Hand

Everything in anatomical position, which is supinated hands at side. Palm forward.

 
 

'' means same as above

 
 

MP-metacarpophalangeal

Cm- Carpometaphalangeal

Bony anatomy

Wrist Bone- Carpals

• Organized into two rows with 4 columns
  
• Right Hand in anatomical position
  
• 
  

Hamate	Capitate	Trapezoid	Trapezium (articulates with thumb)
Pistiform	Triquetrum	Lunate	Scaphoid

• Mnemonic:
  

  Some Lovers Try Positions That They Can't Handle." Starting from the thumb, the eight carpal bones are Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, and Hamate. To tell the three T's apart... triquetrum has "tri/try" in it, and trapezium and trapezoid are in alphabetical order.
  

   
   

Distal Row

 
 

Proximal Row

 
 

Distal phalanx

 
 

Intermediate Phalanx

 
 

Proximal Phalanx

 
 

Numbering system- One is the thumb (Rhymes)

 
 

Actions of Thumb-

Counter intuitive, but just remember that flexion and opposition of thumb are closely related (in opposition you actually touch another finger, extension you don't). Therefore extension is away from middle finger (in anatomical position).

 
 

Actions of other fingers-

Moving fingers away from middle finger extended line, abduction. Middle finger can't aDduct bc it has to move away from line.

 
 

Flexion- Curl fingers up into fist

Extension- move em other way.

 
 

Compartments of Hand

Most superficial (anatomical pos)

Base of thumb- Thenar compartment

Base of pinky- hypothenar (hypo- means less, pinky has less mass than thumb)

In between these two- central compartment (center of hand)

Deep

Interosseous compartments- between metacarpals

Adductor comparment- deep to the thenar comparmtnet.

 
 

If you take off the palm Hannibal-Lector Style, you see the palmar aponeurosis, dense connective tissue

Abnormal thickening,shortening, fibrosis of this band- Dupuytren Contracture

Fingers pulls in to flexion (fist)

Multiple Surgeries to correct

Usually happens to men, some genetic basis

 

Thenar (Thumb) Intrinsic muscles of hand (chicken drumstick muscle)

Muscle	Origin	Insertion	Innervation	Action
Abductor pollicis brevis	Flexor Retinaculum, trapezum, scaphoid.	Base of proximal phalanx of Thumb	Recurrent branch of median nerve (C8,T1)	Abducts thumb, helps to oppose thumbs
Flexor pollicis brevis	''	''	''	Flexs thumb at MC and MP joints
Deep to above muscles: Opponens policis	''	I Don't know, she didn't say	''	Opposes thumb at 1st Carpometacarpal joints

 
 

Hypothenar compt. (Pinky) intrinsic muscles of hand

Pretty much mirror image of thumb intrinsic muscles except pollicis= digit minimi

 
 

Muscle	Origin	Insertion	Innervation	Action
Abductor digiti minimi			Deep branch of ulnar n. (C8,T1)	Abducts at MP
Flexor digiti minimi brevis			''	Flexes V @ MP, PIP
Opponens digiti minimi			''	Opposes V @ MP

 
 

Adductor compartment

Muscle	Origin	Insertion	Innervation	Action
Adductor policis (two heads Transverse			Deep branch of ulnar muscle ( exception bc all other thenar are innervated by median n. recurrent branch)	Adduct thumb @ MP joint

 
 

Central compartment

Weird bc lumbrical attach tendon to bone not bone to bone.

Muscle	Origin	Insertion	Innervation	Action
Lumbrical (1-4) "Bye-bye muscles"			1st & 2nd- Median n. (C& T1) 3rd & 4th- Deep branch of ulnar nerve	Flex MP (all fingers except thumb) Extend MP( all fingers except thumb)

 
 

 
 

FYI: It is impt to think about these muscles in term of compartments, otherwise it seems really random.

Remember hypothenar is on the superficial pinky side, thenar is on the thumb side, central between.

Deep: Adductor deep to thenar and interosseous between metacarpals.

 
 

Interosseus Cmpt (deep to lumbricals)

Muscle	Origin	Insertion	Innervation	Action
Dorsal interossei	Didn't even see on slide		Deep branch of ulnar (C8,TI)	DAB- Dorsal abduct II,III,IV, Help lumbricals flex MP and ext. IP ts
Palmar Interossei			''	PAD- Palmar Adduct II, IV, V, Help lumbircals flex MP and ext. IP joints

 
 

 
 

 
 

 
 

Common finger injuries

 
 

Skier's thumb:

 
 

Mallet thumb:

 
 

Boutonniere Deformity:

Swan-neck Deformity

 
 

 
 

 
 

Swan-neck Deformity

Mechanism of Injury:

• Rheumatoid arthritis, trauma from fall
  
  • Dorsal dislocation of middle phalanx
    
  • May damage joint ligaments
    

  Presentation:
  

  
  

• Hyperextension at PIP, hyperflexion of DIP
  
• Severely limits function
  

   
   

  
  

   
   

   
   

  Once ulnar hits palm goes to deep and superficial branch.
  

   
   

  Carpal Tunnel injury
  

  Bone and dense connective tissue. Space cannot expand. What's in tunnel? All tendons that flex fingers. And the Median nerve. That gets compressed bc space cannot expand. If median nerve compressed? Both motor and sensory functions
  

   
   

  
  

  Mechanism of injury
  

• Inflammation of FDS/FDP/FPL tendons or sheaths, fluid retention, infection
  
• Compression of median nerve (poor bacha)
  

   
   

  Presentation:
  

• Paresthesia, hypoesthesia, anesthesia over lateral 3½ digits (IN ANATOMICAL POS)
  
• Progressive weakness of abductor pollicis brevis & opponens pollicis mm.
  
  • Inability to oppose thumb, difficulty gripping objects in hand
    

   
   

  Distal Median N. Injury
  

  Mechanism of Injury:
  

• Damage to the distal median n./recurrent branch of median n.
  
  • Attempted suicide by wrist slashing, 'bagel cutting' injury
    

  Presentation:
  

• Paralysis of thenar mm. (Simian "Ape" Hand), lumbricals 1-2
  
  • Inability to oppose thumb, limited abduction of thumb
    

    (thumb moves mainly in flexion/extension)
    

  • Loss of fine control in digits II-III
    

   
   

  Suicide can present with median nerve damage similar to
  

  Thenar nerve- Very superficial not well protected.
  

  Ape hand- can still do flexion and extension, but can't oppose.
  

   
   

   
   

   
   

  Ulnar Canal Syndrome ("Guyon Tunnel Syndrome")
  

  Mechanism of Injury:
  

• Compression of ulnar nerve in ulnar (Guyon's) canal
  
  • Pressure against handelbar, carpal fracture, thrombus
    

  Presentation:
  

• Paresthesia, hypoesthesia, anesthesia over medial 1½ digits
  
• Progressive weakness of lumbricals (3^rd-4^th) and interossei mm.
  
  • Clawing of digits IV-V
    

   
   

   
   

  
  

   
   

   
   

   
   

  Blood Supply to hand
  

   
   

  
  

   
   

  
  

   
   

  
  

   
   

Pollicis means thumb

Should be @ CM and MP joints

 
 

 
 

Mechanism of inj: fall onto outstretch hand w obj in palm (ie ski pole

Result: Torn, stretch ulnar collateral ligament

Presentation: Pain, swelling at base of thumb. Weakness/inability to grasp.

 
 

Mechanism of inj: direct blow to distal phalanx

Result: extensor digitorum tendon avulsed from distal phalanx

Presentation: Hyper extended DIP

 
 

Boutonnière Deformity

Mechanism of Injury:

• Rheumatoid arthritis, trauma from fall
  
  • Palmar dislocation of middle phalanx
    
  • May avulse extensor digitorum tendon
    

  Presentation:
  

• Hyperflexion at PIP
  
• Severely limits function
  

 
 

 
 

 
 

 
 

Day 5 in Dubai

The next day I took it easy cause I got food poisoning from that Mexican place. I bought souvenirs at night but otherwise lazed around most of the day.

I took some pictures of Svasti in the car ride over:





She was singing “Paper planes” by MIA in the car ride over, which makes her the coolest little kid I know.

Since she was so cool, she got a reward:

Day 4 in Dubai

The next day we took it easy during the day then we headed to the beach around 4 pm. The pictures below I took with my cousin’s camera. The water was crystal clear blue and warmer than I expected. Me doing my best Michael Phelps impression:




The view of the Burj Khalifa from the beach:



My cousins Rishma and Anish in what Rishma called “A perfect Facebook picture” ;)




Me and Svasti in another perfect Facebook picture:


After the beach we got Mexican food. It was called “Senor Ricardo” or something like that. Don’t ever go there. That place gave me the shits.

After we had dinner we went to the mall where this crazy Arab guy was tearing up the ice rink in traditional Middle Eastern dress. He was too fast for my camera!

Desert Safari- DuneBoarding and Camp

After the Dune Bashing we stopped at a large Dune to try some Dune Boarding. They bust out a snowboard and almost everyone in our tour group (~ 50 people) lined up to try it out. My turn finally came up and I got on the board, the guy gave me a little push and I thought I was gonna go down nice and easy but I picked up speed fast and caught a sand edge. I flew head first into the sand and sand went everywhere. I definitely heard a lot of “ohhhs” behind me. Haha. The fall wasn’t bad but sand went everywhere. It even got into my camera and totally fucked it up. I turned on the camera to see if working but it would open and close the lens three times. Then “Lens error” would flash on the LCD screen. So no more pictures for the rest of the day, which is a shame because I had a great time at the camp we went to after. A corner of the camp was dedicated to smoking hookah with a guy lighting coals for almost 20 hookahs. Heaven!

While I was smoking shisha I met a bunch of college kids from Ole Miss that were pretty cool and fun to talk to. One of the girls I met was a junior at Ole miss that actually grew up in Saudia Arabia, which was definitely something different.

Desert Safari- Dune Bashing

After the bar my cousin Rishma picked me up and dropped me off at the pickup spot for the Desert Safari. First we started off with Dune Bashing in the Driver’s Toyota Highlander. The pictures speak for themselves:

Garment District

After the Dubai museum I walked around the garment district in Dubai. I eventually found a place with made to order dress shirt with a French cuff. After some haggling I got it for 80 dirrhams (~22 dollars), so of course I couldn’t pass that up. When I got it back I was surprised at how well made the shirt was. It was pretty hot outside and I was looking for a place to take a break. I somehow managed to find a bar in the middle of Dubai. If you’ve ever been to a Muslim country you’d know this was not an easy find. Understandably it was pretty tucked away. Here’s a pic of my Foster’s.

Dubai Museum

The morning of the 17th Anish dropped me off at the Dubai Museum in Bur Dubai (transliteration: "Old Dubai"). The exhibits in the museum mostly pay homage to when Dubai was an old fishing and pearling village.

Here's a picture of a skirt that has shells attached to it. When a belly dancer wears one of these they can make music:


I found Bin Laden!


Traditional Saudi Dress:

I saw some women dressed like this in Dubai, they looked kinda like Big Bird with that metal mask they were wearing.