Volar carpal ligament, tunnel of Guyon, palmaris longus
Thenar and hypothenar muscles
Distal carpal bones
Scaphoid and lunate added
Transverse carpal ligament, proximal view
Tendons beneath transverse carpal ligament
Wrist
The lumbar part of the paraspinous muscles receive their blood supply from the lumbar arteries coming off the aorta. The intervertebral discs consist of a strong annulus fibrosis, and a gelatinous central nucleus pulposis. Disruption of the annulus, usually posterolaterally, may impinge on the nerves emerging through the intervertebral foramina. Note the supraspinous and interspinous ligaments connecting adjacent spinous processes.The interspinous ligaments are continuous with the ligamenta flava below.
The vertebral venous plexus lies outside the dura, and the larget veins of the spinal canal (Batson's plexus) lie anterolaterally.
The vertebrae are interconnected by a robust anterior longitudinal ligament, a smaller posterior longitudinal ligament, and the ligamentum flavum between successive laminae posteriorly.
The facets of adjacent vertebrae are enclosed by inner synovial membranes and outer joint capsules. The joint capsule and adjacent lateral edge of ligamentum flavum form the posterior borders of the intervertebral foramina.
Each lumbar vertebra consists of a weight bearing body anteriorly, and a posterior arch consisting of pedicles, lamina, spine, superior and inferior articular processes and facets, and transverse processes. The connections of articular processes maintain the antero-posterior alignment of the spine. The spinal foramen is enclosed by the body and the arch, and the spinal canal is constituted by the spinal foramina of all the vertebrae. Impingement on the spinal canal by acquired or congenital bony deformity can cause neurologic symptoms.
The tough dural sheath is a continuous membrane enclosing the spinal cord, with extensions around the exiting nerve roots.
The central area of lamina removed is shown schematically. The lateral bridges of lamina left intact are necessary to prevent vertebral instability.
Vertebrae
Dorsum of hand
Cutaneous innervation, dorsum of hand
Bones of the hand, dorsal view
Ligaments and joint capsules, dorsal view
Intrinsic and dorsal intrinsic muscles, dorsal view
Radial artery branches to intrinsic muscles
Dorsal extensors, dorsal view
Extensor tendon sheaths, dorsal view
Dorsal fascia
Dorsal veins, dorsal view
Volar surface of hand
Volar cutaneous innervation
Bones of the hand, volar view
Arteries and volar arches of the hand
Ligaments and joint capsules of the hand, volar view
Volar interossei
Thenar and hypothenar muscles and wrist flexors
Flexor pollicis longus
Flexor digitorum profundus
Flexor digitorum superficialis
Volar digital nerves
Superficial palmar arch
Flexor tendon pullies
Flexor tendon sheaths
Palmar fascia
Digit showing proximal and middle phalanges and PIP
