CHAPTER 18 : The Joints of the wrist , hand and fingers

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Skin and fascia
  • Thick on the palmar side and loose dorsal side

  • A fibrous subcutaneous tissue overlies the thick aponeurosis

  • The Palm has flexor lines (creases) and papillary ridges to improve grip

 
Palmar aponeurosis
  • The palmar aponeurosis is reinforced by fibers from palmaris longus tendon

  • It is a continuation of the flexor retinaculum. Distally divided into longitudinal slips which diverge to the fingers

  • Its modifications include:

    • Thickened central part

    • Medial septum to 5 th metacarpal

    • Lateral septum to 1 st metacarpal

    • Thickened to form superficial transverse
      metacarpal ligaments at level of metatarsal heads

    • Inserts onto the fibrous flexor sheaths

    • Distal attachment to the dermis via creases

    • Digital nerves and vessels, lumbrical tendons pass between distal slips

    • Palmaris brevis attaches to it

    • Thinned over the thenar and hypothenar eminences

    • Contracted in Dupuytrens contracture resulting in flexed ring and little fingers
Also note the following:-
  • The dorsal venous network lies beneath skin of the back of hand, superficial to extensor tendons

  • The Network drains into cephalic (radial side) and basilic (ulnar side) veins

  • Beyond the extensor retinaculum, extensor tendons spread out over the hand

  • Tendons are connected by oblique fibers (intertendinous connections)