hello in this video we're going to look at the clinical anatomy of the hand and also the fingers so we'll actually focus on the wrist joint mainly now we'll Begin by focusing on the right hand and here's the right hand um we're looking at it from a Palmer view so the palms of your hands and actually the surface anatomy here you can actually feel um your scao bone the tubal of your scao bone and there's also the piriformis bone you can feel as well as above it the hook of hamade somewhere let's look at the right hand again and introduce some of the bones now here are the forearm Bones the Ona medially and the radius laterally you can remember that radius is lateral because lateral is where you can feel the radial archery the wrist bones consists of many small bones to put it simply there are eight four sitting on the top and four below they are collectively known as the carpal bones you can remember the eight carpal Bones by starting at the thumb and moving around in a clockwise motion and remember this saying so long to pinky here comes the thumb so s is for scoid L for lunate t for tri quenum P for pisiform moving up H is for hamate c for capitate and then trapezoid and then trapezium so again so long to pinky here comes the thumb the bones of the hands are made up of met copples then you have the fanges and then you have the of course the distal middle and proximal fanges which are the fingers essentially but remember the thumb has a metac cople but it has a proximal and then a distal fanges so there's no middle fanges drawing the same rightand diagram again looking at it from a Palmer View and imagine cutting a slice through these two sections at the Copper bones so again we are basically looking at the four copper Bones on the top or the distal four and then the other proximal four Copple bones so focusing on the distal four Copple Bones from the pinky here comes the thumb so H is for hamate c for capitate t for trapezoid and then trapezium trapezoid and trapezium might be confusing because because they sound similar but to remember which one comes first um think of the last letter of each word so the D is before the m and so trapezoid is first and then it's trapezium Which is closest to the thumb the hamate has a hook and traveling across the hamate and the trapezium is the flexor retinaculum the flexor retinaculum is a very important structure to remember but first let's look at the other proximal four Copple bones so long to pinky s is for scoid L for lunate T triquetrum and P pform the scoid has a tubic that can be felt and here again is the flexor retinaculum the flexor retinaculum is important part of the hands Anatomy the wrist Anatomy because things run over it and things run under it so let's have a closer look and let's stick with the right hand for now but before going on I want to introduce to you an attendant ATT tendon that runs over your flexor retinaculum called the tendon of palaris longis this tendon is a big tendon you can see in the middle um of of of your wrist and this tendon it originates essentially from the medial epicondyle the wrist it is innervated by the median nerve so here I'm drawing the Cobble bones of the right hand let us now look at things that run superficial to the flexor retinaculum and things that run deep to the flexor retinaculum let's begin by looking at the Deep structures and there are many structures that run deep to the flex oraculum it's easy to divide it into four things one the median nerve two the T the tendons of flexor digitorium superficialis three the tendons of flexor digitorium profundas and the fourth is the tendem of flexa Pocus longus which goes to the thumb and the flexor digitorium superficialis and flexor digitorium profundus has four actual tendons each I actually Drew this wrong um the tendon of flexor policis longest should be at the right hand side because that's the side of the thumb sorry anyways let's now look and talk about the structures which run superficial to the flexor retinaculum I just want to add the hook of ham here and the trapezium here again these are the distal carpal bones okay so the structure that run superficial to the flexor retinaculum include the tendon of palmaris longus which I talked about because we are looking at the right hand Thea structures are on the left side medially so here is the artery and the nerve Palma cutanous branch of the OA nerve and the Palma cutaneous branch of the median nerve can also be found on the other side okay some clinical relevance of the flexor retinaculum and the median nerve so here is the right hand again here is the flexor retinaculum it's also sometimes referred to as the Copple ligament which makes sense because it literally goes over the Cole bones anyway remember the four main groups of structures that run under under it one of which is the median nerve the media nerve is sensory for the middle index and thumb region and also motor for these regions as well caral tunnel syndrome is where you get compression of the median nerve at the flexor retinaculum causing numbness paresthesia and pain in the median nerve distribution caral tunel syndrome affects females more than men and there are many causes that actually can cause couple tunnel and irritate the median nerve going back to the diagram we drew ear earlier do you remember the tendon of palmaris longus the tendon that goes over your flexor retinaculum the tendon you can see and on on your wrist well this tendon it has some branches that come off it and form What's called the Aon Neurosis the Palma Apon neurosis and this has some clinical relevance another clinical relevance is dupet contracture which is localized thickening and contracture of the Palmer APO Neurosis it causes the proximal and middle fenx or flanges to flex the distal fance is unaffected let's look in more detail at the anatomy of the finger the fanges so here we are mainly looking at either the middle index or pinky or ring finger but we're not looking at the thumb because the thumb does not have a middle fance and these other uh fingers they consist of the distal fance the middle fing and the proximal fings and then you have your metac cople now remember the tendons that run under the flexor retinaculum well this is where we talk about some of those tendons and where they attach on the finger see the flexor digitorium superficialis tendons run towards the proximal fanges then Bates and attaches to the middle phic and so we can say that the flexor digitorium superficialis tendon flexes the proximal inter flangel joint the flexor digitorium profundus tendon run below deep to the flexor digitorium superficialis and attaches to the distal fallings it does not bif thus we can say the flexor digitorium profundus tendon flexes the distal inter fenial joint all right some clinical Anatomy trigger finger is a condition where there is localized thickening of long Flex ATT tendons which then prevent movement of the tendon within the fibrous sheath so just think about it as part of the a tendon thickening creating a lump which prevents movement of the finger so let's just draw it out here is a finger like your index finger here are your fanges and proximately is your metac cople bones sorry I know I wrote metat tassel tassels are in your foot this is meant to be metacap now in this diagram it's also it's also important to know that we have these fibrous sheath sort of um running running on your Palmer surface of your fingers and these fibrous sheath they sort of act as a pulley and under it is the flex ATT tendon so the flex ATT tendon runs under the fibrous sheath a trigger finger is essentially where you have sort of a nodule or thickening of the flexa tendon that runs under the fibrous sheath and this causes a sort of restrictive movement of that finger in this case the flex ATT tendon thickening or nodule is occurring in between the metac cople bone and the proximal fance this inhibits the flexion between the metaco and proximal inter flangel joint