8/9/2019 Applied Anatomy in Hand Infections
1/24
Applied anatomy inhand infections
8/9/2019 Applied Anatomy in Hand Infections
2/24
Skin
The skin of the dorsum of the hand is thin and p It is attached to the hands skeleton only by loos
areolar tissue, which also contains lymphatics an
This explains why oedema of the hand is manisfpredominantly at the dorsum
8/9/2019 Applied Anatomy in Hand Infections
3/24
Skin
The skin of the palmar surface is thick, glabrous less pliable
This enhances the skin ability for grasping funct
The skin is most rmly anchored to the deep strat the palmar creases
8/9/2019 Applied Anatomy in Hand Infections
4/24
Arteries
8/9/2019 Applied Anatomy in Hand Infections
5/24
eins
8/9/2019 Applied Anatomy in Hand Infections
6/24
!erves
8/9/2019 Applied Anatomy in Hand Infections
7/24
"ones
Total #$ bones in the hand and wrist % groups
&arpals
'etacarpals
(halanges
8/9/2019 Applied Anatomy in Hand Infections
8/24
8/9/2019 Applied Anatomy in Hand Infections
9/24
'uscles and tendons
'uscles of the hand are divided into Intrinsic group
)xtrinsic group
8/9/2019 Applied Anatomy in Hand Infections
10/24
)xtensors
All extensors are extrinsics and supplied by the ranerve, except for the interosseous*lumbrical comp
% wrist extensors+ )xtensor carpi radialis brevis
)xtensor carpi radialis longus
)xtensor carpi ulnaris igit extensors
)xtensor digitorum communis
)xtensor indicis proprius
)xtensor digit minimi
8/9/2019 Applied Anatomy in Hand Infections
11/24
Thumb extensors Abductor pollicis longus
)xtensor pollicis brevis
)xtensor pollicis longus
8/9/2019 Applied Anatomy in Hand Infections
12/24
)xtrinsic -exors
% wrist -exors .lexor carpi radialis
.lexor carpi ulnaris
(almaris longus
igital -exors
.lexor digitorum supercialis .lexor digitorum profundus
.lexor pollicis longus
8/9/2019 Applied Anatomy in Hand Infections
13/24
Intrinsics
Situated totally within the hand ivided into / groups
Thenar
0ypothenar
1umbricals
Interossei muscles
8/9/2019 Applied Anatomy in Hand Infections
14/24
Spaces of the hand
Important spaces are Supercial pulp spaces of the nger
Synovial tendon sheaths of the nger
2lnar bursa
3adial bursa
'idpalmar spaceThenar space
8/9/2019 Applied Anatomy in Hand Infections
15/24
Supercial pulp space
The pulp space is a closed fascial compartment in front of the distal phalanx of each nger
)ach space is divided into multiple smallercompartments by brous septa
8/9/2019 Applied Anatomy in Hand Infections
16/24
Accumulation of exudate within these compartmcauses a 4uick rise the pulp space pressure
In children, pressure on the blood vessels may lenecrosis of the diaphysis
The proximal end of the pulp space is closely rel
the digital synovial sheath, hence infection may between these two spaces
8/9/2019 Applied Anatomy in Hand Infections
17/24
Synovial tendon sheaths of thenger
8/9/2019 Applied Anatomy in Hand Infections
18/24
8/9/2019 Applied Anatomy in Hand Infections
19/24
8/9/2019 Applied Anatomy in Hand Infections
20/24
3adial and ulnar bursa
3adial bursa 5synovial sheath of the -exor polliclongus6
2lnar bursa 5common -exor synovial sheath6
3adial bursa communicates with the ulnar bursasome people
8/9/2019 Applied Anatomy in Hand Infections
21/24
Thenar space
The thenar space lies 7ust supercial to the addupollicis muscle, forming a plane connecting the daspect of the radial bursa and ulnar bursa
Abcsess may spread through the thenar space dthe palm between the thumb and carpal tunnel
8/9/2019 Applied Anatomy in Hand Infections
22/24
'idpalmar space
The midpalmar space contains the #nd, %rd, andlumbrical muscles and lies posterior to the long tendons to the middle, ring and little ngers8 It lfront of the interossei and the %rd, /th and 9thmetacarpal bone
Infection of the midpalmar space may result fromtenosynovitis of the middle and ring ngers or frweb infection which has spread proximally throulumbrical canals8
:hen this happens the normal concavity of the obliterated and the swelling extends to the dorsu
the hand8
8/9/2019 Applied Anatomy in Hand Infections
23/24
8/9/2019 Applied Anatomy in Hand Infections
24/24