Week 11, Thursday

Anterior Antebrachium ppt

Osteology of the wrist and hand:

• Metacarpals 1-5 medial to lateral

• Phalanges

• Carpal bones:

  • Distal row:

    • Scaphoid

    • Lunate

    • Triquetrum

    • Pisiform

  • Proximal row:

    • Trapezoid

    • Trapezium

    • Capitate

    • Hamate

• Ulna does not articulate with the carpals like the Radius does. There is an articular disc instead

• Radius has articular surfaces for the Lunate and Scaphoid

Cutaneous Nerves:

• Superficial branch of radial nerve

• Median nerve

• Superficial branch of ulnar nerve

• Dorsal cutaneous branch of ulnar nerve

Dermatomes: know them, love them

Palmar Aponeurosis

Dorsal Venous Network:

• dorsal veins of the hand

• Radial (Thumb) side drains to Cephalic Vein

• Ulnar (5th finger) side drains to the Basilic vein

Palmar Venous Network:

• Superficial Venous Palmar Arch

• Radial side drains into the Cephalic vein

• Ulnar side drains into the Median (antebrachial) vein of the forearm

Arteries:

• Brachial artery →

  • radial →

    • Superficial Branch

    • Deep Dorsal branch

  • ulna →

  • Deep Palmar Arch

Muscular Compartments:

• Anterior = Flexor Pronator compartment

  • Superficial layer: All 4 arise either entirely or in part from the medial epicondyle of the humerus via the common flexor tendon

    • Pronator teres

    • Flexor carpi radial is

    • Palmaris longus

    • Flexor carpi ulnaris

  • Intermediate layer

    • Flexor Digitorum superficialis

  • Deep layer

    • Flexor Digitorum profundus

    • Flexor pollicis longus

    • Pronator Quadratus

• Posterior = Extensor supinator compartment

Learn the O, I, N, Art, and Act

Golfer’s elbow= medial epicondylitis

Flexor Retinaculum

• a strong ligamentous band that runs from the psi form and hook the hamate laterally to the scaphoid tuberosity and palmar side of the trapezium

• Forms the roof of the carpal tunnel

Summary of Muscle innervation:

• Superficial layer:

  • Median Nerve

    • Pronator teres

    • Flexor carpi radial is

    • Palmaris longus

  • Ulnar nerve

    • Flexor carpi ulnaris

• Intermediate layer:

  • Median Nerve

    • Flexor Digitorum superficialis

• Deep Layer:

  • Radial ½ Anterior interosseous nerve, ulnar ½ ulnar nerve

    • Flexor Digitorum Profundus

  • Anterior interosseous nerve (from the median nerve)

    • Pronator Quadratus

    • Flexor Pollicis Longus

Tunnels of the Wrist:

• There are 2 tunnels through which structures from the forearm enter the hand:

  • Carpal Tunnel

    • Deep to flexor retinaculum

  • Tunnel of Guyon

    • Superficial to flexor retinaculum

Carpal Tunnel:

• a passageway for 9 tendons and 1 nerve

  • Tendons=

    • 4 from flexor Digitorum superficialis

    • 4 from flexor Digitorum profundus

    • 1 from flexor pollicis longus

  • Nerve=

    • Median nerve

• Boundaries:

  • Roof= flexor retinaculum

  • Laterally= scaphoid and trapezium

  • Medially= hook of hamate and pisiform

  • Floor= palmar ulnocarpal and radiocarpal ligaments

Tunnel of Guyon:

• a passageway for 1 nerve and 1 artery

  • Ulnar nerve

  • Ulnar artery

Wrist and Palm ppt

Nerves of the hand:

• the hand is innervated by

  • Radial nerve

  • Median nerve

  • Ulnar nerve

Cutaneous nerves of the hand:

• superficial branch of the radial nerve

• Dorsal Cutaneous branch of ulnar nerve

• Dorsal branches of the Poper palmer nerves

• Palmar cutaneous branches

Dermatomes, know them, love them

Radial Nerve →

• superficial branch

• Deep branch →

  • Through supinator muscle Changes name to Posterior interosseous nerve

• Superficial branch of the radial nerve is purely sensory

  • Supplies the skin over lateral 2/3 of the dorsum of the hand, and the proximal parts of the lateral 3 ½ digits

Median nerve

• enters the hand through the carpal tunnel

• Motor to 2 ½ thenar muscles, and the 1st and 2nd Lumbricals

• Sensory to the lateral 2/3 of the palm, the palmar surface of lateral 3 ½ digits, and the dorsum of the distal pat of the same 3 ½ digits

• Palmar Cutaneous branch of the median nerve is sensory to the central palm

  • Arises proximal to the wrist and passes superficial to the flexor retinaculum

Ulnar nerve →

• Dorsal cutaneous branch

• Palmar cutaneous branch →

• Passes through Guyon’s canal and changes its name to Superficial branch

• Deep branch

• Leaves forearm by emerging from deep to the tendon of flexor carpi ulnaris

• continues into Guyon’s canal anterior to the flexor retinaculum passing between the pisiform (medially) and ulnar artery (laterally)

• Superficial branch

  • arises within Guyon’s canal

  • supplies skin of medial 1/3 of the palm and the medial 1 ½ digits

• Deep branch

  • arises within Guyon’s Canal

  • supplies hypothenar and other muscles

• Palmar Cutaneous branch

  • arises proximal to the wrist and passes superficial to the flexor retinaculum and palmar aponeurosis

  • supplies skin at base of medial palm

• Dorsal cutaneous branch

  • supplies medial half of the dorsum of the hand and the proximal part of the medial 1 ½ digits

Ended at Nerve of the Palm/Digits slide