Anatomy of the hand

dorsal palmar
the skin of the dorsum is thin and
mobile(allowing accumulation of fluid
subcutaneously)

•the skin of the palm is thick and anchored.

•the flexure lines associated with

cutaneous movement (which do not
necessarily indicate the sites of joints)
•The subcutaneous fat that constitutes
the tips of the fingers is loculated by
fibrous septa and occupies a closed
pulp space which is liable to infection
( whitlow) from a penetrating wound.

•the fingerprints, and the nails.

 This may be followed by the damage
to the distal phalanx
owing to the interruption of its blood supply

whitlow
Palmar aponeurosis

• Thickened deep fascia.

• Triangular with the apex
continuous with palmaris
longus.
• Splits into 4 processes to
the medial 4fingers.
• Protects the
tendons,blood vessels
and nerves that lie deep
to it
In the olden days, the palm is said to be containing
a mid palmar space and a thenar space where pus
can be accumulated. This view is discarded now.
“Dupuytren's contracture” of one or more
fingers, especially the little and ring fingers,
is commonly attributed to thickening and
shortening of the palmar aponeurosis.
Its causation is not really understood.
Transverse section at the wrist
 Synovial sheaths
• As the digital flexor tendons
pass through
• the carpal tunnel they are all
enclosed in a single (common)
synovial sheath.(ulnar bursa)
• The FPL has its own synovial
sheath.(radial bursa)

Note the continuity between th little finger’s digital sheath with the common sheath
 Space of parona
• The common synovial sheath
extends in to the lower
forearm into a space called
“space of parona”

infection of the synovial sheaths of

the thumb or little finger may spread
readily into the palm and even into
the forearm(space of parona)

Untreated infection of the synovial sheaths

can impair hand function
 Fibrous flexor sheaths

• Thick fibrous arches with

cruciform ligaments
convert the concavity of
metacarpals and
phalanges into tunnels
and protect the flexors
tendons from slipping.
• Inside these tunnels the
tendons are enclosed in
synovial sheaths.
• (digital synovial sheaths)
Insertion of FDS
• Each tendon splits at
base of the middle
phalanx to be inserted
in to the sides of it.
• This splitting is
necessary to allow
the passage of FDP
to the distal phalanx.
FDP
• Has 4 tendons like FDS.
• From these 4 tendons, 4
lumbricals take origin
• FDP is inserted in to the
distal phalanx
• Hence it is capable of
flexing the both I-P joints
• (FDS can flex only
proximal I-P joint)
lumbricals

• 4 small muscles
originate from tendons
of FDP and insert into
the dorsal digital
expansion.
• 1st and 2nd are supplied
by median nerve.
• 3rd and 4th are by ulnar
nerve.
Interossei
• 4 palmar and 4 dorsal
interossei
• Palmar interossei
produce adduction of
fingers (PAD)
• Dorsal interossei produce
abduction of
fingers(DAB)
• Middle finger is the
reference point
• (axis finger)
• Palmar interossei are 4 in number but
the fingers are 5.
• How to distribute?

•Middle finger does not have palmar interosseous.

Dorsal interossei are 4 in number and fingers are 5.
How to distribute?
Middle finger has 2.(index 1,ring finger 1)
Thumb and little finger do not have any.
Extensor expansion (dorsal digital
expansion)

Problems occur when the central slip is damaged,

as can happen with a tear.
 1.Ulnar nerve
2.Median nerve
3.Radial nerve

The dorsum of the hand, sensory innervation

 1.Ulnar nerve
2.Median nerve
3.Radial nerve

The palm of the hand, sensory innervation

 The Z-position of the hand, produced
by the interossei and lumbricals
(Flexion at M-P joints and extension at I-P joints)

Claw hand, due to paralysis of the interossei and

lumbricals (following section of the ulnar nerve).
The unopposed extensor and flexors produce the opposite
of the Z-position.
(extension at M-P joint and flexion atI-P joints)
Hand at rest