Fig. 97. Palm of Hand (Right); Tendon-sheaths and large 



Arteries. 



This diagram illustrates the Flexor Tendon-sheaths, the large Palmar arteries, 



the more definite furrows of the skin of the palm, in addition to the outlines 



of the bones of the hand, as shewn in a skiagram. 



The more definite furrows of the Palm of the hand present the appearance 

 of M or W according to whether they are viewed from the inner or outer aspect 

 of the limb. 



The initial upstroke of the M curves around the balls of the 3rd, 4th and 

 5tli fingers; the second upstroke (or third line) runs almost transversely across 

 from the ulnar to the radial side of the hand. 



The second line, or initial downstroke joins the two upstrokes (ist and 

 3rd lines) of the M, and is variable in its continuit}'. The last stroke of the M 

 skirts the Thenar Eminence. 



The third line is the most important guide for the superficial Palmar arch, 

 whereas the first and third lines combined approximately mark the proximal 

 limitation of tlie tendon-sheaths of the 2nd, 3rd and 4tla fingers. 



A further description of these tendon-sheaths is found in the text 

 (Figs. g8— loi). 



The Tendon-sheaths become of great importance in inflammatory conditions. 

 A whitlow originating at the proximal phalanx may invade the tendon-sheath at 

 the base of this phalanx and extend to the palm, thus endangering the whole hand. 



At the Osseo-aponeurotic canal completed by the anterior Annular Ligament 

 there is formed a constriction of the tendon-sheaths so that in such pathological 

 conditions as Tuberculosis of the Tendon-sheath and Tenosynovitis the swelling 

 presents a constriction at the Annular Ligament with an enlargement both above 

 and below this structure. 



The fold between the hand and the forearm corresponds roughly to the 

 wrist-joint which extends higher into the forearm with its convexity upwards. 



The groove between the first (proximal) and second (intermediate) phalanges 

 corresponds to the joint, but the joint between second and third (distal) phalanges 

 is situated Vio to V^ inch distal to the groove. 



