At the end of Session, you should

be able to define
Bones& joints of Wrist and Hand
Superficial fascia
Deep Fascia
Flexor Retinaculum
Palmar Aponeurosis
Fibrous flexor sheath
Muscles of Hand
Thenar and Hypothenar muscles
Palmar and Dorsal Interosseus
Lumbricles
Nerves of Hand

 X-ray
Photograph of
Hand and
Wrist
Bones of Hand &
Wrist
Scaphoid - Boat
Shaped
Lunate - Crescent
shaped
Triquetral - 3 sided
Pisiform - Pea shaped

Trapezium - 4 sided
Trapezoid - 4 sided
Capitate - has a Head
Hamate - has a Hook
Flexor Retinaculum
Flexor Retinaculum
 Thickened part of deep fascia which covers the anterior concavity
of Carpus and converts into tunnel, Carpal Tunnel

 Attachment:
 Medially (i) Pisiform (ii) Hook of Hamate
 Laterally: (i) Tubercle of Scaphoid (II) Crest of Trapezium
 Lateral deep slip and medial superficial slip (Volar carpal ligament)

 Relations:
 Superficial to it:
 i) Tendon of Pal. Long. ii) Ulnar nerve & Vessels iii) Palmar cut. branch of
Median & Ulnar nerves.
 Deep to it:
 i) Median nerve ii) Tendons of Flex. Dig. Sup. & Prof. iii) Tendon of FPL iv) Ulnar
and Radial Bursa v) Flex. Car. Rad.
Position of Flexor Retinaculum
Palmar
Aponeurosis
 Fibrous Flexor Sheath & Synovial Sheaths
of Hand

Ulnar Bursa

Radial Bursa
Fibrous flexor Sheath
 Dupuytren’s Contracture
Thickening & Contraction of Ulnar side of Palmar Aponeurosis

Due to Inflammation
involving Ulnar side of
Palmar Aponeurosis .

Proximal and Middle

phalanx become flexed
and can’t be extended
(Terminal phalanx
remains unaffected).

Ring finger is commonly

involved.
 Muscles of Hand
Four Thenar muscles
 Abductor Pollicis Brevis, Opponens Pollicis

 Flexor Pollicis Brevis, Adductor Pollicis

Four Hypothenar muscles

 Opponens Digiti Minimi, Flexor Digiti Minimi

 Abductor Digiti Minimi, Palmaris Brevis

Four Lumbricals

Four Palmar Interosseus

Four Dorsal Interosseus

Adductor
Pollicis
Lumbricals
Extensor Hood and
attachment of
Dorsal Interosseus
&
Lumbricals
 Palmar
Interossei
(Palmar View)
Dorsal
Interossei
(Palmar View)
Arterial Supply
of the Hand
Superficial
Palmar Arch
D
e
e
p

P
a
l
m
a
r

A
r
c
h
Nerves of the Hand
Ulnar Nerve

Median Nerve

Radial Nerve
U
l
n
a
r

N
e
r
v
e

in

H
a
n
d
M
e
d
i
a
n

N
e
r
v
e

in

H
a
n
d
Ulnar Claw Complete Claw
Hand Hand
Radial Nerve in Hand
Motor function test of Ulnar and
Median Nerve in Hand

Ulnar nerve Median nerve

Surgical Spaces of Hand
Palmar Spaces

1. Pulp space of fingers

2. Midpalmar space
3. Thenar space
Dorsal Spaces

1. Dorsal subcutaneous space

2. Dorsal subaponeurotic space
The Forearm space of Parona
Digital Pulp space

Infection
of this
space is
called
“Whitlow”
Surgical Spaces of the Hand
Cross Section of the Palm showing
Mid Palmar space & Thenar space
Mid Palmar space
 Shape – Triangular
 Situation – Under the inner half of hollow of palm
 Extent
 Proximally – Inferior margin of Flexor retinaculum
 Distally – Distal palmar crease
 Communication
 Proximally – Forearm space
 Distally – Fascial sheath of 3rd , 4th lumbricals sometimes with 2nd
 Boundaries –
 Anterior – Flexor tendons of 3rd , 4th & 5th fingers, 2nd , 3rd & 4th
lumbricals Palmar aponeurosis
 Posterior – Fascia covering interossei and metacarpals
 Lateral – Intermediate palmar septum
 Medial – Medial palmar septum
 Drainage – Incision at 3rd or 4th web
Thenar space
 Shape – Triangular
 Situation – Under the outer half of hollow of palm
 Extent
 Proximally – Inferior margin of Flexor retinaculum
 Distally – Proximal transverse palmar crease
 Communication
 Fascial sheath of 1st lumbrical and sometimes 2nd
 Boundaries:
 Anterior – Short muscles of thumb, Flexor tendons of index finger, 1 st
lumbrical, Palmar aponeurosis,
 Posterior – Transverse head of adductor policis & 1st dor. Inter. Mus.
 Lateral - Lateral palmar septum
 Medial – Intermediate palmar septum
 Drainage – Incision at 1st web posteriorly
Surgical Incisions of the Hand