The Hand Anatomy Bones Blood Supply Muscles Notes

The Hand Anatomy Bones Blood Supply Muscles Notes

Question 1. Describe the palmar aponeurosis briefly and discuss its applied anatomy.
Answer.

The palmar aponeurosis is the thick central part of the deep fascia of the palm. It is triangular with its apex facing proximally and base facing distally. It overlies the superficial palmar arch, long flexor tendons, terminal part of the median nerve, and superficial branch of the ulnar nerve.

The Hand Anatomy Bones Blood Supply Muscles Notes

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Palmar Aponeurosis  Attachments

Apex:

It is attached to the flexor retinaculum and provides insertion to the tendon of palmaris longus.

Base:

Just proximal to the heads of metacarpals, it divides into four longitudinal slips – one for each medial four digits. Each slip has a superficial and a deep set of fibres. The superficial fibres are attached to the skin of the fingers at their roots. The deep fibres blend with the fibrous flexor sheaths and are also connected to the deep transverse ligaments of the palm.

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Palmar Aponeurosis Relations

• Between the slips (in the web spaces of fingers), the digital nerve and vessels emerge to pass distally.
• From the medial and lateral borders of the palmar aponeurosis, medial and lateral intermuscular septa extend inwards and get attached to the 5th and 1st metacarpals, respectively. These septa divide the palm into compartments.

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Palmar Aponeurosis Functions

• Protects the underlying tendons, nerves, and vessels
• Helps to improve the grip of the hand by fixing the skin of the palm

Palmar Aponeurosis Applied Anatomy

The progressive contraction of the medial part of the palmar aponeurosis produces a deformity called Dupuytren’s contracture. The little and ring fingers are usually involved. The proximal and middle phalanges become flexed and cannot be straightened. The distal phalanges, however, remain unaffected or may become hyperextended.

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Question 2. Give the sensory innervation of the dorsal aspect of the hand.
Answer.

• The lateral two-thirds of the dorsum of the hand and the lateral 3½ digits are innervated by the radial nerve.
• The medial one-third of the dorsum of the hand and the medial 1½ digits are innervated by the ulnar nerve.