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1. Anatomy of the hand

   • bones of the hand
     • carpals
       • 8 in total
         • scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate.
     • metacarpals
       • 5 in total
     • proximal, middle and distal phalanges
       • 14 in total
   • the joints in the hand include
     • wrist joint, synovial ellipsoid
     • mid-carpal joints, synovial planar
     • carpo-metacarpal joints, synovial planar except for the thumb which is saddle
     • metacarpo-phalangeal, synovial ellipsoid/condyloid
     • interphalangeal, synvoial hinge
   • ligaments
     • Anterior radiocalpar ligaments Posterior radiocalpar ligaments Radial collateral ligaments Ulnar collateral ligaments Intercarpal ligaments (deep)
   • muscles
     • 20 intrinsic muscles in total
       • thenar eminence
       • hypthenar eminence
       • palmar and dorsal interossei
       • 4 lumbricals
       • adductor pollicis
       • palmaris brevis
   • arteries supplying the hand
     • superficial palmar arch
       • main artery is the ulna artery
     • deep palmar arch
       • artery is the radial artery

2. structure of the synovial joint

   • Articular surface of bone is covered by hyaline articular cartilage.
   • Whole joint is covered by a fibrous capsule.
     • capsule is lined with synovial membrane
   • Synovial cavity is filled with synovial fluid.
     • the synoviocytes are the cells that produce the synovial fluid

3. Carpal tunnel syndrome

   • Carpal tunnel syndrome occurs when the median nerve becomes compressed
     • the median nerve is deep to the flexor retinaculum
       • provide sensation to
         • index finger
         • middle finger
         • half of the ring finger
   • it can lead to:
     • numbness
     • weakness
     • tingling
   • risk factors
     • performing repetitive tasks with your hands, such as typing for prolonged durations

4. rheumatoid arthtritis

   • it is an autoimmune disease, since the body's immune system attacks the synovial membrane, the lining of the joint becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint
     • The joint stiffnes is worse in the morning and lasts more than an hour , however symptoms improve with activity
       • since the joint are being used up so they loosen
   • women are 3 times more likely to get it than men
   • Clinical findings that indicates Rheumatoid arthritis
     • swan neck deformity: flexion of the DIP and hyperextension of the PIP
     • boutonniere deformity: hyperextension of DIP and flexion of PIP
     • Symmetric swelling of multiple joints with tenderness and pain
     • ulnar deviation

5. Diagnosing rheumatoid arthritis

   • general procedures would be done during the physical examination such as checking the joints for swelling, redness, warmth and reflexes
     • Tests that are done specifically to check for RA
       • Erythrocyte sedimentation rate blood test. Which is a type of blood test that measures how quickly erythrocytes would settle at the bottom of a test tube
         • People with rheumatoid arthritis tend to have higher ESR values, indicating inflammation
       • A blood sample is taken is to look for rheumatoid factor and anti-citrullinated peptide antibodies.
       • The full blood count test can also be used to check if you have anemia
       • Imaging tests
         • ultrasound, X-rays and MRI scans are used
           • to check for joint inflammation and damage

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