Discussion of various hand pathologies focusing on nerve, muscle, tendon injuries, and bone fractures.
Median Nerve Palsy
Sensation: Affects the first three digits and half of the ring finger.
Motor: Innervates most extrinsic muscles and four intrinsic muscles (LOAF: Lumbricals 1 & 2, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis).
Symptoms:
Difficulty moving the thumb away from the hand (opposition and abduction issues).
Thumb is often found close to the other digits (Adductor pollicis still functioning).
Limited thumb function, often referred to as "Ape Hand".
Ulnar Nerve Palsy
Innervation: Most intrinsic muscles, hypothenar muscles, half of the lumbricals, and interossei muscles. Only a few extrinsic muscles (Flexor carpi ulnaris and half of Flexor digitorum profundus).
Sensation: Affects the last two digits (ring and little fingers).
Symptoms:
Atrophy of the intrinsic muscles.
MCP joints in hyperextension, PIP and DIP joints in flexion.
Often referred to as "Claw Hand".
Loss of motor and sensory function in the fourth and fifth digits.
Difficulty with power grip and precision activities.
Radial Nerve Palsy
Nerve Path: Radial nerve at upper arm; changes to Posterior Interosseous Nerve (PIN) after passing the elbow joint.
Sensation: Affects the dorsal side of the hand.
Motor: Extensors of the wrist and fingers.
Symptoms:
Difficulty with hand extension and making a fist (wrist drop).
Extensors are atrophied, flexors are unopposed.
Use of wrist splints to support the wrist in a functional position.
Common reference to "Drop Hand" or PIN syndrome when related to radial nerve issues.
Summary
Understanding the specific nerve involvements can help diagnose and manage various hand pathologies effectively.
Treatment often involves supportive splints and rehabilitation exercises to improve hand function.