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