1.

PALMAR APONEUROSIS
It is the central part of the deep facia of the palm which is
a highly specialized thickened structure with little
mobility. It is triangular in shape and it covers the
underlying neurovascular and tendon structure.
It lies immediately deep to the subcutaneous tissue of
the palm. It extends distally from the flexor retinaculum
and divides into 4 slips, one to each finger, to be attached
to the fibrous flexor sheath.

2. RIGHT PALMAR DIGITAL NERVES

Each digit is innervated by 4 digital nerves. In the upper
extremities, the digital nerves arise from the median,
ulnar and radial nerves. The 2 palmar digital nerves
innervate the palmar aspect of the digit and the nail bed
where as dorsal nerves innervate the dorsum of the digit.
The tibial and peroneal nerve branch off into the digital
nerves of the lower extremities, which follow a pattern of
distribution analogus to those of the upper extremity.
In the palm of the hand, the median nerve is covered by
the skin and the palmar aponeurosis, and rests on the
tendons of the FLexors muscles. Immediately, after
emerging from under the transverse carpal ligament, the
nerve becomes enlarged and flattened and splits into a
smaller lateral and a larger medial portion.
The lateral portion supplies the short, stout branch to
certain of the muscles of the ball of the thumb, viz, the
Abductor brevis, the opponens and the superficial head
of the flexor brevis, and then divides into 3 proper
palmar digital nerves; 2 of these supply the side of the
thumb, while the third gives a twig to the first lumbricalis
and is distributed to the radial side of the index finger.
The medial portion of the nerve divides into 2 common
palmar digital nerves. The first of these gives a twig to
the 2nd lumbricalis and runs towards the cleft between
the index and middle fingers, where it divides into 2
proper digital nerves for the adjoining sides of these
digits; the 2nd runs towards the cleft between the middle
and ring fingers, and splits into 2 proper digital nerves for
the adjoining sides of these digits; it communicates with
a branch from the ulnar nerve and sometimes sends a
twig to the 3rd lumbricalis.
The superficial branch of the ulnar nerve divides into a
proper palmar digital nerve, which supplies the medial
side of the 5th digit and a common palmar digital nerve
which divides into 2 proper palmar digital nerves that
supply the adjacent sides of the 4th and 5th digits.

3. THENAR MUSCLES
Superficial to deep
a. Abductor pollicis brevis
b. Right flexor pollicis brevis
c. Right opponens pollicis
4. ARTERIAL SUPPLY OF THE HAND:
The arterial supply to the hand is comprised of a complex
vascular network formed from the branches and distal
continuations of the RADIAL and ULNAR arteries. This
rich vascular network can divided into palmar and dorsal
components.
A. PALMAR ARTERIAL SUPPLY
The palmar arterial supply can be divided into superficial
and deep components.
* SUPERFICIAL COMPONENT*
1. SUPERFICIAL PALMAR ARCH
> the superficial branch of the ulnar artery
> distal to the flexor retinaculum
> superficial to the long flexor tendons of the digits and
deep to the palmar aponeurosis
> in 2/3rd of cases, the palmar arch is incomplete and
forms a hockey stick shape.
> arch lies across the centre of the palm at the level of
the distal border of the extended thumb.
2. PALMAR DIGITAL ARTERY
> branches off the superficial palmar arch
> runs on the ulnar side of the little finger
3. COMMON PALMAR DIGITAL ARTERIES
> there are 3 palmar digital arteries
> branches off the superficial palmar arch
> runs in the webs between fingers, splitting into 2
proper palmar digital arteries that supply adjacent
fingers.
4. PROPER PALMAR DIGITAL ARTERIES
> branch off the common palmar digital arteries
> runs of either side of palmar aspect of each finger
> occasionally gives off dorasal branch distally at distal
interphalangeal joint.
> As the common digital arteries travel from the palm
towards the fingers, they split near the finger web spaces
to become the proper digital arteries. The split feeds 2
different fingers. For example, the common digital artery
that travels in the palm between the middle and ring
fingers splits and then gives one vessel to the ring finger
and one vessel to the middle finger. Each finger has 2
proper digital arteries that run on either side along its
length. If one of these vessels is injured, the several
connections between these 2 proper digital arteries
usually maintain the blood supply to the entire finger.

5. SUPERFICIAL PALMAR BRANCH

> branches off the radial artery
> superficial to ( or travels through) the thenar muscles.
> in 1/3rd of the cases, the superficial palmar branch
joins the superficial palmar arch to form a true arcade.
*DEEP COMPARTMENT*
1. RADIAL ARTERY
> Passes into the wrist/hand along the floor of the
anatomical snuffbox and then dorsally around the
scaphoid and trapezium before passing between the 2
heads of the first dorsal interosseous muscle and then
between the 2 heads of the adductor pollicis to enter
into the deep plane of the palm and form the deep
palmar arch.
2. PRINCEPS POLLICIS ARTERY
> Branches off the radial artery
> Travel along the first metacarpal
> Divides into 2 palmar digital branches at the metacarpal
head.
>d. Digital arteries to the Thumb:
The thumb receive its blood supply from the digital
arteries to the thumb. The largest of these is a branch
from the deep palmar arch and is called the "PRINCEPS
POLLICIS" artery.

3. RADIALIS INDICIS ARTERY

> Branches off the radial artery
> Supplies radial aspect of the index finger
> f. Radial artery of the Index finger:
Near the digital artery to the thumb, the radial artery to
the index finger branches off of the deep palmar arch. It
brings blood supply to the index finger along its thumb
side. The other side (ulnar side) of the index finger is
supplied by the branch of a common digital artery.

4. DEEP PALMAR ARCH

> Continuation of the radial artery that anastomoses with
the deep branch of the ulnar artery; often the arch is
complete ( unlike the superficial arch)
> originates between the oblique and transverse heads of
adductor pollicis
> lies 1 cm proximal to the superficial arch
> This small but important vessel sends off small
branches to supply blood to the thumb and index finger.
It also connects to the superficial palmar arch in most
people.
5. PALMAR METACARPAL ARTERIES

> There are 3 palmar metacarpal arteries

> Branch off the deep palmar arch
> At the metacarpal heads, they anastamose with the
common palmar digital branches of the superficial arch
> They perforate the interosseous spaces to anastamose
with the dorsal metacarpal arteries.
B. DORSAL ARTERIAL SUPPLY
1. POSTERIOR CARPAL ARCH
>anastamosis between the dorsal carpal branches of the
radial and ulnar artery, and the dorsal branch of the
anterior interosseous artery.
> Lies dorsal to the wrist.
2. DORSAL METACARPAL ARTERIES
> Branches off the posterior carpal arch
> Split at the webs to supply dorsal sides of the fingers via
the dorsal arteries
> They anastamose with the deep arch via the palmar
metacarpal arteries.