ANATOMY. Su~,ect : Lecturer : Maher Hadidi Done by: lecture # : 1 3 Date :

Transcription

1 ANATOMY Su~,ect : Lecturer : Maher Hadidi Done by: lecture # : 1 3 Date :

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3 HAND Skin ~ Thick and shovv many flexure creases (folds). ~ Flexure creases are an important landmarks. 111 Proximal palmar crease. ca Distal palmar crease. Then>1r ominoncn Scaphoid --: I! I. ~'F- ~- i ' Pisiforni i i Flexor re!inaculuni i j 1,7,.// / /// f ~Proximal oalmar / creas~ I Distal palmar crease Spnng 2013 Dr. Maher T. Hadidi, University of Jordan 105 3

4 Deep fascia Thin peripheral. a Thick central to form palmar a poneu ros1s. HAND Spring 2013 Dr. Maher T. Hadidi, University of Jordan 106 4

5 !'A A triangular-shaped thickening of the deep fascia in the central Part Of the Pa I m Ell A p_ ex Palmar.. aponeurosis Logitudinal bands.. l_j l fr : 0. ~~,!,,. 1,~1 '<1 '. I l, c;h,._ "-- -- Attach to the distal :.r\\ r( 'i';_/'w~~~:~~~wl i 0 '._\ \~ f I~,j : border of the flexor.\"~.\ ~ ~ 1 }, retinaculum. ;)_. ' \.1 ~t :1, Base-1r'i'll \)_....,, '; ' ~, A''" a Base has 4 longitudinal. bands that fuse to the ;. \~,\ 1 1. /_.t: 1-..c J...h. 1 1 ~A,llll:::~l hnrrlar "~ I.. uases 01 L 1e prox1ma1 """""""'""'. ~:: ' /i border phalanx of the medial Apex :a., ~,.;;..:~ 4 fingers. Palmaris longus Spring 2013 Dr. Maher T. Hadidi, University of Jordan 107 L ~

6 Palmar aponeurosis Synovial sheath surrounding tendons of FOS, FDP Flexor pollicis longus 1 Thenar muscles I Medial fibrous, septum '~ ~---~--~~~~ Hypothenar muscles "" 1st metacarpal Interosseous muscles '--...,_Long flexor tendons ~ toindex ~-Transverse head of adductor pollicis M. \_Oblique fibrous septum Spring 2013 Dr. Maher T. Hadidi, University of Jordan 108

7 Palmar aponeurosis Functions:!!! Drnt-t=~rt- tht=~ undcrj,,i,...g,, '-''-'--'-'- '-' '- \,.;I I Y II structures. Improve the grip. Give attachment to skin. Syno,ial sheath surrounding tendons of FDP Palmar aponeurosis Palmar aponeurosis sends 2 septums to the metacarpal bones. Medial septum: To the 5th MC bone. Oblique septum: To the 3rd MC bone. Medial fibro septum Interosseous Lateral fibrous septum.. 1st met3carpa/ flexor 1endons to 111dex ~Transverse head of adductor pol/icis M. blique fibrous septum Spring 2013 Dr. Maher T. Hadidi, University of Jordan 109

8 Compartments of the Hand These 2 septums divides the hand into three compartments: Thenar compartment, ==>lateral (contain 3 muscles). Hypothenar compartment, ==>medial (contain 3 muscles). Midpalmar compartment ==> Central (Contain All long flexor tendons +4 Lumbrical muscles). Syno, ial sheath surrounding tendons of FDS, FDP Medial fibrous septum \ H ypomenar I musc:es I _ Palmar aponeurosis,flexor pollicis!ongus Thenar muscles / / Lateral fibrous : /~~ septum Spring 2013 Dr. Maher T. Hadidi, University of Jordan 110

9 Srnall muscles of the 1-land Arranged in five groups: r;) Thenars (3) a Hypothenars 3 I!J Lumbricals 4 Palmar interossei 4 Dorsal interossei 4 Adductor pollicis ( 1) :E "' '- ~ jf1exor digiti minimi- - _ i I Abductor digiti mini mi.. ~ LD_ppenens digiti minimi 1[.:- All move little finger All by ulnar nerve. FDS ---tt+ll-~1+! II' FOP &1'---r+Fiexor pollrcis brevis l ~ I' ~Opponens pollicis i ~ 'Ill Abductor pollrcis J ~ brevis m:..: All move thumb. All by median nerve. Spr ing 2013 Dr. Maher T. Hadidi, University of Jordan 111 9

10 1st Lumbrical (4) 1st dorsal us (4) ~ ~-Flexor digiti minirni ~ Abductor digiti minimi. ~ Oppenens dig1ti rninirnl... 1:.: All move little finger All by ulnar nerve. FDS ---~~t+=frn \exor pollicis brevis l ~ pponens pollicis 1 \ ~ v: nbductor pollicis _! brevis Ill"' All move thumb. All by median nerve. r carpi radialis ~-+---+lexor pollicic longus Spring 2013 or. Maher T. Hadidi, University of Jordan 112

11 Sht)rt muscles of the thurnb 3 thenar iv1uscles 1. Flexor po!!icis brevis 2u Abductor pollicis brevis 3a Opponens pollicis m All moves the thumb according to their names. m All supplied by median nerve.!i... --Opponens pol!ic1s! ~ - A~d.JC\Or pollicis, f:_ " brevis 1-'' All move thumb. All by median nerve. Spring Dr. Maher T. Hadidi, University of Jordan 113

12 Short muscles of the thumb Adductor pollicis Action: Adducts thumb NS: Ulnar nerve Spring 2013 Dr. Maher T. Hadidi, University of Jordan

13 Short musc~es of little finger 3 hypothenar Muscles 1. Flexor digiti minimi 2. Abductor digiti minimi 3. Opponens digiti minimi 1!11 All moves the little finger according to their names. All supplied by deep branch of ulnar N. ~ l~lexor drgrlr minrrnr. '[ Abductor drgdr mrnrmr Oppenens drgrlr mrnrmr. 1;.;-AII move little finger All by ulnar nerve. Jir;, FDS ---. p /~.-r..---th.s/ I. FDP j --.-,-,.,<--L- ~1st Lumbrical (4) 1 1st dorsal _c./. e ~~_/.II') -Flexor poiiicis bre' IS i ~ / I L...,.. Oppcnens pollrcrs I ~ Abcuctor pollicrs j ;_ brevis Iii-' 1.11 move thumb. All by median nerve. Spring 2013 Dr. Maher T. Hadidi, University of Jordan 115 '13

14 LATERAL :::a-... MEDIAL ~ Lumbricals, I Jra & ~th Lumbricals 0: FOP tendons Ins. Lateral side of extensor expansion. Actn: Wrilling position NS: 1.2 = Median 13, 4= Ulnar Flexor digitoru profundus pollicis longus ---Flexor digitorum Superficia lis Spring '.., Dr. M~h~rT. Hadidi, Univers-ity of Jordan

15 Axial line 4 Palmar interossei 1st palmar interoseous Spr1ng 2013 Dr. Maher T. Hadidi, University of Jordan "

16 Axial line +-<Abduction j Abduction>+ 4 Dorsal interossei.. Spring 2013 Dr. Maher T. Hadid1, Un1versity of Jordan 118

17 Cutaneous nerve supply to the hand MEDIAN U ir,ar Nenrll I I I It I I W l Palmar & Dorsal surfaces of the Medial 1& 1/2 fingers + Both surfaces of Medial 1/3 of palm " ---ULNAR RADIAL MEDIAN NERVE: Lateral 2/3 of palmar skin & Palmar aspect of the Lateral 3 & 1/2 fingers+ their Nail beds Latera\2/3 of the Dorsal aspect of hand & Dorsal aspect of the 3 & 1/2 fingers except Nail beds. Spring 2013 Dr. Maher T. Hadidi, University of Jordan 119 L

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