Ανατομία και Βιομηχανική

Παρουσίαση με θέμα: "Ανατομία και Βιομηχανική"— Μεταγράφημα παρουσίασης:

1 Ανατομία και Βιομηχανική
dsfsf Καρπός - Άκρα χείρα dsfsf dsfsf Ελευθερία Θωμαΐδου, Pt

2 Μαθησιακά Αποτελέσματα
Κατανόηση βασικών στοιχείων ανατομίας και βιομηχανικής του καρπού Οστικά σημεία Αρθρώσεις Μύες Σύνδεσμοι Κατανόηση βασικών στοιχείων παθο-ανατομίας Must understand proximal, distal, medial, lateral, plantar, dorsal structure and function of bones, joints, tendons, ligaments and muscles.

3 Οστά αντιβραχίου Κεφαλή κερκίδας Ωλέκρανο Αυχένας Κορωνοειδής απόφυση Κερκιδικό όγκωμα Όγκωμα της ωλένης Λοξή γραμμή Πρόσθια επιφάνεια Πρόσθιο χείλος Μεσόστεο χείλος Μεσόστεο χείλος Στυλοειδής απόφυση ωλένης Στυλοειδής απόφυση Ωλένια εντομή NMS

4 Οστά καρπού και άκρας χειρός
Κερκίδα & Ωλένη The lower ends of the radius and ulna form a shallow mortice into which three of the four bones of the proximal row of carpals – scaphoid, lunate and triquetral – fit. The fourth bone in the proximal row, the pisiform, lies anterior to the triquetral. Distally, the proximal row of carpal bones forms another concavity for the reception of the second row of carpal bones – the trapezium, trapezoid, capitate and hamate. The capitate is the largest of the four and fits snugly into the deepest part of the concavity, being in contact with all the carpal bones expect the pisiform, triquetral and trapezium.

5 NMS

6 Οστά καρπού και άκρας χειρός
Οστά 1ου στίχου Οστά 2ουστίχου Αγκιστρωτό Κεφαλωτό Έλασσον Πολύγωνο Μείζον πολύγωνο Πισοειδές Πυραμοειδές Μηνοειδές Σκαφοειδές Καρπιαίο τόξο( καμάρα) Σχηματίζεται από το σκαφοειδές-μείζον πολύγωνο και πισοειδές –αγκιστρωτό + εγκάρσιο σύνδεσμο του καρπού καρπιαίο σωλήνα Scaphoid – the peanut-shaped bone is the most commonly fractured carpal. It is located on the radial side of the hand, distal to the styloid process of the radius. Although the scaphoid forms the floor of the tendinous anatomical snuff box [wrist in neutral position, ask your partner to extend her thumb, just distal to the styloid process of the radius will be a small trough formed by the surrounding tendons. This is the anatomical snuff box. Posterior border - extensor pollicis longus, anterior border (closest to the edge of the hand) is a pair of parallel and intimate tendons, of the extensor pollicis brevis and the abductor pollicis longus]. It is still accessible from the dorsal, palmar and ulnar sides of the wrist. Beginning on the wrist’s radial surface, locate the radius’ styloid process. Slide your thumb distally off the process, falling between the superficial tendons and into the natural ditch where the scaphoid will be found. Maintain your position and passively adduct the wrist. As you do so, feel for the scaphoid to bulge into your thumb. Now abduct the wrist and feel how the scaphoid disappears back into the wrist. From here, explore the scaphoid’s dorsal and palmar surfaces. On the palmar surface, along the flexor crease, is the scaphoid tubercle. Lunate – this bone is the most frequently dislocated carpal. Located just distal to Lister’s tubercle (found on the dorsal surface of the radial styloid process. With its oblong shape, Lister’s tubercle acts as a hook for the extensor pollicis longus tendon. Locate the styloid process of the radius; slide your thumb over to the dorsal surface of the process. The tubercle will be felt directly across from the head of the ulna – perhaps an inch away. To check you are in the right place – the bump should fell superficial, oval and across from the head of the ulna. If you passively flex and extend the wrist, the tissue over the tubercle should move, yet the tubercle itself should stay stationary. Ulna head – slide your fingers distally along the ulnar shaft. Just proximal to the wrist, the shaft will bulge to become the head of the ulna). It is relatively inaccessible when the wrist is in a neutral position; flexing the wrist, however, will slide the lunate to the dorsal surface. Capitate – this is the largest of the carpals and is located distal to the lunate. It has a shallow ditch on it dorsal surface that can be easily palpated. Lunate & Capitate – Although this bone lies deep to the extensor tendons, both carpals are accessible on their dorsal surfaces and can be isolated between Lister’s tubercle and the shaft of the 3rd metacarpal. Locate the Lister’s tubercle and the base of the 3rd metacarpal. With the wrist slightly extended, lay your thumb between these points and notice how it falls into a small cavity. This is the location of the lunate and capitate. Set your thumb at the proximal end of this cavity. Then flex the wrist and feel the lunate press into your finger. Next extend the wrist and feel this carpal disappear back into the wrist. Shift your thumb to the distal end of the cavity and notice how it bumps into the base of the 3rd metacarpal. Passively flex the wrist, noting how the capitate rolls into your finger ‘filling’ its own cavity. Triquetrum – pyramid shaped bone is located on the dorsal surface of the pisiform, just distal to the styloid process of the ulna. In a neutral position only the dorsal surface of the triquetrum is palpable; however abduction shifts the triquetrum so it is accessible on the wrist’s ulnar surface. With the palm of the hand facing away from you locate the styloid process of the ulna (process is sharp and more pronounced. It is a tooth-like projection pointing distally off the head of the ulna. It is located on the posterior, medial side of the wrist. These are both superficial and the tendons of the forearm muscles pass beside them. Shake hands with your partner. Passively adduct the wrist to soften the surrounding tendons. Use your thumb to locate the posterior aspect of the ulnar head. Slide distally off the head to palpate the small tip of the styloid process). Slide distally noting a slender ditch, before rising to the surface of the triquetrum. Keeping your finger stationary, abduct (radial) the wrist and note how the bone protrudes to the side. Adduct (ulnar) and feel the bone disappear back into the wrist. Pisiform – the knobby pisiform is an attachment site for the FCU, protruding along the ulnar/palmar surface of the wrist, the pisiform is just distal to the flexor crease. Locate the flexor crease of the wrist, then slide over to the ‘pinky’ side of the crease. Move slightly distal to the crease rolling your thumb pad in small circles. Explore under the thick tissue of the palm for a nugget like pisiform. Passively flex the wrist and notice how the pisiform can be wriggles from side to side. Extend the wrist and observe how it becomes immobile – due to the tension creased by the FCU). Trapezium – located distal to the scaphoid, the small trapezium articulates with the base of the 1st metacarpal. This articulation, the first metacarpophalangeal joint, is the source of the thumb’s unique movements. The trapezium is most accessible on its radial or dorsal side, and can be isolated either distally from the scaphoid or proximally from the 1st metacarpal. Palpating along the hand’s radial/dorsal side, locate the scaphoid. Then slide distally. You may, by accident, pass the trapezium and ride up onto the base of the 1st metacarpal. If so, simply slide back proximally to the trapezium. To check if you are feeling the base of the 1st metacarpal instead of the trapezium, ask your partner to slowly flex and extend his thumb. With this action, the base of the 1st metacarpal should clearly move. Trapezoid – distal part of the 2nd metacarpal, following it proximally until you reach the trapezoid Hamate (hook of hamate) – located distal and lateral to the pisiform, the hamate has a small protuberance or ‘hook’ that is palpable on the hand’s palmar surface. The pisiform and the hook serve as attachment sites for the flexor retinaculum, the connective tissue band that forms the ‘roof’ of the carpal tunnel. The flat surface of the hamate’s body is accessible on the hand’s dorsal surface where the bases of the 4th and 5th metacarpal merge. When palpated the hook is often tender. Locate the pisiform, draw an imaginary line from the pisiform to the base of the 1st finger. Using your thumbpad, slide off the pisiform along this line, approximately half an inch from the pisiform, explore for this subtle mound beneath the padding on the hand.

7 Οστά καρπού και άκρας χείρας
Μετακάρπια( βάση, διάφυση, κεφαλή Φάλαγγες ( 3 σε κάθε μετακάρπιο πλήν αντίχειρα) The metacarpals are miniature long bones lying distal to the carpals: that for the thumb articulating with the trapezium; the second mainly articulating with the trapezoid; that for the middle finger mainly articulating with the capitate; and the fourth and fifth articulating with the hamate. Each metacarpal head articulates with a proximal phalanx. Each finger has a middle and a distal phalanx, the thumb just a distal phalanx.

8 Έκταση Καρπού Κάμψη καρπού
Anterior Forearm Muscles (incl. pronator teres (PT)*: Superficial & Deep Group. * - Are in the Superficial Group and arise from the medial epicondyle of the humerus by the Common Flexor Tendon. FDP and FPL comprise the deep compartment, FDP is innervated by both the Ulnar Nerve – medially and the Anterior Interosseous Nerve laterally. The FPL just the Ant. Inter. – a branch of the Median Nerve. Because of their close proximity, individual identification of the muscles of the forearm is difficult. The point of greatest clarity is where their tendons cross the wrist joint; consequently most muscles will be identified at this point and then traced proximally. Έκταση Καρπού Κάμψη καρπού

9 Ωλένια Απόκλιση Κερκιδική Απόκλιση

10 Κάμψη Δακτύλων Έκταση Δακτύλων Απαγωγή δακτύλων Προσαγωγή Δακτύλων

11 Έκταση αντίχειρα Κάμψη Αντίχειρα

12 Απαγωγή Αντίχειρα Προσαγωγή αντίχειρα

13 Αρθρώσεις Καρπού και άκρας χείρας
Αρθρώσεις: Κάτω κερκιδωλενική Πηχεοκαρπική Μεσοκαρπική Καρπομετακάρπια Μετακαρποφαλαγγική Μεσοφαλαγγική UH/IST NMS 2

14 Αρθρώσεις Καρπού Πηχεοκαρπική (διάρθρωση)
Πηχεοκαρπική (διάρθρωση) Το περιφερικό άκρω της κερκίδας και του αρθρικού δίσκου ( τρίγωνου διάρθριου χόνδρου) που καλύπτει την ωλένη, με το σκαφοειδές, το μηνοειδές και το πυραμοειδές οστό του καρπού. The wrist joint is formed by the inferior surface of the lower end of the radius and a interarticular disc superiorly and the proximal surfaces of the scaphoid, lunate and triquetral inferiorly, which together with the ulnar and radius styloid processes forma synovial ellipsoid joint. All joint surfaces are covered with articular cartilage and the joint is surrounded by a capsule, lined with synovial membrane and supported by the palmar and dorsal radiocarpal, ulnacarpal, radial and ulnar collateral ligaments. The interarticular disc lies between the inferior surface of the head of the ulna and the triquetral bone. The surface marking of the wrist joint is a line drawn between the tips of the two styloids processes, being slightly concave distally, with the line becoming increasingly curved as it approaches the styloid processes. RADIO – CARPAL JOINT – A synovial Condyloid/Ellipsoid joint the surface of which consists of the distal surface of the radius and the lower surface of an articular disc of the Inferior Radio – Ulnar Joint. In the measure of 2/3’s radius to 1/3 disc. This forms a concave receiver for the ovoid convex distal joint surface formed by the proximal bones of the carpus and their interosseous ligaments. The disc is surrounded by the Dorsal and Palmar radio – ulnar ligament. A capsule surround the joint & is attached to all bony surfaces with a distinct synovium. The capsule is thicken laterally by Radial and Ulnar Collateral ligaments, which run from the radial and ulnar styloid processes to the scaphoid and the triquetrum respectively.

15 Τρίγωνος διάρθριος χόνδρος
UH/IST NMS 2

16 Οστά της άκρας χείρας Καρπομετακάρπιες αρθρώσεις: διάρθρωση ,
Explain DIPs and PIPs ITERPHALANGEAL – are Hinge joints – 9 in total Distal and Proximal – the same set-up as the foot with 2 in the each of the 2- 5 fingers & 1 in the Pollux. The head of each phalanx is pulley – shaped & matched by the corresponding bases of adj. Phalanges. Thus fingers cannot move sideways. Καρπομετακάρπιες αρθρώσεις: διάρθρωση , 1st = εφιππιοειδής Καρπομετακάρπιες αρθρώσεις Μετακαρπιοφαλαγγικές αρθρώσεις

17 Σύνδεσμοι του καρπού Παλαμιαίος κερκιδοκαρπικός Κερκιδικός( έξω) πλάγιος Παλαμιαίος ωλενιοκαρπικός ωλένιος( έσω) πλάγιος Ραχιαίος κερκιδοκαρπικός The Radial Collateral connects a bony process (styloid) of the Radius to two bones on the thumb side of the hand (scaphoid and trapezium). The Ulnar Collateral Ligament connects a bony process of the Ulna to two bones of the hand (pisiform and triquetrum) on the pinky side. Both the ulnar and the radius have styloid processes at their distal ends. The radius’ styloid process is larger and extends further distally. The ulna’s styloid process is sharper and more pronounced. It is a toothlike projection pointing distally off the head of the ulna. It is located on the posterior, medial side of the wrist. Both styloid processes are superficial and the tendons of the forearm muscles pass beside them. The Ulnar Collateral Ligament (ligamentum collaterale carpi ulnare; internal lateral ligament) is a rounded cord, attached above to the end of the styloid process of the ulna, and dividing below into two fasciculi, one of which is attached to the medial side of the triangular bone, the other to the pisiform and transverse carpal ligament. The Radial Collateral Ligament (ligamentum collaterale carpi radiale; external lateral ligament) extends from the tip of the styloid process of the radius to the radial side of the navicular, some of its fibers being prolonged to the greater multangular bone and the transverse carpal ligament. It is in relation with the radial artery, which separates the ligament from the tendons of the Abductor pollicis longus and Extensor pollicis brevis.

18 Μύες καρπού και άκρας χείρας
NMS

19 Κερκιδικό νεύρο: Μακρός και βραχύς κερκιδικός εκτείνων τον καρπό Κοινός εκτείνων τους δακτύλους Ωλένιος εκτείνων τον καρπό

20 Μακρός Κερκιδικός Εκτείνων του καρπού
Έκφυση Υπερπαρακονδύλια ακρολοφία κατάφυση Στη ραχιαία επιφάνεια της βάσης του 2ου μετακαρπίου και κάποιες φορές στου 1ου και 3ου Νεύρωση Κερκιδικό ν. Nerve supply Radial nerve (C6, 7). Actions Extension and, (particularly when acting together with flexor carpi radialis) IST/UH NMS2

21 Βραχύς Κερκιδικός Εκτείνων του καρπού
Έκφυση Παρακονδύλιο απόφυση, έξω πλάγιο σύνδεσμο Ο ΒΚΕΚ είναι ενας από τους 4 εκτείνοντες μύες που έχουν κοινή έκφυση (ωλένιος εκτείνων καρπού, εκτείνων του μικρού δακτύλου, εκτείνων τους δακτύλους, και ΒΚΕΚ) Κατάφυση Ραχιαία επιφάνεια της βάσης του 3ου μετακαρπίου. Κάποιες φορές έχει κατάφυση και στη βάση του 2ου μετακαρπίου. Νεύρωση Κερκιδικό ν. Nerve supply The posterior interosseous nerve, a branch of the radial nerve (C 7 , 8). Occasionally the nerve supply to the extensor carpi radialis brevis may come from the superficial branch of the radial nerve. Actions Extension and when acting together with flexor carpi radialis and extensor carpi radialis longus) IST/UH NMS2

22 Κοινός Εκτείνων τους Δακτύλους
Έκφυση Παρακονδύλιος απόφυση Κατάφυση Με ξεχωριστούς τένοντες στα 4 δάκτυλα Νεύρωση Κερκιδικό (Οπίσθιο μεσόστεο) ν.

23 Ωλένιος εκτείνων τον καρπό
Έκφυση Παρακονδύλιο απόφυση Κατάφυση Ραχιαίο και έσω χείλος βάσης του 5ου μετακαρπίου Νεύρωση Οπίσθιο μεσόστεο ν.

24 Εκτείνων του Μικρού Δακτύλου
Έκφυση Παρακονδύλιος απόφυση Κατάφυση Εκτατικό μηχανισμό μικρού δακτύλου Νεύρωση Οπίσθιο μεσόστεο ν.

25 Μακρός Απαγωγός Αντίχειρα
Έκφυση Οπίσθια επιφάνεια κερκίδας, ωλένης και μεσόστεο υμένα Κατάφυση Κερκιδικό χείλος της βάσης του 1ου μετακαρπίου Νεύρωση Οπίσθιο μεσόστεο ν.

26 Βραχύς Εκτείνων του Αντίχειρα
Έκφυση Κερκίδα και μεσόστεο υμένα κάτω από τον μακρό απαγωγό του αντίχειρα Κατάφυση Ραχιαία επιφάνεια της βάσης της πρώτης φάλαγγας του αντίχειρα Νεύρωση Οπίσθιο μεσόστεο ν.

27 Μακρός Εκτείνων του Αντίχειρα
Έκφυση Οπίσθιο-έξω χείλος ωλένης και μεσόστεος υμένας Κατάφυση Ραχιαία επιφάνεια της βάσης της 2ης φάλαγγας του αντίχειρα Νεύρωση Οπίσθιο μεσόστεο ν.

28 Μέσο νεύρο Κερκιδικός καμπτήρας του καρπού Μακρός Παλαμικός Επιπολής κοινός καμπτήρας δακτύλων Εν τω βάθει κοινός καμπτήρας δακτύλων Ωλένιο νεύρο: Ωλένιος καμπτήρας του καρπού Εν τω βάθει κοινός καμπτήρας των δακτύλων

29 Κερκιδικός καμπτήρας καρπού
Έκφυση Παρατροχίλιο απόφυση,περιτονία του πήχη κατάφυση Παλαμιαία επιφάνεις της βάσης του 2ου μετακαρπίου Νεύρωση Μέσο ν. Anterior Forearm Muscles (incl. pronator teres (PT)*: Superficial & Deep Group. * - Are in the Superficial Group and arise from the medial epicondyle of the humerus by the Common Flexor Tendon. FDP and FPL comprise the deep compartment, FDP is innervated by both the Ulnar Nerve – medially and the Anterior Interosseous Nerve laterally. The FPL just the Ant. Inter. – a branch of the Median Nerve. Because of their close proximity, individual identification of the muscles of the forearm is difficult. The point of greatest clarity is where their tendons cross the wrist joint; consequently most muscles will be identified at this point and then traced proximally. They are located on the forearm’s anterior/medial surface between the brachioradialis and the ulnar shaft. Most of the flexors originate as one mass from the common flexor tendon. As a group the flexors are thicker and more pliable than the extensors, difficult to isolate. The flexors are arranged in 3 layers. Superficial layer is formed by the long bellies of FCR, PL, FCU. The middle and deep layers contain the wide bellies of FDS and FDP, respectively. Each digitorum muscle has four thin tendons which pass through the carpal tunnel and attach at the phalanges.

30 Μακρός παλαμικός Δεν υπάρχει στο 20% του πληθυσμού. Όταν υπάρχει, εν δυνάμει αποτελεί πηγή τενόντιων μοσχευμάτων. Έκφυση Παρατροχίλιο απόφυση κατάφυση Παλαμιαία απονεύρωση Νεύρωση - Μέσο ν.

31 Ωλένιος καμπτήρας του καρπού
Έκφυση Παρατροχίλιο απόφυση, έσω χείλος ωλεκράνου, πρόσθιες περιτονίες αντιβραχίου κατάφυση Πισοειδές, άγκιστρο αγκιστρωτού, βάση 5ου μετακαρπίου Νεύρωση Ωλένιο ν.

32 Επιπολής κοινός εκτείνων τους δακτύλους
Έκφυση Παρατροχίλιο απόφυση, πρόσθιο τμήμα του έσω πλαγίου συνδ., έσω χείλος κορονοειδούς απόφ κατάφυση Μέση φάλαγγα 2ου-5ου δακτύλου Νεύρωση - Μέσο ν. ** Superficial Group - (incl. Brachioradialis) – Arise from the Common Extensor Origin on the lateral Epicondyle of the Humerous (except Brachioradialis). (not indicis) Indicis - The Deep Group includes Supinator and *** all of whom except Supinator are attached proximally to forearm bones alone, and arise from the back of the interosseous membrane and adj. bones.

33 Εν τω βάθει κοινός καμπτήρας των δακτύλων
Έκφυση Πρόσθια επιφάνεια ωλένης και μεσόστεος υμένας κατάφυση Τελική φάλαγγα 2ου-5ου δακτύλου Νεύρωση - Μέσο ν. για 2ο και 3ο δάκτυλο, ωλένιο ν. για 3ο και 4ο δάκτυλο

34 Μακρός καμπτήρας του αντίχειρα
Έκφυση Πρόσθια επιφάνεια κερκίδας, μεσόστεος υμένας, κατάφυση Τελική φάλαγγα αντίχειρα Νεύρωση - Μέσο ν. IST/UH NMS2

35 Τετράγωνος πρηνιστής Έκφυση
Πρόσθιο χείλος ωλένης περιφερικό τεταρτημόριο κατάφυση Κερκίδα πρόσθιο χείλος περιφερικό τεταρτημόριο Νεύρωση - Πρόσθιο μεσόστεο (μέσο ν.)

36 Μύες της άκρας χείρας Αυτόχθονες μυες
There are 18 small but important muscles in the hand which can be split into 3 distinct groups. *Thenar – Ad Pollicis is served by the Ulnar nerve the others by the Median nerve. **Hypothenar - All served by the Ulnar nerve. ***Central Palmar - Lumbricales are served by the Median and Ulnar nerves. Interossei are 7 muscles – 4 dorsal and 3 palmar innervated by the Ulnar Nerve. Superficial & Deep Group. * - Are in the Superficial Group and arise from the medial epicondyle of the humerus by the Common Flexor Tendon. FDP and FPL comprise the deep compartment, The lumbricals sprout from the sides of the flexor digitorum profundas tendons on the palmer side of the hand. Deep to the lumbricals, the palmar interossei are located between the metacarpals and hence difficult to access. The dorsal interossei are accessible between the metacarpals from the hand’s dorsal surface.

37 Παλαμιαίοι μεσόστεοι : προσαγωγή Ραχιαίοι μεσόστεοι: απαγωγή
Dorsal Interossei (ABD 2-5 fingers) Palmar Interossei (ADD 2-5 fingers) There are 18 small but important muscles in the hand which can be split into 3 distinct groups. *Thenar – Ad Pollicis is served by the Ulnar nerve the others by the Median nerve. **Hypothenar - All served by the Ulnar nerve. ***Central Palmar - Lumbricales are served by the Median and Ulnar nerves. Interossei are 7 muscles – 4 dorsal and 3 palmar innervated by the Ulnar Nerve. Superficial & Deep Group. * - Are in the Superficial Group and arise from the medial epicondyle of the humerus by the Common Flexor Tendon. FDP and FPL comprise the deep compartment, The lumbricals sprout from the sides of the flexor digitorum profundas tendons on the palmer side of the hand. Deep to the lumbricals, the palmar interossei are located between the metacarpals and hence difficult to access. The dorsal interossei are accessible between the metacarpals from the hand’s dorsal surface.

38 Μύες του θέναρος Αντιθετικός του αντίχειρα Προσαγωγός του αντίχειρα
Βραχύς απαγωγός αντίχειρα Βραχύς καμπτήρας αντίχειρα Opponens pollicis – pulling the thumb across the palm (opposition), bring the pads of the thumb and last finger together. Adductor pollicis – draws the thumb toward the index and middle finger Extensor - The Deep Group includes Supinator and *** all of whom except Supinator are attached proximally to forearm bones alone, and arise from the back of the interosseous membrane and adj. bones. Superficial & Deep Group. * - Are in the Superficial Group and arise from the medial epicondyle of the humerus by the Common Flexor Tendon. FDP and FPL comprise the deep compartment, There are 18 small but important muscles in the hand which can be split into 3 distinct groups. *Thenar – Ad Pollicis is served by the Ulnar nerve the others by the Median nerve. **Hypothenar - All served by the Ulnar nerve. ***Central Palmar - Lumbricales are served by the Median and Ulnar nerves. Interossei are 7 muscles – 4 dorsal and 3 palmar innervated by the Ulnar Nerve. Short muscles located at the thenar eminence and long, tendinous muscles which attach along the shafts of the radius and ulna. Short – OP performs the important task of pulling the thumb across the palm. It is located deep in the thenar eminence and is difficult to isolate. The strong Add P lies deep along the palmar surface and draws the thumb towards the index and middle fingers. The bellies of Abd P and both extensor P muscles lies along the posterior aspect of the forearm, deep to the wrist extensors. Their distal tendons however are superficial and for the anatomical snuff box

39 Βραχύς απαγωγός του αντίχειρα
Έκφυση Καμπτική απονεύρωση, σκαφοειδές και Μ. Πολύγωνο κατάφυση Ραχιαία επιφάνεια της βάσης της πρώτης φάλαγγας του χεριού. Νεύρωση Μέσο ν. Nerve supply Median nerve (C 8 , T1). Actions Abduction of the thumb, CMC, and MP joints in a plane perpendicular to the palm. May extend the IP joint secondarily by virtue of its attachment into the dorsal apparatus of the thumb. Assists in opposition in combination with opponens pollicis IST/UH NMS2

40 Βραχύς καμπτήρας αντίχειρα
Έκφυση Επιφανειακή: καμπτική περιτονία και το Μ. Πολύγωνο Εν τω βάθει: ελ. Πολύγωνο και κεφαλωτό. Κατάφυση Βάση 1ης φάλαγγας. Νεύρωση Επιφανειακή μοίρα: μέσο ν. Εν τω βάθει μοίρα: ωλένιο ν. Nerve supply Superficial part - Median nerve; deep part - ulnar nerve (C 8 , T1). Its innervation is variable; there may be no contribution from the median nerve. Actions Flexion of the thumb MP joint and thumb CMC joint. This muscle acts synergistically with opponens pollicis in flexing and medially rotating the first metacarpal. IST/UH NMS2

41 Αντιθετικός Αντίχειρα
Έκφυση Καμπτική περιτονία και Μ. Πολύγωνο. Κατάφυση Παλαμιαία επιφάνεια κερκιδικού χείλους του 1ου μετακαρπίου Νεύρωση Μέσο ν. και κάποιες φορές δέχεται ίνες και από το ωλένιο Nerve supply Median nerve (C 8 , T1); sometimes by fibers from the deep terminal branch of the ulnar nerve. Actions Flexion, abduction, and medial rotation of the thumb CMC joint; opposition of the thumb. IST/UH NMS2

42 Μύες του οπισθέναρος: Απαγωγός μικρού δακτύλου
Βραχύς Καμπτήρας μικρού δακτύλου Αντιθετικός μικρού δακτύλου Extensor - The Deep Group includes Supinator and *** all of whom except Supinator are attached proximally to forearm bones alone, and arise from the back of the interosseous membrane and adj. bones. Superficial & Deep Group. * - Are in the Superficial Group and arise from the medial epicondyle of the humerus by the Common Flexor Tendon. FDP and FPL comprise the deep compartment, There are 18 small but important muscles in the hand which can be split into 3 distinct groups. *Thenar – Ad Pollicis is served by the Ulnar nerve the others by the Median nerve. **Hypothenar - All served by the Ulnar nerve. ***Central Palmar - Lumbricales are served by the Median and Ulnar nerves. Interossei are 7 muscles – 4 dorsal and 3 palmar innervated by the Ulnar Nerve. Short muscles located at the thenar eminence and long, tendinous muscles which attach along the shafts of the radius and ulna. Short – OP performs the important task of pulling the thumb across the palm. It is located deep in the thenar eminence and is difficult to isolate. The strong Add P lies deep along the palmar surface and draws the thumb towards the index and middle fingers. The bellies of Abd P and both extensor P muscles lies along the posterior aspect of the forearm, deep to the wrist extensors. Their distal tendons however are superficial and for the anatomical snuff box

43 Απαγωγός μικρού δακτύλου
Έκφυση Πισοειδές και ωλένιο χείλος καμπτικής περιτονίας Κατάφυση Ωλένιο χείλος της βάσης της 1ης φάλαγγας του μικρού δακτύλου. Νεύρωση Ωλένιο ν. Nerve supply Deep branch of the ulnar nerve (C8, T 1 ). Actions Abduction of the MP joint of the little finger IST/UH NMS2

44 Βραχύς καμπτήρας μικρού δακτύλου
Έκφυση Άγκιστρο αγκιστρωτού και ωλένιο χείλος της καμπτικής περιτονίας. Κατάφυση Ωλένιο χείλος της βάση της 1ης φάλαγγας του μικρού δακτύλου. Νεύρωση Ωλένιο ν. Nerve supply Deep branch of the ulnar nerve (C8, T 1 ) . Actions Flexion of the MP joint of the little finger and assists with opposition of the little finger. IST/UH NMS2

45 Αντιθετικός του μικρού δακτύλου
Έκφυση Άγκιστρο αγκιστρωτού και και ωλένιο χείλος της καμπτικής περιτονίας. Κατάφυση Ωλένιο χείλος 5ου μετακαρπίου Νεύρωση Ωλένιο ν. Nerve supply Deep branch of the ulnar nerve (C8, T 1 ). Actions Flexion and rotation of the fifth metacarpal CMC joint. The opponens digiti minimi lifts the ulnar border of the hand, allowing the little finger to oppose the thumb. Assists in cupping of the palm. IST/UH NMS2

46 Ανατομική Ταμπακιέρα Ορίζεται: Βραχύ εκτείνων-μακρό απαγωγό εκτείνων
Μακρό εκτείνων αντίχειρα Στυλοειδή απόφυση κερκίδας Σκαφοειδές

47 Ανατομική Ταμπακιέρα

48 Αισθητική Κατανομή Άκρας Χείρας
Μέσο Νεύρο Κερκιδικό νεύρο Ωλένιο νεύρο Επιπολής έξω πλάγιο αντιβραχίου Επιπολής έσω πλάγιο αντιβραχίου Επιπολής οπίσθιο αντιβραχίου Όλα τα νεύρα μπορεί να τραυματισθούν από τραύμα, να συμπιεστούν ή να ενοχληθούν από συνεχόμενα φορτία UH/IST NMS 2

49 Ευχαριστώ για την προσοχή σας!
NMS