HAND

HAND

1. Bones

   • Carpals
     • She Looks Too Pretty; Try To Catch Her = Scaphoid, Lunate, Triquaterate, Pisiform; Trapezium (ThUMb), Trapezoid, Capitate (head), (hook) Hamate
     • #s/dislocations
   • Metacarpals
   • Phalanges
     • Proximal, Middle and Distal Phalanx

2. Ligaments

   • Radial and ulnar collateral ligaments on each finger and thumb joint. Ulnar CL at thumb is suspceptible to injury
     • In ext position Collateral ligaments at PIP and DIP are stretched and tight at MCP SO if immobilised in a shortened position the collagen reorganises itself so when splinting need to avoid shortened position and splint in lengthened position IE flexed at MCP approx 70 degs and EXTENDED at IP joints
   • Volar plate on PIP joint Palmar surface prevents hyperext of PIP. groove for flexor tendons
   • Pulleys for flexor tendons
     • Annular (5), A1, a3, A5 originate at end of volar plate at joints
     • Transverse ligament
     • Bowstring phenomenon. Pulleys damaged when grip gives way e.g during rock climbing when they slip and there is a large jerk.
     • Cruciate (cross) L (3)
     • Thumb: 2 annular L and 1 oblique ligament
   • Joint capsules at MCP and IP joints

3. Tendons

   • Extensor tendons (become extensor hoods. They originate from extensor mms from back of forearm. Attach to central slip on the distal phalanx.
   • Flexor tendons : travel through carpal tunnel. 2 tendons each travel into the volar side of each finger. Flexor policis longus tendon
   • Lacerations
     • Nerves
   • Tynosynovium= tendon sheaths between flexor tendons and pulleys to reduce friction
     • Trigger finger: bent finger, swollen tendon and sheath stenosis. Jamming of osseous tunnel

4. Muscles

   • Hypothenar (little digit)Eminence
   • Thenar (thumb)Eminence
     • Abductor policis brevis
     • Flexor policis brevis
     • Adductor policis
     • Oponnens policis
   • Intrinsic muscles: hold the finger steady and guides during activity: PALMAR INTEROSSEI, DORSAL INTEROSSEI, LUMBRICALS. Insert into EXT hood, when they contract they pull the hood proximally.
   • Flexors
     • Flexor digitorum profundis. I: Distal phalanx
     • Flexor digitorum superficialis. I: Middle phalanx

5. Nerves

   • Radial.N: Runs along thumb side edge of forearm. Gives sensation to the back of the hand from the thumb to 3rd finger.
   • Median.N: Goes through carpal tunnel. Gives sensation to the thumb, index and ring finger. Innervates thenar mm (opposition)
   • Ulnar.N: Passes through GUOYON's canal between pisiform and hamate. Gives sensation to little finger and half ring finger,

6. Blood Vessels

   • Radial A = largest artery that travel across wrist behind thumb is where pulse is taken
   • Ulnar A = supplies back of hand wrist and thumb. Through Guoyon's canal .

7. Joints

   • MCP (knuckles): hinge joints
   • PIP (proximal interphalangeal joints) hinge
   • DIP (distal interphalangeal joints) hinge
   • Articular cartilage: absorbs shock and facilitate motion on smooth surface
   • Systemic disease: RA esp in thumb. Overuse and Degeneration

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