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Hand surface anatomy
This document provides an overview of hand anatomy including: - Naming the bones, joints, tendons, nerves and skin landmarks of the hand and wrist. - It describes flexor tendon zones, extensor compartments, and pulley system anatomy. - Conditions that require emergency referral are discussed, such as bleeding, amputation, replantation, compartment syndrome, infections, and high pressure injection injuries. Proper management of these conditions focuses on rapid assessment and treatment to prevent further tissue damage.
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Hand surface anatomy
- 1. Section 2 Surface &pertinent anatomy
- 2. Naming the digits TheBirmingham Hand Centre Assessment and Early Management of the Injured Hand University Hospitals Birmingham NHS Foundation Trust
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- 10. Skin landmarks •Wrist crease •Distalpalmar crease
- 11. Skin landmarks •Wrist crease •Distalpalmar crease •Proximal digital crease
- 12. Skin landmarks •Wrist crease •Distalpalmar crease •Proximal digital crease •PIPJ flexor crease
- 13. Skin landmarks •Wrist crease •Distalpalmar crease •Proximal digital crease •PIPJ flexor crease •DIPJ flexor crease
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- 15. Flexor tendon zones •Zone1 •Zone 2
- 16. Flexor tendon zones •Zone1 •Zone 2 •Zone 3
- 17. Flexor tendon zones •Zone1 •Zone 2 •Zone 3 •Zone 4
- 18. Flexor tendon zones •Zone1 •Zone 2 •Zone 3 •Zone 4 •Zone 5
- 19. Naming the bonesin the hand
- 20. Naming the bonesin the hand Proximal phalanx (P1) of index finger
- 21. Naming the bonesin the hand Middle phalanx (P2) of ring finger
- 22. Naming the bonesin the hand Terminal or distal phalanx (P3) of middle finger
- 23. Naming the bonesin the hand Metacarpal of small finger
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- 26. Naming the joints Metacarpo- phalangealjoint (MCPJ) of index finger
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- 28. Naming the joints Proximal interphalangealjoint (PIPJ) of small finger
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- 30. Naming the joints Distalinterphalangeal joint (DIPJ) of ring finger
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- 32. Naming the joints Metacarpo- phalangealjoint (MCPJ) of thumb
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- 34. Naming the joints Interphalangeal joint(IPJ) of thumb
- 35. Naming the bonesin the wrist
- 36. Naming the bonesin the wrist
- 37. Naming the bonesin the wrist • Scaphoid
- 38. Naming the bonesin the wrist • Scaphoid
- 39. Naming the bonesin the wrist • Scaphoid • Lunate
- 40. Naming the bonesin the wrist • Scaphoid • Lunate
- 41. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum
- 42. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum
- 43. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform
- 44. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform
- 45. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate
- 46. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate
- 47. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate • Capitate
- 48. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate • Capitate
- 49. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate • Capitate • Trapezoid
- 50. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate • Capitate • Trapezoid
- 51. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate • Capitate • Trapezoid • Trapezium
- 52. Naming the bonesin the wrist • Scaphoid • Lunate • Triquetrum • Pisiform • Hamate • Capitate • Trapezoid • Trapezium
- 53. Surface anatomy ofthe wrist bones – volar
- 54. Surface anatomy ofthe wrist bones – dorsal
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- 59. Flexor retinaculum • Scaphoidtuberosity • Ridge of trapezium • Hook of hamate • Pisiform • “Postage stamp”
- 60. The dorsal aspectof the wrist
- 61. The extensor compartmentsof the wrist • 6 extensor compartments
- 62. The extensor compartmentsof the wrist • 6 extensor compartments • Under extensor retinaculum
- 63. The extensor compartmentsof the wrist • 6 extensor compartments • Under extensor retinaculum • Junctura tendinae
- 64. The extensor compartmentsof the wrist 1st APL & EPB 2nd ECRL & ECRB 3rd EPL 4th EDC & EIP 5Th EDM 6th ECU
- 65. The extensor tendonsin the digits
- 66. The extensor tendonsin the digits • Extensor tendon
- 67. The extensor tendonsin the digits • Extensor tendon • Extensor hood
- 68. The extensor tendonsin the digits • Extensor tendon • Extensor hood • Sagittal band
- 69. The extensor tendonsin the digits • Extensor tendon • Extensor hood • Sagittal band • Central slip
- 70. The extensor tendonsin the digits • Extensor tendon • Extensor hood • Sagittal band • Central slip • Lateral bands
- 71. The volar aspectof the wrist
- 72. The volar aspectof the hand • FDP
- 73. The volar aspectof the hand • FDP • FDS
- 74. The volar aspectof the hand • FDP • FDS • Metacarpal head
- 75. The volar aspectof the hand • FDP • FDS • Metacarpal head • Flexor retinaculum
- 76. The fibrous flexorsheath • A1 pulley
- 77. The fibrous flexorsheath • A1 pulley • A2 pulley
- 78. The fibrous flexorsheath • A1 pulley • A2 pulley • A4 pulley
- 79. The radial aspectof the wrist
- 80. Cutaneous innervation ofthe wrist & hand • Superficial radial nerve • Dorsal branch of ulnar nerve
- 81. Cutaneous innervation ofthe wrist & hand • Ulnar nerve
- 82. Cutaneous innervation ofthe wrist & hand • Ulnar nerve • Median nerve
- 83. Cutaneous innervation ofthe wrist & hand • Ulnar nerve • Median nerve • Motor branch of median nerve
- 84. Cutaneous innervation ofthe digits • Trifurcation of the digital nerve
- 86. Section 9 What isan emergency referral?
- 87. Bleeding • Practically allupper limb bleeding will stop! • EXCEPTION: partially injured large artery • Treat bleeding with elevation and firm dressing • DO NOT attempt to tie off bleeders in A&E • RARELY should a tourniquet be used
- 88. Amputation •Proximal amputations, speedis of the essence •Warm ischaemic time <6hours •This is an emergency •Quick purposeful action, not cutting corners
- 89. Replantation The decision ofwhether to replant lies with the surgeon in conjunction with the patient. • Urgent transfer, only if the patient is stable • Correct packaging of parts • X-ray limb & amputated part • Cold not frozen • Damp not soggy
- 90. De-vascularised parts /doubtful vascularity • Speed important • Often venously congested • Align digits correctly • No tight bandages • Resting Volar POP for comfort in transit
- 91. Compartment syndrome • Interossei •Flexor compartment forearm • High index of suspicion • Examine by stretching muscles of compartment
- 92. Hydrofluoric acid burns •Lethal due to precipitation of Ca++ • Calcium gluconate • pain relieving • Emergency transfer to regional burns unit • Accept advice from patient –if they work with the stuff they probably know about it!
- 93. High pressure injectioninjuries • Grease, oil, paint, hydraulic fluid, air • Ischaemia/necrosis • Mechanical • Toxic effect • Early transfer • Early washout
- 94. Infections • Calor -warmth • Rubor - redness • Tumor - swelling • Dolor - pain • Functio laesa • Pus (or blood) under pressure destroys tissue (necrosis) • Skin, subcutaneous fat, tendon, cartilage….
- 95. Infections – flexorsheath Kanavel’s signs • Slight flexion • Uniformly swollen • Pain on passive extension • Tenderness along line of sheath • Management • Elevation • Antibiotics • Surgical washout
- 96. Infections – Web-space/DeepPalmar Space• History of FB/ gardening • Fingers separated • Anatomically volar, but most easily seen from dorsal • Management • Elevation • Antibiotics • Surgical washout
- 97. Infections Pulp-space (Felon) Paronychia • Notusually an emergency • May be able to treat within emergency department Herpetic Whitlow