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

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Hand innervation

Main nerves; ulnar, radial, median, cutaneous nerves


Ulnar nerve

Passes anterior to flexor retinaculum and divides into superficial and deep branches
Superficial: supplies palmaris brevis and medial one and half fingers
Deep branch- this arches deep in the concavity of the deep palmar arch and gives motor braches to

  • hypothenar muscles
  • medial two lumbricals
  • 8 interrossei
  • deep head of flexor pollicis brevis
  • heads of adductor hallucis

Ulnar nerve injury presents with

  • Claw hand
  • Loss of sensation medial one and half fingers
  • Loss of finger abduction
  • Loss of finger adduction
  • Atrophy of hypothenar eminence and inter-metatarsal spaces



Median nerve

  • Deep to flexor retinaculum
  • Gives a recurrent branch to thenar muscles
  • The nerve then gives a medial and a lateral branches
  • The medial branch gives 2 common digital for 2nd and 3rd clefts and sides of ring middle and index fingers.
  • The lateral supplies palmar skin, radial side of index and whole of the thumb on the palmar surface and distal dorsal surface.
    The branch to the index finger supplies the 1 st lumbrical

Medial nerve injury

  • The hand position is described “papal hand”
  • There is loss of sensation on the palmar medial three and half fingers to include their nail beds
  • Loss of opposability with atrophy of thenar muscles.


Radial nerve

  • It is a continuation of superficial terminal branch

  • At dorsum of hand it divides into 4-5 dorsal digital branches

  • Supplies lateral three and half fingers on the dorsal side except the nail beds