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The median nerve innervates the flexors of the wrist and digits, the abductors and opponens of the thumb, the first and second lumbricals. The ulnar nerve innervates the remaining intrinsic muscles of the hand. [3] [4] All muscles of the hand are innervated by the brachial plexus (C5–T1) and can be classified by innervation: [1] [4] [5]
Due to a common interconnection between the median and ulnar nerves in the hand (Riche-Cannieu interconnection), the median nerve may innervate the flexor pollicis brevis in 35% of people. It is innervated by the ulnar nerve in 50% of people and by both the median and ulnar nerves in 15%.
Flexor digitorum profundus is a flexor of the wrist , metacarpophalangeal and interphalangeal joints. [2] The lumbricals, intrinsic muscles of the hand, attach to the tendon of flexor digitorum profundus. Thus, the flexor muscle is used to aid the lumbrical muscles in their role as extensors of the interphalangeal joints.
Cutaneous innervation of the upper limbs is the nerve supply to areas of the skin of the upper limbs (including the arm, forearm, and hand) which are supplied by specific cutaneous nerves. Modern texts are in agreement about which areas of the skin are served by which cutaneous nerves, but there are minor variations in some of the details.
The lumbrical innervation always follows the innervation pattern of the associated muscle unit of flexor digitorum profundus (i.e. if the muscle units supplying the tendon to the middle finger are innervated by the median nerve, the second lumbrical will also be innervated by the median nerve).
The relative length of the digit varies during motion of the IP joints. The length of the palmar aspect decreases during flexion while the dorsal aspect increases by about 24 mm. The useful range of motion of the PIP joint is 30–70°, increasing from the index finger to the little finger.
Its primary function is the flexion of the fingers, and this is used as the clinical test for C8 integrity, in conjunction with the finger jerk reflex. [ 4 ] The particular muscles receive innervation from C8 [ 3 ] (shown by specific nerve and spinal nerve segments; muscles in italics only have a minor contribution from C8) :
These tendons, along with those of flexor digitorum profundus, are enclosed by a common flexor sheath. The tendons attach to the anterior margins on the bases of the intermediate phalanges of the four fingers. These tendons have a split (Camper's Chiasm) at the end of them through which the tendons of flexor digitorum profundus pass.