The document provides an overview of the anatomy of the hand and wrist region. It begins with definitions of key terms and descriptions of the bones that make up the hand, including 8 carpal bones, 5 metacarpal bones, and 14 phalanges. It then discusses the dorsal and palmar surfaces in more detail, describing structures like the palmar aponeurosis and flexor retinaculum. The document also provides brief summaries of the embryological development of the hand and some common congenital anomalies that can occur.

1. THE HAND AND WRIST
REGION
Kiryowa Haruna Muhmood
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2. APPROACH/OBJECTIVES
• Definition of the hand.
• Osteology of the bones of the hand
• The dorsum
• The palm
• The anatomical spaces
• Applied anatomy
• Spaces of the hand
• Congenital anomalies
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LECTURE NOTES BY DR . IBINGIRA

3. Introduction
• The hand is the region of the upper limb
distal to the wrist joint
• Most of the functions of the upper limb
depend on the integrity of the hand
• It is important in locomotion, grasping,
feeding and defence.
• It is subdivided into the wrist, metacarpus
and the digits
• It has an anterior surface(the palm) and a
dorsal surface(the dorsum)
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4. Osteology of the hand
Has 3 groups of bones:
 8 carpal bones
 5 metacarpals(1-5) i.e bones
of the metacarpus
 14 Phalanges - bones of the
digits- thumb has 2 and rest
have 3
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6. • The hand is a mechanical and sensory
tool
• Many of the features of the upper limb
are designed to facilitate positioning
the hand in space
• It is required to perform a versatile
range of movement extending from
– A firm grasp needed to carry heavy bags
– Precision gripping as in holding a pencil
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7. osteology
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8. Bone Anatomy
• Scapoid
• Lunate
• Triquetrium
• Pisiform
• Trapeziod
• Trapezium
• Capitate
• Hamate

9. Wrist Articulations
• Radiocarpal Joint
– Proximal portion
– Distal portion
– Most surface
contact found

10. Articulations
• Midcarpal Joint
– Articulation
between proximal
and distal row of
carpals
– Not an uninterupted
joint
– Distal Row
• 2 degrees of
freedom
• Moves as a fixed unit

11. Ligament Support
• Volar Carpal
Ligaments
– Volar Radiocarpal
Ligament
• Three bands
– Volar Ulnocarpal
Ligament
– Scapholunate
Interosseous Ligament
– Lunotriquetral
Ligament

12. • Limb buds become visible as out
pocketing from the ventrolateral body wall
at the end of 4th week of development.
• Initially they consist of a mesenchyme core
derived from the somatic layer of lateral
plate mesoderm that will form the bones
and connective tissue of the limb covered
by a layer of cuboidal ectoderm
• Mesenchyme refers to loosely organized
embryonic tissue regardless of origin.
Embroyology of the hand

13. • Mesenchyme signals ectoderm at the distal
border of the limp to thicken and form the
apical ectoderm ridge(AER)
• AER in return exerts an inductive
influence on the underlying mesenchyme
adjacent to AER to remain as a population
of undifferentiated rapidly proliferating
cells the progress zone.
• Whereas cells located further away from
the influence of the AER begin to
differentiate into cartilage and muscle.
Embryology cont

14. • Development of the limb proceeds in a
proximodistal direction
• In 6 week old embryo a terminal portion of
the limb buds becomes flattened to form
hard plates and is separated from proximal
segment by a circular constriction.
• Later a second constriction divides the
proximal portion into 2-segments main
parts of the extremities recognized.
• Fingers are formed when cell death in the
AER separates this ridge into five parts.
Embryology cont

15. • As the limb grows cells due influence
of AER , mesenchyme begins to
differentiate into cartilage and muscle
• By 6th week, the terminal portion of
limb buds become flattened to form
the hand plates and foot plates
• Fingers and toes are formed when cell
death in this AER separates this ridge
into five parts
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17. • Primary ossication centres are present in
shafts of long bones by 12th week
• At birth, diaphysis or shaft is usually
completely ossified but the two ends, the
epiphyses are still cartilaginous
• The carpus is all cartilaginous by birth. The
capitate ossifies first(1st year) and the
pisiform ossifies last (10th year) and the
others ossify in sequence according to their
size and the whole carpus except pisiform
by 7th year
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18. • The shafts of metacarpals and
phalanges ossify in utero
• Secondary ossification centres
develop at bases of all phalanges
and the thumb metacarpal ;
metacarpals of 2nd,3rd,4th and 5th
digits develop secondary centres at
their heads
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19. Congenital anomalies
• Macrodactyly or local gigantism;
Macrodactyly or local gigantism;
commonly affecting the thumb and
commonly affecting the thumb and
index finger
index finger
• Floating thumb. The metacarpal bone
Floating thumb. The metacarpal bone
of the thumb is absent, but the
of the thumb is absent, but the
phalanges are present.
phalanges are present.
• Brachydactyly due to defects of the
Brachydactyly due to defects of the
phalanges
phalanges
• Partial syndactyly
Partial syndactyly
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20. • Positioning of the limbs along the
craniocaudal axis in the flank regions of the
embryo is regulated by the HOX genes
expressed along this axis.
• These homeobox genes are expressed in
over lapping patterns from head to tail with
some having more cranial limits than others.
• E.g. cranial limit of expression of HOXB8 is
at the cranial border of the fore limb and
misexpression of this gene alters the position
of these limbs.
Molecular Regulation Of limb
Development

21. • Once positioning along the craniocaudal axis
is determined growth must be regulated along
the proximodistal, anteroposterior and dorso
ventral axes.
• Limb out growth which occurs first is initiated
by FGF-10 secreted by lateral plate
mesoderm cells.
• Once out growth is initiated bone
morphogenetic proteins (BMPS) expressed in
ventral ectoderm induce formation of the AER
by signaling through the homobox gene MSX 2
Regulation cont

22. Expression of radical fringe(a homologue
of Drosophila fringe) in the dorsal half of
the limb ectoderm restricts the location
of the AER to the distal tip of the limbs
.This gene induces expression of ser-2 a
homologue of drosophila serrate at the
border between cells expressing radical
fringe and those that are not.
It is at this border that the AER is
established.
Regulation cont

23. • Anteroposterior axis of the limb is
regulated by the zone of polarizing
activity (ZPA) a cluster of cells at the
posterior border of the limb near the
flank .
• These cells produce retinoic acid(vitamin
A which initiates expression of sorie
hedgehog (SHH) a secreted factor that
regulates the anteroposterior axis.
Regulation cont

24. • Deformities by development
suppression,agenesis
• By development arrest: hypoplasia
• By developmental aberrations
• Dysplastic conditions.
• Polyglandular dystrophy
• Contractures(nuerogenic or
amniotic).
Congenital malformation and
classification.

25. • Congenital defects of the fore arm
bones
• Lobster claw hand
• Hemi-melia
Deformity by development
suppression

26. • Syndactyly
• Sym-phalangism – fusion of
interphalangeal joints
Development by arrest

27. • Brachy-dactyly
• Chondro-dystrophy
• Fusion of carpal bones
Dysplastic condition

28. • Polydactily
• Macrodactly
• Arachnodactyly- one of the abnormal
length and thinness of the fingers
resembling spider legs.
Poly glandular dystrophy

29. Congenital anomalies
radial club hand - Shortcut.lnk
radial club hand - Shortcut.lnk

30. Congenital anomalies

31. Congenital anomalies

32. Congenital anomalies

33. GROSS
ANATOMY
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34. Surface Anatomy

35. • The skin of the palm is thick and hairless,
characterized by flexure creases (the lines of
the palm) and the papillary ridges or
fingerprints, which occupy the whole of the
flexor surface.
• Sweat glands are present in large numbers.
• Palmaris brevis is a small muscle that arises
from the flexor retinaculum and palmar
aponeurosis and is inserted into the skin of the
palm.
• Its function is to corrugate the skin at the base
of the hypothener eminence and so improve
the grip of the palm in holding a rounded object.
The skin of the palm

36. • Of the wrist and palm is thickened to
form
flexor retinaculum and the palmar
aponeurosis.
Deep fascia

37. • The palmar aponeurosis is triangular and occupies
the central area of the palm.
• The apex of the palmar aponeurosis is attached to
the distal border of the flexor retinaculum and
receives the insertion of the Palmaris longus
tendon.
• The base of the aponeurosis divides at the bases
of the fingers into four slips.
• Each slip divides into two bands one passing
superficially to the skin and the other passing
deeply to the root of the fingers ,here each deep
band divides into two which diverge around the
flexor tendons and finally fuse with the fibrous
flexor sheath and the deep transverse ligaments
The palmar aponeurosis

38. • The medial and lateral borders of the
palmar aponeurosis are continuous with
the inner deep fascia covering the
hypothenar and thenar muscle. From each
of these border, fibrous septa pass
posterioly into the palm and take part in
the formation of the palmar fascial spaces.
• The function of the palmar aponeurosis is
to give firm attachment to the overlying
skin and so improve the grip and to protect
the underlying tendons.
Palmar aponeurosis cont

39. Palmer apponuerosis

40. • Is thickening of deep fascia
• Holds long flexor tendons at the wrist
• Stretches across the front of the wrist
• Converts the concave anterior surface of
the hand into osteofascial tunnel, the
carpal tunnel
• The tunnel is for passage of the median
nerve and the flexor of the thumb and
fingers.
Flexor Retinaculum

41. Flexor retinaculum

42. From medial to lateral…..
• Flexor capi ulnaris tendon(as it inserts on
the pisiform bone)
• Ulnar nerve: lateral to pisiform bone
• Ulnar artery; lateral to ulna
• Palmar cutaneous branch of ulnar nerve
• Palmaris longus tendon(if present)
• Palmar cutaneous branch of median
nerve.
Structures that pass superficial
to flexor retinaculum

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44. • Flexor digitorum supericialis tendons.
• Flexor Digitorum profundus (behind FDS
tendons)
• Median nerve
• Flexor pollicis longus tendon (sorounded
by a synovial sheath).
• Flexor capi radialis tendon going
through a split in the flexor retinaculum
synovial sheath.
Structures that pass beneath
the flexor retinaculum.

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46. • The anterior surface of each finger from the
head of metacarpal to the base of the distal
phalanx is provided with a strong fibrous
sheath that is attached to the sides of the
phalanges.
• The proximal end of fibrous sheath is open
,whereas the distal end of the sheath is closed
and is attached to the base of the distal
phalanx.
• The sheath, together with the anterior
surfaces of the phalanges and the
interphalangeal joints ,forms a blind tunnel in
which the flexor tendons of the finger lie.
Fibrous Flexor sheaths

47. • In the thumb the osteofibrous tunnel
contains the tendon of the flexor pollicis
longus .
• In the case of the four medial fingers ,the
tunnel is occupied by the tendons of the
flexor digitorum superficialis and
profundus.
• The fibrous sheath is thick over the
phalanges but thin and lax over the joints.
Flexor sheath cont

48. • Tendons of the flexor digitorum superficialis
and profundus muscles invaginate a
common synovial sheath from lateral side
• Medial part extends distally without
interruption on the tendons of little fingers
• Lateral part of the sheath stops abruptly on
the middle of the palm and the distal ends
of the long flexor tendons of the index
,middle and the ring fingers acquire digital
synovial sheaths as they enter the fingers
Synovial Flexor sheaths.

49. • Flexor pollicis longus tendon has its own synovial
sheath that passes into the thumb
• These sheath allow the long tendons to move
smoothly with a minimum of friction beneath the
flexor retinaculum and the fibrous flexor sheaths.
• Synovial sheath of flexor pollicis longus
communicates with the common synovial sheath
of the superficialis and profundus in 50% of
subjects.
• Vincular longer and brevia are small vascula folds
of synovial membrane that connect the tendons
to the anterior surface of the phalanges, convey
blood vessels to tendons.
Flexor sheath cont

50. Flexor sheath

51. • Each tendon of flexor digitorum superficialis enters
the fibrous flexor sheath opposite the proximal
phalanx .
• Divides into two halves which pass around the
profundus tendon and meet on its deep or posterior
surface where partial decussation of the fibers take
place
• The superficialis tendon having united again divides
almost at once into further slips which are attached
to bones of middle phalanx
• Each tendon of the flexor digitorum profundus having
passed through the divisions of superficialis tendon
• Inserted into the anterior surface of the of the base
of distal phalanx
Insertion of the long flexor
tendons

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53. THE DORSUM
• The skin of the dorsum unlike the palm is
thin and freely mobile over underlying
tendons
• There is usually little subcutaneous fat
• Long extensor tendons
– The 4 tendons of extensor digitorum(ED)
pass under the extensor retinaculum, on the
dorsum the ED tendon to index finger is
accompanied by the tendon of extensor
indicis
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54. – The ED tendon to the little finger is
accompanied by the double tendon of
extensor digiti minimi
– The ED tendons of little, ring and middle
fingers are connected to each other by a
fibrous slips
– On the posterior surface of each finger the
extensor tendon spreads to form a dorsal
digital expansion
– Tendons of APL,EPB and EPL proceed to insert
into the thumb
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56. Extensor expansion
• This expansion is triangular shaped
and its apex splits into 3 parts:
– The middle slip attaches to base of
middle phalanx
– The two lateral slips converge to attach
to base of distal phalanx
– The base of the expansion receives the
appropriate interossei and lumbricals
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60. muscles of
the hand
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61. • 4 lumbricals
• Eight interossei.
• 4 short muscles of the thumb
• 3 short muscles of the little finger.
Small muscles of the hand

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63. Lumbricales
• Origin
– Tendons of FDP
• Insertion
– Extensor expansion on
dorsal aspect of each
digits radial side
• Nerve supply
– 1 and 2 – median
– 3 and 4 – ulnar
• Action
– Assisted by interossei,
they flex MCP and extend
interphalangeal joints

64. interrossei

65. Palmar Interossei
• Origin
– 1st – ulnar side base of 1st
metacarpal bone
– 2nd – ulnar side of 2nd MC
bone
– 3rd – radial side of 4th MC
bone
– 4th – radial side of 5th MC
bone
• Insertion
– Extensor expansion of 2,4
and 5th digits
• Nerve supply
– Ulnar
• Fxn; adduction of 1st, 2nd, 4th
and 5th digits toward midline of
hand

66. Dorsal Interossei
• O
– 1st lateral head – ulnar
side of 1st metacarpal
bone
– 1st medial head – radial
side of 2nd metacarpal
bone
– 2nd, 3rd, 4th space between
metacarpal bones
• I
– 1st – radial side 2nd
proximal phalanx
– 2nd – radial side of 3rd
– 3rd – ulnar side of 3rd
– 4th – ulnar side of 4th
• N
– Ulnar
• F; abduction of 2nd, 3rd,
and 5th finger from midline

67. Thenar Muscles
• The thenar muscles are three short
muscles located at the base of the
thumb. The muscle bellies produce a
bulge, known as the thenar
eminence. They are responsible for
the fine movements of the thumb.
• The median nerve innervates all the
thenar muscles.

68. Opponens Pollicis
the largest of the thenar muscles, and lies
underneath the other two.
 Origin: the tubercle of the trapezium, and
the associated flexor retinaculum.
 Insertion: lateral margin of the metacarpal of
the thumb.
 Actions: Opposes the thumb, by medially
rotating and flexing the metacarpal on the
trapezium.
 Innervation: Median nerve.
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70. Abductor Pollicis Brevis
This muscle is found anteriorly to the
opponens pollicis and proximal to the
flexor pollicis brevis.
 Origin; from the tubercles of the
scaphoid and trapezium, and from the
associated flexor retinaculum.
 Insertion; lateral side of proximal
phalanx.
 Actions: Abducts the thumb.
 Innervation: Median nerve.

72. Flexor Pollicis Brevis
The most distal of the thenar muscles.
 Origin: from the tubercle of the trapezium
and from the associated flexor retinaculum.
 Insertion: base of the proximal phalanx of
the thumb.
 Actions: Flexes the MCP joint of the thumb.
 Innervation: Median nerve.

74. The hypothenar muscles
• These make up the hypothenar
muscles, a smaller eminence on the
medial side of the palm, at the base
of the little finger. These muscles are
very similar to the thenar muscles in
both name and organisation.

76. Opponens Digiti Minimi
The opponens digit minimi lies deep to
the other hypothenar muscles.
 Origin: the hook of hamate and
associated flexor retinaculum
 Insertion: medial margin of 5th
metacarpal Actions: It rotates the
metacarpal of the little finger towards
the palm, producing opposition.
 Innervation: Ulnar nerve.
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78. Abductor Digiti Minimi
The most superficial of the hypothenar
muscles.
 Origin: from the pisiform and the
tendon of the flexor carpi ulnaris.
 Insertion: base of the proximal
phalanx of the little finger.
 Actions: Abducts the little finger.
 Innervation: Ulnar nerve.

79. Flexor Digiti Minimi Brevis
This muscles lies laterally to the abductor
digiti minimi.
 Origin: from the hook of hamata and
adjacent flexor retinaculum
 Insertion:the base of the proximal phalanx
of the little finger.
 Actions: Flexes the MCP joint of the little
finger.
 Innervation: Ulnar Nerve.

80. Nerve supply
• Sensory nerve supply to the skin on the
dorsum is derived from the superficial
branch of radial nerve and posterior
cutaneous branch of ulnar nerve
– Superficial branch of radial nerve winds
around the radius deep to brachioradialis
and supplies lat 2/3 of dorsum and divides
into dorsal digital nerves that supply the
thumb, index, middle and lat side of ring
finger(lat 3 1/2)
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81. -Post cutaneous branch of the ulnar nerve winds
around the ulna deep to flexor carpi ulnaris
tendon extends over the extensor digitorum to
supply the medial 1/3 of the dorsum. It also
supplies medial side of the ring finger and sides
of little finger(medial 11/2 fingers)
NB. Dorsal digital branches of radial and ulnar
nerves donot extend beyond the proximal
phalanx. The reminder of the dorsum of each
finger receives its nerve supply from palmar
digital branches
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82. Cutanous nerve supply to
the hand

83. Blood supply
• Dorsal carpal arch/network
– Arterial anastomosis btn radial, ulnar and ant
interosseous arteries lies at the back of the carpus
– Sends dorsal metacarpal arteries distally in the
intermetacarpal spaces deep to the long tendons
– They split at the webs to supply the dorsal
aspects of adjacent fingers
– Communicates thru interosseous spaces with
palmar metacarpal branches of deep palmar arch
and palmar digital branches of superficial palmar
arch
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84. • Dorsal venous network/arch
– Lies in s/c tissue proximal to the MCP
joints and drains on the lateral side into
cephalic vein and medial side to basilic
vein
– Communicates with the deep veins of the
palm thru interosseous spaces
– Greater part of blood from the hand
drains into the arch which receives digital
branches
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86. Lymphatic drainage
• Infraclavicular nodes drain lateral
aspect of the arm, forearm and hand
• Lateral(humeral)nodes drain the rest
of the hand
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87. The spaces of the hand
• superficial pulp spaces of the
superficial pulp spaces of the
fingers
fingers
• synovial tendon sheaths of the
synovial tendon sheaths of the
2
2nd
nd
, 3
, 3rd
rd
, 4
, 4th
th
fingers
fingers
• the ulna bursa
the ulna bursa
• the radial bursa[ FPL]
the radial bursa[ FPL]
• the mid palmar space
the mid palmar space
• the thenar space
the thenar space
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88. SPS
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89. BURSAE
The synovial
The synovial
sheaths of the flexor
sheaths of the flexor
tendons of the hand—the
tendons of the hand—the
Radial[FPL] and ulnar
Radial[FPL] and ulnar
bursae[ little finger.
bursae[ little finger.
track proximally deep to
track proximally deep to
the flexor retinaculum
the flexor retinaculum
and provide a potential
and provide a potential
pathway of infection into
pathway of infection into
the forearm. In many
the forearm. In many
cases these bursae
cases these bursae
communicate.
communicate.
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90. SPACES
Infection of these two spaces
Infection of these two spaces
sometimes results from penetrating
sometimes results from penetrating
wounds or may be due to secondary
wounds or may be due to secondary
involvement from a long-neglected
involvement from a long-neglected
tendon sheath infection. Nowadays
tendon sheath infection. Nowadays
they are fortunately extremely
they are fortunately extremely
rare, thanks to antibiotic treatment
rare, thanks to antibiotic treatment
and the early surgical drainage of
and the early surgical drainage of
pus
pus
collections.
collections.
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LECTURE NOTES BY DR . IBINGIRA

91. • Is localized thickening and contracture of the
palmar aponuerosis.
• Normally starts near the root of the ring finger
into the palm, flexing it at the
metacarpophalangeal joint.
• Later it involves the little finger in the same
manner. In the long standing cases, the pull on
the fibrous sheaths of these fingers results in
flexion of the proximal interphalangeal joints.
• Distal interphallangeal joints are not involved
and are extended by the pressure of the fingers
against the palm.
Dupuytrens Contracture

92. Applied anatomy cont.

93. • Is an infection of a synovial sheath
sheath
• Commonly results from the
introduction of bacteria into a sheath
through a penetrating wound .
• Infection of a digital sheath results in
distension of the sheath with pus, the
finger is held semi flexed and is
swollen.
Tenosynovitis

94. • Pulp space of fingers is a closed facial
compartment situated in front of the
terminal phalanx of each finger. Occurs
most often in the thumb and index
finger.
• Bacteria usually introduced by a prick
• Pressure in pulp space rises quickly in
inflammation because the space is sub
divided by numerous small
compartments by fibrous septa
Pulp-space infection

95. • Fracture line usually goes through the
narrowest part.
• Blood supply is through its proximal
and distal ends, although the blood
supply is occasionally confined to its
distal end.
• If the latter occurs the proximal
fragment is deprived of blood supply
and a vascular necrosis occurs.
Fracture of scaphoid bone

96. MORE
• Dermatoglyphics e.g simian crease.
Dermatoglyphics e.g simian crease.
wrist creases[proximal, middle, distal],
wrist creases[proximal, middle, distal],
palmar creases[radial longitudinal,
palmar creases[radial longitudinal,
proximal transverse, distal transverse,
proximal transverse, distal transverse,
digital creases,
digital creases,
• Thumb has 2 creases
Thumb has 2 creases
• Skin ridges- unique pattern, hence
Skin ridges- unique pattern, hence
finger prints.
finger prints.
• Reduce slippage when grasping.
Reduce slippage when grasping.
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97. MORE
• Lacerations of palmar arches.
Lacerations of palmar arches.
it may be necessary to compress the
it may be necessary to compress the
brachial artery and its branches proximal
brachial artery and its branches proximal
to the elbow.
to the elbow.
• Carpal tunnel syndrome- paraesthesia,
Carpal tunnel syndrome- paraesthesia,
hypoesthesia or anaesthesia in the lateral
hypoesthesia or anaesthesia in the lateral
3 ½ digits. Centre is unaffected.
3 ½ digits. Centre is unaffected.
Recurrent branch, motor to thenar[APB,
Recurrent branch, motor to thenar[APB,
Opponens p are affected.
Opponens p are affected.
Carpal tunnel release. Where is the incision.
Carpal tunnel release. Where is the incision.
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98. Trauma
• Wrist laceration, the median nerve is injured
Wrist laceration, the median nerve is injured
.
.
• Recurrent branch lies subcutaneously.
Recurrent branch lies subcutaneously.
• Ulna canal syndrome- between the pisiform
Ulna canal syndrome- between the pisiform
and the hook of H.[pisohamate ligament.
and the hook of H.[pisohamate ligament.
• Compression of the ulna nerve-
Compression of the ulna nerve-
hypoesthesia,
hypoesthesia,
• Weakness of the intrinsic muscles , clawing
Weakness of the intrinsic muscles , clawing
of the 4
of the 4th
th and 5
and 5th
th fingers. Ability to flex is not
fingers. Ability to flex is not
affected.
affected.
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99. Handlebar neuropathy
• Riding long distances on a bicycle,
Riding long distances on a bicycle,
pressure on the hook of Hamate.
pressure on the hook of Hamate.
• Radial nerve injury, at the arm
Radial nerve injury, at the arm
causes a wrist drop.
causes a wrist drop.
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kiryowa

100. Fractures
• Scaphoid- fall on the palm, abducted
Scaphoid- fall on the palm, abducted
hand. AVN
hand. AVN
• Fracture of Hamate, non union due to
Fracture of Hamate, non union due to
traction ulna nerve and artery are
traction ulna nerve and artery are
close.
close.
• Fracture of the meta-carpals- stable, 1
Fracture of the meta-carpals- stable, 1st
st
is alone, 5
is alone, 5th
th can lead to a boxer’s
can lead to a boxer’s
fracture.
fracture.
• Fracture of phalanges, need careful re-
Fracture of phalanges, need careful re-
alignment.
alignment.
• Peri lunate dislocation of the carpus.
Peri lunate dislocation of the carpus.
12/10/20 100
LECTURE NOTES BY DR . IBINGIRA

101. others
• Bennett's fracture is a fracture of the
Bennett's fracture is a fracture of the
base of the metacarpal of the thumb
base of the metacarpal of the thumb
caused when violence is applied
caused when violence is applied
along the long axis of the thumb or
along the long axis of the thumb or
the thumb is forcefully abducted. The
the thumb is forcefully abducted. The
fracture is oblique and enters the
fracture is oblique and enters the
carpometacarpal joint of the thumb,
carpometacarpal joint of the thumb,
causing joint instability.
causing joint instability.
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kiryowa

102. ASB
• The anatomic snuffbox is a term
The anatomic snuffbox is a term
commonly used to describe a
commonly used to describe a
triangular skin depression on the
triangular skin depression on the
lateral side of the wrist that is
lateral side of the wrist that is
bounded medially by the tendon of
bounded medially by the tendon of
the extensor pollicis longus and
the extensor pollicis longus and
laterally by the tendons of the
laterally by the tendons of the
abductor pollicis longus and extensor
abductor pollicis longus and extensor
pollicis brevis
pollicis brevis
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kiryowa

103. more
• Mallet Finger
Mallet Finger
• Avulsion of the insertion of one of the
Avulsion of the insertion of one of the
extensor tendons into the distal
extensor tendons into the distal
phalanges can occur if the distal
phalanges can occur if the distal
phalanx is forcibly flexed when the
phalanx is forcibly flexed when the
extensor tendon is taut.
extensor tendon is taut.
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kiryowa

104. Boutonnière Deformity
• The deformity results from flexing of
The deformity results from flexing of
the proximal interphalangeal joint
the proximal interphalangeal joint
and hyperextension of the distal
and hyperextension of the distal
interphalangeal joint. This injury can
interphalangeal joint. This injury can
result from direct end-on trauma to
result from direct end-on trauma to
the finger, direct trauma over the
the finger, direct trauma over the
back of the proximal interphalangeal
back of the proximal interphalangeal
joint, or laceration of the dorsum of
joint, or laceration of the dorsum of
the finger
the finger
12/10/20 104
kiryowa

105. • The palm of the hand has papillary ridges
called finger prints.
• Finger prints are used to identify an
unknown victim, witness or suspect and
most importantly as links and matches
between a suspect and crime.
• Prints can substantiate or disprove the story
of a victim or witness by locating their prints
where they said they were.
Legal aspects of the hand

106. • Arches-African ancestry
• Loops –European ancestry
• Whorls-Asians/Orientals
Classification of ridge
patterns

107. Examples of ridge patterns

108. Examples cont

109. Examples cont.

110. • A variety of powders are used in dusting for
prints ,many containing aluminium or carbon
• This finely crushed powder is gently applied
to a surface and the minute particles of
powder cling to the print residue , making it
visible to the human eye.
• These prints are then lifted using adhesive
tape.
• The information obtained is compared with
countries finger Data bases which may have
been taken for a number reasons.
Powder and tape

111. • Is sprayed or swabbed onto surface
• Ninhydrin reacts with amino acids in the prints
forming a purple or pink compound.
• Prints are most commonly made or made in
• 1.Plastic-impressions left in soft material like
wax, paint
• 2.Visible-made by blood ,dirt, ink or grease.
• 3.Latent-normally invisible and must be
developed before they can be seen and
photographed.
Ninhydrin

112. • Fracture of one finger-up to 1,750 pounds
• Severe dislocation of thumb-3,000 pounds
• Amputation of little finger-5,850 pounds
• Severe injury to ring or middle finger-7,750p.
• Loss of index finger up to 9,000 pounds.
• Loss of the thumb-18,500 pounds.
• Records of hand injury from family Doctor or
hospital are used when making compensation
claims.
Typical Hand Injury
Compensation Amounts.