The hand

The hand

1. Anatomy of the hand

   • Bones
   • Muscles
     • Adductor pollicis muscle
     • Lumbericals
     • Palmar interossi and Dorsal interossi

2. 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

3. Blood supply

   • Arteries
   • Veins

4. Innervation of the hand

   • Ulnar
   • Radial
   • Median

5. 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

6. 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

7. 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

8. Types of hand deformities

   • Boutonniere Deformity
   • Swan neck deformity
   • Mallet finger

9. 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

10. 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

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