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Anatomy of the Hand
Anatomy of the Hand
20
Medical
Professional
09/01/2010

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Term
scaphoid (Navicular)
Definition
1) Largest and MOST COMMONLY FRACTURED CARPAL BONE as a result of falling on a outstretched hand & often associated with fractured distal radius.
2) On lateral side and gives attachment to RADIAL COLLATERAL LIGAMENT and FLEXOR RETINACULUM (retains most of the flexor ligaments).
Term
avascular necrosis
Definition
Due to fracture of the scaphoid bone, swelling and tenderness occur over the anatomic snuff box and the arterial supply (nutrient artery), which passes from DISTAL TO PROXIMAL, may be cut off.
Term
scaphoid fracture
Definition
1) Wrist sprain as a result of hyperextension injury secondary to a fall on an outstretched hand may produce scaphoid fracture
2) A missed scaphoid fracture has a high incidence of SCAPHOID NONUNION and SUBSEQUENT ARTHRITIS
3) Under-treated occult scaphoid fracture can cause major complications!
4) Complains of pain over the “snuff box” and scaphoid tubercle should make you think of possible scaphoid fracture.
5) Scaphoid fractures can be seen in COLLE'S FRACTURES.
Term
Colle's Fracture
Definition
1) Fracture of the DISTAL end of the radius as a result of fall on outstretched hand, extended, or abducted hand.
2) Fractured distal segment displaces DORSALLY and distal end of ulna & scaphoid may also fracture.
Term
lunate
Definition
crescent shaped and and contributes to articular surface of wrist joint.
1) Rarely fractures but can dislocate commonly as a result of a fall on a dorsiflexed hand.
2) Dislocated lunate produces shortening of the 3rd metacarpal bone (as a result of another carpal bone moving proximal) and paresthesia (tingling sensation) in the cutaneous area of the median nerve (mimics carpal tunnel syndrome).
Term
triquetrum
Definition
Gives attachment to the ulnar collateral ligament. Not really important.
Term
pisiform
Definition
1) important seasmoid bone (embedded in tendon)
2) embedded in flexor carpi ulnari and gives attachment to ulnar collateral ligament and flexor retinaculum (common to most carpal bones as well as one of the muscles known as the abductor digiti minimi).
Term
trapezium
Definition
not important, gives attachment to flexor retinaculum like any other carpal bone.
Term
trapezoid
Definition
SMALLEST carpal bone, gives attachment to to carpal ligaments. not important
Term
capitate
Definition
centrally located, articulates with most other carpal and metacarpal bones. NOT important.
Term
hamate
Definition
small bone.
1) Hamulus of hamate (hook of hamate) and psiform forms the CANAL OF GUYON (common site of ulnar entrapment--very important site! compression of ulnar nerve--HANDLEBAR NEUROPATHY)
Term
radiocarpal bones
Definition
1) ELLIPSOID bone between proximal row of carpal bones (with exception of psiform) and distal end of radius. Ulna is NOT involved because of the presence of articular disc.
2) Articular disc connects distant end of ulna and radius.
3) Movements: a) Primary flexors -- flexor carpi radialis and ulnaris.
b) primary extensors -- extensor carpi radialis longus et brevis & extensor carpi ulnaris
c) ulnar deviation (adduction) -- extensor carpi ulnaris & flexor carpi ulnaris
d) radial deviation (abduction) -- extensor carpi radialis longus et brevis and flexor carpi radialis.
Term
flexor retinaculum
Definition
carpal bones give attachment to this thick band, connective tissue. has attachment to carpal bone on lateral and medial side. covers long flexor tendon to the side.
1) superifical component -- palmar carpal ligament, only connects distal end of radius and ulna
2) deep component (our concern) -- transverse carpal ligament. connects to the psiform and hamate medially & scaphoid and trapezium laterally which is responsible for converting that part to the osseofibrous tunnel that allows passage of long flexor tendons and median nerve.
3) transverse carpal ligament is responsible for carpal tunnel syndrome
4) gives origin to carpal tunnel and hypothenar muscles
5) content-median nerve, extensor digitorium profundus and superificalis
5) median nerve and associated tendon are most likely effected as result of carpal tunnel syndrome.
Term
Carpal Tunnel Syndrome
Definition
1) generally affects dominant hand (commonly extends or flex).
2) Anything that can compress median nerve can exhibit symptoms of carpal tunnel (such as dislocation of lunate).
3) acroparasthesia--tingling sensation that usually happens at night
4) atrophy of thenar muscles (ape-hand configuration when thenar muscles flatten)
5) opposition and thumb abduction are most commonly affected (movements supplied by median nerve).
Term
carpometacarpal joint
Definition
sellar (saddle-shaped) synovial joint. formed by ARTICULATION of TRAPEZIUM AND FIRST METACARPAL BONE.
1) Allows flexion (flexor pollicis longus et brevius), extension (extensor pollicis longus et brevius), abduction (abductor pollicis longus), adduction (adductor pollicis), and opposition (opponens pollicis).
Term
metacarpophalangeal Joint
Definition
1)CONDYLOID synovial joint formed by the heads of metacarpals and base of proximal phalanges.
2) Strengthened by COLLATERAL LIGAMENT.
3) Permits flexion, extension, abduction, adduction.
Term
Skier's Thumb
Definition
AKA gamekeeper's thumb
1) Results from minor rupture or tear of ULNAR collateral ligament of the MCP joint of the thumb.
2) Fracture of the base of proximal phalanx may be due to acute radial abduction.
3) Patient will experience pain and be unable to form a grip.
Term
interphalangeal joint
Definition
PIP (proximal)- flexor digitorium superficialis and DIP (distal) joints-flexor digitorium profundius.
Extensor digitorium expansion is the common area of many tendons that insert to DIP and PIP joints.
Term
Rheumatoid Arthritis
Definition
1) symmetric inflammation of articular synovia of multiple joints and painless subcutaneous nodules.
2) Systematic condition-fever, morning stiffness and in extreme cases, ULNAR DEVIATION
AFFECTS THE ___ AND ___ joints (MP AND PIP).
1) associated with pannus destruction.

Disease only affects selective joints.
Term
Osteoarthritis
Definition
Affects ___ joint (DIP).
Bony spires. Caused by wear and tear of articular surfaces.
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