Human Anatomy Vol 1

(mdmrcog) #1
UPPER LIMB

Digital nerves
Palmar aponeurosis
Superficial palmar arch
Tendons of flexor digitorum
superficialis

Hypothenar muscles

Tendons offlexor
digitorum profundus

Dorsal subaponeurotic space

Dorsal subcutaneous space
Fig. 9.52:

Septum
Thenar muscles

Tendon of flexor pollicis longus

Flexor tendons to index finger
Thenar space
Midpalmar space

Thenar, midpalmar, dorsal subcutaneous and dorsal subaponeurotic spaces

Transverse head oi
adductor pollicis

Oblique head
of adductor
pollicis
Fascia over interossei
Fig. 9.53: Muscles forming floor of the thenar and midpalmar
spaces

The forearm space may be infected through
infections in the related synovial sheaths, esPecially of
the ulnar bursa. Pus points at the margins of the distal
part of the forearm where it may be drained by giving
incision along the lateral margin of forearm.

SYN IAt SHEATHS
Many of the tendons entering the hand are surrounded
by syrrovial sheaths. The extent of these sheaths is of
surgical importance as they can be infected (Fig.9.7).

Digitol Synoviol Sheoths
The synovial sheaths of the 2nd,3rd and 4th digits are
independent and terminate proximally at the levels of
the heads of the metacarpals. The symovial sheath of
the little finger is continuous proximally with the ulnar
bursa, and that of the thumb with the radial bursa.

Therefore, infections of the little finger and thumb are
more dangerous because they can spread into the palm
and even up to 2.5 cm above the wrist.

Ulnor Burso
Infection of this bursa is usually secondary to the
infection of the little finger, and this in turn may spread
to the forearm space of the Parona. It results inanhour-
glass swelling (so called because there is one swelling in
the palm and another in the distal part of the forearm,
the two being joined by a constriction in the region of
the flexor retinaculum). It is also called compound
palmar ganglion.

Rodiol Burso
Infection of the thumb may spread to the radial bursa'

Surgicol Incisions
The surgical incisions of the
Fig. 9.54.

hand are shown in

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This section deals mainly with the extensor retinaculum
of the wrist, muscles of the back of the forearm, the
deep terminal branch of the radial nerve, and the
posterior interosseous artery.

Surfoce Londmorks
1 The olecranon process of the ulna is the most
promine
(Fig. e.1)
with the
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