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Hand and Wrist

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Hala Kh

on 22 October 2012

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Transcript of Hand and Wrist

Hhala A. Khasawneh, M.S. Hand and Wrist Outline Carples Anatomy
Bones & joints
Joints
Muscle & tendons
Nerves
Arteries & veins
Pathologies of the hand
Hand deformities
Acute infections
De Quervain's disease
CTS Bones 27 bones:
8 carpals (wrist bone)
5 metacarpals (palm bones)
14 digital bones 2 Rows:
Proximal raw: Pisiform –Tiquetrum-Lunate-Scaphoid
Distal raw: Hamate – Capitate-Trapezoid-Trapezium Metacarpal & phalange bones Metacarpal bones divide into:
Base, shaft & head.

The 14 phalanges are divided to:
-Proximal, Middle & distal.

-Except the thumb which contain only the proximal & distal The joints of the hand Wrist: the distal end of the radius articulates with lunate, scaopoid & triquetrum to form the wrist joint

Intercarpal joints: articulation between the carpal bones. Carpometacarpal joints:
The base of metacarpals articulate with the distal raw of the carpal bones.
1st metacarpal & Trapezium
2nd metacarpal, trapezoid, trapezium & capitate
3rd metacarpal & capitate
4th metacarpal, hamate & capitate
5th metacarpal & hamate



Metacarpophalangeal joint: The head of the metacarpals articulate with the base of the proximal phalnges

Interphalangeal joint: which are 9 joints articulate between the phalnges, DIP & PIP, except the thumb. Muscles and tendons The muscles of the hand subdivided into :

*Intrinsic muscles are located within the hand itself.
Thenar
Hypothenar
lumbrical.
Interossei


*Extrinsic muscles are located proximally in the forearm and insert to the hand skeleton by long tendons.
Extensor
Flexor Extensors Wrist muscles:
Extensor carpi radualis longus
Extensor carpi radualis brevis
Extensor carpi ulnaris







Digit muscles:
Extensor pollicis brevis
Extensor pollicis longus
Abductor pollicis longus
Extensor digitorum communis
Extensor digit minimi Extrinsic extensors They can be divided into:
A - primary action is wrist extension;




Extend & abduct the hand at the wrist joint.




Extend & adduct the hand at the wrist joint
2- Primary action is at the digits



Extends the MCP of the thumb.

Extends the IP joint of the thumb.

Abducts and extends the CMC of the thumb.

Extends the fingers from II –V at the MCJ.

Extend little finger at the MCP.





*All of the extrinsic extnsor group innerated by the radial nerve . Flexors Superficial muscles:
*Flexor carpi ulnaris
*Flexor carpi radialis
*Palmar longus


Intermediate muscles:
*Flexor digitorum superficialis


Deep muscles:
*Flexor pollicis longus
*Flexor digitorum profounds There are 3 layers of extrinsic flexors:
1- The superficial muscle: their primary action at the wrist or palm.

Adduct:

Flex:

Abduct:




2- The intermediate muscle: Flexes PIP joints of 2-5 digits, assists in flexion of the MCP
joints and in wrist flexion. 3- The deep muscles: Primary action at the digits;

Flexes DIP joint of digits 2-5.
Assists in flexion of proximal PIP and MCP joints of digits 2-5.
May assist in flexion of wrist.




Flexes IP joint of thumb






All the extrinsic flexor are innervated b the median nerve exept the FCU by ulnar nerve. Intrinsic muscles Situated totally within the hand.Divided into 4 groups:
Thenar:
Opponens pollicis
Adductor pollicis
Flexor pollicis brevis
Abductor pollicis brevis

Hypothenar:
Opponens digiti minimiAbductor digiti minimiFlexor digiti minimi


Lumbrical
Interossei Thenar: The thenar group consists of :
Abducts the CMC and MCP joints of the thumb.


Pull the thumb medially & dorward across the palm.


Flexes the MCP.


Adducts of the thumb



**All the muscle of the thenar are innervated by median nerve except (AP) by deep branch of the ulnar nerve . Opponens pollicis Hypothenar The hypothenar group consists of:

Flexes the MCP joint of the little finger.


Abducts, assists in opposition.


Pull the 5th metacarpal forward & medially.



**All the muscle of this group innervated by the deep branch of the ulnar. Lumbricals The lumbrical muscles contribute to:
Flexion of the MCP joints & Extension of the interphalangeal joints.









**Nerve to Lumbricals I, II, Median
**Nerve to Lumbricals III, IV: deep branch of the Ulnar Interossei The interossei group consists of:
3 palmar muscles adduct the fingers to the hand axis.




4 dorsal muscles abduct the fingers.





**Innervated by the deep branch of the ulnar nerve. Nerves The hand is innervated by 3 nerves:
Each one has a sensory and motor components.
Median nerve
Ulnar nerve
Radial nerve Originates from the lateral and medial cords of the brachial plexus (C5-T1).

Palmar cutaneous branch provides sensation at the thenar eminence.

Recurrent motor branch innervates the thenar and lumbrical muscles.

Sensory digital branches provide sensation to:
Thumb
Index
Ring finger (radial side) Median Nerve Ulnar Nerve Innervates the muscles involved in the power grasping function of the hand. It originates at the medial cord of the brachial plexus (C8-T1).

Motor branches innervate:
Flexor carpi ulnaris.
Flexor digitorum profundus.

Palmar cutaneous branch provides sensation at the hypothenar eminence.

The dorsal branch provides sensation to:
Ulnar portion of the dorsum of the hand and small finger.
Part of the ring finger.

*At the hand, The superficial branch forms the digital nerves.
*Provide sensation at the small finger and ulnar aspect of the ring finger. Radial Nerve Innervating the wrist extensors
Originates from the posterior cord of the brachial plexus
(C6-8).

At the elbow, motor branches innervate the brachioradialis and extensor muscles. carpi radialis longus

Superficial & deep terminal branches. BLOOD SUPPLY The radial and ulnar arteries, which are branches of the brachial artery, provide the blood supply to the hand. The radial artery runs distally in the forearm between the brachioradialis and flexor carpi radialis muscles.
The ulnar artery runs distally in the forearm under the flexor carpi ulnaris muscle. The superficial palmar arch: is formed mainly by the ulnar artery with a contribution of the radial artery, the arch gives raise to common palmar digital arteries wich supply the palm & each divide into a pair of proper palmar digital arteries, which supply the finger.


Deep palmer arch: is formed mainly by the radial artery with a contribution from a branch of the ulnar artery. It give raise to palmar metacarpal arteries which supply the palm and anastomose with the common palmar digital arteries to the superficial palmar arch. Veins Veins generally follow the deep arterial system as venae comitantes.

A superficial venous system also exists at the dorsum of the hand

Contributes to the cephalic and basilic vein in the upper extremity. Dorsal digital veins: pass along the sides of the fingers and are joined to one another by oblique communicating branches. Those from the adjacent sides of the fingers unite to form 3 dorsal metacarpal veins.

Dorsal metacarpal veins: which end in dorsal venous network of hand opposite the middle of the metacarpus.

Dorsal venous network of hand: It is found on the back of the hand and gives rise to veins such as the cephalic and the basilic veins. Palmar metacarpal veins: drains the metacarpal region of the palm, eventually draining into the deep palmar venous arch & then to the radial veins which drain the lateral aspect of the arm.

Proper palmar digital: which drain into the common palmar digital veins then drain to the superficial palmar venous arch and eventually draining to the ulnar veins which drain the medial aspect of the arm. Pathologies of the Hand Hand deformities:
Mallet finger
Trigger finger
Boutonniere deformity
Swan neck deformity


Acute infections:
Paronychia
Whitlow (Felon)
Tendon sheath infection
Fascial spaces infection


De Quervain's disease


CTS
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