Upper Limb Notes

Upper Chest
o Forearm
BEARINGS
Flexion, extension
Flexor aspect - front of forearm
Extensor aspect - back of forearm
Radial side - side w/thumb
Ulnar side - side w/o thumb
MOVEMENT
Rotation
Pronation [brings palm down]
Supination [brings palm up]
Ulnar abduction, radial abduction
BONES
HUMERUS - LATERAL END
Two bumps on sides of lateral end
Medial epicondyle
Lateral epicondyle
Above each epicondyle is a ridge
Articular surface is in 2 parts
Trochlea articulates w/ulna
Capitulum articulates w/radius
Hollow thing at back of humerus
Olecranon fossa, holds olecranon on back on ulna in full extension
Ulna bigger proximally, radius bigger distally
The radius rotates, the ulna doesnt
The radius and ulna have two joints at both ends, radio-ulnar joints
Distal and proximal
Held together by interosseus membrane
ULNA
PROXIMAL END
Trochlear notch, articulates with trochlea of humerus
Very end of ulna is olecranon
TRICEPS TENDON IS ATTACHED TO THIS
Coronoid process
Distal to it is ulnar tuberosity.
Has insertion of brachialis tendon
Radial notch, where it articulates with radius
DISTAL END
Head of ulna
Pointed tip called ulnar styloid
RADIUS
PROXIMAL END
Head of radius
End of head articulates with capitulum
Curved side articulates with radial notch AND ligament
Distal to head is radial tuberosity
Insertion to biceps tendon
Distal end

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 Pointed end - radial styloid
Has two surfaces - one for attaching to triangular fibrocartilage or
articular disk and to ulnar
ELBOW JOINT AND RADIOULNAR JOINT
Two ligaments hold radioulnar joint and elbow joint
Radial collateral ligament
Arises from lateral epicondyle
Fans out and becomes continous with anular ligament
Annular ligament
Together with radial notch of ulna, forms socket for radius to rotate in
Attached to edges of radial notch of ulna
Shaped like a shallow cup to fit radial head
Hold humerus and radius closely together
Ulnar collateral ligament
Arises from medial epicondyle
Fans out in triangle,
Attached to ulna on medial side of trochlear notch
Flexible sleeve of joint capsule between anular ligament and head of radius
Elbow joint is stable because of
Shape of bones
Humerus and ulna interlock deeply, curved surfaces in two dimensions
Strength of ligament
BOTH JOINTS CONSIDERED TO BE ONE, ONE ENCLOSED SPACE
DISTAL RADIOULNAR JOINT
WRIST JOINT
Really two joints
CARPUS
Formed by 8 small bones
2 rows
Proximal
SCAPHOID
LUNATE
TRIQUETRAL
PISIFORM
Arrangement is from RIGHT TO LEFT when looking at RIGHT HAND FROM FORWARD
Pisiform sits on triquetral
Scaphoid, lunate, part of triquetral form radiocarpal joint with radius
Distal surface of proximal row forms notch in which distal row fits in
Distal
TRAPEZIUM
Articulates with thumb by itself
TRAPEZOID
CAPITATE
Projects proximally
HAMATE
Part of it projects proximally
RADIOCARPAL JOINT
Responsible for partly extension flexion
Radial deviation + ulnar deviation mainly happens here
MIDCARPAL JOINT
Distal row bones fit into proximal row notch
Responsible for partly extension flexion
Radial Collateral Ligament
Goes from radial styloid to scaphoid and trapezium
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 Ulnar collateral ligament
Ulnar styloid to triquetrial and pizoform bones
joint capsule around joint is thick and strong
Forms dorsal radiocarpal ligament on extensor side
Forms palmar radiocarpal ligaments on flexor side
Wrist joint held together ENTIRELY BY ligaments
Collateral ligaments hold it in radial, ulnar abduction
Radiocarpal hold it in extension, flexion
MUSCLES
3 sets of muscle
FLEX AND EXTEND ELBOW
3 FLEXORS
BRACHIALIS
Rises from anterior humerus
Inserted on ULNAR TUBEROSITY
Flexes elbow whether pronated or supinated
BICEPS BRACHIA
Lies in front of the brachialis
TWO HEADS
Long
Runs up bicipital groove, passes inside shoulder groove, supraglenoid
tubercule of scapula is origin
Short
Tendon of origin merges with coracobrachialis
Common tendon of origin rises from coracoid process
Two heads unite to form belly
Belly divides into two part tendon
Main part inserts on RADIAL TUBEROSITY
Lateral edge, tendon FANS OUT
Thin sheet of fascia, bicipital aponeurosis
Indirect attachment to ulna
Merges into deep fascia
Flexes elbow
MORE EFFICIENT WHEN FOREARM IS PRONATED
Fully stretched then
BRACHIORIADALIS
Origin is halfway up humerus below deltoid tuberosity
Inserted on distal radius
Efficient flexor
1 EXTENSOR
TRICEPS
Head
Long head Infraglenoidtuberclue
Lateral headPosteriorhumerus
Deep or medial head
Lower down in humerus, broad area medially
Converge to form a massive tendon
Inserts on olecrenon
Contract of triceps extends the elbow
ANCONEUS
Tiny muscle runs from lateral epicondyle to lateral aspect of ulna
MINOR EXTENSOR
SUPINATE, PRONATE ELBOW
PRONATOR
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 PRONATOR TERES
Arises from medial epicondyle
Small deep head in ulna too
Median nerve passes between two heads
Pronator
Inserts halfway down lateral surface of radius
PRONATOR QUADRATUS
Anteromedial aspect of ulna
Inserts on anterior surface of radius
SUPINATION
SUPINATOR
Rises from lateral epicondyle, anular ligament and supinator crest on ulna
Inserted on radius above pronator teres
BICEPS
Insertion in radial tuberosity gives it power to rotate, when elbow is
flexed.
Flexing action held in check by triceps
Supination is more powerful than pronation
FLEX AND EXTEND HAND
3 FLEXORS
FLEXOR CARPI RADIALIS
Arise from medial epicondyle, from
COMMON FLEXOR TENDON
Massive tendon, with two other flexor muscles
Inserts on base of second metacarpal, goes through ligamentous tunnel in
hand
FLEXOR CARPI ULNARIS
Extensive ulnar head from lower border of ulnar [facing ground]
Inserts on pisoform bone
Pull of pisoform bone transmitted to HAMATE BONE and base of 5th metacarpal
by piso-hamate and piso-metacarpal ligaments.
These two muscles produce flexion together
Separately they contribute to radial and ulnar abduction
PALMARIS LONGUS
Third small muscle
Arises from medial epicondyle
Tendon lies superficial to all neighbours and INSERTS INTO PALMARIS LONGUS,
a layer of dense fascia which covers hand
HELPS FLEX WRIST
Frequently absent
3 EXTENSORS
EXTENSOR CARPI RADIALIS LONGUS
Arises from lateral epicondyle ridge below brachiaradialis
Inserted on base 2nd metacarpal
EXTENSOR CARPI RADIALUS BREVIS
Arises from lateral epicondyle ridge, same as longus
Inserted on base of 3rd metacarpal
EXTENSOR CARPI ULNARIS
Same as longus
Also has ulnar head
Rises from lower border of ulna
Inserted on base of 5th metacarpal
Extensor tendons pass under extensor retinaculum
Acts as pulley.

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 Wrist extensor also help in gripping something, powerful gripping muscles
are feeble when wrist is relaxed.
When radial or ulnar extensors contract separately, help do radial or ulnar
abduction, in correspondence with flexor muscle, radial or ulnar.
VEINS
Superficial veins converge to form
Cephalic
Stays at superficial level
At top of arm lies between deltoid and pectoralis major
Basilic
The antecubital vein crosses from cephalic to basilic vein.
Going up the arm, it joins the pair of brachial veins.
Now basilic vein is known as Axillary vein.
Axillary
Runs alongside median nerve, disappears behind pectoralis major
ARTERIES
Axillary Artery
Emerges from beneath pectoralis major
Changes name to brachial artery as it passes into arm
BRACHIAL ARTERY
Gives off large branch - Deep brachial [profunda brachial] near latissimus
tendon - SUPPLIES TRICEPS
Runs down medial side of arm, next to brachialis muscle
At this point, median nerve crosses over.
Passes beneath bicipital aponeuroses.
Divides into two major arteris, radial and ulnar besides bicep tendon.
ULNAR
Deeper course.
Dives down in brachialis tendon and passes deep to pronator teres
RADIAL
Stays superficial.
Runs down forearm b/w pronator teres, and brachioradialis.
NERVES
Four nerves surround axillary artery
MUSCULOCUTANEOUS NERVE
COURSE
Runs through coracobrachialis, runs down the arm b/w biceps and brachialis,
emerges in forearm to become lateral cutaneous nerve of forearm.
SUPPLIES
Three flexor muscles
Corocabrachialis
MEDIAN NERVE
COURSE
Run down to elbow without supplying.
Halfway down, median nerve crosses in front of brachial artery, at elbow it
lies medial to artery.
Dives between brachialis and pronator teres and passes through two heads of
pronator teres entering forearm
SUPPLIES
Pronator teres
Flexor carpi radialis
Ulnaris longus
Pronator quadratus
ULNAR NERVE

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 COURSE
Run down to elbow without supplying.
Runs medial to triceps, behind medial epicondyle.
Turns sharp corner around underside of medial epicondyle, goes through
fibrous tunnel, passes b/w two heads of flexor carpi ulnaris.
SUPPLIES
Flexor carpi ulnaris
RADIAL NERVE
COURSE
It spirals around the back of upper arm
At axilla lies deep, at latissimus tendon runs deep in long head and medial
head of triceps.
Lies right on bone,
Runs b/w medial and lateral heads of triceps.
Runs around lateral head of triceps on the bone, emerging around
brachoradialis.
Reaches lateral epicondyle, dividing into
DEEP BRANCH
SUPERFICIAL [SENSORY] BRANCH
SUPPLIES
Triceps
Brachoradialis
anconeus
All 3 wrist extensors
Supinator
Hands
o BEARINGS
Palmar
palm surface
Dorsal
Dorsal surface
Radial
Side towards thumbs
Ulnar
Side towards ulna
o BONES
8 carpal bones
5 metacarpals
Each finger
Proximal phalanx
Middle phalanx
THUMB DOESNT
Distal phalax
CARPO METACARPAL JOINTS [CMC]
METACARPOPHALANGEAL JOINTS [MP]
INTERPHALANGEAL JOINTS [IP]
Proximal
Distal
Carpal Tunnel formed from bony projections on eeither side of carpal bones
Ulnar side
Pisoform bone
Hook of hamate
Radial
Crest of trapezium

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 Tubercle of scaffoid
4 CMC joints allow small amount of movement
5th MC really mobile
4th less so
3rd hardly moves
2nd hardly moves
Deep tranverse metacarpal ligament
Crosses MP joints
Is strong, stops heads from spreading
Continuous with palmar plate
Doesnt connect with thumb
BONES AND JOINTS OF FINGERS
Proximal phalanx and middle phalanges flattened on flexor aspect
Sheath which surrounds flexor tendons attaches to ridges
MP JOINT
Articular surface of metacarpal head curved in two planes
Side to side
Front to back
Base of proximal phalanx
Concave articular surface curved in two places
Wide range of flexion and extension
And lateral movement
JOINT CAPSULE
Loose on extensor aspect to allow joint to flex
Toughens on fx. Aspect to form palmar plate [palmar ligament]
Moves along with proximal phalanx when joint flexes
Deep transverse metacharpal
Collateral ligaments of MP joints
Run from back of MP head to base of proximal phalanx
Loose when joint extended
Side to side movement easily occurs
Tight when joint flexed
Side to side movement easily
IP JOINTS
Only allow flexion and extension
Head of phalanx curved mainly from side to back
Slight depression in middle
Base of adjoining phalanx has corresponding curve
Capsule
Like mp but collateral ligament different
EQUALLY TIGHT IN FLEXION AND EXTENSION
BONES AND JOINTS OF THUMBS
CMC JOINT of Thumb
Sits in front of other CMC joints and at angle
Therefore lie in front of fingers and their MC's.
Articular surface on trapezium curved in 2 planes
Side to side
Back to front
Same for first metacarpal^
Movement away from 2nd MC - ABDUCTION
Movement towards it is ADDUCTION
Flexion and extension
OPPOSITION
o MP JOINT
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 Permits ONLY FLEXION AND EXTENSION
On flexor aspect,
TWO TINY SESAMOID BONES
Embedded in joint capsule
o IP Joint
Same as finger.
o Abducted, flexed - MEDIAL ROTATION
o Adduction, extended, LATERAL ROTATION
o OPPOSITION
Is combination of medial rotation, abduction, flexion
o OTHER PULLEYS AND MECHANISMS
FLEXOR RETINACULUM
Forms roof of carpal tunnel
Strap of fibrous tissue
Attached to
Pisoform bone and hook of hamate on ulnar side
Scaffoid and trapezium on radial side
All nerves go through carpal tunnel
Branches off at ulnar and radial sides to form tunnels
TUNNEL FOR FLEXOR CARPIAL RADIULUS
Towards radial side
TUNNEL FOR ULNAR ARTERY AND NERVE
Towards ulnar side
EXTERNAL RETINACULUM
Runs obliquely from a ridge on radius to ulnar styloid, triquetrum and
hamate.
Number of deep extensions attached to radius dividing it into tunnels
All wrist extensors and for fingers and thumbs pass
Is on DORSAL SIDE
Flexor Tendon Sheath
DORSAL SIDE
Starts below MP joints, provides flexor tendons with 2 tunnels to run in
Runs all the way to distal phalanx
Some parts are thick and fibrous, and some are thin
Act as pulleys.
Attached to edge of palmar plate and along phalanx
Floor of tunnel is formed by smooth flattened surface of phalanges
EXTENSOR MECHANISM
Extensor tendon and tendon of three intrinsic muscles come together on each
finger to form EXTENSOR MECHANISM.
Consists of extendor tendon
Interosseous tendons on both sides of finger [radial and ulnar]
On radial side, LUMBRICAL MUSCLE TENDON
On each site, triangular tendon sheet connecting interosseus tendon to
extensor tendon, called EXTENSOR HOOD
EXTENSOR TENDON
Divides into three slips over proximal phalanx
CENTRAL SLIP
Crosses proximal IP joint and inserts on base of middle phalanx
SLIPS ON EACH SIDE
Fuse with interosseus tendon to form lateral bands, insert on base of
distal phalanx after joining together
THUMB has simpler extensor mechanism, later in muscles.
PALMAR FASCIA

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 Also known as palma aponeurosis
Dense triangular sheet of fibrous tissue
Continuous with flexor retinaculum and palmarus longus tendons
Distally separates into slips, insert into slips of palmar plates of fascia.
Prevent nerves from harm and stuff.
o MUSCLES
EXTRINSIC MUSCLES
Lie in forearm
FLEXORS OF FINGERS
Flexor Digitorum Profundus
Arises from anterior/medial surface of ulna and interosseus membrane.
4 tendons enter carpal tunnel
ACTION
Flex both MP and IP joints
Flexor Digitorum Superficialis
Lies superficial to FDP
IS PALMAR
Has two origins
Humeroulnar
Arises from common flexor tendon
Radial
Arises from long oblique line on radius palmarly.
Between the two heads, theres a gap b/w which medial nerve and ulnar artery
pass
4 tendons are bundled together as the pass through carpal tunnel
Enfolded within common synovial sheath, extends into palm of hand
4 profundus tendons give rise to 4 intrinisc muscles, Lumbrical muscles
ACTION
Flex both MP and PROXIMAL IP joints
Tendons of FDP and FDS
Superficialis and profundus tendons enter flexor tendon sheath together
Over proximal phalanx, superficialis tendon splits into 2 halves which move
around profundus tendons
Reunite and insert on middle phalanx
Profundus tendon emerges b/w two halves of supeficialis and inserts on base
of distal phalanx
EXTENSORS OF FINGERS
Extensor Digitorium [Extensor Digitorum Communis]
Long muscle
Rises from common extensor tendon
Divides into four slips which pass under extensor retinaculum
Extends all
TENDONS ARE ON DORSAL ASPECT
Extensor Digiti Minimi
Short
Arises from ulnar side of extensor digitorium
Extends small finger
Extensor Indicis
Short
Lies deep to extendor digitorum
Arises from ulna + interosseus membrane
Tendon passes under retinaculum with Ex.Digitorium
Extends index finger
Extendor tendons fan out, branch and rejoin in irregular fashion.

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 Extensor indicis and minimi joins Ex.Digitorium and corresponding MP
Also give rise to extensor hood
LONG MUSCLES OF THUMBS
Long flexor, long abductor, two extensors, long and short
FLEXOR POLLICIS LONGUS
Lies on flexor aspect
Lies deep in forearm.
Lies alongside FDP
Arises from anterior surface of radius and interosseus membrane
Tendon passes through carpal tunnel
Enters fibrous flexor sheet of thumb and inserts on base distal phalanx
Flexes both IP and MP joint
ABDUCTOR POLLICIS LONGUS
Arises from posterior radius about midway through and interosseus membrane.
Tendor inserts on base of first metacarpal
Is dorsal
EXTENSOR POLLICIS LONGUS
Arises from ulna a bit distally and I.O.S membrane
Inserts on base of distal phalanx posteriorly.
Is dorsal
EXTENSOR POLLICIS BREVIS
Arises from radius, and I.O.S membrane
Inserts on base of proximal phalanx posteriorly
Is dorsal
INTRINSIC MUSCLES
Interosseus muscles
7 muscles
One for each side of middle, index, ring finger and one for radial side of
little finger
Divided into
4 DORSAL
3 PALMAR
Let's consider them in pairs
Interossei for middle fnger
Arise from shaft of metacarpal and its neighbours
Pass behind deep transerve ligament
On each side of MP joint, I.O muscle narrows down to double tendon
Long part
Joins extensor mechanism to become outlying part
Forms lateral band of extensor mechanism
Insert on distal phalanx like we seen
Short part
Inserts on base of proximal phalanx
Line of action passes in front of axis of rotation of mp joint
Behind axis of two ip joints
When contract, flexes Mp joint, and extend both IP joint
When one contract separately, causes deviation at MP joint
First dorsal interosseus muscle
On radial side of index finger
Unusually large
Two heads
Arise from first and second metacarpal, radial side
Radial artery passes between these dorsally
Powerful radial deviation
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 One of a pair that is involved in "key-pinch"
Lumbricals
4 muscles
1 for each finger
Arises from side of one or both of adjoining FDP tendons
Pass in front of deep transverse metacarpal ligament
Inserts on radial side of extensor mechanism, just distal to long part of
I.O tendons
ACTION
Extends IP joints
Assists radial deviation of MP joint
Short Muscles of Thumb
4 MUSCLES
1 lies by itself, 3 lie close together
ADDUCTOR POLLICIS
Lies by itself
Transerve head
Arises from 3rd metacarpal
Oblique head
Arises from ligaments in base of carpal tunnel
Inserts on ulnar sesamoid bone and on base of proximal phalanx of thumb
Produces adduction at CMC join
THENAR EMINENCE
Consists of three muscles that lie together, forming an eminence below the
thumb
Also known as thenar muscles
FLEXOR POLLICIS BREVIS
Lies outside
Arises from flexor retinaculum and trapezoid
Insert on radial side of base of proximal phalanx of thumb.
ABDUCTOR POLLICIS BREVIS
Lies outside
Arises from trapezium + flexor retinaculaum
Insert on radial side of base of proximal phalanx of thumb.
OPPONENS POLLICIS
Deep to both
Arises from trapezium and flexor retinaculum
Inserts radial side of first metarcapal
Produce abduction, flexion of CMC joint
Also rotates it medially
Adds up to opposition of thumb
Short Muscles of little finger
Make up Hypothenar eminence
Called hypothenar muscles
ABDUCTOR DIGITI MINIMI
Arises from pisoform bone
Inserts like an IO muscle partly into base of proximal phalanx and partly
into extensor mechanism
FLEXOR DIGITI MINIMI
Arises from flexor retinaculum and hamate
Inserts near abductor on proximal phalanx on ulnar side
OPPONENS DIGITI MINIMI
Lies deep
Arises from hook of hamate

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 Inserts at ulnar side of 5th metacarpal
Ulnar nerve and artery pass underneath flexor and opponens
Abductor has same funciton as I.O msuscle
Flexor flexs MP joint
Opponens produces flexion of little finger, at CMC.
Makes little finger very mobile.
o VEINS
Veins of finger, thumb mainly pass through dorsal aspect
Crossing wrist, joined my veins draining dorsal spect of foream
Combine to form cephalic vein
Veins draining flexor aspect of forearm make Basilic vein
Anticubital passes from cephalic to basilic
Concommitant Veins
Veins that pass deep with the arteries alongisde it
Concommitant veins of radial artery
" " of ulnar artery
RADIAL ARTERY
Runs down the forearm
Lies on Flexor pollicis longus, FDS.
In distal forearm it emerges from beneath brachioradialis, and lies
superficially b/w border of radius and tendon of FLEXOR CARPUS RADIULAS
At wrist, 2 branches
Superficial branch
Anastomoses with superficial branch of ulnar artery
Deep branch
spirals around to dorsal aspect, runs beneath tendons of abductor pollicis
longus, extensor pollicis longus, brevis
Passes b/w two heads of first dorsal interosseus muscle
Gives off branches to thumb and index
Finally passses b/w two heads of adductor pollicis to enter arm
Crosses in front of I.O, usually anastomosing with branches of ulnar artery
forming deep palmar arch
ULNAR ARTERY
Passes beneath pronator teres
Gives off common interosseus artery
Passes b/w two heads of FDS.
Runs down forearm b/w FDS and FDP
In distal forearm, it emerges along with ulnar nerve b/w FDP and FCU
Passes through tunnel in side of flexor retinaculum in wrist.
Divides into
Large superficial branch
Runs behind palmar aponeurosis
Runs across palm in front of flexor tendon
Usually ends by anastomosing with superficial branch of radial artery
forming
SUPERFICIAL PALMAR ARCH
Gives off common digital arteries
Each common digital artery divides into two digital arteries
Each digital artery runs along one side of finger besides flexor sheath
Accompanied by digital nerve
At tip of finger, they rejoin to form a terminal anastomoses
Deep branch
Dives b/w hyperthenar muscle
o NERVES

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 RADIAL NERVE
Superficial branch
Runs down forearm deep to brachioradialis
Distal forearm emerges beneath brachioradialis
Crosses over extensor pollics longus and bravis
Superficial branch of radial entirely sensory
DISTRIBUTION
Radial half of back of hand
Back of thumb
Part of back on index
Deep branch
Also known as posterior interosseus nerve
Motor nerve
Passes through supinator and emerges deep the extensor digitorum
Breaks up into branches
SUPPLIES
Extensor carpiulnaris
Extensor digitorum and other two finger extensors
Abductor pollicis longus
Extensor pollicis bravis
Extensor pollicis longus
MEDIAN NERVE
First dives b/w two heads of pronator teres.
Then passes b/w two heads of FDS.
Passes down forearm b/w FDS and profundus
Emerges at wrist on radial side of superficialis tendons
Crossed by tendons of palmaris longus and flexor carpi radiulus
Lies beneath palmar aponeurosis
Passes through carpal tunnel
Gives off branches
Motor branch of median nerve
Common Digital Nerves
Break up into Palmar Digital Nerves
2 each for thumb index and middle fingers
1 for radial side of ring finger
Provides sensation to
Medial part of nerve
Flexor aspect of thumb
Index, middle finger
Radial side of ring finger
MUSCLES SUPPLIED
EXTRINSIC
Flexor digitorum superficialis
Flexor pollicis longus
Radial half of flexor digitorum profundus
INTRINSIC
Supplies only 3 thenar muscles
Radial 2 lumbricals
ULNAR NERVE
Runs down forearm b/w FCU and FDS
Gives off dorsal sensory branch halfway down forearm
At wrist, runs alongside radial side of flexor carpi ulnaris
Passes through side tunnel in edge of flexor retinaculum
Divides into
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 Superficial branch
Divides into palmar digital nerves for little finger and ulnar side of ring
finger
Deep branch
Passes b/w hyperthenar muscles
Runs across palm in front of inter ossei
Passes in b/w two heads of adductor pollicis
Reaches most radial of interossei
Provides sensation to
Little finger
Ulnar half of back and front of hand
Ulnar half of ring finger
SUPPLIES
EXTRINSIC
Ulnar half of FDP
INTRINSIC
Hyperthenar muscles
All the interossei
Adductor pollicis
And ulnar two lumbricals
o SKIN
BACK OF HAND
Thin
Freely movable due to
Underlying layer of loose Areolar tissue
When MP joint flexed
Becomes tight otherwise loose
FRONT OF HAND
Thick
Less movable
Affixed to palmar aponeurosis by many strands of tough fibrous tissue
Creases are lines where skin is thinner
MP joints in front are in line with distal palmar skin crease
HALF THE LENGTH of proximal phalanx of each finger lies beneath skin of palm
FINGERS
Thin at back
Thick, creased at front
FINGERTIP
Skin of fingertip has huge amounts of sensory endings
PULP OF FINGERTIP
Is composed of fat with many fibrous strands anchoring skin to distal
phalanx
FINGERNAIL
Nail bed
Closely adherent to underlying phalanx
Nail matrix
Nail forming tissue produces lunula, pale area underneath nail

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