Anatomy Bones and Muscles · MU Pleven

231. Palma manus.

Covers the palm of the hand, starting with its skin: its thickness, the three deep permanent palmar lines and what they reflect functionally, and the subcutaneous nerves and veins. It then describes the palmar aponeurosis and fascia, the midpalmar space with its layered contents from superficial to deep, and the thenar, hypothenar and midpalmar septa. The note also outlines the dorsum of the hand and the digits, including the extensor tendons, dorsal blood supply, synovial sheaths and tendon arrangement in the fingers.

Inside: 18 sections · 4 labelled pictures · 15 flashcards · 6 min

Topic 230 of 236 in the MU Pleven syllabus for Anatomy Bones and Muscles (Medicine, Year 2). The free AceMed note covers it in 16 sections, about 786 words (6 min of reading), with 15 flashcards.

In this note

  1. PALMAR Region.
  2. Skin :
  3. Subcutaneous tissue:
  4. Palmar Aponeurosis & fascia
  5. DORSUM of the hand
  6. Superficial fascia
  7. Cutaneous Nerves :
  8. Deep fascia
  9. Extensor muscles tendons
  10. Dorsal aponeurosis
  11. Superficial blood vessels
  12. DIGITS of the hand
  13. Skin & Subcutaneous layer :
  14. Neurovascular Bundles (NVBs) :
  15. Synovial sheaths
  16. Muscle Tendons :

Skin :

  • Thickness: The skin of the palm is thick and tough.
  • Lines: Three deep, permanent lines are characteristic:
  • Distal Line
  • Middle Line
  • Proximal Line
  • Attachment: The skin is tightly connected to the underlying structures by fibrous strands, especially along these lines.

Functional Significance of Lines:

  • Distal and Middle Lines: Reflect the repeated flexion of the 2nd to 5th fingers.
  • Proximal Line: Reflects the movement of thumb opposition.

Subcutaneous tissue:

  • Contains small veins and cutaneous nerves.
  • Nerves:
  • R. Palmaris N. Mediani
  • R. Palmaris N. Ulnaris
  • Small branches from N. Digitales Palmares Communes

Palmar Aponeurosis & fascia

  • Remaining Areas: The skin is firmly attached to the aponeurosis palmaris via fibrous strands.
  • Enclosed Spaces: These strands create tiny fat-filled spaces, limiting skin mobility.

Distal Line:

  • Origin: Starts at the first commissural pad, between the heads of the 2nd and 3rd metacarpal bones.
  • Path: Extends to the medial margin of the hand, near the head of the 5th metacarpal bone.

Middle Line:

  • Origin: Begins at the head of the 2nd metacarpal bone.
  • Path: Travels towards the hypothenar eminence, around the middle of the palm.

Proximal Line:

  • Origin: Also starts at the head of the 2nd metacarpal bone.
  • Path: Runs obliquely, ending at the median line at the level of os capitatum.

The hand is a part of the upper limb situated distally from the wrist. The regions of the hand include the palm, dorsum of the hand and the five digits. The palm is further divided into three main regions by the thenar and hypothenar septa. It has a slight concave shape, due to the hypothenar and thenar eminences. This prevents compression of its nerves and vessels during firm hand grasps.

Content

  1. 1 Thenar eminence – formed by the thenar muscles
  2. 2 Hypothenar eminence – formed by the hypothenar muscles
  3. 3 Midpalmar space (spatium palmare medium)

– structures listed from superficial to deep:

  1. 3.1 Palmar aponeurosis
  2. 3.2 Superficial palmar arch
  3. 3.3 Median nerve and its branches
  4. 3.4 Ulnar nerve and its superficial branches
  5. 3.5 Tendons of flexor digitorum superficialis
  6. 3.6 Tendons of flexor digitorum profundus
  7. 3.6.1 Lumbricals
  8. 3.7 Arterial deep palmar arch
  9. 3.8 Ulnar nerve and its deep branch
  10. 3.9 Palmar and dorsal interossei

Septa

  1. 4.1 Thenar septum of Kanaveli
  • – is the most significant septum
  • – is attached to the third metacarpal bone
  • – separates the thenar eminence from the midpalmar space
  1. 4.2 Hypothenar septum
  2. 4.3 Septum extending from the palmar aponeurosis

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