapazoid , capitate ,
hamate
BONES OF THE HAND

5 Metacarpals
Thumb is no. 1
Little finger is no. 5
 PHALANGES
All fingers have 3 phalanges
proximal
middle
distal
Except thumb has 2
proximal
distal
 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 )
Extensors on dorsal aspect of the
forearm arise from common
extensor tender on lateral
epicondyl
 In the hand ulnar side hypo thenar
muscles acting on the little fingers:
Abductor digitiminimi
Flexor digitiminimi brevis
Opponens digitiminimi
 Radial side thenar muscle acting on
the thumb
Flexor, adductor pollices
Abductor pollices brevis
Opponen pollices brevis
Long flexors
fl. digitorum superficialus
fl. digitorum profundus
Act on all the fingers
 Intrinsic
Lumbrical
Dorsal
Ventral interrosies
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
 VENOUS DRAINAGE OF
HAND
Via : Dorsal digital vein dorsal
venous arch
Basillic vein in front of forearm
Peripheral nerve entrapment

There is a disproportion between

volume of the peripheral nerve
and space within the extremity
through which it passes
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
 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)
8 cm above medial epicondyl
with branch of superior ulnar
collateral artery diverge medially
from brachial artery to pierce
medial intramuscular septum
 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
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
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
 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
Supply of ulnar nerve in forearm

Muscular branch to fl. Digitorum

profundus ( i.e. ulner ) 3 cm distal
to medial epicondyl
Palmer cutanous branch
Dorsal cutanous branch
 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
Muscle supplied by ulnar nerve
Flexor corpi ulnaris
Flexor digitorum profundus ( medial 2
tendons )
Flexor digiti minimi
2 ,3 ,4th web space interossei
3rd & 4th lumbricle
Adductor pollicis
1st dorsal interosseous
Sensory Supply of Ulnar Nerve
Dorsal cutanous branch
of ulnar : skin
dorsoulnar side of hand ,
little finger and ulnar
of index finger
Medial cutanous nerve of
forearm : C8-T1
skin over biceps elbow
crease middle 1/3 of
armpalmer skin down to
forearm
Anatomical Sites of Compression

Points in elbow and forearm

Anconeus epitrochlearis muscle
Fibrous arcade between 2 heads of fl.
carpi ulnaris
 Site of compression
in hand &wrist
Palmaris brevus muscle
Fibrous origin of fl digitiminmi
Ulnar artery aneurysm or
thrombosis
Distal ulnar tunnel ganglia
 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
 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
 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
MEDIAN NERVE IN THE WRIST

It enters the wrist dorsal to transverse carpal

lig through the carpal tunnel
 Boundaries Of Carpal Tunnel

Dorsally: radio carpal lig.

Radially: scaphoid & trapezium
Palmorly: transverse carpal lig.
Ulnary: hood of hamate & pisiform
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
Muscle supplied by median nerve
Forearm
Pronator teres
Flexor digitorum superficialis
Flexor carpi radialis
Palmaris longus
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
 HAND
Flexor pollicis brevis
Abductor pollicis brevis
Opponens pollicis
First lumbrtical
Second lumbrical
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
 FOREARM
Lacertus fibrosus
Pronator teres muscle
Flexor digitorum superficialis arch
Anomalous muscles
Ulnar collateral or radial artery branches
 HAND / WRIST

Carpal tunnel
Palmar cutaneous branch within the
transverse retinacular ligament
 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
 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
 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
 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
 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
 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
Muscles supplied by radial nerve
Triceps : long head
medial head lateral head
Anconeus
Brachioradialis
Extensor carpi longus
Extensor carpi radialis brevis
Muscles supplied by radial nerve
Extensor carpi ulnaris
Extensor digitorum communis
Extensor digiti minimi
Abductor pollicis longus
Extensor pollicis longus
Extensor pollicis brevis
Extensor indicis proprius
Anatomical compression points of
the radial nerve
ARM:
Accessory subscapularis teres latissimus
Lateral head of the triceps muscle
Lateral intermuscular septum
 FOREARM:
Posterior interosseous nerve within radial
tunnel
Fibrous bands attached to radiocapitelar
joint
Extensor carpi radialis brevis muscle
Arcade of Frohse
Fibrous bands within the supinator muscle
 Superficial radial nerve
Between brachioradialis muscle & radial
shaft
Between brachioradialis and extensor carpi
radialis longus tendons
 THANK YOU

THE END