Hand Surgery Source

ANATOMY

Introduction

The anatomy of the hand and upper extremity has been studied for centuries. A vast amount of human anatomical knowledge was added by the anatomist-surgeons in the 17th and 18th centuries. Masters of anatomy like Galen, Fabrica, Vesalius, Willis, Harvey, Hunter, Cline, Cooper, Dupuytren, Velpeau, LisFranc and Goyrand did thousands of human dissections.  This work markedly extended the understanding of human anatomy.  Modern anatomists like Stark, Cleland, Grayson, Gray, Netter and many others have since made significant additions to this initial anatomic data. This Hand Surgery Source diagnostic guide highlights the anatomy of the hand and upper extremity. The guide reviews the anatomy of the upper extremity with multiple system-based sections.  The structure of normal skin is diagramed. Layers of the skin include the epidermis with 5 layers (stratum basale, stratum spinosum, stratum granulosum, stratum lucidum [not shown], & stratum corneum); Dermis with the papillary layer and the reticular layer; Hypodermis or subcutaneous fatty layer; and the Fascia. Epidermis has 5 layers.  The deepest layer is the stratum basale which includes the dermal papilla and is separated from the dermis by the basement membrane.  The next layer is the stratum spinosum which is also known as the prickle cell layer.  Moving close to the surface the stratum granulosum layer is next followed by the stratum lucidum (not shown in drawing) which is a thin clear layer seen in the palm of the hand and sole of the foot.  The layer on the surface is the stratum corneum which contains dead keratinocytes (anucleate squamous cells).  The cell of the epidermis includes keratinocytes (the most common skin cell type) which produces keratin; the melanocytes which are in the stratum basale and produce melanin and, therefore, provide the pigment of the skin; the Langerhans’ cells are in the stratum spinosum and take up antigens in the skin and the Merkel’s cells are in the stratum basale and function as mechanoreceptors.  Dermis is deep to the epidermis and contains two parts; the papillary layer and the reticular layer.  The dermis attaches to the epidermis by a basement membrane.  The dermis contains hair follicles; arrector pili muscle; sensory nerve endings and blood vessels.  Beneath the dermis is the hypodermis or subcutaneous fatty layer.  This layer contains adipose tissue, follicles, neurons, and blood vessels.  The three layers of the skin rest on the fascia which separates the skin and the muscle.

The major nerves, the brachial plexus, and the cervical roots are illustrated in detail. The muscle section has images and content describing the muscles of the hand and forearm. The vascular section describes the major arteries and veins in the upper extremity. The finger section provides detailed descriptions of the extrinsic and intrinsic tendons of the finger along with a diagram of the flexor pulley system. In addition, hand sections with information on the fascial structures (retention ligaments), the wrist, joint cartilage, potential spaces of the hand and osteology are included. Finally, there is a video dissection library with eight new videos. These videos highlight the important anatomical structures of the hand, wrist, and forearm. There are two new volar forearm dissections videos, three palm dissections videos, two finger dissections videos and one video highlighting the thenar and hypothenar compartments of the hand.

Pathoanatomy Photos and Related Diagrams
Skin
  • Layers of the skin: Epidermis with 5 layers (stratum basale, stratum spinosum, stratum granulosum, stratum lucidum [not shown], & stratum corneum); Dermis with the papillary layer and the reticular layer; Hypodermis or subcutaneous fatty layer; and the Fascia. Note inclusions: Hair shaft (1), Sebaceous gland (2), Arrector pili muscle (3), Hair follicle (4), Papilla of hair (5), Pacinian corpuscle (6), Nerve fibers (7), Sweat gland (8), Dermal papilla (9), and Sweat pore (10).
    Layers of the skin: Epidermis with 5 layers (stratum basale, stratum spinosum, stratum granulosum, stratum lucidum [not shown], & stratum corneum); Dermis with the papillary layer and the reticular layer; Hypodermis or subcutaneous fatty layer; and the Fascia. Note inclusions: Hair shaft (1), Sebaceous gland (2), Arrector pili muscle (3), Hair follicle (4), Papilla of hair (5), Pacinian corpuscle (6), Nerve fibers (7), Sweat gland (8), Dermal papilla (9), and Sweat pore (10).
  • Skin inclusions: Hair shaft (1), Sebaceous gland (2), Arrector pili muscle (3),  Hair follicle (4), Papilla of hair (5), Pacinian corpuscle (6), Nerve fibers (7), Sweat gland (8), Dermal papilla (9), Sweat pore (10), Macrophage (11), Neutrophil (12), Collagen (13), Meissner’s corpuscle (14), and Ruffini corpuscle (15).
    Skin inclusions: Hair shaft (1), Sebaceous gland (2), Arrector pili muscle (3), Hair follicle (4), Papilla of hair (5), Pacinian corpuscle (6), Nerve fibers (7), Sweat gland (8), Dermal papilla (9), Sweat pore (10), Macrophage (11), Neutrophil (12), Collagen (13), Meissner’s corpuscle (14), and Ruffini corpuscle (15).
Nerves of the Hand, Upper Extremity, Brachial Plexus & Cervical Spine
  • Median Nerve Muscle Innervations
    Median Nerve Muscle Innervations
  • Ulnar Nerve Muscle Innervations
    Ulnar Nerve Muscle Innervations
  • Radial Nerve Muscle Innervations
    Radial Nerve Muscle Innervations
  • Brachial Plexus diagram showing roots, trunks, divisions & cords. (Remember RTDCBs - Running Together Down Country Byways). Also note the Nerve Branching  2 2 0 3 5 5 Rule for the number of branches from each part of the plexus. Also see the brachial plexus branching table in the next image. Note the green asterisk at Erb’s point.  Also note the brachial plexus “M” landmark shape anterior to the axillary artery which is defined by the musculocutaneous nerve, the median nerve and the ulnar nerve. Finally not
    Brachial Plexus diagram showing roots, trunks, divisions & cords. (Remember RTDCBs - Running Together Down Country Byways). Also note the Nerve Branching 2 2 0 3 5 5 Rule for the number of branches from each part of the plexus. Also see the brachial plexus branching table in the next image. Note the green asterisk at Erb’s point. Also note the brachial plexus “M” landmark shape anterior to the axillary artery which is defined by the musculocutaneous nerve, the median nerve and the ulnar nerve. Finally note the divisions of the brachial plexus posterior to the clavicle.
  • Brachial Plexus Branching Pattern
    Brachial Plexus Branching Pattern
  • Horner’s sign is frequently associated with C8 and T1 root avulsions which also damage the sympathetic fibers to the face and may produce an ipsilateral Horner’s sign: 1) Ptosis (drooped eyelid); 2) meiosis (constricted pupil); 3) enophthalmos (sunken globe). Horner’s sign is associated with anhydrous of the ipsilateral face and a poor prognosis when connected with a brachial plexus injury.
    Horner’s sign is frequently associated with C8 and T1 root avulsions which also damage the sympathetic fibers to the face and may produce an ipsilateral Horner’s sign: 1) Ptosis (drooped eyelid); 2) meiosis (constricted pupil); 3) enophthalmos (sunken globe). Horner’s sign is associated with anhydrous of the ipsilateral face and a poor prognosis when connected with a brachial plexus injury.
  • Motor, sensory and biceps reflex exam for C5 Root
    Motor, sensory and biceps reflex exam for C5 Root
  • Motor, sensory and triceps reflex exam for C6 Root
    Motor, sensory and triceps reflex exam for C6 Root
  • Motor, sensory and triceps reflex exam for C7 Root
    Motor, sensory and triceps reflex exam for C7 Root
  • Motor and sensory exam for C8 Root
    Motor and sensory exam for C8 Root
  • Nerve with axons enclosed in endoneurium (1); Fascicle enclosed in perineurium (2); Fascicular groups enclosed in connective tissue called internal epineurium (3); Internal epineurium (4); External epineurium (5); Epineural blood vessels (6).
    Nerve with axons enclosed in endoneurium (1); Fascicle enclosed in perineurium (2); Fascicular groups enclosed in connective tissue called internal epineurium (3); Internal epineurium (4); External epineurium (5); Epineural blood vessels (6).
  • Nerve Internal Structure
    Nerve Internal Structure
Muscle Anatomy Upper Extremity - Dorsal Forearm
  • Extensor Carpi Radialis Longus (ECRL) - Origin: Humerus (lateral supracondylar ridge, distal 1/3), common forearm extensor tendon, and lateral intermuscular septum. Insertion: 2nd metacarpal bone (base on radial side of dorsal aspect).  Innervation: Cervical root(s):  C6 and C7; Nerve: radial nerve (lateral muscular branch).
    Extensor Carpi Radialis Longus (ECRL) - Origin: Humerus (lateral supracondylar ridge, distal 1/3), common forearm extensor tendon, and lateral intermuscular septum. Insertion: 2nd metacarpal bone (base on radial side of dorsal aspect). Innervation: Cervical root(s): C6 and C7; Nerve: radial nerve (lateral muscular branch).
  • Extensor Carpi Radialis Brevis (ECRB) - Origin: Humerus (lateral epicondyle via common forearm extensor tendon, radial collateral ligament of elbow joint, and aponeurosis of muscle. Insertion: 3rd metacarpal bone (base of dorsal surface on radial side) and 2nd metacarpal (occasionally). Innervation: Cervical root(s):  C7 and C8; Nerve: radial nerve (posterior interosseous branch)
    Extensor Carpi Radialis Brevis (ECRB) - Origin: Humerus (lateral epicondyle via common forearm extensor tendon, radial collateral ligament of elbow joint, and aponeurosis of muscle. Insertion: 3rd metacarpal bone (base of dorsal surface on radial side) and 2nd metacarpal (occasionally). Innervation: Cervical root(s): C7 and C8; Nerve: radial nerve (posterior interosseous branch)
  • Extensor Pollicis Longus (EPL) - Origin: Ulna (posterolateral surface of middle shaft), and interosseous membrane.  Insertion: Thumb (base of distal phalanx, dorsal side) Innervation: Cervical root(s):  C7 and C8; Nerve: radial nerve (posterior interosseous branch).
    Extensor Pollicis Longus (EPL) - Origin: Ulna (posterolateral surface of middle shaft), and interosseous membrane. Insertion: Thumb (base of distal phalanx, dorsal side) Innervation: Cervical root(s): C7 and C8; Nerve: radial nerve (posterior interosseous branch).
  • Extensor Indicis Proprius (EIP) - Origin: Ulna (posterior surface of shaft) and interosseous membrane.  Insertion: 2nd digit (via tendon of extensor digitorum into extensor hood). Innervation: Cervical root(s):  C7 and C8; Nerve: radial nerve (posterior interosseous branch).
    Extensor Indicis Proprius (EIP) - Origin: Ulna (posterior surface of shaft) and interosseous membrane. Insertion: 2nd digit (via tendon of extensor digitorum into extensor hood). Innervation: Cervical root(s): C7 and C8; Nerve: radial nerve (posterior interosseous branch).
  • Extensor Digitorum Communis (EDC) - Origin: Humerus (lateral epicondyle via common extensor tendon), intermuscular septum, and antebrachial fascia.  Insertion: Four tendons to digits 2–5 (via the extensor expansion, to dorsum of middle and distal phalanges; one tendon to each finger).  Innervation: Cervical root(s):  C7 and C8; Nerve: radial nerve (posterior interosseous branch).
    Extensor Digitorum Communis (EDC) - Origin: Humerus (lateral epicondyle via common extensor tendon), intermuscular septum, and antebrachial fascia. Insertion: Four tendons to digits 2–5 (via the extensor expansion, to dorsum of middle and distal phalanges; one tendon to each finger). Innervation: Cervical root(s): C7 and C8; Nerve: radial nerve (posterior interosseous branch).
  • Extensor Digitorum Minimi (EDM) - Origin: Humerus (lateral epicondyle via common extensor tendon) and intermuscular septum.  Insertion: 5th digit (extensor hood).  Innervation: Cervical root(s): C7 and C8;  Nerve: radial nerve (posterior interosseous branch).
    Extensor Digitorum Minimi (EDM) - Origin: Humerus (lateral epicondyle via common extensor tendon) and intermuscular septum. Insertion: 5th digit (extensor hood). Innervation: Cervical root(s): C7 and C8; Nerve: radial nerve (posterior interosseous branch).
  • Extensor Carpi Ulnaris (ECU) - Origin:	 Humerus (lateral epicondyle via common extensor tendon) and ulna (posterior border by an aponeurosis).  Insertion:	5th metacarpal bone (tubercle on medial side of base).  Innervation: Cervical root(s):  C7 and C8; Nerve: Radial nerve (posterior interosseous branch).
    Extensor Carpi Ulnaris (ECU) - Origin: Humerus (lateral epicondyle via common extensor tendon) and ulna (posterior border by an aponeurosis). Insertion: 5th metacarpal bone (tubercle on medial side of base). Innervation: Cervical root(s): C7 and C8; Nerve: Radial nerve (posterior interosseous branch).
Muscle Anatomy Upper Extremity - Volar Forearm
  • Origin: Humeral head: Humerus (medial epicondyle via common flexor tendon); ulnar head: Ulna (olecranon, medial margin; shaft, proximal 2/3 posterior via an aponeurosis), and the Intermuscular septum Insertion:	Pisiform, Hamate, 5th metacarpal base, and the flexor retinaculum Innervation:	Cervical root(s):  C7–T1 Nerve: ulnar nerve
    Flexor Carpi Ulnaris (FCU) - Origin: Humeral head: Humerus (medial epicondyle via common flexor tendon); ulnar head: Ulna (olecranon, medial margin; shaft, proximal 2/3 posterior via an aponeurosis), and the Intermuscular septum. Insertion: Pisiform, Hamate, 5th metacarpal base, and the flexor retinaculum. Innervation:Cervical root(s): C7–T1 Nerve: ulnar nerve
  • Origin: Humerus (medial epicondyle via common flexor tendon), intermuscular septa, and deep fascia.  Insertion:  Flexor retinaculum, palmar aponeurosis, and slip sent frequently to the short thumb muscles.  Innervation: Cervical root(s): C7–8; Nerve: median nerve
    Palmaris Longus (PL) - Origin: Humerus (medial epicondyle via common flexor tendon), intermuscular septa, and deep fascia. Insertion: Flexor retinaculum, palmar aponeurosis, and slip sent frequently to the short thumb muscles. Innervation: Cervical root(s): C7–8; Nerve: median nerve
  • Origin: Humerus (medial epicondyle via common flexor tendon), antebrachial fascia, and intermuscular septum.  Insertion:  2nd and 3rd metacarpals (base, palmar surface).  Innervation:  Cervical root(s):  C6–C7; Nerve: median nerve
    Flexor Carpi Radialis (FCR) - Origin: Humerus (medial epicondyle via common flexor tendon), antebrachial fascia, and intermuscular septum. Insertion: 2nd and 3rd metacarpals (base, palmar surface). Innervation: Cervical root(s): C6–C7; Nerve: median nerve
  • Flexor Digitorum Sublimis (FDS) - Origin: Humeral-ulnar head: Humerus (medial epicondyle via the common flexor tendon), ulnar collateral ligament (UCL) of the elbow joint, ulna (coronoid process, medial side), and intermuscular septa.  Radial Head: Radius (oblique line on anterior surface).  Insertion: Four tendons arranged in two pairs: Superficial pair: Long and ring fingers, and deep Pair: Index and little fingers with inserting into the appropriate middle phalanx. Innervation: Cervical root(s): C8–T1; N
    Flexor Digitorum Sublimis (FDS) - Origin: Humeral-ulnar head: Humerus (medial epicondyle via the common flexor tendon), ulnar collateral ligament (UCL) of the elbow joint, ulna (coronoid process, medial side), and intermuscular septa. Radial Head: Radius (oblique line on anterior surface). Insertion: Four tendons arranged in two pairs: Superficial pair: Long and ring fingers, and deep Pair: Index and little fingers with inserting into the appropriate middle phalanx. Innervation: Cervical root(s): C8–T1; Nerve: median nerve.
  • Flexor Digitorum Profundus (FDP) - Origin: Ulna (proximal 3/4 of anterior and medial shaft; medial coronoid process), interosseous membrane (ulnar).  Insertion: Four tendons to digits 2–5 (distal phalanges, at base of palmar surface).  Note index finger tendon is distinct in its course Innervation: Cervical root(s):  C8–T1; C8–T1; Nerve: median nerve, digits 2–3; ulnar nerve, digits 4–5.
    Flexor Digitorum Profundus (FDP) - Origin: Ulna (proximal 3/4 of anterior and medial shaft; medial coronoid process), interosseous membrane (ulnar). Insertion: Four tendons to digits 2–5 (distal phalanges, at base of palmar surface). Note index finger tendon is distinct in its course Innervation: Cervical root(s): C8–T1; C8–T1; Nerve: median nerve, digits 2–3; ulnar nerve, digits 4–5.
  • Flexor Pollicis Longus (FPL) - Origin: Radius (anterior surface of middle 1/2) and adjacent interosseous membrane, ulna (coronoid process, lateral border [variable]), and humerus (medial epicondyle [variable]).  Insertion: Thumb (base of distal phalanx, palmar surface) Innervation: Cervical root(s):  C7 and C8; Nerve: median nerve (anterior interosseous branch)
    Flexor Pollicis Longus (FPL) - Origin: Radius (anterior surface of middle 1/2) and adjacent interosseous membrane, ulna (coronoid process, lateral border [variable]), and humerus (medial epicondyle [variable]). Insertion: Thumb (base of distal phalanx, palmar surface) Innervation: Cervical root(s): C7 and C8; Nerve: median nerve (anterior interosseous branch)
  • Brachioradialis - Origin: Humerus (lateral supracondylar ridge, proximal 2/3) and lateral intermuscular septum (anterior).  Insertion: Radius (lateral side of shaft just proximal to styloid process). Innervation:	Cervical root(s): C5–6; Nerve: radial nerve
    Brachioradialis - Origin: Humerus (lateral supracondylar ridge, proximal 2/3) and lateral intermuscular septum (anterior). Insertion: Radius (lateral side of shaft just proximal to styloid process). Innervation: Cervical root(s): C5–6; Nerve: radial nerve
Vascular Anatomy of Hand and Upper Extremity
  • Arteries of Hand and Upper Extremity
    Arteries of Hand and Upper Extremity
  • Veins of Hand and Upper Extremity
    Veins of Hand and Upper Extremity
Detailed Finger Anatomy
  • A. Extensor tendon; B. Central slip; C. Oblique fibers of the dorsal aponeurosis; D. Lateral slip; E. Conjoined lateral band; F. Triangular ligament; G. Terminal extensor tendon
    A. Extensor tendon; B. Central slip; C. Oblique fibers of the dorsal aponeurosis; D. Lateral slip; E. Conjoined lateral band; F. Triangular ligament; G. Terminal extensor tendon
  • H. Flexor digitorum profundus; I. Volar plate; J. A-2 & A-4 pulley; K. Flexor digitorum superficialis; L. Transverse retinaculum
    H. Flexor digitorum profundus; I. Volar plate; J. A-2 & A-4 pulley; K. Flexor digitorum superficialis; L. Transverse retinaculum
  • A. Extensor tendon; B. Central slip; C. Oblique fibers of dorsal aponeurosis; D. Lateral slip; E. Conjoined lateral band; F. Triangular ligament; G. Terminal extensor tendon; H. Flexor digitorum profundus; I. Volar plate; J. A-2 & A-4 pulleys; K. Flexor digitorum superficialis; L. Transverse retinaculum; M. Accessory collateral ligament; N. Proper collateral ligament
    A. Extensor tendon; B. Central slip; C. Oblique fibers of dorsal aponeurosis; D. Lateral slip; E. Conjoined lateral band; F. Triangular ligament; G. Terminal extensor tendon; H. Flexor digitorum profundus; I. Volar plate; J. A-2 & A-4 pulleys; K. Flexor digitorum superficialis; L. Transverse retinaculum; M. Accessory collateral ligament; N. Proper collateral ligament
  • This diagram highlights the vascular supply and components of the flexor tendon sheath. The three cruciate pulleys (C1-3), the five annular pulleys (A1-A5) and the palmar aponeurotic pulley (PA) are shown. The A2 and A4 pulleys are the biomechanically the most important pulleys. During flexor tendon surgery, Tang(ref14) has shown that the A2 pulley can be 50% excised or vented and the A4 can be 100% vented if needed for tendon excursion if the other parts of the sheath are intact
    This diagram highlights the vascular supply and components of the flexor tendon sheath. The three cruciate pulleys (C1-3), the five annular pulleys (A1-A5) and the palmar aponeurotic pulley (PA) are shown. The A2 and A4 pulleys are the biomechanically the most important pulleys. During flexor tendon surgery, Tang(ref14) has shown that the A2 pulley can be 50% excised or vented and the A4 can be 100% vented if needed for tendon excursion if the other parts of the sheath are intact
Hand Anatomy
  • Extensor Tendon Zones of Injury. Zone I to Zone VII for the fingers, hand and wrist. Zones TI to Tv for the thumb.
    Extensor Tendon Zones of Injury. Zone I to Zone VII for the fingers, hand and wrist. Zones TI to Tv for the thumb.
  • Flexor Tendon Zones of injury for fingers, thumb, hand, and wrist. The most difficult repairs are those done in Zone II where the fibro osseous tunnel of the flexor tendon sheath is narrow and tight.
    Flexor Tendon Zones of injury for fingers, thumb, hand, and wrist. The most difficult repairs are those done in Zone II where the fibro osseous tunnel of the flexor tendon sheath is narrow and tight.
  • Normal Fascial structures of Distal Palm and Finger
    Normal Fascial structures of Distal Palm and Finger
Wrist Anatomy
  • Carpal tunnel anatomy: Carpal bones form the dorsal roof and the sides of the tunnel while the transverse palmar ligament forms the tunnel floor volarly. The tunnel contains nine flexor tendons and the median nerve.
    Carpal tunnel anatomy: Carpal bones form the dorsal roof and the sides of the tunnel while the transverse palmar ligament forms the tunnel floor volarly. The tunnel contains nine flexor tendons and the median nerve.
  • The extensor retinaculum prevents bowstring during extension. Its vertical septa define six extensor compartments. The first contains the Abductor Longus and Extensor Pollicis Brevis; the second contains the Extensor Carpi Radialis Longus & Brevis; The third contains the Extensor Pollicis Longus; The fourth contains the Extensor Digitorum Communis & Extensor Indicis Proprius: The fifth contains the Extensor Digiti Minimi; & the sixth contains the Extensor Carpi Ulnaris.
    The extensor retinaculum prevents bowstring during extension. Its vertical septa define six extensor compartments. The first contains the Abductor Longus and Extensor Pollicis Brevis; the second contains the Extensor Carpi Radialis Longus & Brevis; The third contains the Extensor Pollicis Longus; The fourth contains the Extensor Digitorum Communis & Extensor Indicis Proprius: The fifth contains the Extensor Digiti Minimi; & the sixth contains the Extensor Carpi Ulnaris.
  • TFCC & DRUJ: T - Triquetrum; L - Lunate; R - Radius; U - Ulnar head; 1- TFC articular disc; 2- Dorsal radioulnar ligament; 3- Deep radioulnar (foveal or ligament subcruentum) insertion; 4- Ulnar styloid TFCC insertion; 5- Ulnar collateral ligament (floor of the ECU tendon sheath; 6- Ulnotriquetral and ulnolunate ligaments; 7- Palmar (volar or anterior) radioulnar ligament; 8- Lunotriquetral ligament.
    TFCC & DRUJ: T - Triquetrum; L - Lunate; R - Radius; U - Ulnar head; 1- TFC articular disc; 2- Dorsal radioulnar ligament; 3- Deep radioulnar (foveal or ligament subcruentum) insertion; 4- Ulnar styloid TFCC insertion; 5- Ulnar collateral ligament (floor of the ECU tendon sheath; 6- Ulnotriquetral and ulnolunate ligaments; 7- Palmar (volar or anterior) radioulnar ligament; 8- Lunotriquetral ligament.
  • Ulnar Variance -When the distal radius and distal ulna are equal in length at the distal radioulnar joint, the ulnar variance is neutral. In this X-ray the ulnar variance is being measured with the method of perpendiculars. The forearm is in neutral rotation, wrist at neutral deviation and flexion/extension, and the elbow at 90 degrees of flexion. The X-ray beam is at a zero-degree angle of incidence for this PA view.
    Ulnar Variance -When the distal radius and distal ulna are equal in length at the distal radioulnar joint, the ulnar variance is neutral. In this X-ray the ulnar variance is being measured with the method of perpendiculars. The forearm is in neutral rotation, wrist at neutral deviation and flexion/extension, and the elbow at 90 degrees of flexion. The X-ray beam is at a zero-degree angle of incidence for this PA view.
Joint Anatomy
  • Normal and Osteoarthritic Cartilage Anatomy
    Normal and Osteoarthritic Cartilage Anatomy
Potential Anatomic Spaces of the Hand and Wrist
  • Thumb flexor tendon sheath shown separate but is connect to the radial bursa at the MP joint level and extends proximal to the transverse carpal ligament.
    Thumb flexor tendon sheath shown separate but is connect to the radial bursa at the MP joint level and extends proximal to the transverse carpal ligament.
  • The thenar space is the index flexor sheath and the adductor pollicis fascia. Infection can spread here from the index flexor tendon sheath or from puncture wounds.
    The thenar space is the index flexor sheath and the adductor pollicis fascia. Infection can spread here from the index flexor tendon sheath or from puncture wounds.
  • Index finger flexor tendon sheath which can connect to the thenar space.
    Index finger flexor tendon sheath which can connect to the thenar space.
  • Note the thenar space and its relationship to the radial bursa and flexor sheaths of the thumb and index finger.
    Note the thenar space and its relationship to the radial bursa and flexor sheaths of the thumb and index finger.
  • The Parona Space is superficial to the pronator quadrates and under the flexor tendons. Infection can spread here from the radial or ulnar bursa.
    The Parona Space is superficial to the pronator quadrates and under the flexor tendons. Infection can spread here from the radial or ulnar bursa.
  • Long finger flexor tendon sheath which can connect to the mid-palmar space.
    Long finger flexor tendon sheath which can connect to the mid-palmar space.
  • Ring finger flexor tendon sheath which can connect to the mid-palmar space.
    Ring finger flexor tendon sheath which can connect to the mid-palmar space.
  • Little finger flexor tendon sheath is usually connected to the ulnar bursa.
    Little finger flexor tendon sheath is usually connected to the ulnar bursa.
  • The midpalmar space is a potential space between the volar interosseous fascia, the flexor sheath, the oblique and hypothenar septum. Infection is usually secondary to spread of infection from flexor sheath of long and ring fingers.
    The midpalmar space is a potential space between the volar interosseous fascia, the flexor sheath, the oblique and hypothenar septum. Infection is usually secondary to spread of infection from flexor sheath of long and ring fingers.
  • Infections of the long and ring finger flexor tendon sheaths (arrows) can spread into the midpalmar space.
    Infections of the long and ring finger flexor tendon sheaths (arrows) can spread into the midpalmar space.
  • The ulnar bursa which can connect to the radial bursa and flexor sheaths of thumb and little finger to form "horseshoe" abscess.
    The ulnar bursa which can connect to the radial bursa and flexor sheaths of thumb and little finger to form "horseshoe" abscess.
  • The hypothenar space is a potential space between the combined palmar and superficial hypothenar muscle fascia and the deep hypothenar muscle fascia. Infection is usually secondary to a puncture wound.
    The hypothenar space is a potential space between the combined palmar and superficial hypothenar muscle fascia and the deep hypothenar muscle fascia. Infection is usually secondary to a puncture wound.
Osteology of the Hand and Upper Extremity
  • 1. Distal Clavicle    2. Acromion     3. Coracoid Process   5. Humeral Head 6. Anatomical Neck   7. Greater Tuberosity   8. Bicipital Groove    9.  Lesser Tuberosity   10.  Surgical Neck
    1. Distal Clavicle 2. Acromion 3. Coracoid Process 5. Humeral Head 6. Anatomical Neck 7. Greater Tuberosity 8. Bicipital Groove 9. Lesser Tuberosity 10. Surgical Neck
  • 1. Deltoid Tuberosity   2.  Lateral Supercondylar Ridge    3.  Radial Fossa   4.  Coronoid Fossa   5.  Medial Supercondylar Ridge
    1. Deltoid Tuberosity 2. Lateral Supercondylar Ridge 3. Radial Fossa 4. Coronoid Fossa 5. Medial Supercondylar Ridge
  • 1.  Lateral Epicondyle   2.  Capitellum   3. Trochlea   4.  Medial Epicondyle   5. Radial Head   6. Coronoid Process
    1. Lateral Epicondyle 2. Capitellum 3. Trochlea 4. Medial Epicondyle 5. Radial Head 6. Coronoid Process
  • 1.  Radial Head   2.  Olecranon   3. Radial Tuberosity   4. Radial Styloid 5.  Distal Radioulnar Joint   6.  Ulnar Styloid
    1. Radial Head 2. Olecranon 3. Radial Tuberosity 4. Radial Styloid 5. Distal Radioulnar Joint 6. Ulnar Styloid
  • 1.  Scaphoid   2. Lunate   3. Triquetrum   4. Pisiform 5.  Hamate   6. Capitate    7. Trapezoid   8. Trapezium
    1. Scaphoid 2. Lunate 3. Triquetrum 4. Pisiform 5. Hamate 6. Capitate 7. Trapezoid 8. Trapezium
  • 1. Thumb Metacarpal   2. Index Metacarpal   3. Long Metacarpal 4. Ring Metacarpal   5. Little Metacarpal   6. Thumb Proximal Phalanx 7. Index Proximal Phalanx (P1)   8. Long Proximal Phalanx (P1) 9 Ring Proximal Phalanx (P1)   10. Little Proximal Phalanx (P1) 11. Thumb Distal Phalanx   12. Index Middle Phalanx (P2) 13. Long Middle Phalanx (P2)   14. Ring Middle Phalanx (P2) 15. Little Middle Phalanx (P2)   16.  Index Distal Phalanx (3) 17. Long Distal Phalanx (3)   18.   Ring Distal Phalanx (3) 19.  Little
    1. Thumb Metacarpal 2. Index Metacarpal 3. Long Metacarpal 4. Ring Metacarpal 5. Little Metacarpal 6. Thumb Proximal Phalanx 7. Index Proximal Phalanx (P1) 8. Long Proximal Phalanx (P1) 9 Ring Proximal Phalanx (P1) 10. Little Proximal Phalanx (P1) 11. Thumb Distal Phalanx 12. Index Middle Phalanx (P2) 13. Long Middle Phalanx (P2) 14. Ring Middle Phalanx (P2) 15. Little Middle Phalanx (P2) 16. Index Distal Phalanx (3) 17. Long Distal Phalanx (3) 18. Ring Distal Phalanx (3) 19. Little Distal Phalanx (3)
  • 1. Radial Tuberosity   2. Radial Head   3. Coronoid Process   4. Olecranon  5.  Trochlea   6.  Medial Epicondyle
    1. Radial Tuberosity 2. Radial Head 3. Coronoid Process 4. Olecranon 5. Trochlea 6. Medial Epicondyle
Video
Volar Forearm Anatomy Part 1
Volar Forearm Anatomy Part 2
Dorsal Finger Anatomy
Palmar Finger Anatomy
Anatomy of the Hand Palm Part 1
Anatomy of the Hand Palm Part 2
Anatomy of the Hand Palm Part 3
Thenar and Hypothenar Anatomy
Superficial Dorsal Hand Anatomy
Extensor Tendons Part 1
Extensor Tendons Part 2
Thumb MP Joint Anatomy
Dorsal Forearm Anatomy Part 1
Dorsal Forearm Anatomy Part 2
References
  1. Henry AK: Extensile Exposure applied to Limb Surgery, first edition.  Baltimore, The Williams and Wilkins Company 1952.
  2. Kaplan EB:  Surgical Approaches to the Neck, Cervical Spine and Upper Extremity.  Philadelphia, W.B. Saunders Company 1966.
  3. Hollinshead WH:  Anatomy for Surgeons: Volume 3 The Back and Limbs, 2nd edition. New York, Harper & Row Publishers 1969.
  4. Boileau Grant JC:  Grant’s Atlas of Anatomy, fifth edition.  Baltimore, The Williams and Wilkins    Company, 1962.
  5. Llusa M, Meri A, Ruano D:  Surgical Atlas of the Musculoskeletal System.  American Academy of Orthopaedic Surgeons, 2008.
  6. Schmidt HM, Lanz U:  Surgical Anatomy of the Hand.  New York, Thieme, 2004.
  7. Doyle JR, Botte MJ:  Surgical Anatomy of the Hand and Upper Extremity.  Philadelphia,    Lippincott, Williams & Wilkins, 2003.
  8. Netter FH:  Atlas of Human Anatomy, second edition.  East Hanover, Novartis, 1997.
  9. Zancolli EA, Cozzi EP:  Atlas of Surgical Anatomy of the Hand.  New York, Churchill Livingstone, 1992.