bone and muscles of the hand
Post on 14-Jan-2015
4.010 Views
Preview:
DESCRIPTION
TRANSCRIPT
COLLEGE OF ALLIED COLLEGE OF ALLIED HEALTH AND SCIENCESHEALTH AND SCIENCES
ANATOMY ANATOMY MUSKULOSKELETALMUSKULOSKELETAL
UPPER LIMB (PART 5) UPPER LIMB (PART 5)
Carpals, Metacarpals and Carpals, Metacarpals and PhalangesPhalanges
By : HERMIZAN BIN HALIHANAFIAH
HANDHAND
Introduction Introduction
Gross motor skills and fine motor skills.Gross motor skills and fine motor skills.
5 Digits / fingers5 Digits / fingers
Thumb – pollexThumb – pollex
Index finger – digitus indicisIndex finger – digitus indicis
Middle finger – digitus tertiusMiddle finger – digitus tertius
Ring finger – digitus annulusRing finger – digitus annulus
Little finger – digitus minimiLittle finger – digitus minimi
HandHand Hand composed by a bony Hand composed by a bony
framework :framework : 8 carpals bones8 carpals bones 5 metacarpals5 metacarpals 14 phalanges14 phalanges
Carpal BonesCarpal Bones
The names reflect on their shapeThe names reflect on their shape
Divide in two rows; proximal and distal rowDivide in two rows; proximal and distal row
Proximal row:Proximal row:
From lateral to medialFrom lateral to medial
Scaphoid, lunate, triquetrum and pisiformScaphoid, lunate, triquetrum and pisiform
Distal rowDistal row
From lateral to medialFrom lateral to medial
Trapezium, trapezoid, capitate and hamateTrapezium, trapezoid, capitate and hamate
8 bones of Carpals8 bones of Carpals
A – Scaphoid (boatlike)A – Scaphoid (boatlike) B – Lunate (moon-shaped)B – Lunate (moon-shaped) C – Triquatrum (three-cornered)C – Triquatrum (three-cornered) D – Pisiform (pea-shaped)D – Pisiform (pea-shaped) E – Trapezium (four sided figure)E – Trapezium (four sided figure) F – Trapezoid F – Trapezoid G – Capitate (head-shaped)G – Capitate (head-shaped) H – Hamate (hooked)H – Hamate (hooked)
Try this pneumonic!!: She Look Too Pretty, Try To Catch Her
CapitateCapitate
Largest carpal boneLargest carpal bone
Rounded projectionRounded projection
Head articulate with lunate boneHead articulate with lunate bone
LunateLunate
Large hook-projection on its anterior Large hook-projection on its anterior
surfacesurface
ScaphoidScaphoid 70 % fractures involve the 70 % fractures involve the
scaphoidscaphoid Fall on outstretched hand – force Fall on outstretched hand – force
is transmitted from the capitate is transmitted from the capitate
through the scaphoid to the radiusthrough the scaphoid to the radius
Carpal TunnelCarpal Tunnel
Concave space formed by the pisiform and hamate (on Concave space formed by the pisiform and hamate (on
the ulnar side), and the scaphoid and trapezium ( on the ulnar side), and the scaphoid and trapezium ( on
the radial side) plus the flexor retinaculum (deep the radial side) plus the flexor retinaculum (deep
fascia)fascia)
Long flexor tendons of the digits and thumb (flexor Long flexor tendons of the digits and thumb (flexor
digitorum superficialis, flexor digitorum profundus, digitorum superficialis, flexor digitorum profundus,
flexor pollicis longus) and the median nerve pass flexor pollicis longus) and the median nerve pass
through the carpel tunnelthrough the carpel tunnel
Narrowing of the carpel tunnel may give rise to a Narrowing of the carpel tunnel may give rise to a
condition called condition called carpal tunnel syndromecarpal tunnel syndrome..
Anatomy of Carpal Tunnel
Carpal Turnel SyndromeCarpal Turnel Syndrome
Flexor RetinaculumFlexor Retinaculum
The The flexor retinaculumflexor retinaculum ( (transverse transverse
carpal ligamentcarpal ligament, or , or anterior annular anterior annular
ligamentligament) is a strong, fibrous band, which ) is a strong, fibrous band, which
arches over the carpus. arches over the carpus. Converting the deep groove on the front of Converting the deep groove on the front of
the carpal bones into a tunnel, the the carpal bones into a tunnel, the carpal carpal
tunneltunnel Flexor tendons of the digits and the Flexor tendons of the digits and the
median nerve pass.median nerve pass.
Flexor Retinaculum
Extensor RetinaculumExtensor Retinaculum
The The extensor retinaculumextensor retinaculum ( (dorsal dorsal
carpal ligamentcarpal ligament) is an anatomical term ) is an anatomical term
for the fascia that holds the tendons of the for the fascia that holds the tendons of the
extensor muscles in place. extensor muscles in place.
It is located on the back of the forearm, It is located on the back of the forearm,
just proximal to the hand.just proximal to the hand.
Extensor Retinaculum
Joints of the Carpal BonesJoints of the Carpal Bones
Intercarpal Intercarpal
/midcarpal joint/midcarpal joint
Articulation between Articulation between
carpals bone.carpals bone.
Planar jointPlanar joint
Biaxial movement – Biaxial movement –
gliding gliding
movement( back – movement( back –
forth , side – side)forth , side – side)
MetacarpalsMetacarpals
Divide into:Divide into:
Proximal baseProximal base
Intermediate shaftIntermediate shaft
Distal headDistal head
It consists of five cylindrical bones which are It consists of five cylindrical bones which are
numbered from the radial (lateral ) to the numbered from the radial (lateral ) to the
ulnar (medial) side.ulnar (medial) side.
1.1. First metacarpal bone First metacarpal bone
2.2. Second metacarpal bone Second metacarpal bone
3.3. Third metacarpal bone Third metacarpal bone
4.4. Fourth metacarpal bone Fourth metacarpal bone
5.5. Fifth metacarpal bone Fifth metacarpal bone
MetacarpalsMetacarpals
MetacarpalsMetacarpals
Proximal base
Intermediate Shaft
Distal Head
Joints of the MetacarpalsJoints of the Metacarpals Carpometacarpal jointsCarpometacarpal joints
Proximal based of metacarpals articulate with Proximal based of metacarpals articulate with distal row of carpal bones.distal row of carpal bones.
11stst metacarpal articulate with trapezium bones metacarpal articulate with trapezium bones The second metacarpal articulates primarily The second metacarpal articulates primarily
with the trapezoid and secondarily with the with the trapezoid and secondarily with the trapezium and capitate. trapezium and capitate.
The third metacarpal articulates primarily with The third metacarpal articulates primarily with the capitate, the capitate,
The fourth metacarpal articulates with the The fourth metacarpal articulates with the capitate and hamate. capitate and hamate.
The fifth metacarpal articulates with the The fifth metacarpal articulates with the hamate. hamate.
CarpometacarpalCarpometacarpal The 1The 1stst CMC (between trapezium and 1 CMC (between trapezium and 1stst
metacarpal) is a saddle jointmetacarpal) is a saddle joint
Also known as a trapeziometacarpal joint Also known as a trapeziometacarpal joint
(TMC)(TMC)
Produce triaxial diarthrosisProduce triaxial diarthrosis
The rest CMC – condyloid jointThe rest CMC – condyloid joint
Produce biaxial diarthrosisProduce biaxial diarthrosis
Joints of the MetacarpalsJoints of the Metacarpals
Metacarpophalangeal jointMetacarpophalangeal joint
Distal head of metacarpals articulate Distal head of metacarpals articulate
with proximal phalanges.with proximal phalanges.
Condyloid jointCondyloid joint
Produce biaxial diarthrosis ; flexion – Produce biaxial diarthrosis ; flexion –
extension / abduction - adductionextension / abduction - adduction
Joints of the MetacarpalsJoints of the Metacarpals
PhalangesPhalanges
14 bones14 bones Numbered 1-5 same with metacarpalsNumbered 1-5 same with metacarpals Each phalanx consist:Each phalanx consist:
Proximal baseProximal base Intermediate shaftIntermediate shaft Distal headDistal head
2 phalanges in thumb, 3 the other 2 phalanges in thumb, 3 the other
fingers.fingers.
Phalanges can divide into:Phalanges can divide into:
Proximal phalanxProximal phalanx
Middle phalanxMiddle phalanx
Distal phalanxDistal phalanx
Except thumb; only proximal and distal Except thumb; only proximal and distal
part.part.
PhalangesPhalanges
Joint of the PhalangesJoint of the Phalanges
Interphalangeal jointInterphalangeal joint Joint between phalangesJoint between phalanges
Proximal and distal IP Proximal and distal IP
except thumbexcept thumb
Hinge jointHinge joint
Permits monoaxial Permits monoaxial
diarthrosis ; flexion and diarthrosis ; flexion and
extensionextension
Movement of Hand and DigitsMovement of Hand and Digits
ulnar and radial deviation at RCulnar and radial deviation at RC Wrist flexion and extension at RCWrist flexion and extension at RC Flexion and extension digit at MCPFlexion and extension digit at MCP Abduction and adduction digits at MCPAbduction and adduction digits at MCP Abduction and adduction thumb at 1Abduction and adduction thumb at 1stst CMC CMC Opposition and reposition thumb at 1Opposition and reposition thumb at 1stst
CMCCMC Flexion and extension digits at IPFlexion and extension digits at IP
Wrist MovementWrist Movement
Thumb MovementThumb Movement
Thumb opposition Thumb adductionThumb abduction
Adduction / abduction digits at MCPAdduction / abduction digits at MCP
Thumb extension / flexion at Thumb extension / flexion at MCP / CMCMCP / CMC
Flexion Digit at PIP / DIPFlexion Digit at PIP / DIP
Muscles of the Forearm Move the Muscles of the Forearm Move the Wrist, Hand, Thumb and FingersWrist, Hand, Thumb and Fingers
Group of muscles that act on the digits are known Group of muscles that act on the digits are known
as as extrinsic hand musclesextrinsic hand muscles because originate because originate
outside the hand and insert within it.outside the hand and insert within it.
There is 2 groups of forearm muscles:There is 2 groups of forearm muscles:
Anterior compartment (flexor muscles)Anterior compartment (flexor muscles)
Posterior compartment (extensor muscles)Posterior compartment (extensor muscles)
Extrinsic Hand MusclesExtrinsic Hand Muscles
Anterior compartment of Anterior compartment of Forearm MusclesForearm Muscles
Muscle of the forearm originate on Muscle of the forearm originate on
the humerusthe humerus Insert on the carpals, metarcarpals, Insert on the carpals, metarcarpals,
and phalangesand phalanges Act as flexorAct as flexor Divide into superficial or deep Divide into superficial or deep
muscles.muscles.
Posterior compartment of Posterior compartment of Forearm MusclesForearm Muscles
Muscle of the forearm originate on Muscle of the forearm originate on
the humerusthe humerus Insert on the carpals, metarcarpals, Insert on the carpals, metarcarpals,
and phalangesand phalanges Act as extensorAct as extensor Divide into superficial or deep Divide into superficial or deep
muscles.muscles.
Forearm MusclesForearm Muscles
Superficial anterior compartment Superficial anterior compartment
musclesmuscles
Deep anterior compartment musclesDeep anterior compartment muscles
Superficial posterior compartment Superficial posterior compartment
musclesmuscles
Deep posterior compartment musclesDeep posterior compartment muscles
Superficial Anterior Compartment Superficial Anterior Compartment MusclesMuscles
Arrange in following order from lateral to Arrange in following order from lateral to
medial:medial:
1.1. Flexor carpi radialisFlexor carpi radialis
2.2. Palmaris longusPalmaris longus
3.3. Flexor carpi ulnarisFlexor carpi ulnaris
4.4. Flexor digitorum superficialis – deep to the Flexor digitorum superficialis – deep to the
other 3 muscles and is a largest superficial other 3 muscles and is a largest superficial
muscle in the forearm.muscle in the forearm.
From lateral – medial : Flexor Carpi Radialis, Palmaris Longus, Flexor Carpi Ulnaris, Flexor Digitorum Superficialis
Deep Anterior Compartment Deep Anterior Compartment MusclesMuscles
Arrange in following order from Arrange in following order from lateral to medial:lateral to medial:
1.1. Flexor pollicis longusFlexor pollicis longus
2.2. Flexor digitorum profundusFlexor digitorum profundus
Deep Flexor Muscles: From lateral to Medial : Flexor Pollicis Longus, Flexor Digitorum Profundus (deep to flexor digitorum
superficialis)
Superficial Posterior Compartment Superficial Posterior Compartment MusclesMuscles
Arrange in following order from lateral Arrange in following order from lateral
to medial:to medial:
1.1. Extensor carpi radialis longusExtensor carpi radialis longus
2.2. Extensor carpi radialis brevisExtensor carpi radialis brevis
3.3. Extensor digitorumExtensor digitorum
4.4. Extensor digiti minimiExtensor digiti minimi
5.5. Extensor carpi ulnarisExtensor carpi ulnaris
From lateral – medial : extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
Deep Posterior Compartment Deep Posterior Compartment MusclesMuscles
Arrange in following order from Arrange in following order from
lateral to medial:lateral to medial:
1.1. Abductor pollicis longusAbductor pollicis longus
2.2. Extensor pollicis brevisExtensor pollicis brevis
3.3. Extensor pollicis longus Extensor pollicis longus
4.4. Extensor indicisExtensor indicis
From lateral to medial : abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis.
Flexor Carpi RadialisFlexor Carpi Radialis Origin – medial epicodyle of Origin – medial epicodyle of
humerushumerus
Insertion –base of Second Insertion –base of Second
and third metacarpalsand third metacarpals
ActionAction
Flexion and abduction Flexion and abduction
hand (radial deviation) at hand (radial deviation) at
wrist jointwrist joint
Nerve innervations – Nerve innervations –
median nervemedian nerve
Palmaris longusPalmaris longus
Origin – medial epicondyle of Origin – medial epicondyle of
humerushumerus
Insertion – flexor retinaculum Insertion – flexor retinaculum
and palmar aponeurosis (deep and palmar aponeurosis (deep
fascia in center of palm)fascia in center of palm)
ActionAction
Weakly flexes hand at wrist Weakly flexes hand at wrist
jointjoint
Nerve innervations – median Nerve innervations – median
nervenerve
Flexor Carpi UlnarisFlexor Carpi Ulnaris Origin – medial epicondyle of Origin – medial epicondyle of
humerus, proximal posterior of humerus, proximal posterior of
ulnaulna
Insertion – pisiform, hamate, Insertion – pisiform, hamate,
and base of fifth metacarpal.and base of fifth metacarpal.
Action – flexion and adduction Action – flexion and adduction
hand (ulnar deviation) at wrist hand (ulnar deviation) at wrist
joint.joint.
Nerve innervations – ulnar Nerve innervations – ulnar
nervenerve
Flexor digitorum superficialisFlexor digitorum superficialis
Origin – medial epicondyle of humerus, coronoid process Origin – medial epicondyle of humerus, coronoid process
of ulna, ridge along lateral margin of anterior surface of of ulna, ridge along lateral margin of anterior surface of
radius.radius.
Insertion – middle phalanx of each fingers (2Insertion – middle phalanx of each fingers (2ndnd – 5 – 5thth digits) digits)
Action Action
Flexion the proximal interphalangeal joints of 2Flexion the proximal interphalangeal joints of 2ndnd
through 5through 5thth digits digits
Assist flexion metacarpophalangealAssist flexion metacarpophalangeal
Assist wrist flexionAssist wrist flexion
Nerve innervations – Medial nerveNerve innervations – Medial nerve
Flexor digitorum superficialisFlexor digitorum superficialis
Flexor Pollicis LongusFlexor Pollicis Longus Origin – anterior surface of Origin – anterior surface of
radius and interosseous radius and interosseous
membrane, medial epicondyle membrane, medial epicondyle
of humerusof humerus
Insertion – base of distal Insertion – base of distal
phalanx of thumbphalanx of thumb
Action – flexes distal phalanx of Action – flexes distal phalanx of
thumb at interphalangeal joint.thumb at interphalangeal joint.
Nerve innervations – Median Nerve innervations – Median
nervenerve
Flexor Digitorum ProfundusFlexor Digitorum Profundus
Origin - anterior medial surface of proximal body of Origin - anterior medial surface of proximal body of
ulnaulna Insertion – base of distal phalanx of each finger (2Insertion – base of distal phalanx of each finger (2ndnd – –
55thth)) ActionAction
Flexion distal interphalangeal joint of 2Flexion distal interphalangeal joint of 2ndnd – 5 – 5thth
digitsdigits Assist flexion proximal interphalangeal and MCPAssist flexion proximal interphalangeal and MCP Assist wrist flexionAssist wrist flexion
Nerve innervations – index and middle (median Nerve innervations – index and middle (median
nerve), ring and digiti minimi (ulnar nerve)nerve), ring and digiti minimi (ulnar nerve)
Flexor Digitorum ProfundusFlexor Digitorum Profundus
Flexor Digitorum Profundus (FDP) & Superficialis (FDS)
Flexor digitorum superficialis (FDS) insert into middle phalanx.
Flexor digitorum profundus (FDP) runs deep to the FDS until the level of the MP joint where FDS bifurcates.
FDP inserts at the base of the distal phalanx and acts primarily to flex the DIP joint as well as all other joints flexed by FDS.
Extensor Carpi Radialis LongusExtensor Carpi Radialis Longus
Origin – lateral Origin – lateral
supracondylar ridge of supracondylar ridge of
humerushumerus
Insertion – dorsal surface Insertion – dorsal surface
of base second of base second
metacarpal metacarpal
Action – extend and Action – extend and
abduct hand at wrist jointabduct hand at wrist joint
Nerve innervations – Nerve innervations –
Radial nerveRadial nerve
Extensor Carpi Radialis BrevisExtensor Carpi Radialis Brevis
Origin – lateral epicondyle Origin – lateral epicondyle
of humerusof humerus
Insertion – dorsal surface Insertion – dorsal surface
of base third metacarpalof base third metacarpal
Action - Extend and Action - Extend and
adduct hand at wrist jointadduct hand at wrist joint
Nerve innervations – Nerve innervations –
Radial nerveRadial nerve
Extensor digitorumExtensor digitorum Origin – lateral epicondyle of humerusOrigin – lateral epicondyle of humerus Insertion – dorsum of distal and middle phalanges of Insertion – dorsum of distal and middle phalanges of
each fingers (2each fingers (2ndnd - 5 - 5thth digits). digits). Action Action
Extends proximal of each finger at Extends proximal of each finger at metacarpophalangeal jointmetacarpophalangeal joint
Extends distal and middle phalanges of each Extends distal and middle phalanges of each fingers at interphalangeal joint.fingers at interphalangeal joint.
Assists in Extends hand at wrist jointAssists in Extends hand at wrist joint Nerve innervation – Radial nerveNerve innervation – Radial nerve
Extensor digitorumExtensor digitorum
Extensor digiti minimiExtensor digiti minimi
Origin – lateral epicondyle of Origin – lateral epicondyle of
humerushumerus Insertion – tendon of extensor Insertion – tendon of extensor
digitorum on fifth phalanx.digitorum on fifth phalanx. ActionAction
Extends proximal phalanx of Extends proximal phalanx of
little finger at little finger at
metacarpophalangealmetacarpophalangeal Extend the interphalangeal of Extend the interphalangeal of
little finger.little finger. Nerve supply – Radial nerveNerve supply – Radial nerve
Extensor Carpi UlnarisExtensor Carpi Ulnaris
Origin – lateral epicondyle Origin – lateral epicondyle
of humerus and posterior of humerus and posterior
border of ulnaborder of ulna Insertion –base of fifth Insertion –base of fifth
metacarpalmetacarpal Action – extends and Action – extends and
adducts hand at wrist adducts hand at wrist
joint.joint. Nerve innervations – Nerve innervations –
Radial nerveRadial nerve
Abductor Pollicis LongusAbductor Pollicis Longus
Origin – posterior surface of Origin – posterior surface of middle of radius and ulna and middle of radius and ulna and interosseous membraneinterosseous membrane
Insertion – base of first Insertion – base of first metacarpalsmetacarpals
ActionAction Abducts and extends thumb Abducts and extends thumb
at carpometacarpal jointat carpometacarpal joint Abducts hands at wrist jointAbducts hands at wrist joint
Nerve innervations – Radial Nerve innervations – Radial nervenerve
Extensor pollicis brevisExtensor pollicis brevis
Origin – posterior surface of middle of radius and Origin – posterior surface of middle of radius and interosseous membrane.interosseous membrane.
Insertion – base of proximal phalanx of thumbInsertion – base of proximal phalanx of thumb ActionAction
Extends proximal phalanx of thumb at Extends proximal phalanx of thumb at metacarpophalangeal jointmetacarpophalangeal joint
Extends1Extends1stst metacarpal of thumb at metacarpal of thumb at carpometacarpal jointcarpometacarpal joint
Assists in radial deviation at wrist jointAssists in radial deviation at wrist joint Nerve innervations – Radial nerveNerve innervations – Radial nerve
Extensor pollicis brevisExtensor pollicis brevis
Extensor Pollicis LongusExtensor Pollicis Longus Origin – posterior surface of middle of ulna and Origin – posterior surface of middle of ulna and
interosseous membraneinterosseous membrane Insertion – base of distal phalanx of thumbInsertion – base of distal phalanx of thumb Action Action
extend distal phalanx of the thumb at interphalangeal extend distal phalanx of the thumb at interphalangeal
jointjoint Assist in extension of thumb at metacarpophalangeal Assist in extension of thumb at metacarpophalangeal
and carpometacarpal joint.and carpometacarpal joint. Assist radial deviation and extension hand at wrist Assist radial deviation and extension hand at wrist
joint.joint. Nerve innervations - Radial nerveNerve innervations - Radial nerve
Extensor pollicis longusExtensor pollicis longus
Extensor IndicisExtensor Indicis
Origin – posterior surface of Origin – posterior surface of
ulna, interosseous membraneulna, interosseous membrane
Insertion – tendon of entensor Insertion – tendon of entensor
digitorum of index fingerdigitorum of index finger
Action – extend distal and Action – extend distal and
middle phalanx at IP joint, middle phalanx at IP joint,
extend proximal phalanx at extend proximal phalanx at
MCPMCP
Deep radial nerveDeep radial nerve
Surface anatomy of hand
The tendons that are
palpated with thumb
abducted and
extended form an
anatomic snuff-box
Surface anatomy of hand
Flexor Tendons: Flexor carpi
radialis, flexor carpi ulnaris, and palmaris longus primarily flex the wrist
Intrinsic Hand MusclesIntrinsic Hand Muscles
Has a origins and Has a origins and insertions within insertions within the handthe hand
Produce weak but Produce weak but intricate and intricate and precise precise movements of the movements of the digits (Fine motor digits (Fine motor skills)skills)
Intrinsic Hand MusclesIntrinsic Hand Muscles
The intrinsic muscle of the hand divided The intrinsic muscle of the hand divided
into 3 groups:into 3 groups:
Thenar musclesThenar muscles
Hypothenar musclesHypothenar muscles
Intermediate musclesIntermediate muscles
Thenar MusclesThenar Muscles
Thenar (lateral aspect of palm)
Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis
Adductor pollicis
Move the thumb (pollex)
This 4 muscles form the thenar eminence, lateral
rounded contour on the palm. (ball of the thumb)
Abductor Pollicis Abductor Pollicis BrevisBrevis
OriginOrigin Flexor retinaculumFlexor retinaculum ScaphoidScaphoid TrapeziumTrapezium
InsertionInsertion Lateral side of proximal Lateral side of proximal
phalanx of thumbphalanx of thumb Action Action
Abduct of thumb at CMC Abduct of thumb at CMC
joint.joint. Median NerveMedian Nerve
Opponens PollicisOpponens Pollicis OriginOrigin
Flexor retinaculumFlexor retinaculum TrapeziumTrapezium
InsertionInsertion Lateral side of 1Lateral side of 1stst
metacarpal (thumb)metacarpal (thumb)
ActionAction Opposition thumb at CMC Opposition thumb at CMC
joint.joint.
Median nerveMedian nerve
Flexor Pollicis BrevisFlexor Pollicis Brevis OriginOrigin
Flexor retinaculumFlexor retinaculum TrapezoidTrapezoid TrapeziumTrapezium CapitateCapitate
InsertionInsertion Lateral side of proximal phalanx of Lateral side of proximal phalanx of
thumb.thumb. ActionAction
Flexion thumb at CMC and MCP joint.Flexion thumb at CMC and MCP joint. Median and ulnar nervesMedian and ulnar nerves
Adductor PollicisAdductor Pollicis OriginOrigin
Oblique head – Capitate and 2Oblique head – Capitate and 2ndnd
and 3and 3rdrd metacarpals metacarpals
Transverse head – 3Transverse head – 3rdrd metacarpal metacarpal
InsertionInsertion
Medial side of proximal phalanx of Medial side of proximal phalanx of
thumbthumb
Action – adduct thumb at CMC and Action – adduct thumb at CMC and
MCPMCP
Ulnar NerveUlnar Nerve
Hypothenar Muscles
Medial aspect of palm
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi
Move the digiti minimi
This 3 muscles form the
hypothenar muscles (medial
rounded contour in the palm)
– ball of the little finger
Abductor digiti minimiAbductor digiti minimi OriginOrigin
Tendon flexor carpi ulnarisTendon flexor carpi ulnaris
PisiformPisiform
InsertionInsertion
Medial side of proximal phalanx of Medial side of proximal phalanx of
little fingers.little fingers.
ActionAction
Abduction little finger at MCPAbduction little finger at MCP
Assist flexion little finger at MCPAssist flexion little finger at MCP
Ulnar nerveUlnar nerve
Flexor digiti minimi Flexor digiti minimi brevisbrevis
OriginOrigin
Flexor retinaculumFlexor retinaculum
HamateHamate
InsertionInsertion
Medial side of proximal phalanx Medial side of proximal phalanx
of little fingersof little fingers
Action – flexion little finger at MCP, Action – flexion little finger at MCP,
assist opposition little finger at assist opposition little finger at
CMC CMC
Ulnar nerveUlnar nerve
Opponens Digiti Opponens Digiti MinimiMinimi
Origin Origin
Flexor retinaculumFlexor retinaculum
HamateHamate
InsertionInsertion
Medial side of entire length Medial side of entire length
fifth metacarpals (little fifth metacarpals (little
finger)finger)
ActionAction
Opposition little finger at Opposition little finger at
CMCCMC
Ulnar nerveUlnar nerve
Intermediate MuscleIntermediate Muscle
Midpalmar / intermediate (11 muscles)
Lumbricals
Palmar interossei
Dorsal interossei
Acts on all the digits
Important muscles for movements in skilled
activities (playing piano , writing, typing,
precision handling etc)
Lumbricals Consists of 4 musclesConsists of 4 muscles OriginOrigin
Lateral and adjacent side of tendons of flexor digitorum Lateral and adjacent side of tendons of flexor digitorum
profundus of each fingers (2profundus of each fingers (2ndnd – 5 – 5thth)) InsertionInsertion
Lateral side of tendon of extensor digitorum on Lateral side of tendon of extensor digitorum on
proximal phalanges of each fingers (2proximal phalanges of each fingers (2ndnd – 5 – 5thth)) ActionAction
Flexion each finger at MCP and extend each finger at IPFlexion each finger at MCP and extend each finger at IP Median and ulnar nerveMedian and ulnar nerve
Lumbricals
Flexor Digitorum
Profundus
1st lumbricals
Insertion to tendon of
Extensor digitorum
4th lumbricals
Palmar interosseiPalmar interossei 4 muscles Origin
Sides of shafts of metacarpals of all digits (except the middle one)
Insertion Side of bases of proximal
phalanges of all digits (except the middle finger)
Action Adduction each finger at
MCP assists in Flexion each finger at MCP
Ulnar nerves
Dorsal InterosseiDorsal Interossei
4 muscles4 muscles OriginOrigin
Adjacent side of metacarpalsAdjacent side of metacarpals InsertionInsertion
Proximal phalanx of each Proximal phalanx of each fingerfinger
ActionAction Abduction Finger 2-4 at MCPAbduction Finger 2-4 at MCP Assist Flexion Finger 2-4 at Assist Flexion Finger 2-4 at
MCP and extension at IP at MCP and extension at IP at the same fingerthe same finger
Ulnar nerveUlnar nerve
Carpal TunnelCarpal Tunnel
Concave space located at the palmar Concave space located at the palmar
surface of the wrist.surface of the wrist. Formed by medially by pisiform and Formed by medially by pisiform and
hamate and laterally by scaphoid hamate and laterally by scaphoid
and trapezium.and trapezium. Cover by flexor retinaculum on the Cover by flexor retinaculum on the
roof side.roof side.
Carpal TunnelCarpal Tunnel
10 structures passed through this 10 structures passed through this
passageway.passageway. 4 flexor digitorum superficialis4 flexor digitorum superficialis 4 flexor digitorum profundus4 flexor digitorum profundus 1 flexor pollicis longus1 flexor pollicis longus Median nerve Median nerve
Thank YouThank You
For Your For Your UnbelievableUnbelievable
Attention!!!Attention!!!
top related