Mediallv: extensor pollicis longus.
Laterallv: abductor pollicis longus & extensor pollicis brevis.
Content: radial artery, cephalic vein, trapezium, scaphoid.
Fracture scaphoid (commonest frA$ure of carpal bone):
. Swelling & tenderness in {fie anatomical snuff box.
o Avascular necrosis & non-union are common complications.
Stf g ) Thick band stretches distat to wrist joint.
, Mediallv ) attached to pisiform bone & hook of hamate.
, Laterallv ) tubercle of scaphoid bone & crest of trapezium.
. Superiorlv )to the deep fascia of the forearm.
, lnferiorlv )central portion of palmar fascia.
SUPERFlCIALLYtredialto taterat) r{r,.'.
3. Palmar cutaneous branch of ulnar nerve.
4. Tendon of palmaris longus muscle.
5. Palmar cutaneous branch of median nerve.
N.B. Radial artery does not pass superficialto flexor retinaculum
Df gp TO lT The carpaltunnet containing:
1. Flexor digitorum superficialis tendons.
2. Flexor digitorum profundus tendons.
3. Ulnar bursa enclosing flexor digitorum superficialis. & profundus tendons
(tendons of superficialis are arranged in two starta).
4. Flexor pollicis longus tendon.
5. Radial bursa enclosing flexor pollicis longus tendon.
7. Flexor carpi radialis tendon & its synovial sheath (SPECIAL CANAL).
Thickened part of deep fascia which covers the extensor tendons
The space is divided by 5 septa into 6 compartments:
. 1"t comp: Abductor pollicis longus & Extensor
. 2nd comp: Extensor carpi radialis longus &
Extensor carpi radialis brevis
, 3'd comp: Extensor pollicis longus.
. 4th comp: Extensor digitorum (4 tendons) &
Extensor indices (ant. interosseous A + post.
sth comp: Extensor digiti minimi.
6th comp: Extensor carpi ulnaris.
Structures superficial to the retinaculum
o 2 Veins: cephalic vein (lateral) & basilic vein (medial).
o 2 Nerves: Superficial branch of radial nerve (lateral) & dorsal branch of
It is the subcutaneous compartment which is related to the palmar
surface of the distal phalanx,
It is closed proximally by a fibrous septum at the level of epiphyseal line
It is separated from the distal volar space by a deep fascia.
- Fibrous tissue septa, which extends from the skin to periosteum.
- Digital artery which gives epiphyseal branch before it enters the space.
S.Ufgip.A.L.!mpg..tknge..: Pulp space infection may lead to osteomyelitis of
the terminal phalanx except epiphysis.
o Triangular region between the dorsum & ventral skin present at the bases
o They contain: fat, digitalvessels & nerves, lumbricals & interossei.
o They communicate with mid-palmar & thenar spaces.
o Anterior ) thenai muscle, radial bursa, and flexor pollicis longus.
o Posterior ) adductor pollicis & 2'd & 3'd metacarpals.
. Medial ) deep mid palmar space (separated from it by a fibrous septum
extending from palmar aponeurosis to 3'o metacarpal bone'
o Distal ) extends to the web of the thumb.
Anterior ) middle part of palmar aponeurosis.
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d pattEr apo0am6bb 3rd mohcflEl
It is a contracture of palmar aponeurosis.
It leads to flexion of MP joint & sometimes
It is seen in patients with liver cirrhosis.
- Synovial sheath of the middle 3 fingers
Each finger of these has a separate synovial sheath.
- At the level of metacarpo-phalangeal Joint.
Distal end ) at base of distal phalanges.
They enclose the flexor tendons.
Anterior) flexor tendon of the medial 3 fingers & ulnar bursa.
Posterior ) fascia covering the interossei & 3'0, 4tn & 5th metacarpals.
Lateral ) fibrous band from palmar aponeurosis to 3'd metacarpal.
Distally ) 3 lumbrical canals to the medial 3 webs.
Medially ) separated from hypothenar muscles by mediar parmar
; Synovial sheath of the thumb &little fingers
. Proximally they continue with radial & ulnar bursae, respectively.
Distally connected with synovial
Proximally ) runs below the flexor retinaculum ) extends 1" in the forearm
Envelops the flexor tendons of - Envelops the tendon of flexor pollicis
- Distally connected with synovial
Elrouhl *lmtft ot tg0n ol lsrd
{// p(olund{6 tetdors / ar, tumbrids
BeOtruSl at the outer border of 1't rib as a
continuation of subclavian artery.
EttOSl at the lower border of the teres major
Pectoralis minor divides axillarv arterv into 3 parts:
o Lies above the pectoralis minor muscle.
. !!rang@: superior thoracic artery.
. Lies behind pectoralis minor.
1- Thoraco-acromial artery (pierce clavi-pectoral fascia).
2- Lateral thoracic artery (supplies ! breast).
o Lies below pectoralis minor.
o Lies medial to the short head of biceps & coracobrachialis.
. Eelallon: (see diagram) .@i. Sub-scapular: give circumflex scapular (anastomosis around
ii. Posterior circumflex humoral: around the surgical neck.
iii. Anterior circumflex humeral: around surgical neck and gives
branches to the shoulder joint.
o The incision used to expose the subclavian artery in the neck can be
extended across the clavicle into the delto-pectoral groove.
. A sub-clavicular incision 1 cm below the clavicle (started at the junction of
the medial %wifh the outer Yo of lhe clavicle & extended for 6 cm laterally).
BeCtruS I nt tfre lower border of teres major.
EttOS I in the cubital fossa opposite the neck of radius by dividing into radial & ulnar
' Lies on anterior aspect of Triceps, coracobrachialis & brachialis muscles.
, ln the cubitalfossa, it is crossed by the median cubital vein.
. lt is crossed by the median nerve.
- Ascending branch ) shares in the anastomosis
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