MUSCULOTENDINOUS

SYSTEM OF THE HAND

Nursharmila Mohd Nor
1214854
 Bone
Surface
Joints
Anatomy

Anatomy Of Hand

Blood Nerve
supply Musculotendinous
system

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Overview

Muscles For
Muscles For
Local Positions
Digital Motion
Of The Hand

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Muscles for
digital motion

Extrinsic Intrinsic

Hypothenar
Flexor Extensor Thenar Adductor pollicis Interosseous Lumbricals
eminence

Flexor digitorum Extensor Abductor pollicis Abductor digiti

superficialis digitorum brevis minimi

Flexor digitorum Extensor digiti Opponens Flexor digiti

profundus minimi pollicis minimi brevis

Flexor pollicis Flexor pollicis Opponens digiti

Extensor indicis
longus brevis minimi

Extensor pollicis
Pollicis brevis
longus

Extensor pollicis
brevis

Abductor pollicis
longus
Extrinsic Muscles
Flexor System
1) Flexor Digitorum Superficialis
- Origin
a) Humeroulnar head from medial
epicondyle of humerus and medial
side of coronoid process
b) Radial head – ant.surface of
radius
- Insertion
Four tendon separating into 2
parts that insert into lateral crest
on the shaft of the middle phalanx
of index finger (IF), middle finger
(MF), ring finger (RF), and little
finger (LF).
- Nerve
Median
- Function
Metacarpophalangeal (MCP) and
proximal interphalangeal (PIP)
flexion of the IF, MF, RF and LF.
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 2) Flexor Digitorum Profundus
• Origin
• Proximal ¾ of the anterior and
ulna surfaces of the ulna
• Interroseous membrane
• Insertion
• Four tendons inserting into
bases of the distal phalanx of IF,
MF, RF and LF
• Nerve
• IF and MF – median
• RF and LF – ulna
• Function
• Distal interphalangeal (DIP)
flexion of IF, MF, RF and LF
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 3) Flexor Pollicis Longus
• Origin
• Anterior middle half of the radius
• Interosseous membrane
• Insertion
• Palmar tubercle at the base of the
distal phalanx of the thumb
• Nerve
• Median
• Function
• Interphalangeal (IP) flexion of
thumb

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Fibrous Sheath Of The Flexor
Tendons To The Finger
• An osseofibrous tunnel for the passage of the flexor
tendons in the finger
• Can be divided into 5 annular and 3 cruciate

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
• Fibrous sheath with its floor lined with parietal
synovial membrane
• All the pulleys come into apposition when the finger
is flexed

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Fibrous Sheath Of The Flexor
Tendons To The Thumb
• Passage for the tendon pf the FPL.

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Synovial Bursae Of The Flexor
Tendons
• Synovial membranes that lines
the wall of the osteofibrous
tunnel (parietal layer) and
investing the flexor tendons
(visceral layer).
• Synovial bursae – between the
parietal and visceral layers
• Filled with synovial fluid for
lubrications

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
• 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).

• Flexor tendon in digits – digital bursa

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Vincular System Of The Flexor
Tendon
• Vinculum tendinum – specialized remnant of the
degenerative mesotenon for neurovascular bundles
passing to nourish the flexor tendons in the fibrous
sheath

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
• Vincular breve for the superficialis tendon ( VBS)
• Vincular breve for the profundus tendon ( VBP)
• Vincular longa for the superficialis tendon ( VLS)
• Vincular longa for the profundus tendon ( VLP)

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Vincular System In The Thumb
• 2 vincula – neurovascular bundle passing through
to nourish the tendon of the FPL
• Vincula pollicis 1 ( VP1)
• Vincula pollicis 2 ( VP2)

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Anatomic
zones for
flexor
tendons

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Extrinsic Muscles
Extensor System
 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

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 2) 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

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 3) Extensor Digiti Minimi
• Origin
• Lateral epicondyle of
humerus
• Insertion
• The extensor hood of the LF
• Nerve
• PIN (radial nerve)
• Function
• Independent extension of
LF

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 4) Extensor Pollicis Longus
• Origin
• Radiodorsal aspect of the
middle third of the ulna
• Insertion
• Dorsal tubercle of distal
phalanx of thumb
• Nerve
• PIN (radial nerve)
• Function
• Extends IP , retroposition of
thumb

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 5) Extensor Pollicis Brevis
• Origin
• Dorsal aspect of on the
third distal third of radius
• Insertion
• Dorsal ridge at the basal of
proximal phalanx of thumb
• Nerve
• PIN ( radial nerve)
• Function
• Extend the MCP joint of
thumb, radial abduction in
carpometacarpal (CMC)
joint
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 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 MCP
• Nerve
• PIN ( radial nerve)
• Function
• Palmar abduction of first
CMC joint

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Anatomic
zones of
extensor
tendons

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Extensor Apparatus
• Other name : dorsal digital expansion / extensor
hood / dorsal apparatus / dorsal digital
apponeurosis
• Fibrotendinous and sheet like complex lying on the
dorsal aspect of a digit from the MCP joint to the
DIP joint

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Finger Extensor Apparatus
• 1) Terminal extensor ligament
• 2) triangular ligament
• 3) Oblique retinacular
ligament
• 4) Transverse retinacular
ligament
• 7) Lateral slip
• 8) Central slip
• 9) Lateral band
• 10) Sagittal band

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Synovial Bursae Of Extensor Tendons

• Extensor tendons are

wrapped about by a
synovial membranes
of visceral layers
• For lubrication while
tendons are gliding

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Intrinsic muscles
1) Thenar muscle
2) Hypothenar eminence
3) Adductor pollicis
4) Interosseous
5) Lumbricals
 Thenar Muscle :
1) Abductor Pollicis Brevis
• Origin
• Radial half of the distal part
of the flexor retinaculum
• Tuberosity of scaphoid
• Ridge of trapezium
• Insertion
• Radial side of the base of
the proximal phalanx of
thumb
• Nerve
• Median
• Function
• Abducts the thumb at CMC
and MCP joints
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 2) Opponens Pollicis
• Origin
• Ridge of trapezium
• Adjacent area of flexor
retinaculum
• Insertion
• Palmar-radial aspect on the
entire shaft of thumb
• Nerve
• Median
• Function
• Opposition (or
anteposition) at the first
CMC joint

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 3) Flexor Pollicis Brevis
• Origin
• Sf. Head – distal border of the
flexor retinaculum and ridge
of trapezium
• Deep head – palmar aspect of
trapezoid, capitate and distal
part of ridge of trapezium
• Insertion
• Sf. Head – radial side at the
base of proximal phalanx
• Deep head – radial sesamoid
in the palmar plate of the
MCP joint
• Nerve
• Sf. head – median
• Deep head – ulna
• Function
• Flexion at MCP joint
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Hypothenar Eminence:
1) Abductor Digiti Minimi
• Origin
• Pisiform
• Tendinous arcade between
the hamulus of hamate and
the pisiform
• Tendon of flexor carpi ulnaris
• Insertion
• Ulnar tubercle
• Extensor hood on LF
• Nerve
• Ulnar
• Function
• Abduct LF at MCP and CMC
joint
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 2) Flexor Digiti Minimi Brevis
• Origin
• Tip of the hook of the
hamate
• Insertion
• Ulna tubercle
• Nerve
• Ulnar
• Function
• Flex of LF at MCP joint

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 3) Opponens Digiti Minimi
• Origin
• Distal border of hook of
hamate
• Adjacent flexor
retinaculum
• Insertion
• Ulnar margin of the LF
• Nerve
• Ulnar
• Function
• Flex the fifth CMC joint of
the LF

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Adductor Pollicis
• Origin
• Oblique head – capitate bone,
bases of 2nd and 3rd MCP
• Transverse head – palmar
surface on the shaft of MCP of
MF
• Insertion
• Ulnar side of base of first
proximal phalanx of thumb
• Nerve
• Ulnar
• Function
• Adductor of thumb at CMC
joint

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Palmar Interossei
• Origin
• 1st muscle– ulnar-palmar side
shaft of MCP bone of IF
• 2nd and 3rd muscles – radial-
palmar side of the shaft of
MCP bone of 2nd, 4th, and 5th
• Insertion
• 1st – proximal phalanx of IF
• 2nd and 3rd proximal phalanx
of RF and LF
• Nerve
• Ulnar
• Function
• Adduction of IF, RF and LF
towards the MF at the MCP
joint

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Dorsal Interossei
• Origin
• 1st,2nd,3rd,4th – contiguous
aspect of the 1st,2nd, 3rd,4th,
and 5th MCP bones
• Insertion
• 1st – radial tubercle of IF
• 2nd – radial tubercle of 3rd
proximal phalanx
• 3rd – ulnar side of extensor
apparatus
• 4th – ulnar side of 4th proximal
phalanx
• Nerve
• Ulnar
• Function
• Abduct the IF, RF and LF apart
from MF
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Lumbricals
• Origin
• 1st and 2nd muscles – radial side of
FDP of IF and MF (unipenniform)
• 3rd muscle– FDP of MF and RF
(bipenniform)
• 4th muscle– FDP of RF and LF
(bipenniform)
• Insertion
• 1st muscle – radial side of MCP
joint of index finger
• 2nd ,3rd,4th muscles – radial side of
extensor hood of their respective
fingers
• Nerve
• 1st and 2nd muscles – median
• 3rd and 4th muscles – ulnar
• Function
• Flex the MCP joint
• Extend PIP and DIP joint
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Muscles For Local Positions Of
The Hand
• Flexor Carpi Radialis
• Palmaris Longus
• Flexor Carpi Ulnaris
• Extensor Carpi Radialis Longus
• Extensor Carpi Radialis Brevis
• Felxor Carpi Ulnaris

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Flexor Carpi Radialis
• Origin( proximal)
- Arises from the medial epicondyle of the
humerus and the antebrachial fascia

• Insertion(distal)
- Inserts into the base of the 2nd metacarpal
bone and sends a slip to the base
of the 3rd metacarpal bone

• Nerve
- Median nerve

• Functions
- Flexion of the wrist

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Palmaris Longus
• Origin(proximal)
- Arises from the medial epicondyle of the
humerus by the common flexor tendon and
the antebrachial fascia

• Insertion(distal)
- Inserts into the anterior aspect of
the distal flexor retinaculum
and into the palmar aponeurosis

• Nerve
- Median nerve

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

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Flexor Carpi Ulnaris
• Origin( proximal)
- Humeral head : arise from the medial epicondyle
of the humerus by the common flexor tendon
- Ulnar head : arises from the medial margin
of the olecranon and posterior border
of the ulna

• Insertion (distal) :
- pisiform bone, an extension
of its ligament attaches to the hook of the
hamate and base of the 5th metacarpal.
Several of its fibers also attach to the
flexor retinaculum

• Nerve
- Median nerve

• Functions
- Flexes and adducts the hand of the wrist
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 Extensor Carpi Radialis Longus
• Origin (proximal)
- Lateral supracondylar ridge
of the humerus

• Insertion( distal)
- Attaches to the base of the
2nd metacarpal

• Nerve
- Radial nerve

• Function
- Extends and abducts the hand at
the wrist

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Extensor Carpi Radialis Brevis
• Origin (proximal)
- Lateral epicondyle of the humerus

• Insertion(distal)
- Base of the 3rd metacarpal bone

• Nerve
- Radial nerve (PIN)

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

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Extensor Carpi Ulnaris
• Origin (proximal)
- One head arises from the lateral
epicondyle of the humerus
- The other, from posterior
border of the ulna.

• Insertion(distal)
- Attaches to the medial side of
the base of the 5th metacarpal

• Nerve
- Radial nerve(PIN)
• Function
- Extends and adducts the hand at the
wrist

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Blood Supply - Arteries

• Radial artery
• Palmar carpal branch
• Superficial palmar
arch

• Ulnar artery
• Superficial palmar
arch
• Deep palmar arch

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Superficial Palmar
Arch
1) Ulnar artery
2) Sf. Palmar arch
3) Deep branch of
ulnar artery
9) Ulnar palmar
digital artery of
little finger
8) Common palmar
digital arteries
7) Sf.palmar branch
of radial artery

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Deep Palmar
Arch
1. Radial artery
2. Deep Palmar arch
3. Deep palmar
branch of ulnar
artery
4. Palmar metacarpal
artery
5. Perforating
branches
6. Princeps pollicis
artery
7. Radial index artery

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
 1) Palmar digital arteries
2) Proximal transverse palmar arch
Palmar Digital Arteries 3) Middle transverse palmar arch
4) Distal transverse palmar arch
5) Matrix arches
6) Longitudinal arteries
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Dorsal Carpal Branch

1) Radial artery
2) Dorsal carpal
branch
3) First dorsal
metacarpal artery
5) Dorsal metacarpal
artery
6) Dorsal digital
arteries
7) Dorsal carpal
branch of ulnar
artery
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Palmar Digital Artery Of
The Thumb
1) Princeps
pollicis artery
6) Palmar digital
artery
7) Proximal
transverse
palmar arch
8) Distal
transverse
palmar arch

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Blood Supply - Veins
• Dorsal (superficial)
• Dorsal metacarpal vein
• Proximal venous arch of the digits
• Central metacarpal venous arch
• Palmar (deep )
• Natatory vein
• Intercapitular vein
• Sup.palmar venous network
• Lateral palmar vein of the digits

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Venous Drainage Of
Thumb
1) Distal venous arch
2) Proximal venous
arch
3) Midline vein
4) Lateral vein
5) Middle metacarpal
venous arch
6) Central palmar veins
7) Lateral palmar vein
8) Oblique
communicating vein
9) Cephalic vein

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Dorsal Veins Of Hand And
Wrist
1) Dorsal metacarpal
vein
2) Proximal venous
arch of the digits
3) Central metacarpal
venous arch
4) Basilic vein
5) Cephalic vein
6) Inter capitular
vein

Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby
Yu, H.L, Chase, R.A, & Strauch, B.(2004). Atlas of hand anatomy and clinical implications. St.Louis, Missouri: Mosby