 Good day everybody, Dr. Sanjay Sanyal, Professor, Department Chair. So this is going to be a section of the right palm. I'm standing on the right side, the camera person is on the right side. So we have dissected out this structure here that you can see. This is the palmar aponeurosis. The palmar aponeurosis was densely adhered to the overlying skin and we can see these structures which were holding it to the skin. That is the reason why we cannot pinch up the palmar skin so easily. The palmar aponeurosis is a triangular shaped structure as you can see here. The base of the triangle has got four slips. One, two, three, four. Each of these slips go to each of the digits and they form part of the fibrous flexor sheets. Approximately the palmar aponeurosis converges and forms the apex which gets attached to this structure here. This is the flexor retiniculum. Even further, approximately there is supposed to be a tendon which is missing in this cadaver and that is the palmaris longus tendon. So therefore attached here will be normally the palmaris longus tendon. The apex of the palmar aponeurosis and underlying that will be the flexor retiniculum. This has got a septum which gets attached here to the fifth metacarpal bone and it has also got a septum this side on the lateral side which gets attached to the third metacarpal bone and this demarcates the hand into several compartments. Palmar aponeurosis has got one important clinical correlation due to some unknown reasons. Sometimes slip of the palmar aponeurosis which goes to the little finger or the slip of the palmar aponeurosis which goes to the ring finger they undergo contracture and therefore the finger becomes flexed like this and this is referred to as dupetrinse contracture. The cause of this dupetrinse contracture is not very well known. Now let's take a look at this compartment here. This is the thinner compartment. This was covered by a thinner fascia which was continuous with the palmar aponeurosis which has been removed and we can see the three thinner muscles. The three thinner muscles are this muscle that we have picked up here. This is the flexor policies braves. This has got a superficial head and a deep head. Then we have this muscle here. This is the abductor policies braves and under that we have the third muscle. This is the opponent's policies. These three muscles constitute the thinner eminence and the thinner muscles and here we can note that they are supplied by this nerve here. This is the recurrent branch of the median nerve. The median nerve came from the wrist and it entered under the carpal tunnel and it entered into the palm and it gave this recurrent branch and this is the one which supplies the thinner muscles. Here we have an important clinical correlation. This recurrent branch is very superficial so therefore it can be very easily injured if there's a superficial injury to the palm and in case there will be paralysis of the thinner muscles and the person will get what is known as semen hand that is flattening of the thinner eminence and the person will not be able to flex the thumb, butt the thumb and oppose the thumb. Now let's take a look at this compartment here. This is the hypothenar compartment. This was also covered by a hypothenar fascia and we have retained a part of it here. Before I continue with the hypothenar eminence let me mention a few words about this superficial muscle that we have retained here. This was present in the superficial fascia and these few slips of muscle fibers. This is referred to as palmaris brevis and this is the one which is responsible for producing this groove on the medial side of the hand. Now let's come to the hypothenar eminence proper. The hypothenar eminence also has got three muscles which are the counterparts of the three muscles in the thinner eminence and they are these muscles. The first muscle that we see here on the medial side this one. This is the abductor digiti minimi. Then we have this muscle here. This is the flexor digiti minimi brevis and deep to that we have a third muscle that we can see here. This is the opponents in digiti minimi. So these are the three counterparts and these are all supplied by the ulnar nerve. So that brings me to the ulnar nerve itself. This is the ulnar nerve coming from the wrist. The ulnar nerve goes above the carpal tunnel and it enters this canal here. This is referred to as the guion canal. The guion canal is just next to this piezo-hammet ligament. This is the PC-formed bone and we can see a ligament stretching and getting attached here. This is the piezo-hammet ligament which is actually the continuation of this flexor carpial ulnaris. In fact the PC-formed bone is like a systemoid bone within the flexor carpial ulnaris. Guion tunnel, your guion canal is right next to that and we can see in the guion canal we have two structures. This one which I have picked up here this is the ulnar artery and under that we have this structure here. This is the ulnar nerve and I'm pulling it here and we can see it is moving here. The ulnar nerve divides into a superficial branch, a communicating branch which communicates with the median nerve and a deep branch and the deep branch is the one which supplies the hypothyna muscles and all the intrinsic muscles of the hand namely the intratray and the lumbricals except the lateral two lumbricals. This ulnar nerve in this guion canal can be injured by three mechanisms. One is fracture of the hook of hammet which is located here. Then there's a condition known as handlebar neuropathy. Those who are riding motorcycles for long durations they can get compression of the ulnar nerve and other is something called the guion canal or the guion tunnel syndrome where the ulnar nerve can get entrapped. Now let me draw your attention to a few other muscles that we can see in this interdigital cleft. We can see this muscle here. This is the adductor policies which is in a separate compartment all by itself called the adductor compartment. This has got two heads, a transverse head and an oblique head and they get inserted onto the thumb and they are responsible for adduction of the thumb. This is also supplied by the ulnar nerve. I have now turned the hand and we can see this muscle here. This is the first dorsal introsius muscle. This first dorsal introsius muscle is pierced by this structure which I have lifted up. This is the radial artery. The radial artery comes from the wrist. It crosses through the anatomical snob box here and then it continues and it pierces through the first dorsal introsius and here it gives off the radialis indices and the princips, polysips arteries and then it pierces through and goes into the palm and then it forms the deep palmar arch and from the deep palmar arch we can see these vessels coming out. This is one of those vessels that we have picked up here. That brings me to the final structure. This nerve that I've picked up here. This is the continuation of the median nerve and to just to bring you up to speed this is the median nerve in the wrist. It went through the carpal tunnel and it divided into multiple branches and we can see it is giving branches to the index finger. It is giving branches to the thumb one on this side and one on this side and this is the median nerve which I told you gives rise to this branch also. This is the recurrent branch of the median nerve which supplies the thinner muscles and which can be injured. Finally we have mentioned this is the thinner compartment. We have mentioned this is the adductor compartment. We have mentioned this is the hypothenor compartment. Just under the palmar aponeurosis is a compartment which is known as the central compartment which contains the tendons of the flexor digitalum superficialis and the flexor digitalum profundus and under that there is a potential space which is known as the mid palmar space and this mid palmar space continues through the carpal tunnel and communicates with the space of parona which is where my finger is located right now. This space of parona is between the flexor digitalum profundus and this muscle that we see here this is the pronator quadratus. We shall talk more about this when in the next dissection when we remove the palmar aponeurosis. There is yet one more space between the thinner evinence and the adductor compartment and that is known as the thinner space which also is a potential space for pus or other abnormal fluid to collect. So these are some of the points which I want to mention about the initial first dissection of the palm and stay tuned for the next dissection of the palm. Thank you very much for watching Dr. Sanjeev signing out. Mr. Kendal Kambabaj is the camera person. If you have any questions or comments please put them in the comment section below. Have a nice day.