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medial epicondyle is known as the common flexor origin (CFO) and the
lateral epicondyle is known as the common extensor origin (CEO;

carpo-metacarpal joints
metacarpophalangeal joints
interphalangeal joints

a trapezoid
b tubercle of trapezium
c trapezium
d tubercle of scaphoid
e scaphoid
f wrist joint
g radius
h ulna
i lunate
j riquetrum
k pisiform
l hamate
m hook of hamate
n capiate

Sprained wrist: t occurs after a fall on an outstretched hand stretches or tears theligaments of the wrist. A wrist strain or sprain will cause pain, tenderness, and swelling around
the wrist after a fall. It will be red, tender and warm to the touch. There may be bruising, decreased range of motion, and a dull deep ache in the wrist.
Tendonitis:  of wrist is an irritation and swelling of the tissue or 'tunnel' which surrounds the tendons of the wrist. Pain in the front of the wrist is a common symptom of tendonitis. Bending and
extending the wrist is usually painful and there may be swelling in the wrist. If the hand is made into a fist with the thumb tucked inside and the pain gets worse, the diagnosis is likely to be tendonitis. can be caused by biomechanical problems, injury to the arm, overuse,
Scaphoid fracturemost commonly fractured carpal bone. A fall on an outstretched arm often results in a fracture of the scaphoid bone in the wrist. This complex bone has limited blood supply from a small vessel that enters the most distal part of the bone and flows back through the bone to supply it.
The blood supply to the scaphoid can be easily disrupted by a fracture; Scaphoid fractures may heal  slowly or not at all

colles : falllin on wrist on extesion
distal fragement of radius is displaced dorsally ( in anatomial positon)
smith: falling on wrist on felxion, displaced anteriorly

like palmaris longus, palmaris brevis steadies and corrugates skin of palm to help with grip. Palmaris brevis is innervated by the superficial branch of ulnar
nerve (C8, T1) and it covers and protects the
ulnar nerve and artery

it results from progressive thickening and contracture of the palmar fascial bands which eventually causes flexion deformities of the fingers, usually in the fourth and fifth digits. as it thickens it   "shrinks" and produces a tightness in hand. It is an
autosomal dominant condition occurring more commonly in patients with diabetes, alcoholism, or epilepsy. Its incidence is higher in men and increases after age 45. Initial treatment is a corticosteroid injection into the thickened area of the palmar fascia, but if the hand cannot be placed flat on a table or,
especially, when significant contracture develops
at the PIP joints, surgery is usually indicated.

the thenar muscles (at the base of the
thumb), the hypothenar muscles (at the base of the 5th digit) and the short muscles of the hand, known as the
interosseous and lumbrical muscles.

deep branch of ulnar nerve (c8, 1)

These are the dorsal and palmar interosseous muscles and the lumbrical muscles. Acting together
these muscles produce flexion at the metacarpophalangeal (MCP) joints and extension of the proximal
and distal interphalangeal (IP) joints.

a attached to dorsal hood
b 1st and second lumbricoids ( unipennate)
c flexor pollicis longus nedon
d flexor retinaculum
e 3rd and 4th lumbricoids (bipennate)
f felxor digitorum profundus tendon
g flexor digitorum superficialis tendon
h deep transverse metacarpal ligament

origin tendon of felxor digitorum profundus
attachment lateral sides of extensor expansion of digits 2 to 5
1 and 2: median nerve (cd8, t1)
3, 4: deep branch of ulnar nerve (c8, t1)

flexes digits at
metacarpophalangeal
joints & extends
interphalangeal joints

origin from metarparpals insert into Extensor expansions
& bases of proximal phalanges of digits 2-
4
supplied by ulnar nerve
DAB3; abducts middle 3
digits & assists
lumbricals in flexing the
interphalangeal joints

palmar surfaces of
2nd, 4th & 5th
metacarpal bones
Extensor expansions
of digits & bases of
proximal phalanges
of digits 2,4, & 5
PAD; adducts digits &
assists lumbricals in
flexing the
interphalangeal joints
deep branch of ulnar nerve (c8, t1)

inflammation of the fluid-filled sheath (called the synovium) that
surrounds a tendon.
Symptoms of tenosynovitis include pain, swelling, and difficulty moving the particular joint where the inflammation occurs. The tendons of the 2-4th fingers have separate
synovial sheaths, so an infection in any one of these sheathes does not spread, unlike the case of the 5th digit where infection can spread through the sheaths travelling through the palm, carpal tunnel and even into the anterior forearm. Likewise an infection or tenosynovitis in the thumb can spread via the continuous sheath of flexor pollicis longus

a x
b anterior interosseous artery
c ulnar artery
d dorsal carpal
e palmar carpal
fdeep parlmar arch
g suerpficial parlmar arch (terminal branch of ulnar artery)
h parlmar metacarpal arteries
icommon palmar digital arteries
j proper palmar digital arteries
k radialis indices artery
l deep palmar arch
m principes pollicis artery
n superficial palmar arch
o palmar carpal branch
p radial artery
Q mainl radial artery supply
R mainz ulnar arterial supply

The radial nerve does
not supply any muscles
in the hand – it is
entirely sensory.
supply the skin and
fascia over the lateral 2/3
of the dorsum of the
hand, i.e. the dorsum of
the thumb and dorsal
surface of the proximal
parts of the lateral 11/2
digits.

- a recurrent branch to
the thenar muscles
- branches to the 1st
and 2nd lumbrical
- digital nerves to the
skin and nail beds of
the lateral 31/2 digits
- a palmar branch
which is superficial to
the flexor retinaculum
and supplies the skin
of the central palm area

a lateral two lumbical muscles
b flexor pollicis brevis
c abducotr pollcis brevis
d recurrent branch of median nerve
e median nerve
f palmar branch of median nerve
g digital nerves of median nerve

Proximal to the carpal tunnel the ulnar nerve divides to give a :
Palmar cutaneous branch which passes superficial to the flexor retinaculum and palmar aponeurosis to supply the skin on
the medial side of the dorsum of the hand, the dorsum of the 5th finger and half of the 4th finger.
Distal to the carpal tunnel it divides into a superficial and deep
branch: the superficial branch gives off cutaneous branches to supply the anterior surface of the medial 1 1/2 fingers. The deep branch supplies the hypothenar muscle, the medial 2 lumbricals, adductor pollicis, flexor pollicis brevis and all the interossei.

a c3
b c4
c t2
d t1
e c6
f c7
g c8
h c5

a hypothenar muscles
a1 flexor digiti minimi brevis
a2 opponens digiti minimi
a3 abductor digiti minimi
b thenar muscles
b1 flexor pollicis brevis
b2 opponens pollicis
b3 abductor pollicis brevis
c recurrent branch of median nerve
d flexor pollicius brevis and abductor pollicis brevis insert both into the lateral side ot hte extensor hood
e extensor hood
f adducor pollicis and first palmar interosseos insert into the medail side of the extensor hood.
g deep branch of ulnar artery and nerve
h flexor carpi ulnaris
i median nerve
j flexor retinaculum

The muscles of the thenar eminence are all innervated by the recurrent branch of the
median nerve (c8, t1)

Flexor retinaculum;
tubercles of scaphoid &
trapezium bones

The muscles of the hypothenar eminence (listed below) are all innervated by the deep branch of the ulnar
nerve and they are mainly responsible for moving the little finger.

commonest
fractures in children and the elderly.
-a distal radial fracture with dorsal displacement,
which may also involve the ulna.

fracture of the distal radius where the
radial fragment is displaced anteriorly
and the fracture does not extend into the
joint.

Answer

• Medially: pronator teres
• Laterally : brachioradialis and supinator
• Supero-posteriorly: brachialis
• Base: an imaginary line drawn between the two humeral epicondyles

pronation:
Pronator teres (superficial muscle powerful) Pronator quadratus (deep muscle weaker )

supination
Biceps (superficial and powerful)
Supinator (deeper less powerful

Superficial group (pronator teres, flexor carpi radialis, palmaris longus, flexor carpi
ulnaris)
2. Intermediate ‘group’ (flexor digitorum superficialis).
3. Deep group (flexor digitorum profundus, flexor pollicis longus and pronator quadratus)
Superficial flexors

medial epicondyle of the humerus

Medial epicondyle of humerus & coronoid process of ulna
to Middle of lateral surface of radius
Median n (C6 & C7)
Pronates forearm & flexes

Medial epicondyle of humerus to Base of 2nd
metacarpal bone
Flexes hand and
abducts it
median nerve c6, 7

Medial epicondyle of humerus to  Distal half of flexor
retinaculum  & palmar
aponeurosis
Median n (C7 &
C8)
Flexes hand and
tightens palmar
aponeurosis

Humeral head:
Medial epicondyle
of humerus;
Ulnar head:
olecranon &
posterior border of
ulna
to Pisiform,
hook of
hamate, 5th
metacarpal
Ulnar n (C7 &
C8)
Flexes hand and
adducts it

Humeroulnar head:
Medial epicondyle
of humerus, coronoid process of
ulna;
Radial head:
superior half of
anterior border of
radius to
Bodies of middle phalanges of medial 4 digits
Median n (C7,
C8 & T1)
Flexes middle
phalanges of 4
medial digits;

Flexor digitorum
profundus
(FDP)
Proximal ¾ of
medial and anterior surfaces of ulna & interosseous membrane
tp Bases of distal phalanges of medial 4 digits
Medial part :
ulnar n (C8 &
T1) ;
Lateral part :
median nerve
(C8 & T1) ;
Flexes distal
phalanges of 4
medial digits;
assists with
flexion of the hand

Anterior surface of radius & adjacent interosseous membrane
to Base of distal phalanx of thumb
Anterior  interosseous nerve from median (C8 and T1)
Pronates
forearm; deep
fibres bind radius
and ulna together

Distal anterior surface of ulna to Distal anterior surface of radius
Pronates
forearm; deep
fibres bind radius
and ulna
together
Anterior
interosseous
nerve from
median (C8
and T1)

lateral supraepicondylar ridge of humerus and adjacent inter-muscular septum to  Lateral surface of distal end of radius
Radial nerve [C5,C6] before division into superficial and deep branches Accessory flexor of elbow joint when forearm is mid-pronated

A group of five superficial extensors each takes origin from
the lateral epicondyle of the humerus (the common extensor origin).

Lateral epicondyle of humerus to lateral  surface of olecranon &
superior part of posterior surface of ulna
Radial n (C7,
C8 & T1)
Assists triceps in
extending elbow joint;
stabilizes elbow joint;
abducts ulna during
pronation.

lateral epicondyle of humerus to Base of 2nd
metacarpal
Radial n (C6
& C7)
Extend & abduct

lateral humarl epicondyle to Base of 3rd
metacarpal bone
Deep branch
of radial n
(C7 & C8)
extends and abductts

lateral epicondyle to of medial 4 digits
Posterior
interosseous
n. (C7 & C8),
a branch of
the radial n.
Extends medial 4
digits at
metacarpophalangeal
joints; extends hand
at wrist joint

lateral humearl epiconyle to 5th digit
Extends 5th digit at
metacarpophalangeal
and interphalangeal
joints

Posterior
interosseous
n. (C7 & C8),
a branch of
the radial n.

Lateral epicondyle of humerus & posterior border of ulna to
Base of 5th
metacarpal
Extends and adducts
hand at wrist

Posterior
interosseous
n. (C7 & C8),
a branch of
the radial n

tendon of extensor pollicis longus and the
tendon of extensor pollicis brevis.
Also note the radial artery within the anatomical
snuff box.

Lateral epicondyle of humerus, radial collateral and annular  ligaments, supinator fossa & crest of ulna to
Lateral, posterior & anterior surfaces of proximal 1/3 of radius
Deep branch
of radial n
(C5 & C6)
Supinates forearm

Posterior surfaces of ulna, radius & interosseous
membrane to
Base of 1st metacarpal bone
Posterior interosseous n. (C7 & C8), a branch of the radial n.
Abducts thumb &
extends it at
carpometacarpal
joint

Posterior surfaces of middle 1/3 of ulna & interosseous membrane
to Base of distal phalanx of thumb
Extends distal phalanx of thumb at metacarpophalange al and
interphalangeal
joints

Posterior
interosseous
n. (C7 & C8),
a branch of
the radial n.

Posterior surfaces of ulna & interosseous membrane to Extensor
expansion
of 2nd digit
Extends 2nd digit &
helps to extend
hand

Posterior
interosseous
n. (C7 & C8),
a branch of
the radial n.

-arises when the space available in the tunnel is reduced,
-this could be due to damage to the tunnel itself or to the flexor retinaculum, or due to enlargement of one or more of the structures travelling through it
- The median nerve is usually most affected and become compressed in the tunnel;

Posterior surfaces of
radius & interosseous membrane to
Base of
proximal
phalanx of
thumb
Extends proximal
phalanx of thumb at
carpometacarpal
joint

Posterior
interosseous
n. (C7 & C8),
a branch of
the radial n.