Topic 229. Dorsum Manus PDF

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TOPIC 229. DORSUM MANUS REGIO MANUS 1. LANDMARKS - Styloid process of the ulna and radius - Skin fold of the wrist joint - Metacarpal bones - Phalanges of fingers 2. BORDERS - 2 cm above the styloid process of the ulna - 2 vertical lines are drawn along the ulna and radius and divide the hand region into the anterior (palmar) and posterior (dorsal) regions

REGIO DORSI MANUS 1. LAYERS - SKIN o Thin and movable o Contains:  Hair follicles  Sweat glands  Sebaceous glands o Innervated by:  Ulnar n.  Median n.  Radial n. - SUBCUTANEOUS TISSUE o Contains loose connective tissue o Contains:  Cephalic (radial margin) vein → vascular network between it and basilic.  Basilic (ulnar margin) vein → vascular network between it and cephalic.  Radial n. (superficial branch)  Ulnar n. (dorsal branch) - SUPERFICIAL FASCIA o Fixed to the styloid process and bones of the wrist - DEEP FASCIA o Forms the extensor retinaculum (retinaculum extensorum) o It has 6 canals (osteofibrous canals) which are formed by the extensor retinaculum with the carpal bones. The canals from lateral to medial, contain: 1. Tendons of abductor pollicis longus and extensor pollicis brevis 2. Tendons of the extensor carpi radialis longus and brevis 3. Tendon of the extensor pollicis longus 4. Tendons of the extensor indicis and the extensor digitorum 5. Tendon of the extensor digiti minimi 6. Tendon of the extensor carpi ulnaris o On the dorsal part of the fingers, tendons of the extensors consist of 3 parts:  Median → fixed to the middle phalanges  Medial → fixed to the distal phalanges  Lateral → fixed to the distal phalanges

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o Aponeurotic tension is located above the proximal phalanges (around the interosseous muscles)  Distal and middle phalanges can be flexed simultaneously MUSCULAR LAYER o Dorsal interosseous mm.

REGIO CARPI POSTERIOR -

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Structures passing superficial to the extensor retinaculum from lateral to medial: o Radial n. (superficial branch) o Cephalic v. o Basilic v. o Ulnar n. (dorsal/posterior branch) Structures passing beneath the extensor retinaculum (from lateral to medial) 1. Tendons of abductor pollicis longus and extensor pollicis brevis 2. Tendons of the extensor carpi radialis longus and brevis 3. Tendon of the extensor pollicis longus 4. Tendons of the extensor indicis and the extensor digitorum 5. Tendon of the extensor digiti minimi 6. Tendon of the extensor carpi ulnaris

REGIO DIGITI Its soft tissues are thin and muscles are absent in the fingers (it only contains tendons of the muscles) 1. LAYERS - SKIN o Thicker in the palmar surface, thiner in the dorsal surface  PALMAR – sweat glands  DORSAL – hair follicles, sebaceous glands and sweat glands - SUBCUTANEOUS TISSUE o Thin o PALMAR – Surrounds the tendinous sheath of the flexor digitorum profundus and flexor digitorum superficialis  This sheath of the index, middle and ring fingers terminates at the level of the heads of the metacarpal bones.  For the thumb and little finger, it continues to the palm and forms the ulnar and radial bursae, connecting with the Pirigov’s space. o DORSAL – tendon of extensor digitorum muscle does not have any sheath and is connected deep with the phalanges. - SUPERFICIAL FASCIA o Almost absent → transformed into the fibrous bundles from the skin to tissue. - DEEP FASCIA o On the phalangeal shafts, synovial sheaths of the fingers are covered by dense annular (circular-shaped) fibrous sheaths. o On the phalangeal joints, synovial sheaths of the fingers are covered y the thin cruciform fibrous sheaths....