HAND ANATOMY

Some Lovers Try Positions

That They Cant Handle
Scaphoid, Lunate, Triquetrum, Pisiform
Trapezium, Trapezoid, Capitate, Hamate

Trapezium is under the thumb!

Musculature of the Hand

Superficial

Deep

Thenar

Hypothenar

Flexor Pollicis Brevis

Flexor Digiti Minimi

Abductor Pollicis Brevis

Abductor Digiti Minimi

Opponens Pollicis

Opponens Digiti Minimi

MEDIAN NERVE

ULNAR NERVE

Adductor
Adductor Pollicis
ULNAR NERVE!!!

Lumbricals Median
(1 & 2),
(3 & 4) Flex MCP, Extend IPs
Nerve Supply
& Ulnar
Action?
Interossei Ulnar
Dorsal - AB)
Nerve(Palmar
Supply -&AD,
Action?
Remember Forearm muscles in the hand!!!

Carpal Tunnel

Contents
- 4 x Flexor Digitorum Profundus Tendons
- 4 x Flexor Digitorum Superficialis Tendons
- Flexor Pollicis Longus Tendon
- Median Nerve
- Signs & Symptoms? Tingling, Pain, Thenar Wasting

Clinical Case 1
A 30-year-old man presents to A&E with incised wounds
to the anterior aspect of his wrist and forearm following
a suicide attempt. Preliminary inspection reveals that the
patient has four deep, linear incised wounds involving
the palmar region of the wrist. The thumb and medial
three fingers are noted to be gently flexed while the
index finger is held in extension.
Q - What specific anatomical structures do you think are
injured?
A - FDS and FDP of the index finger

Clinical Case 2
A 16-year old male presents to A&E after
slipping on ice. He states that he attempted to
break his fall and fell on an outstretched hand.
He complains of pain and swelling in the area
indicated by the arrow in the photograph
below.

Q - What is the most common injury sustained by falling on an outstretched hand in

young, healthy individuals?
A Scaphoid fracture
Q - What are possible complications of this condition?
A Avascular Necrosis, Osteoarthritis, Malunion, Non-union

Colles vs Smiths #
Dorsum

Palm

Distal Radius Fractured

Q Dorsal angulation of the distal bone fragment
A Colles

Q Palmar angulation of the distal bone fragment

A Smiths More dangerous due to the neurovascular structures in this direction!

Boutonnieres vs Swan Necking

Boutonnieres PIP & DIP

PIP flexed, DIP Hyper-extended
Swan Necking PIP & DIP
PIP Hyper-extended, DIP Flexed

Which nerve innervates the lateral half of the

muscle that flexes the fingers at the DIP joint?

ulnar nerve
radial nerve
median nerve
musculocutaneous nerve

Which of the following structures does

not pass through the carpal tunnel?

Median nerve
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus

Which part of the scaphoid is most

commonly affected by avascular
necrosis following a fracture?

scaphoid waist
proximal pole
distal pole
whole bone

Skiers Thumb
Skiers Thumb is caused by a traumatic force
on the thumb that forces it out (radial
deviation is the anatomical direction). It often
occurs with skiing and football.
Signs and symptoms include pain in the
knuckle of the thumb, swelling, and an
unstable joint. X-rays often show a small
fragment of the metacarpal that has been
pulled off by the ligament (called an avulsion
fracture).
Treatment usually consists of bracing or
splinting of partial tears and in some cases,
surgical repair if the tear is complete.

Mallet Finger
This fracture results from a trauma to tip of the
finger forcing it into flexion (rapidly bending it
down toward the palm) and avulsing the
extensor tendon. This injury commonly occurs
in baseball and basketball when attempting to
catch a ball. Signs and symptoms include pain,
swelling, and an inability to straighten out the
last digit of the involved finger.
Treatment includes splinting of the finger in
the straight position for 6-8 weeks. In some
cases, surgical pinning of the finger in a
straight position along with splinting is
necessary.

FOOT ANATOMY

Musculature of the Foot

Remember Leg muscles in the foot!!!
1st Layer of Sole:

Medial Plantar Nerve

Lateral Plantar Nerve

Musculature of the Foot

Remember Leg muscles in the foot!!!
2nd Layer of Sole:

1st Medial Plantar Nerve

2nd 4th Lateral Plantar Nerve

Lateral Plantar Nerve

Musculature of the Foot

Remember Leg muscles in the foot!!!
3rd Layer of Sole:

Lateral Plantar

Medial Plantar

Lateral Plantar Nerve

(Like Ulnar in Adductor Pollicis)

Musculature of the Foot

4th Layer of Sole:

Lateral Plantar Nerve

PAD, DAB

Structures Behind the Medial Malleolus

Tom
Dick
And
Nervous
Harry

&

Q Which muscles invert the foot?

A Tibialis Anterior (Deep Fibular Nerve) & Tibialis Posterior (Tibial Nerve)
FIBULAR = PERONEAL
Q Which muscles evert the foot?
A Fibularis Longus & Fibularis Brevis (Superficial Fibular Nerve)

Foot Drop
Q How would someone with foot drop walk?
A High Stepping Gait
Q Where could a nerve problem be localised?
Deep fibular Supplies Ant. Compartment (Tib Ant, EDL, EHL)
Common Fibular Nerve - Affects Deep & Superficial Fibular nerves
Sciatic Affects Deep & Superficial Fibular & Tibial nerves.i.e. every muscle
below the knee

What is this?

Hallux Valgus
Bunion