THE FOKEABM AND HAND. 



1451 



Brachialis 

 Cephalic vein 

 Biceps 



Median cephalic vein ; 



Tendon of biceps 

 Radial nerve 



Deep ramus of 

 radial nerve 



Brachio-radial 



Radial nerve 

 (superficial ramus) 



Radial artery 



rachial artery 



Median basilic 

 vein 



ertus fibrosus 



Ulnar artery 



of Lister's dorso-radial incision for excision of the wrist. The dorsal border of 

 the ulna is subcutaneous throughout, and may be felt along the interval between 

 the flexor and extensor carpi ulnaris muscles. Upon the ulnar side of the 

 dorsal aspect of the wrist, when the forearm is in the prone position, there is a 

 well-marked rounded prominence formed by the distal extremity of the ulna, anterior 

 to which is the styloid process, 

 the deep groove between the 

 two being occupied by the 

 tendon of the extensor carpi 

 ulnaris. 



The carpal bones are built 

 up so as to form an arch, con- 

 verted by the transverse carpal 

 ligament into a tunnel for the 

 transmission of the flexor ten- 

 dons. At each extremity of 

 the arch the two bony points 

 to which the ligament is at- 

 tached furnish important land- 

 marks. These bony points are : 

 laterally, the tuberosity of the 

 navicular and the ridge of the 

 greater multangular bone ; 

 medially, the pisiform and the 

 hamulus of the os hamatum. 

 The tuberosity of the navicular 

 is felt immediately proximal to 

 the root of the thenar eminence, 

 midway between the tendons 

 of the abductor pollicis longus 

 and the flexor carpi radialis ; 

 J in. distal to the tuberosity 

 of the navicular is the ridge 

 of the greater multangular bone, 

 felt deeply beneath the medial 

 part of the thenar eminence. 

 At the root of the hypothenar 

 eminence, and crossed by the 

 crease which separates the fore- 

 arm from the hand, is the pisi- 

 form bone, proximal to which is 

 the tendon of the flexor carpi 

 ulnaris, passing to be inserted 

 into it. The hamulus of the 

 os hamatum is felt deeply be- 

 neath the radial side of the 

 hypothenar eminence, and a 

 full finger's breadth distal and 

 lateral to the pisiform. 



The bases of the first, third, 

 and fifth metacarpals, all of which 



can be readily identified on the dorsal aspect, furnish a sufficient guide to the 



line of the carpo-metacarpal articulations. At the base of the third metacarpal is 



' a tubercle, which can be felt projecting from its dorsal aspect at a point If in. 



; vertically distal to the tubercle upon the back of the distal end of the radius. 



This metacarpal tubercle marks the insertion of the extensor carpi radialis brevis, 



the favourite site for the development of a "ganglion" which may frequently 



be ruptured by pressing it firmly against the tubercle. Anteriorly, the carpo-meta- 



carpal articulations correspond to the distal border of the transverse carpal ligament. 



Tendon of flexor carpi 

 radialis 

 Base of styldid process 



Radial artery 



Median nerve 



Flexor carpi 

 ulnaris 



Flexor digitorum 

 sublimis 



Pisiform bone 



Transverse carpal 

 ligament 



Superficial 

 volar arch 



Deep volar arch 



FlG 1115> _ BEND OF ELBOW, VOLAR SURFACE OF FOREARM, 

 AND HAND. 



