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HAND ANATOMY
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HAND ANATOMY
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Some Lovers Try PositionsThat They Cant Handle
Scaphoid, Lunate, Triquetrum, Pisiform
Trapezium, Trapezoid, Capitate, Hamate
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Trapezium is under the thumb!
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LumbricalsMedian (1 & 2), Ulnar (3 & 4)Flex MCP, Extend IPs
InterosseiUlnar (Palmar - AD, Dorsal - AB)
RememberForearm muscles in the hand!!!
Nerve Supply & Action?
Musculature of the Hand
Thenar Hypothenar Adductor
Flexor Pollicis Brevis Flexor Digiti Minimi
Abductor Pollicis Brevis Abductor Digiti Minimi Adductor Pollicis
Opponens Pollicis Opponens Digiti Minimi
MEDIAN NERVE ULNAR NERVE ULNAR NERVE!!!
Superficial
Deep
Nerve Supply & Action?
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Carpal Tunnel
Contents
- 4 x Flexor Digitorum Profundus Tendons- 4 x Flexor Digitorum Superficialis Tendons
- Flexor Pollicis Longus Tendon
- Median Nerve
- Signs & Symptoms?Tingling, Pain, Thenar Wasting
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Clinical Case 1
A 30-year-old man presents to A&E with incised woundsto the anterior aspect of his wrist and forearm followinga suicide attempt. Preliminary inspection reveals that thepatient has four deep, linear incised wounds involving
the palmar region of the wrist. The thumb and medialthree fingers are noted to be gently flexed while theindex finger is held in extension.
Q - What specific anatomical structures do you think are
injured? A - FDS and FDP of the index finger
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Clinical Case 2
A 16-year old male presents to A&E after
slipping on ice. He states that he attempted to
break his fall and fell on an outstretched hand.
He complains of pain and swelling in the area
indicated by the arrow in the photograph
below.
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Q - What is the most common injury sustained by falling on an outstretched hand in
young, healthy individuals?
AScaphoid fracture
Q - What are possible complications of this condition?
AAvascular Necrosis, Osteoarthritis, Malunion, Non-union
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Colles vs Smiths #
Distal Radius Fractured
QDorsal angulation of the distal bone fragment
AColles
QPalmar angulation of the distal bone fragment
ASmiths More dangerous due to the neurovascular structures in this direction!
Dorsum
Palm
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Boutonnieres vs Swan Necking
Boutonnieres PIP & DIP
PIP flexed, DIP Hyper-extended
Swan NeckingPIP & DIP
PIP Hyper-extended, DIP Flexed
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Which nerve innervates the lateral half of the
muscle that flexes the fingers at the DIP joint?
ulnar nerve
radial nerve
median nerve
musculocutaneous nerve
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Which of the following structures does
not pass through the carpal tunnel?
Median nerve
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
Whi h t f th h id i t
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Which part of the scaphoid is most
commonly affected by avascular
necrosis following a fracture? scaphoid waist
proximal pole
distal pole
whole bone
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Skiers Thumb is caused by a traumatic force
on the thumb that forces it out (radial
deviation is the anatomical direction). It often
occurs with skiing and football.
Signs and symptoms include pain in the
knuckle of the thumb, swelling, and an
unstable joint. X-rays often show a small
fragment of the metacarpal that has been
pulled off by the ligament (called an avulsion
fracture).
Treatment usually consists of bracing or
splinting of partial tears and in some cases,
surgical repair if the tear is complete.
Skiers Thumb
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This fracture results from a trauma to tip of the
finger forcing it into flexion (rapidly bending it
down toward the palm) and avulsing the
extensor tendon. This injury commonly occurs
in baseball and basketball when attempting to
catch a ball. Signs and symptoms include pain,
swelling, and an inability to straighten out thelast digit of the involved finger.
Treatment includes splinting of the finger in
the straight position for 6-8 weeks. In some
cases, surgical pinning of the finger in a
straight position along with splinting is
necessary.
Mallet Finger
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FOOT ANATOMY
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RememberLeg muscles in the foot!!!
1stLayer of Sole:
Musculature of the Foot
Medial Plantar Nerve Lateral Plantar Nerve
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RememberLeg muscles in the foot!!!
2nd Layer of Sole:
Musculature of the Foot
1stMedial Plantar Nerve
2nd4thLateral Plantar Nerve
Lateral Plantar Nerve
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RememberLeg muscles in the foot!!!
3rd Layer of Sole:
Musculature of the Foot
Lateral Plantar Nerve
(Like Ulnar in Adductor Pollicis)
Medial PlantarLateral Plantar
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4th Layer of Sole:
Musculature of the Foot
Lateral Plantar Nerve
PAD, DAB
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Structures Behind the Medial Malleolus
Tom
DickAnd
Nervous
Harry
&
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QWhich muscles invert the foot?
ATibialis Anterior (Deep Fibular Nerve) & Tibialis Posterior (Tibial Nerve)
FIBULAR = PERONEAL
QWhich muscles evert the foot?AFibularis Longus & Fibularis Brevis (Superficial Fibular Nerve)
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Foot DropQHow would someone with foot drop walk?
AHigh Stepping Gait
QWhere could a nerve problem be localised?
Deep fibularSupplies Ant. Compartment (Tib Ant, EDL, EHL)
Common Fibular Nerve - Affects Deep & Superficial Fibular nerves
SciaticAffects Deep & Superficial Fibular & Tibial nerves.i.e. every muscle
below the knee
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What is this?
Hallux Valgus
Bunion
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