MUSCULOTENDINOUS

SYSTEM OF THE HAND

AND ITS BLOOD SUPPLY
FARIS MOHD NASIR
1314597
 Muscles of the hand

Intrinsic Extrinsic

• Intrinsic muscles – fine motor functions of the hand.

• Extrinsic muscles- crude movements and forceful grip.
 Muscles for
digital motion
Extrinsic

Intrinsic

Adductor Hypothenar
Lumbricals Interosseus Thenar
Pollicis Eminence

Abductor Abductor
Pollicis Brevis Digiti Minimi

Opponens Flexor Digiti

Pollicis Minimi Brevis

Flexor Pollicis Opponens

Brevis Digiti Minimi
Lumbric
als
• Flex the MCP
joint
• Extend PIP &
DIP joint

https://classconnection.s3.amazonaws.com/1
56/flashcards/3086156/gif/lumbricals1365648
753942.gif
Interosseus

• Dorsal interossei • Palmar interossei

• Abduct • Adduct

"PAD" "DAP"
https://quizlet.com/30956533/12-wrist-and-
hand-flash-cards/
Adductor
Pollicis
• "Adductor of the
thumb"
• Adduct at the CMC
joint

http://rad.washington.edu/muscle-atlas
Thenar
1) Abductor
Pollicis Brevis
• Abducts thumb at CMC
& MCP joint
2) Opponens
Pollicis
• Opposition at
the first CMC
joint

http://www.easynotecards.com/print_list/326
25
3) Flexor Pollicis
Brevis
• Flexion at MCP
joint

http://www.easynotecards.com/print_list/326
25
Hypothenar

1) Abductor Digiti Minimi 2) Flexor Digiti Minimi Brevis

• Abduct the little finger • Flex the little finger at
at MCP & CMC the MCP joint

http://www.easynotecards.com/print_list/326
25
3) Opponens
Digiti Minimi
• Flex the 5th CMC joint
of the little finger.

http://www.easynotecards.com/print_list/326
25
 Intrinsic Flexor

Muscles for Flexor Digitorum Flexor Digitorum Flexor Pollicis

digital motion Superficialis Profundus Longus

Extrinsic Extensor

Extensor Digiti Extensor Pollicis

Minimi Longus

Extensor Extensor Pollicis

Digitorum Brevis

Abductor Pollicis
Extensor Indicis
Longus
 Flexor
1) Flexor Digitorum
Superficialis
• Humeroulnar and radial head
• 4 tendons separate to 2 parts and inserted at
the lateral crest on the shaft of each middle
phalanges.
• Flex the fingers at the MCP & PIP

http://rad.washington.edu/muscle-atlas
 2) Flexor Digitorum
Profundus
• The 4 tendons insert into bases of the distal
phalanges.
• Flex the fingers at the DIP

http://rad.washington.edu/muscle-atlas
 3) Flexor Pollicis
Longus
• Flex the thumb at the interphalangeal joint

http://rad.washington.edu/muscle-atlas
 TENDON BURSAE
• Tough band of fibrous • Fluid-filled sac lined by
connective tissue that synovial membrane
connects muscle to with inner capillary
bone layer of synovial fluid.
Fibrous Sheath of the
Flexor Tendon to the Finger

• The flexor tendons passage through an osseofibrous tunnel on the finger

• 5 annular & 3 cruciate
Fibrous
Sheath of the
Flexor Tendon
to the Thumb
• Passage for the flexor
pollicis longus
• 2 annular
Synovial
Bursae of the
Flexor Tendon
• Synovial bursae –
between the parietal
and visceral layers
• Parietal – fibrous
sheath (osseofibrous
tunnel)
• Visceral – flexor tendon
• In carpal tunnel there
are 2 bursae :
• Radial bursa -
surrounding the
flexor pollicis
longus ( FPL)
• Ulnar bursa –
surrounding the
flexor tendon of
the flexor
digitorum
superficialis ( FDS)
and flexor
digitorum
profundus ( FDP).

https://upload.wikimedia.org/wikipedia/com
mons/0/02/Gray423.png
Extensor
1) Extensor Digitorum
• Origin
• Lateral epicondyle of humerus
• Insertion
• Dorsal tubercle at the base of
the proximal, middle and distal
phalanx of IF, MF, RF and LF.
• Nerve
• PIN ( posterior interosseous
nerve)- branch from radial nerve
• Function
• Extension of the MCP joint, PIP
and DIP
http://rad.washington.edu/muscle-atlas
 2) Extensor Digiti Minimi
• Origin
• Lateral epicondyle of
humerus
• Insertion
• The extensor hood of the LF
• Nerve
• PIN (radial nerve)
• Function
• Extend the little finger

http://rad.washington.edu/muscle-atlas
 3) Extensor Indicis
• Origin
• Dorsal aspect of the distal third
of the ulna
• Insertion
• Ulnar side of index tendon of ED
and joins extensor hood of IF
• Nerve
• PIN (radial nerve)
• Function
• Independent extension
movement to IF
http://rad.washington.edu/muscle-atlas
 4) Extensor Pollicis Longus &
Brevis Brevis
Longus
• Origin • Origin
• Posterior surface of the • Posterior surface of
shaft of the ulnar shaft of radius
• Insertion • Insertion
• Dorsal tubercle of distal
• Base of proximal
phalanx of thumb
phalanx of thumb
• Nerve
• PIN (radial nerve) • Nerve
• Function • PIN ( radial nerve)
• Extends the distal • Function
phalanx of thumb • Extend the MCP
joint of thumb
http://rad.washington.edu/muscle-atlas
 6) Abductor Pollicis Longus
• Origin
• Radial part of the dorsal aspect
of the proximal third of ulna
• Insertion
• Radial tubercle at the base of
first metacarpal bone
• Nerve
• PIN ( radial nerve)
• Function
• Abducts and extends the
thumb

http://rad.washington.edu/muscle-atlas
Synovial
Bursae of
Extensor
Tendons
• Extensor tendons are
wrapped by a
synovial membrane.
• For lubrication
Compartments of the Hand
• Total 10
compartments
• Hypothenar
• Thenar
• Adductor pollicis
• Dorsal
interosseous (x4)
• Palmar
interosseous (x3)

http://www.orthobullets.com/trauma/1064/hand-and-forearm-compartment-syndrome
 Muscles for
Wrist Motion

Flexor Extensor

Flexor Carpi Extensor Carpi

Radialis Radialis Longus

Flexor Carpi Extensor Carpi

Ulnaris Radialis Brevis

Palmaris Extensor Carpi

Longus Ulnaris
 Flexor Carpii
Radialis & Ulnaris
• Both muscles originated from medial
epicondyle. FCU has an ulna head originate
from medial margin of olecranon
• FCR inserted at the anterior aspect of the base
of the second metacarpal
• FCU inserted into the pisiform bone, hamate
and base of 5th metacarpal
• Both flex, but FCR ABDUCT, FCU ADDUCT

http://rad.washington.edu/muscle-atlas
 Palmaris Longus
• Origin
- Medial epicondyle of humerus

• Insertion
- Distal half of flexor retinaculum and palmar aponeurosis

• Nerve
- Median nerve

• Functions
- Flexes the hand at the wrist
- Tightens the palmar aponeurosis

http://rad.washington.edu/muscle-atlas
 Extensor Carpi
Radialis Longus
• Origin(proximal)
- Lateral supracondylar ridge of humerus

• Insertion(distal)
- Base of 2nd metacarpal

• Nerve
- Radial nerve

• Functions
- Extends and abduct hand at the wrist joint

http://rad.washington.edu/muscle-atlas
Extensor Carpi
Radialis Brevis
• Origin (proximal)
- Lateral epicondyle of the humerus

• Insertion(distal)
- Posterior surface of base of the 3rd metacarpal bone

• Nerve
- Radial nerve (PIN)

• Function
- Extend and abducts the hand at the wrist joint

http://rad.washington.edu/muscle-atlas
Extensor Carpi
Ulnaris
• Origin (proximal)
- Lateral epicondyle of humerus

• Insertion(distal)
- the base of the 5th metacarpal

• Nerve
- Radial nerve(PIN)

• Function
- Extends and adducts the hand at the wrist

http://rad.washington.edu/muscle-atlas
 Blood Supply
of the Hand -
Artery
• Radial artery
• Palmar carpal
branch
• Superficial palmar
arch

• Ulnar artery
• Superficial palmar
arch
• Deep palmar arch
http://teachmeanatomy.info/wp-content/uploads/2012/04/Arterial-Supply-to-the-Hand-
via-the-Ulnar-and-Radial-Arteries.-Superficial-and-Deep-Arches.jpg
Superficial Palmar Arch
• Direct continuation of the
ulnar artery.
• Ulnar artery curves laterally
behind palmar aponeurosis
• The arch is completed on
the lateral side by one
branch from the radial
artery
• 4 digital arteries arise and
pass to the fingers
https://www.studyblue.com/notes/note/n/wri
st-hand/deck/11562043
 Deep Palmar
Arch
• Direct continuation of radial
artery, curves medially
beneath the long flexor
tendon.
• The arch is completed by the
deep branch of ulnar artery
• Sends branches superiorly –
take part is anastomosis
around the wrist joint, join
the digital branches of SPA
• Radial artery also gives a
branch – radial artery of
index finger & princeps
pollicis artery (lateral &
medial)
http://teachmeanatomy.info/wp-content/uploads/2012/04/Arterial-Supply-to-the-Hand-
via-the-Ulnar-and-Radial-Arteries.-Superficial-and-Deep-Arches.jpg
http://www.medscape.com/viewarticle/423195_3
Dorsal Carpal
Branch
• Radial artery give 2
branches

• Drosal carpal branch – passes

medially as dorsal carpal arch

• First dorsal metacarpal artery

– supplies adjacent sides of
index finger and thumb

https://quizlet.com/15506261/the-extensor-posterior-compartment-
and-dorsum-of-the-hand-flash-cards/
Venous Drainage
• Dorsal Venous Network
(superficial)
• Formed by the dorsal
metacarpal veins
• Cephalic vein – lateral side
• Basilic vein – medial side

http://slideplayer.com/slide/6023516/
 Palmar (deep)
• Superficial palmar
arch
• Accompany
superficial
arterial arch
(venae
comitantes)
• Deep palmar arch
• Accompany
deep palmar
arterial arch
• Natatory vein
• Intercapitular vein
• Lateral palmar vein
of digits

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas

of hand anatomy and clinical implications.
St.Louis, Missouri: Mosby