(surface anatomy) (surface anatomy) (surface anatomy) (surface anatomy) 표면해부 (surface anatomy)

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Elfrieda Barrett
6 years ago
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1 Hand 와 Wrist 의기능해부와이학적검사 김상수서울마이크로병원 www:microhospital.com 1. 표면해부 a.forearm: 근위부는근육 : 요골측 : 요골신경지배 척골측 : 정중, 척골신경지배 원위부는건으로형성 b.wrist 주위 :palmaris longus( 장장근 ), median nerve( 정중신경 ) flexor carpi rad( 요수근굴근 ) c.palm( 손의수장부 ) carpus: 8 bones: 수근관증후군 ( 정중신경 ) metacarpus:5 bones digits: 5 digits(thumb and 4 fingers) interdigital space thenar muscle:median n( 정중신경 ) hypothenar m:ulnar n( 척골신경 ) d.skin crease( 피부선 )--손금 thenar crease, distal palmar crease, proximal palmar crease median crease : 피부밀림방지 epidermal ridge( 융기선 ) 지문 땀샘 (sweat gland) e.dorsum of hand and 손톱 : ext poll longus( 장무지신전건 ), snuff box ext poll brevis( 단무지신전건 ) Lister tubercle,first dorsal inteross m. 손톱 :nail root,nail plate,lunula, paronichyum,eponichyum. :spoon nail,raynaud s disease etc. 손의 volar surface scaphoid,pisiform, hamate(hook) carpal tunnel, median nerve 와 recurrent branch no man s land 손의 dorsal surface knuckles,snuff box 1

2 2.Anatomy(Bones) A.forearm bones: radius:head,tuberosity,shaft, pronator tuberosity,styloid process, prox & distal radio-ulnar joints ---radial tilt, inclination ulna:olecranon,semilunar notch, coronoid process,shaft, head,styloid process ---plus or minus varients carpal boe---8개 metacarpal bones---5개 Phalanges---14개 Two arches longitudinal--flex & exten의 tension claw finger deformity transverse--thenar,hypothenar m: ape hand deformity 8 carpals: proximal:scaphoid,lunate,pisiform, triquetrum distal:trapezium,trapezoid,capitate, trapezoid hamate **scaphoid, lunate:alignment,shape hamate:hook 골절 carpal height 5 metacarpals: 제 1 metacarpal Bennet 골절 (abd poll long) 수술요함 carpo-metacarpal joint 제 4,5 metacarpals movable(opposition) 14 phalanges:collateral lig of PIP joint, joint fracture (anatomy,joint, 관절 ) 1.proximal radio-ulnar joint radial head-radial notch,annular lig. --rotation of forearm 2.distal radio-ulnar joint 3.triangular fibrocartilage complex TFCC:distal rad-ulna stability, cushion from carpal pressure (anatomy,joint) 4.wrist:radio-carpal joint inter or mid-carpal joint movement of wrist:flexion,extension ulnar & radial deviation *ligaments:extrinsic-collateral lig. intrinsic:scaphoid-lunate 2

3 (anatomy,joint) 5.carpometacarpal joint: thumb:trpezio-metacarpal:saddle j. 골절 -abd pollicis long 6.metacarpophalangeal joint: thumb:collateral lig 7.proximal & distal interphalangeal j: collateral lig and 골절 (anatomy,muscle & tendon) 1.forearm flexor-pronator group superficial:pronator teres,fcr,fcu, palmaris long middle:fds deep:fdp,fpl,pronator quadratus (anatomy,muscle & tendon) 2.forearm extensor-supinator group superficial:brachioradialis, ECRL,ECRB,ext digi comm, ext digiti mini,ecu deep:supinator,abd poll longus, ext poll longus,ext poll brevis, ext ind prop *DeQuervain s disease (anatomy,muscle-tendon) 3.hand muscles(intrinsic muscles) a.thenar muscles:abd poll brevis, flex poll brevis,oppon pollicis, add pollicis b.hypothenar m:pal brevis,abd digi mini,flex digi mini brev, opponence digi mini (anatomy,muscle-tendon) c. interoseoleus m: palmar int m:3 개 toward middle finger dorsal int m: 4 개 away from middle finger d. lumbricals: 4 개 radial side of extensor (anatomy,tendon) Extension apparatus of fingers central tendon: EDC MP:ext, PIP:ext. lateal bands:intrinsics MP:flex, PIP:ext, DIP:ext *sagital band,retinacular lig.triangular lig. *intrinsic minus,intrinsic plus position, button-hole,swan neck,mallet 변형 3

4 (anatomy,tendon sheath) 1.Flexor tendon a.synovial sheath:synovial fluid 생산 tendon nutrition 표피부공급 ** 심부는 blood supply b.fibrous sheath:pulley system annular pulley:4 개 cruciform pulley: 3개 **to prevent bowstring effect, trigger finger 2.Extensor tendon a. wrist retinaculum: 6 compartments (anatomy,fascia) 1.superficial fascia 2.deep fascia( 근육을싸고있는막 ) a.forearm fascia:comparment synd, VIC(Volkman ischemic cont) b. 수장부 :trans carpal lig:cts volar carpal lig:guyon canal palmaraponeurosis: Dupuytren cont 말초신경 신경기능 :1. 감각기능 2. 운동기능 3. 자율신경기능 신경종류 :1. 순수감각신경 2. 순수운동신경 3. 혼합신경 1. 감각신경 a.forearm:med.antebrachial cut n lat antebrachial cut n(mcn) post antebrachial cut n(rad) bhand b.hand &fingers: med n: thumb,index,middle ring1/2 ulnar n: ring1/2,small radial n: dorsal surface **autonomous zone 2. 운동신경 a.median n; forearm flexors: pronator teres,flex carpi rad, palmaris long,flex dig superf, *ant inteross n:flex dig prof(ii,iii) flex poll long,pronator quad hand:thenar m,lumbricals(i,ii) 2. 운동신경 b. 척골신경 :cubital tunnel을지나 (cubital tunnel syndrome) flex carpi ulna,flexor digi prof(iv,v), Guyon canal 을지나 (ulnar tunnel synd) hypothenar m,inteross m, lumbricals(iii,iv),add poll, **claw hand def(intrinsic minus), Froment s sign 4

5 2. 운동신경 c. 요골신경 :brachioradialis,ext carpi long,ext carpi brev,supinator post inteross n:ext digi comm, ext digi quinti,ext carp ulna, ext poll long,ext poll brev, abd poll long,ext indi prop. **wrist drop (anatomy,artery) Subclavian ar--axillary art --brachial art a.forearm:radial art & ulnar art b. hand:superficial and deep palmar arches c. fingers:two digital art **Allen test, Volkmann s ischemic contracture 5

MCQWeek2. All arise from the common flexor origin. The posterior aspect of the medial epicondyle is the common flexor origin.

MCQWeek2. All arise from the common flexor origin. The posterior aspect of the medial epicondyle is the common flexor origin. MCQWeek2. 1. Regarding superficial muscles of anterior compartment of the forearm: All arise from the common flexor origin. The posterior aspect of the medial epicondyle is the common flexor origin. Flexor