Clinical Anatomy of the Hand and Fingers Lecture

Overview

• Focuses on the wrist joint and right hand.
• Palmar view (palm side) used primarily.
• Importance of recognizing surface anatomy.
• Key bones: scaphoid, piriformis, hook of hamate.

Bone Structure

Forearm Bones

• Ulna: Medial.
• Radius: Lateral (location of the radial artery).

Wrist Bones

• 8 carpal bones (2 rows of 4 each).
• Remembering: "So Long To Pinky, Here Comes The Thumb."
  • S: Scaphoid
  • L: Lunate
  • T: Triquetrum
  • P: Pisiform
  • H: Hamate
  • C: Capitate
  • T: Trapezoid
  • T: Trapezium (last letters help differentiate: D before M)

Hand Bones

• Metacarpals: 5 total, one for each finger and thumb.
• Phalanges: 14 total.
  • Proximal, middle, and distal for fingers (except the thumb lacks a middle phalanx).

Carpal Bones from Palmar View

Distal Four Carpal Bones

• H (Hamate), C (Capitate), T (Trapezoid), T (Trapezium).
• Hook of hamate and flexor retinaculum connections.

Proximal Four Carpal Bones

• S (Scaphoid), L (Lunate), T (Triquetrum), P (Pisiform).
• Scaphoid tubercle and flexor retinaculum connections.

Flexor Retinaculum

• Connects hamate hook and trapezium.

• Structures running deep:

  1. Median nerve
  2. Tendons of flexor digitorum superficialis
  3. Tendons of flexor digitorum profundus
  4. Tendon of flexor pollicis longus

• Structures running superficial:

  1. Tendon of palmaris longus
  2. Ulnar artery
  3. Ulnar nerve
  4. Palmar cutaneous branch of ulnar nerve
  5. Palmar cutaneous branch of median nerve

Clinical Relevance

Median Nerve and Carpal Tunnel Syndrome

• Median nerve: Sensory and motor functions (middle, index, thumb region).
• Carpal tunnel syndrome: Compression of median nerve, leading to numbness, paresthesia, pain.
• Higher prevalence in females.

Palmar Aponeurosis

• Originates from palmaris longus tendon.
• Clinical relevance: Dupuytren's contracture, causing flexion of proximal/middle phalanges.

Anatomy of the Fingers

• Typically discussing middle, index, pinky, or ring finger (not thumb).
• Bones: Proximal, middle, distal phalanx, metacarpal.
• Tendon attachments:
  • Flexor digitorum superficialis: Attaches to middle phalanx (flexes proximal interphalangeal joint).
  • Flexor digitorum profundus: Attaches to distal phalanx (flexes distal interphalangeal joint).

Trigger Finger Condition

• Caused by localized thickening of long flexor tendons within fibrous sheath.
• Results in restricted finger movement.
• Clinical example: Thickening between metacarpal bone and proximal phalanx affecting flexion.