what’s the hand? definitions of hand: verb: place into the hands or custody of noun: ability noun:...
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What’s the hand? Definitions of hand: verb: place into the hands or custody of noun: ability noun: a card player in a game of bridge noun: a hired laborer on a farm or ranch noun: a member of the crew of a ship noun: a position given by its location to the side of an object noun: a rotating pointer on the face of a timepiece noun: a round of applause to signify approval noun: a unit of length equal to 4 inches; used in measuring
horses noun: one of two sides of an issue noun: physical assistance noun: something written by hand noun: terminal part of the forelimb in certain vertebrates (e.g.
apes or kangaroos): "the kangaroo's forearms seem undeveloped but the powerful five-fingered hands are skilled at feinting and clouting"- Springfield (Mass.) Union
noun: the cards held in a card game by a given player at any given time
noun: the (prehensile) extremity of the superior limb
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¼ of the motor cortex is devoted to the hand
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Motions of the Wrist and Hand• Forearm
– Flexion– Extension– Supination– Pronation
• Wrist– Flexion– Extension– Ulnar deviation– Radial deviation– Circumduction
• Hand– Flexion– Extension– Adduction– Abduction– Opposition– Circumduction
*Palmar and Dorsal Side
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Bony Anatomy of the Forearm • Two Bones that articulate with the elbow (proximal) and the wrist (distal)
• Ulna– Larger and longer bone of the two (extension of the humerus). It distally articulates with the triquetrium and lunate via the TFCC.
– Ulnar styloid process• Radius
– Distal end makes up majority of the wrist articulation
– Two articulations -one with the carpal bones and the other with the ulna
– Articulates with the scaphoid and lunate– Radial styloid process
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Hand and Wrist Anatomy14 phalanges
2 sesamoid bones (thumb)5 metacarpals8 carpal bonesDistal Radius
Forms small ulnar notch to accept the ulnar head
Radial styloid processDistal Ulna
Ulnar styloid process arises from medial surface
Ulnar head
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Carpals(flat bones aligned in 2 rows)Proximal
Scaphoid-most commonly fractures Lunate-most commonly dislocated Triquetrum Pisiform-acts as sesmoid bone
Distal Trapezium(aligns with 1st metacarpal) Trapezoid(2nd metacarpal) Capitate(3rd metacarpal) Hamate(4th and 5th metacarpal)
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Anatomy of the Carpal BonesWrist is made up of 8 carpal bonesScaphoid- name is derived from the Greek word skaphe, meaning boat. Most commonly fractured carpal bone
Lunate- Poor blood supply. Triquetrum- Three sided bonePisiform- Sesamoid bone, floating in the flexor carpi ulnaris muscle
Trapezium-Lays between the scaphoid and the thumb’s metacarpal
Trapezoid- Lays at the base of the second metacarpal (index or pointer finger)
Capitate-Largest of the carpal bonesHamate- Latin word means “hook”. “She Looks Too Pretty; Try To Catch Her”
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Anatomy of the Phalanges5 MetacarpalsNumbered 1-5 starting at the thumbOr named thumb, index, middle, ring and little finger
Thumb = pollicusPinky = digiti minimiIndex = IndicusJoints
Carpometacarpal (CMC) = carpals to metacarpals Metacarpophalangeal (MCP) = metacarpals to phalanges
Proximal interphalangeal (PIP) = proximal phalanges to middlephalanges
Distal Interphalangeal (DIP) = middle phalanges to distal phalanges
Collateral ligaments of the IP joints
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ArticulationsDistal Radioulnar
Formed by ulnar head and ulnar notchAllows 1 degree freedom of movement
Pronation/supinationRadius glides around the ulna
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Radiocarpal jointReinforced by ligamentous thickeningFormed by distal radius articulating with scaphoid, lunate and triangular fibrocartilage disk(TFCC)
Ellipsoid joint (2 degrees freedom) Flexion/extension Radial/ulnar deviation
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Intercarpal JointsPalmar/dorsal/interosseous ligaments between each carpal
Very little gliding
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Midcarpal JointsProximal/distal carpal row separated by a single joint cavity with small fibrous projections connecting the rows
Limited mobility in flex/ext, radial/ulnar deviation
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Carpometacarpal Joint (CMC)MC1/trapeziumMC2/trapezoidMC3/capitateMC4and 5/hamate (forms 1 articulation)
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1st CMC (thumb)Saddle joint
2 degrees of freedom(3)Flexion/extensionAbduction/adduction
Accessory rotationAllows for opposition
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2-4 CMCPlane/synovial joint1 degree freedom
Flexion/extension
5th CMC2 degree freedom
Flexion/extension Abduction/adduction
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Metacarpophalangeal Joint (MCP)Two degrees freedom of movement
Flexion/extension Abduction/adduction
Thumb can abduct at any point/fingers only when extended
Collateral ligaments Varus/valgus force
When fingers are in flexion they tighten and limit abduction/adduction
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Interphalangeal JointOne degree freedom of movement
Flexion/extensionCollateral ligaments
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Muscular AnatomyWrist Extensors (innervated by radial n.)Superficial
Extensor carpi radialis brevis/longusExtensor carpi ulnarisExtensor digitoriumAbductor pollicus longusExtensor Digiti Minimibrachioradialis
Deep compartmentExtensor pollicus longus/brevisExtensor indicessupinator
Secured by extensor retinaculum
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Wrist flexors (median n.)Superficial
Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Pronator teres
- Intermediate Flexor digitorium superficialis
Deep Flexor digitorium profundus Flexor pollicis longus Pronator quadratus
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Palmar (intrinsic)Thenar
Abductor pollicis brevis Flexor pollicis brevis Opponens Pollicis Tendon FPL Adductor pollicis
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HypothenarAbductor digiti minimiOpponens digiti minimiFlexor digiti minimi brevis
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Muscles of the ForearmAnterior MusclesWrist and Finger Flexors and Wrist PronatorsFlexors of the wrist
Flexor Carpi Radialis = near carpals on radial side
Flexor Carpi Ulnaris = near carpals on ulnar side
Palmaris Longus (absent in about 25% of population)(thumb and little finger opposition)
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Muscles of the ForearmAnterior Muscles
Pronators Pronator Teres Pronator Quadratus
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Muscles of the ForearmAnterior Muscles
Digit Flexors Flexor Digitorum Superficialis (share a muscle belly with FDP, why all fingers will move)
Flexor Digitorum Profundus (lumbrical muscles of fingers arise from the distal tendons)
Flexor Pollicis Longus (10% of population the tip of the index and the thumb move together)
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Muscles of the ForearmPosterior MusclesWrist and Finger Extensors and Wrist SupinatorsWrist Extensors
extensor carpi radialis brevis = posterior & radial side, short
extensor carpi radialis longus = posterior & radial side, long extensor carpi ulnaris = posterior & ulnar side
Finger Extensors (attach at the common extensor tendon on the lateral epicondyle) extensor digitorum = extends digits extensor indicis = extends pointer finger extensor digiti minimi = extends pinky
Thumb Extensors abductor pollicis longus (Lay hand flat on table and abduct thumb)
extensor pollicis brevis/longus (Lay hand flat on table and extend only the thumb)
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Nerve Distribution of the Hand
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Ligaments of the Forearm• Interosseus Membrane- A fibrous sheath that connects the radius and the ulna.
• Radiocarpal ligaments-– Volar Radiocarpal ligament– Dorsal Radiocarpal ligament
• Ulnar collateral ligaments• Radial collateral ligaments
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Dorsal Wrist ligaments Volar Wrist Ligaments
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CentralTendons FDS/FDP
Superficialis (PIP) Profundus (DIP)
LumbricalesRadial side profundus tendon(extensor hood) Flex MP/ext PIP/DIP
Palmar aponeurosisInterossei
4 palmar/4 dorsal
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Carpal TunnelFibro-osseous structure
Floor is proximal carpal bonesRoof is transverse carpal ligament
Tunnel contains 10 structuresMedian n., flexor pollicis longus tendon, 4 slips of flexor digitorium superficialis, flexor digitorium profundus
Compression results in paresthesia 2-4 fingers and decrease grip