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HAND ANATOMY

HAND ANATOMY. S ome L overs T ry P ositions T hat T hey C an’t H andle S caphoid, L unate, T riquetrum , P isiform T rapezium, T rapezoid, C apitate , H amate. “Trapezium is under the thumb!”. Musculature of the Hand. Superficial. Deep.

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HAND ANATOMY

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  1. HAND ANATOMY

  2. Some Lovers Try Positions That They Can’t Handle Scaphoid, Lunate, Triquetrum, Pisiform Trapezium, Trapezoid, Capitate, Hamate

  3. “Trapezium is under the thumb!”

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

  5. 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

  6. 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

  7. 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.

  8. 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

  9. Colle’s vs Smith’s # Dorsum Palm Distal Radius Fractured Q – Dorsal angulation of the distal bone fragment… A – Colle’s Q – Palmar angulation of the distal bone fragment… A – Smith’s – More dangerous due to the neurovascular structures in this direction!

  10. Boutonniere’s vs Swan Necking Boutonniere’s – PIP & DIP… PIP flexed, DIP Hyper-extended Swan Necking – PIP & DIP… PIP Hyper-extended, DIP Flexed

  11. 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

  12. 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

  13. Which part of the scaphoid is most commonly affected by avascular necrosis following a fracture? • scaphoid waist • proximal pole • distal pole • whole bone

  14. “Skier’s Thumb” Skier’s 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.

  15. “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.

  16. FOOT ANATOMY

  17. Musculature of the Foot Remember – Leg muscles in the foot!!! 1st Layer of Sole: Medial Plantar Nerve Lateral Plantar Nerve

  18. 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

  19. Musculature of the Foot Remember – Leg muscles in the foot!!! 3rd Layer of Sole: Medial Plantar Lateral Plantar Lateral Plantar Nerve (Like Ulnar in Adductor Pollicis)

  20. Musculature of the Foot 4th Layer of Sole: Lateral Plantar Nerve PAD, DAB

  21. Structures Behind the Medial Malleolus Tom Dick And Nervous Harry &

  22. 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 – FibularisLongus & FibularisBrevis (Superficial Fibular Nerve)

  23. 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

  24. What is this? Hallux Valgus – “Bunion”

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