Mind map

The hand

Dana Ali English

Map content

The hand

Anatomy of the hand
- Bones
- Muscles
  - Adductor pollicis muscle
  - Lumbericals
  - Palmar interossi and Dorsal interossi
Types of joints
- The wrist joint
  - type:ellipsoid
  - Movements : Abduction , Adduction , Extension , Flexion
- Midcarpal joint
  - Type : plane
  - Movements : gliding
- carpometacarpal joint
  - First metacarpal bone
    - Type : saddle
    - Movements : Abduction , Adduction , Extension , Flexion , limited circumduction
  - The other four metacarpal bones
    - Type : plane
    - Movements : gliding
- metacarpophalangeal joints .
  - Type : condyle
  - Movements : Abduction , Adduction , Extension , Flexion
Blood supply
- Arteries
- Veins
Innervation of the hand
- Ulnar
- Radial
- Median
Synovial Fluid
- Composition
  - Hyaluronan
  - Lubricin
  - proteins derived from the blood plasma
  - Interstitial fluid
- Function
  - Reduction of friction Shock absorption Nutrient and waste transportation Molecular sieving
Carpal tunnel
- What is it
- carpal tunnel syndrome
  - compression of the median nerve as it travels through the wrist at the carpal tunnel
    - Symptoms
      - pain, numbness, and tingling, in the thumb, index finger, middle finger, and the thumb side of the ring fingers
      - Weakness in the hand Flat thenar emenance Can’t oppose Median claw hand
    - Causes
      - Heredity Repetitive hand movement Hand and wrist position Pregnancy
Hand examination
- History
  - Patient demographics
  - Past medical history
    - example:Prior surgical history
  - Social history
    - example:Patient’s hobbies and sports activities
- Inspection
- Palpation
- Range of Motion
- Nerve examination
  - Phalen's test
Types of hand deformities
- Boutonniere Deformity
- Swan neck deformity
- Mallet finger
Rheumatoid Arthritis
- Rheumatoid disease (RD) is a systemic autoimmune disease characterized by inflammatory polyarthritis, which affects peripheral joints, especially the small joints of the hands and feet
- Irritates synovium covering your joints
  - become sore and inflamed, releasing chemicals that damage nearby tissues like bone,ligaments, tendons and cartilage
  - Th1 cells play a central role by interacting with other cells in the synovium
    - macrophages - activated by immune complexes - produce proinflammatory cytokines, including TNF, IL-1, IL-6 and IL-15
      - inflammatory granulation tissue (pannus) is formed
        leads to fibrous or bony ankylosis
- Causes
  - Genes
  - Hormones
  - Age
  - Smoking
  - Environmental factors
- clinical manifestations of rheumatoid arthritis
  - Joint swelling Tenderness Redness Limitation of Motion Pain on motion morning stiffness
  - Rheumatoid nodules
    - found:Fingers and knuckles Elbows Forearms Knees Backs of heels
- Diagnosis of Rheumatoid arthritis
  - Rheumatoid factor (RF)
  - Cyclic Citrullinated Peptide (CCP)
  - Erythrocyte Sedimentation Rate (ESR)
  - C-Reactive Protein (CRP)
  - Antinuclear Antibody (ANA)
- Extra-articular Manifestations of Rheumatoid Arthritis
  - Systemic Cutaneous Pulmonary Cardiac Vascular Musculoskeletal Hematological Lymphatic Ocular Neurological
- Management of RA
  - NSAIDs
    - Drugs with analgesic, antipyretic and anti-inflammatory effects
  - DMARDs
    - Disease Modifying Anti-Rheumatic Drugs which control current systemic inflammatory features
  - Glucocorticoids
    - Disease Modifying Anti-Rheumatic Drugs which control current systemic inflammatory features
  - Splinting
    - designed to protect and support painful joints and to make sure your wrist and hand are positioned correctly
Nerve conduction velocity test
- measures how fast an electrical impulse moves through your nerve. NCV can identify nerve damage
- Nerve conduction studies is done to find the cause of symptoms, such as numbness, tingling, and continuous pain