1. The bones of the hand

3. Ossification of carpal bones
Capitate – by 2nd month
Hamate by 3rd month
Triquetral by 3rd year
Lunate by the 4th year
Scaphoid, Trapezium and Trapezoid by 5th year
Pisiform 10 to 12th year
Females ossify before males.

4. The joints of the hand

5. The wrist joint

8. Joints of the wrist area
Wrist joint
Joints between proximal row of carpal bones
Joints between distal row of carpal bones
Joints between the proximal and distal rows

9. Movements of wrist Flexion 85 deg. Mostly at radiocarpal joint
Extension 85deg. Mostly midcarpal
Abduction 15 deg. Mostly midcarpal
Adduction 45 deg. Mostly radiocarpal

11. Carpometacarpal joints
The thumb: Between first metacarpal base and t he trapezium
Sellar type joint
Wide mobility
Palmar, dorsal ligaments and Lateral ligament
Second to fifth carpometacarpal joints and interm etacarpal joints have restricted mobility

12. Metacarpo-phalangeal joints
Ellipsoid joints (sometimes called bicondylar)
Palmar and collateral ligaments for stability
Fair range of movements
Flexion 90 deg or more but extension small
Abduction and adduction limited more so in flexio n.

13. Inter phalangeal joints

14. The carpal tunnel

17. Other tunnels & canals

18. is a space at the wrist between flexor retinaculum and the palmar carpal ligament (which runs between the pisiform bone and the hamate bone), through which the ulnar artery and the ulnar nerve travel into the hand.

20. Near the elbow – the ulnar nerve is pinched

24. Intrinsic muscles of hand
The muscles of the hand
aka
Small muscles of hand
Intrinsic muscles of hand

26. The fascia of the hand

27. Fascial framework/skeleton
Aponeuroses
Sheaths
Retiancula
Bands
Septa

28. Fascial spaces

29. Longitudinal fibre system
Palmar aponeurosis
These are in three layers
Just under skin
Deep to web space apex and fingers
A third layer on either side of the MPJ and atta ch to metacarpal, proximal phalanx and extens or tendon

30. Palmar fascial complex
Transverse fibre system
Vertical fibre system

33. Transverse system - Flexor retinaculum
It is attached, medially, to the pisiform and the hamulus of the hamate bone; laterally, to the tubercle of the scaphoid, and to the medial part of the volar surface and the ridge of the trapezium.

36. Flexor tendon sheaths
Annular
Criciate
Pulleys

37. Extensor or Dorsal

39. Synovial sheaths and spaces

43. Altered balance in tendon and tissue tensions result in deformity

44. Mallet finger

45. Infected, swollen finger.

46. The skin of the hand

47. Skin of the hand Dorsal skin Palmar skin
Relationship to the fascial framework
Fat pads

48. Wrist and palmar creases
Wrist has three lines
Proximal at the level of flexor synovial sheath s
Intermediate at the level of wrist joint
Distal at the level of flexor retinaculum
These creases fix and bend - “skin joints”

50. Single palmar crease of Downs syndrome

51. Nails

52. Parts of a nail
Plate
Matrix
Folds
Bed
Hyponychium

53. Nails grow at a speed of 0.1mm a day.
Vary with sex, age, health, nutrition...

56. Nerve supply of the hand
Nerve damage

57. Blood supply

60. Intravenous cannulae are best put into the veins of the hand. Why?

61. Sclerotherapy!! Sheer stupidity?