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
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