Find the deep branch the radial artery forms most deep arch
Hand / Wrist
3 sets of bones:
Note: flexor digitorum superificialis inserts at base of middle phalanx of 2-5.
Flexor digitorum profundus inserts at tip of distal phalanx of 2-5.
lunate – head is quarter moon shape.
triquetrum – 3 cornered hat
capitate- has a fairly large / prominent articular surface that looks like a head.
hamate – “hook” – refers to process that protrudes toward palmar side that is the “hook of the hamate”
Wrist – extension (back hand), flexion (smack). Abduction = radial deviation Adduction = ulnar deviation.
Fingers: Distinct from thumb (which is set at right angles to other fingers).
reach to grab bar / open hand to choke someone = abduction, moving thumb toward palm to actually grab bar / choke someone = adduction. Thus reference of motion is palm.
Opposition = touch thumb across palm to pinky, finger tips touch.
Palmaris brevis: origin in skin (?) inserts into palmar aponeurosis as well. On medial aspect near wrist.
Around each of the long tendons in the fingers = have fibrous digital sheath. Inside this – have synovial sheath which permits free motion (similar to bursae).
opponens digiti minimi
flexor digiti minimi (brevis)
abductor pollicis brevis
Innervation: Radial nerve is only cutaneous, no muscle innervation in the dorsal hand.
first dorsal interosseous muscle – inerts first metacarple. Pull #2 toward thumb.
No interosseous on medial side of little finger = it is abducted by abductor digiti minimi.
III and IV = ulnar nerve.
Note that #s are not in sync with digit #s.
interosseal
abductor digiti minimi
radial / ulnar artery approach hand on anterior side. Radial artery is used for taking pulse at wrist.
Largest part of radial passes behind the thumb and into the palm of the hand deep to adductor pollicis arches over to join up with a smaller branch of the ulnar = forms the Deep palmar arch. This is “radial artery dominant”.
Thumb / index finger have special arteries: Radialis indicis for index finger (radial side of index finger) and the princeps pollicis artery for the thumb. These are all branches of either the radial / ulnar arteries.
Allen Test: deals with arterial patency (openness of the arteries in the hand). Pump fist a few times open to see perfusion.
3. Radial nerve: related to anatomical snuff box. It does supply the edge of the palm beneath thumb (related to thenar muscles). Also the dorsal lateral portion of the hand but not the tips.
Carpal tunnel:
4 from flexor digitorum profundus
median nerve passes as well.
Tendon of abductor pollicis longus is close to EPB and attaches to 1st metacarple.
Structures:
