Topic 230. Palma Manus PDF

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TOPIC 230. PALMA 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 PALMAE MANUS 1. LAYERS - SKIN o Thick with limited movement o Stratum corneum is well developed o Contains:  Sweat glands  Sebaceous glands o Innervated by:  Radial n.  Ulnar n.  Median n. - SUBCUTANEOUS TISSUE o Contains:  Vessels  Nerves  Lymphatic vessels with lymphatic nodules  Superficial palmar branch of the radial artery - SUPERFICIAL FASCIA o Continuation of the superficial fascia of the forearm o Slightly movable and fixed to the bones - DEEP FASCIA o Stretches from the palmaris longus tendon (proximally) to the ligamentum carpi volare (distally) o Forms the palmar aponeurosis, flexor retinaculum (transverse carpal ligament), synovial sheaths of the hand and fingers.  FLEXOR RETINACULUM  Strongest and thickest fascia which is fixed to the bone  Between the eminentia carpi ulnaris and eminentia carpi radialis, flexor retinaculum converts the sulcus carpi into canalis carpi.  Then the flexor retinaculum forms the canalis carpi radialis and canalis carpi ulnaris.  SYNOVIAL SHEATHS OF THE HAND AND FINGERS  THUMB o Situated laterally

o This long narrow canal encloses the tendon of flexor pollicis longus o Superiorly it protrudes 1 – 2 cm proximal to the flexor retinaculum. o Inferiorly it extends on the tendon to the base of the distal phalanx of the thumb.  INDEX, MIDDLE & RING fingers o They have a common sheath on the palmar surface o They have separate sheaths in the segment of the distal halves of the metacarpal bones. These sheaths stretch from the line of the metacarpophalangeal joints to the base of the distal phalanges.  LITTLE FINGER o Covers the flexor digitorum superficialis and profundus muscles. o Superiorly it protrudes 1 – 2 cm proximal to the flexor retinaculum. o Inferiorly it extends on the flexors until the base of the distal phalanx of the little finger.  FOR ALL THE FINGERS o On the phalangeal shafts:  Synovial sheaths of the fingers are covered by the dense annular (circular-shaped) fibrous sheaths. o On the phalangeal joints:  synovial sheaths of the fingers are covered by the thin cruciform fibrous sheaths. The tendons are connected with the walls of the thin mesotendineum, which transmit blood vessels and nerves. o CANALS OF THE ANTERIOR REGION OF THE HAND  CANALIS CARPI ULNARIS  Formed by fascia around the pisiform bone  Contains: o Ulnar a. o Ulnar n. Which then pass under the palmaris brevis m.  CANALIS CARPALIS  Formed by fascia between the flexor retinaculum and bones (scaphoid bone, trapezium bone, pisiform bone and hamate bone)  Contains: o Median n. o 4 flexor digitorum superficialis tendons o 4 flexor digitorum profundus tendons  There are 2 separate synovial sheaths: o 1 for the tendons of the flexor digitorum superficialis and profundus muscles (MEDIALLY) o 1 for the tendon of the flexor pollicis longus muscle (LATERALLY)

CANALIS CARPI RADIALIS  Contains: o Tendon of flexor carpi radialis m. MUSCULAR LAYER o THENAR MUSCLES (lateral muscle group)  Abductor pollicis brevis  Opponens pollicis  Flexor pollicis brevis  Adductor pollicis o HYPOTHENAR MUSCLES (medial muscle group)  Abductor digiti minimi  Opponens digiti minimi  Flexor digiti minimi brevis  Palmaris brevis o Median muscle group  Lumbrical mm.  Palmar interosseous mm.  Dorsal interosseous mm. 

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REGIO CARPI ANTERIOR 1. LANDMARKS - Structures passing superficial to the flexor retinaculum (from lateral to medial): o Palmar cutaneous branch of the median n. o Palmaris longus tendon o Palmar cutaneous branch of the ulnar n. o Ulnar a. o Ulnar n. (palmar branch) o Flexor carpi ulnaris tendon - Structures passing deep to the flexor retinaculum (from lateral to medial): o Flexor carpi radialis tendon o Flexor pollicis longus tendon o Median n. o Flexor digitorum superficialis tendon...