anatomy of the hand - anatomie appliquée à la chirurgie ... · pdf fileanatomy...
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ANATOMY of the HAND
DIU d’anatomie appliquée à la chirurgie plastique
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Marc REVOLUniversité Paris Diderot
2010
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
1. Scaphoid2. Lunate3. Triquetrum4. Pisiform5 Trapezium
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5. Trapezium6. Trapezoid7. Capitate8. Hamate9. Metacarpals (M1 to M5)10.Phalanges
bones nerves regionsmuscles vessels
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Flexor retinaculum and carpal tunnel
bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
flexor
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Intrinsic m.EDMEPLEPBAPL
extensor
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
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bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
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bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
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bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
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bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
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bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m.
FDSFDPFPLEDCEIPEDM
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Intrinsic m.EDMEPLEPBAPL
bones nerves regionsmuscles vessels
Extrinsic m. InterosseousLumbrical
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Intrinsic m.LumbricalThenar musclesHypothenar muscles
bones nerves regionsmuscles vessels
Extrinsic m. InterosseousLumbrical
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Intrinsic m.LumbricalThenar musclesHypothenar muscles
bones nerves regionsmuscles vessels
Extrinsic m.
Proximal attachments
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Intrinsic m.
12 3 4 5
Dorsal interossei
Palmar interossei
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bones nerves regionsmuscles vessels
Extrinsic m.
Distal attachmentsDeep insertions
Superficial insertions
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Intrinsic m.
bones nerves regionsmuscles vessels
Extrinsic m.
Deep insertionsDistal attachments
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Intrinsic m.
capsular
bony
bones nerves regionsmuscles vessels
Extrinsic m.
Deep insertionsDistal attachments
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Intrinsic m.
bones nerves regionsmuscles vessels
Extrinsic m.
Superficial insertions
Deep insertionsDistal attachments
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Intrinsic m.
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
Schmidt HM, Lanz U. Surgical anatomy oo the hand.(Thieme, Stuttgart 2004)
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
Variations are common ++++
Schmidt HM, Lanz U. Surgical anatomy oo the hand.(Thieme, Stuttgart 2004)
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bones nerves regionsmuscles vessels
Extrinsic m.
MP flexion IP extension
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Intrinsic m.
bones nerves regionsmuscles vessels
Extrinsic m. InterosseousLumbrical
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Intrinsic m.LumbricalThenar musclesHypothenar muscles
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
DOYLE JR, BOTTE MJ. Surgical anatomy of the hand and upper extremity (Lippincott. Philadelphia, 2003)
bones nerves regionsmuscles vessels
Extrinsic m.lumbrical
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Intrinsic m.
Schmidt HM, Lanz U. Surgical anatomy oo the hand.(Thieme, Stuttgart 2004)
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m. Lumbricals arise fromflexor tendons and insert into the extensorapparatus
Schmidt HM, Lanz U. Surgical anatomy oo the hand.(Thieme, Stuttgart 2004)
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
Variations are common +++
A. Martinage(Thèse. Nice, septembre 2006)
www.anato.infoSchmidt HM, Lanz U. Surgical anatomy oothe hand.(Thieme, Stuttgart 2004)
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bones nerves regionsmuscles vessels
Extrinsic m. InterosseousLumbrical
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Intrinsic m.LumbricalThenar musclesHypothenar muscles
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
APB
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
Opponens pollicis
bones nerves regionsmuscles vessels
Extrinsic m.
FPB
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Intrinsic m.FPB
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
Adductor pollicis
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
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bones nerves regionsmuscles vessels
Extrinsic m.
Antepulsion
APL
EPB
APB
Opp
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Intrinsic m.
Retropulsion
Abduction Adduction
EPL Add
FPB
FPB
bones nerves regionsmuscles vessels
Extrinsic m. InterosseousLumbrical
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Intrinsic m.LumbricalThenar musclesHypothenar muscles
bones nerves regionsmuscles vessels
Extrinsic m.
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Intrinsic m.
Palmaris brevis
DOYLE JR, BOTTE MJ. Surgical anatomy of the hand and upper extremity (Lippincott. Philadelphia, 2003)
bones nerves regionsmuscles vessels
Extrinsic m.
H l f
Similar to the interossei of the « mixed » type
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Intrinsic m.
Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi
pisiforme
Hamulus of the hamatum
Pisohamate ligamentTransverse
carpal ligament
Schmidt HM, Lanz U. Surgical anatomy oo the hand.(Thieme, Stuttgart 2004)
bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
1. Radial artery2. Ulnar artery3. Palmar branch of anterior interosseous
a.4. Palmar radiocarpal arch5. Superficial palmar branch of radial a.
and superficial palmar arch6. Dorsal radiocarpal arch7. Deep palmar arch8. Palmar radiocarpal arch9 Dorsal radiocarpal arch
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9. Dorsal radiocarpal arch10. Deep branch of ulnar artery11. 12, 13, 14. Common palmar digital
arteries15. Recurrent branches from the deep
palmar arch16. Perforating branches17. 18, 19. palmar metacarpal arteries20. Princeps pollicis artery21. Radial indicis artery
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bones nerves regionsmuscles vessels
Superficial palmar arch
www.tetraplegia.infowww.anato.info PDA : Proper palmar digital artery
CPDA : Common palmar digital artery
bones nerves regionsmuscles vessels
Deep palmar arch
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PMA : Palmar metacarpal artery
bones nerves regionsmuscles vessels
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Variations of the superficial palmar branch of the radial artery(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
Variations of the superficial palmar arch
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(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
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Variations in the origin of the common palmar digital arteries arising from the superficial palmar arch(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
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Variations of the deep palmar arch(in Schmidt & Lanz)
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bones nerves regionsmuscles vessels
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Variations of second palmar metacarpal artery(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
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The arteries of the dorsal wrist
bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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1. Dorsal carpal arch2. Dorsal metacarpal artery3. Deep palmar arch4. Palmar metacarpal artery5. Superficial palmar arch6. Common palmar digital artery7. Direct cutaneous branch
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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Variations of the dorsal arteries of the thumb and the first and second dorsal metacarpal arteries(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
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Variations of the branches of the princeps pollicis artery(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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Variations of the metacarpal ligament of the thumb(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
Mesotendineum structures and vincula of the FPL tendon(in Schmidt & Lanz)
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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Neurovascular structures of the fingers(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
www.anato.info Variations in the communications between the ulnar and median nerves(in Schmidt & Lanz)
bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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bones nerves regionsmuscles vessels
median
ulnar
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radial
ulnar
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bones nerves regionsmuscles vessels
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bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
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bones nerves regionsmuscles vessels
palmar
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dorsal
1. Superficial palmar arch + digital nerves
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
2. FDS + FDP + lumbricals
bones nerves regionsmuscles vessels
palmar
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dorsal
3. Deep fascia
bones nerves regionsmuscles vessels
palmar
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dorsal
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bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
The deep palmar space is sudivided into• medial midpalmar space• lateral thenar space
By a middle palmar septum in the region of the 3rd metacarpal
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bones nerves regionsmuscles vessels
palmar
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dorsal
Deep (interosseous) compartment
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bones nerves regionsmuscles vessels
palmar
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dorsal
Palmar interossei
bones nerves regionsmuscles vessels
palmar
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dorsal
Dorsal interossei
bones nerves regionsmuscles vessels
palmar
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dorsal
Deep branch of ulnar artery
bones nerves regionsmuscles vessels
palmar
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dorsal
Deep branch of ulnar nerve
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
APB
1. APB + superficial palmar branch of radial artery
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bones nerves regionsmuscles vessels
palmar
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dorsal
Opponens pollicis
FPB
2. Opponens + FPB (superficial)
bones nerves regionsmuscles vessels
palmar
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dorsal
FPB
FPL
3. FPB (deep) + FPL
bones nerves regionsmuscles vessels
palmar
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dorsal
Adductor pollicis
4. Adductor + radial artery
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
1. Hypothenar muscles
bones nerves regionsmuscles vessels
palmar
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dorsal
3. Deep branch of ulnar nerve
2. Deep branch of ulnar artery
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bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
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bones nerves regionsmuscles vessels
palmar
Superficial fascia
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
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dorsal
bones nerves regionsmuscles vessels
palmar
Deep fascia
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dorsal
bones nerves regionsmuscles vessels
Transverse section through the middle of the right metacarpal : proximal aspect
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References
Doyle JR, Botte MJ. Surgical anatomy of hand and upper extremityLippincott. Philadelphia, 2003 (720 p).
Grant’s atlas of anatomyWilliams and Wilkins. Baltimore, 9th edition, 1991 (650 p)
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Gray’s anatomy. The anatomical basis of clinical practice.Elsevier Churchill Livingstone, 39th edition, 2005 (1627 p)
Manuel de chirurgie plastique, reconstructrice et esthétiqueSauramps Médical, 2ème édition, 2009 (874 p)
Schmidt HM, Lanz U. Surgical anatomy of the hand.Thieme. Stuttgart, 2004 (258 p)
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