0:01 quick one I got to be really quick
0:02 because there's some students who want
0:04 to come in and use the lab they're doing
0:08 some revision exams or something um so
0:11 we looked at the forearm and the hand
0:13 last time and sorry I started talking
0:16 about extensor carpy oh know I started
0:18 talking about the extens of carpy
0:20 radialis muscles and I flipped and
0:22 started calling them flexor carpy
0:23 radialis brevis and flexor carpy
0:26 radialis long sorry thank you Terence
0:28 for pointing that out um I've added a
0:30 little annotation so watch out for that
0:33 yeah so this week we got that far how
0:35 about we do that bit we do that bit just
0:38 add the next set of muscles on there so
0:40 here's the hand um I got the bones as
0:42 well so we maybe talk about some of the
0:43 carpal bones should we start with the
0:46 carpal bones can do right so let's stick
0:48 with the right hand cuz that model is
0:49 the right hand as well so here's the
0:51 right hand here's the thumb here's the
0:53 first metac carple of the thumb the
0:55 first metac carple articulates with
0:58 trapezium trapezium is here so trapezium
1:00 then has scaphoid
1:03 and scoid is between trapezium and the
1:05 radius and it's the scaphoid that people
1:08 break when they fall and break their for
1:11 with a flexed wrist and so on and of
1:13 course we were talking about the
1:16 anatomical snuff box if you if somebody
1:17 has broken their scaphoid bone you can
1:20 often tell that it's broken by uh poking
1:22 inside the anatomical snuff box in
1:23 between those tendons that's where you
1:25 find the scaphoid bone and if they get
1:26 pain they may well have broken the
1:29 scaphoid bone the other thing I always
1:31 remember is is this little bone here
1:34 like a PE so that's peasy form also over
1:36 this side we've got this hook this is
1:38 the hook of the hammade so the hamate is
1:40 over here so this is over by digiti
1:42 minimi the little finger
1:43 finger
1:48 um and pey form is beside triquetrum so
1:50 now we got three more bones left these
1:54 two in the middle we've got capitate and
1:57 lunate so capitate is the big one here
2:00 so capitate is articulating articulating
2:03 with this metacarpal here uh and lunate
2:05 is around
2:09 here so trapezium scao and then the little
2:15 bone so that's
2:18 trapezoid so trapezium at the base of
2:21 the thumb scaphoid between the trapezi
2:25 trapezium and the radius bone and
2:27 trapezoid is the little bone in there
2:31 and then we've got capitate and
2:33 lunate and then the one with a hook
2:35 that's the hamate hook of the hamate
2:38 this P here is peasy form and peasi
2:41 form is on top of
2:49 wrist what about the muscles the muscles
2:52 so here are the muscles of the hand um
2:54 we talked about palmara longest last
2:57 week as one of these tendons here so
2:59 palar long as continues and it flattens
3:01 out into this a Pon eurosis this is a
3:03 palmara Pon eurosis this flatten
3:05 connective tissue sheet which actually
3:07 is tightly adherent to the skin this is
3:09 really awkward to dissect away from the
3:11 skin because it it sticks so tightly to
3:12 it and it's important when gripping
3:14 things it gives you a good grip As you
3:16 move your hand to hold on to something
3:18 so let's take that
3:20 off BL
3:25 me um there's usually um a palmaris
3:28 brevis muscle in there as well which is
3:31 missing from this so right hand should
3:33 we take the thumb first so the thumb we
3:35 said was the pox so the muscles of the
3:38 thumb are picus muscles and we have this
3:40 lump here this
3:42 Mass all right which is the thear
3:46 Eminence uh literally it means you know
3:47 that bit of your hand that's where the
3:49 word came from it's the the ball of the
3:53 thumb and we have some muscles here now
3:55 we talked
3:59 about we talked about uh so we've got flexion
4:00 flexion
4:04 an extension an abduction an
4:07 adduction so these muscles are doing
4:10 those jobs and are named appropriately
4:13 so this muscle out here right so if you
4:15 if you contract this muscle you're going to
4:16 to
4:21 be abducting the thumb and we saw there
4:23 is a long abductor of the thumb this is
4:26 a short abductor of the thumb so this is
4:30 um abductor pocis brevis
4:32 inductor pois brevis is going from the
4:34 scaphoid and trapezium bones and
4:38 inserting into part of the the connected
4:41 tissues of the thumb but also into
4:45 the the proximal fank here we've got so
4:46 with this is the muscle that's going to
4:48 help us Flex this is flex aolis brevis
4:50 also going from trapezium out to the
4:54 first fanal bone uh abduct AIS brevis
4:55 and flex aolis brevis now if we take
4:58 those off we see the third muscle of the
5:00 thear remance and this here is the um
5:03 opponent's pocis muscle so opponent's
5:05 pocis that again goes from the tra the
5:08 trapezium bone but it passes to the
5:11 first metacarpal and that does a couple
5:13 of things cuz rather than flexing the
5:16 thummal it it it flexes that joint but
5:18 it also rotates that joint a little bit
5:20 so if we're talking about if we're
5:22 talking about opposition of bringing the
5:23 thumb and the little finger together
5:26 opponent's pisses give some rotation to
5:28 help that so those are the three muscles
5:30 of the thear
5:32 those are innovated by the media nerve
5:34 um there's another muscle here which you
5:37 can see if I take that off that
5:42 helps this is a adductor policis so if
5:45 that is abduction then this is adduction
5:47 then adductor policis is bringing the
5:48 thumb back to the fingers this is what
5:51 adductor pocis is doing now this has got
5:53 two heads it's got two parts um so
5:55 there's usually some all Innovation
5:57 there so while the muscles of the theeni
5:58 remnants are innovated by the median
6:02 nerve this adductor pocis muscle is also
6:03 innovated by the owner nerve so if a
6:05 patient has um median nerve weakness
6:07 then they still may be able to adduct
6:09 their thumb just
6:16 thumb on the other side of the hand we
6:18 have muscles that let us move our little
6:20 finger independently gives us a little
6:23 bit more control so these muscles are of
6:25 the little finger these muscles are of
6:27 digiti minimi so if these muscles are of
6:29 the little finger they're of um their
6:32 digiti minimi muscles and we can use the
6:35 same thinking again so if you abduct
6:38 your little finger then there's a muscle
6:43 here which will be abductor digiti
6:45 minimi uh so that's that's this muscle
6:49 here and of course this is flexion oh
6:51 look see I got to flex other fingers if
6:53 I flex my little finger that's I'm using
6:55 flexor digiti minimite as well as other
6:57 muscles but then this muscle then is
7:01 anterior so this is flexa digiti minimi
7:03 this is in fact flexa digiti minimi
7:05 brevis because there is also a flexa
7:07 digiti minimi longest which I think we
7:11 talked about last time um flexor digiti
7:14 minimi brevis is coming from the hook of
7:19 the hamate and abductor digiti minimi is
7:22 coming from PE form and then they're
7:24 extending into the extensor retinaculum
7:26 these connected tissues at the back of
7:29 the finger and into the U the proximal
7:31 fingy your bone of the fifth digit now
7:34 if we take those muscles off there we go
7:37 we can see this deeper muscle and this
7:38 deeper muscle look how it's kind of
7:41 twisting around here this is opponent's
7:44 digiti minimiz so this is the opposite
7:46 uh this is the matching muscle to
7:50 opponent's policis and uh so opponent's
7:52 digiti minimize passing from the hook of
7:56 the Hammet to the fifth meta carpal and
7:58 if you contract that muscle that's going
8:02 to rotate this joint and probably Aid in
8:04 flexion so it's helping that opposition
8:07 movement so that's opponent's digiti
8:09 minimi so those are the muscles of the hypoa
8:12 hypoa
8:15 Eminence oh the hypothenar muscles are
8:17 also innovated by the eler neres eler
8:19 nerve medium nerve so Theo remnance
8:23 hyperth remnance Adu pocis all right
8:28 we're almost there um I took this off so
8:31 these are the tendons of flexa digitorum
8:33 superficialis and beneath those flexor
8:35 digitorum profundus that we looked at
8:37 last time and we have these muscles here
8:39 these muscles are pretty unique in the
8:41 body and instead of passing from bone to
8:43 bone they're passing from connective
8:45 tissue to connective tissue these are
8:48 the lumbal so these
8:51 lumbal the lumbal pass from the tendons
8:54 of flexid digitorum
8:57 profundus to the extensor hoods the
8:59 extensor connective tissues of the
9:01 fingers look you can see this
9:04 here now the lumbal well they'll do this
9:08 is a weird thing but uh um they kind of they
9:10 they
9:14 help Flex the metacarpo Fingal joint
9:18 while also pulling on the extensor
9:21 sheaths to keep the Fingal joints
9:23 extended right so it
9:26 let it lets you do it kind of lets you
9:29 do that it lets you bend a straightened
9:31 finger these are the lumbal giving us
9:36 that control all right um two more
9:41 sets we have interus muscles interus
9:43 literally between bones so we've got
9:46 these metacarpal uh bones in here right
9:50 and we have muscles running from the
9:54 metacarpal bones up again to the the
9:57 extensor hoods and we have palar interus
10:00 muscles and we have d interus muscles
10:01 which we'd be able to see if we took all
10:04 these apart the palmon interus muscles
10:06 pass from the metacarpal to those
10:08 extensor hoods and the dorsal osus
10:10 muscles do the same but they're on the
10:12 dorsal side the we can use we can
10:15 remember pad and dab so the Palma
10:18 interus muscles adduct the dorsal
10:22 interus muscles abduct pad and dab right
10:23 they're all innovated by the olner nerve
10:26 so that's a test of the eler nerve so
10:30 abduction adduction um
10:33 Okay so we've looked at the carpal bones
10:35 and the metacarpal and the Fang the
10:37 fanges um in the hand then we want to
10:39 think about the Palmar
10:41 aponeurosis the muscles of the thear
10:44 remnance innovated by the median nerve
10:46 the muscles of the hypoa Eminence
10:49 innovated by the ELA nerve the lumbal
10:51 and the Palmar interus muscles and the
10:54 dorsal interus muscles which let us
10:56 adduct and abduct also innovated by the
11:00 El the nerve and then don't forget
11:04 adductor policis uh and forms this forms
11:06 kind this is this bit here this part of
11:09 the web all right right I'm done I got
