Dr Syed Ajaz Babar Consultant Radiologist and Honorary Senior Lecturer Hammersmith Hospital Imperial Healthcare NHS Trust The hands are two intricate prehensile multifingered body parts normally located at the end of each arm of a human or other primate ID: 908765
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Slide1
Anatomy - wrist and hand
Dr
Syed
Ajaz
Babar
Consultant Radiologist and Honorary Senior Lecturer
Hammersmith Hospital
Imperial Healthcare NHS Trust
Slide2The hands are two intricate, prehensile, multi-fingered body parts normally located at the end of each arm of a human or other primate.
Wikipedia
Slide3ThemeBones of the wrist and handSurface anatomyJoints of the wrist and hand
Ligaments
Tendons
Nerves and vessels
Slide4BONES
Slide5Clinical ScenarioA 23 years old pizza delivery boy fell from his scooter on an outstretched hand. He felt pain in the wrist localised to the anatomical snuff box.
What is the most likely injury ?
Scaphoid Fracture
Slide6Scaphoid Fracture
Slide7Scaphoid fractureMost common fracture (> 90%)4 series view
Presence or absence of a scaphoid
Volar
Tubercle
Distal pole
Waist
Proximal pole
Slide870%
10%
20%
Slide9Slide10AVN Scaphoid
Blood Supply
Intraosseous blood supply
Distal pole dorsally 70-80%
Palmar distal pole minor component
Extraosseous blood supply
Scapholunate and radioscaphocapitate ligaments
Slide11Scaphoid AVN
AVN related to position of the fracture
Middle third -
30%
Proximal 5
th
-
100%
Slide12Bones
Slide13Bones
Slide14Bones
Slide15Bones
Slide16Bones
Slide17Bones
Slide18BonesScaphoid- Greek “rowing boat” shape of a boat
Lunate- semilunar in shape
Triquetrum- pyramidal in shape
Pisiform- small pea shaped sesamoid in tendon of Flexor Carpi Ulnaris
Slide19BonesTrapezium-possesses a tubercle on its palmar surface for flexor retinaculum
Trapezoid-3 facets
Capitate- largest carpal bone
Hamate- Hook or hamulus
Slide20BonesMetacarpals
Phalanges
Proximal
Distal
Slide21Surface anatomyAnatomical snuff box
Slide22Surface anatomyStyloid process of ulna
Slide23JOINTS
Slide24Clinical ScenarioA 51 year old violinist with the Royal Philharmonic Orchestra complained of pain in the wrist joint and fingers in the morning. Few years later she noticed some swelling in the small joints with an element of stiffness in the morning and also during her practise session brakes.
Slide25Plain x-rays
Slide26Long standing complications
Slide27Ultrasound
Normal
Rheumatoid
Slide28MRI
Normal
Rheumatoid Arthritis
Slide29Nuclear Medicine
Slide30JointsWristDRUJMid-carpal
Carpo-metacarpal
Meta-carpophalangeal
Inter-phalangeal
Slide31Wrist
Slide32WristSynovial joint
Capsule lined by synovium
Does not communicate with DRUJ or intercarpal joints
Movements-flexion, extension, abduction, adduction
Slide33Wrist joint ligaments
Slide34Wrist-Arthrogram and MRI
Slide35Injuries to the wrist jointFall on the outstretched handForce of transmission
Scaphoid
Distal radius
Ulna via interosseous membrane
Humerus
Glenoid fossa
Clavicle and coraco-clavicular ligament
Slide36Hand joints
Slide37Hand jointsIntercarpal
Individual carpal bones
Synovial plane joints
Carpometacarpal of the thumb
Trapezium and base of 1
st
metacarpal
Synovial saddle-shaped joint
Metacarpophalangeal
Synovial condyloid joint
Interphalangeal
Synovial hinge joint
Slide38TENDONS
Slide39Clinical ScenarioA young rock climber whilst practising on a wall in Milton Keynes slipped and latched onto a handhold. She noticed pain in the index finger with swelling as she got down to the floor. 1 week later, she could not straighten her index finger which was held in a fixed flexion deformity at the distal interphalangeal joint.
Slide40Mallet Finger
Slide41Slide42Tendons
Slide43Tendons
Slide44Tendon sheath
Slide45Slide46Slide47Surface anatomy
FCRL
Palmaris Longus
FCU
Slide48Tendons
Slide49Tendons
Slide50Tendons-wrist
EPL
ECRB
ECRL
EPL
ED
ECRB
ECR
L
Slide51Tendons
Slide52Nerves
Slide53Carpal Tunnel
FCR
FPL
FDP
FDS
S
P
Slide54Carpal Tunnel
FC
MN
Slide55Anatomy of carpal tunnelBoundariesFlexor retinaculum
Carpal bones
FPL laterally
FDS medially
Slide56Carpal Tunnel
Proximal Tunnel
Distal Tunnel
Slide57Carpal Tunnel Syndrome
Slide58Guyon’s Canal
FCR
FPL
S
P
Ulnar nerve & artery
Slide59Nerve supply
Median Nerve
Ulnar Nerve
Slide60Nerve supply
Slide61Nerve supplyMotorAll small muscles of the hand by ulnar nerve exceptThenar muscles and lateral 2 lumbricals
Sensory
Lateral three fingers flexor surface-median nerve
Medial two fingers flexor surface-ulnar nerve
Dorsal surface lateral 3 fingers-radial nerve
Dorsal surface medial 2 fingers-ulnar nerve
Slide62VesselsSuperficial palmar arch
Ulnar artery
Deep Palmar arch
Radial artery
Slide63Vessels
Slide64Vessels-angiography
Slide65Vessels-Doppler
Slide66Vessels-MRA
Slide67ConclusionUnderstanding of the anatomy is importantHand plays a vital role in the human bodyThis ranges from the delicate task of touch and feel to the application of brute force!