Hand surface anatomy

Hand anatomy by examination, surface anatomy of hand, hand surgery examination, hand surgery

1. Section 2 Surface & pertinent anatomy

2. Naming the digits The Birmingham Hand Centre Assessment and Early Management of the Injured Hand University Hospitals Birmingham NHS Foundation Trust

3. Naming the digits Thumb

4. Naming the digits Thumb Index

5. Naming the digits Thumb Index Middle

6. Naming the digits Thumb Index Middle Ring

7. Naming the digits Thumb Index Middle Ring Small

8. Skin landmarks

9. Skin landmarks Wrist crease

10. Skin landmarks Wrist crease Distal palmar crease

11. Skin landmarks Wrist crease Distal palmar crease Proximal digital crease

12. Skin landmarks Wrist crease Distal palmar crease Proximal digital crease PIPJ flexor crease

13. Skin landmarks Wrist crease Distal palmar crease Proximal digital crease PIPJ flexor crease DIPJ flexor crease

14. Flexor tendon zones Zone 1

15. Flexor tendon zones Zone 1 Zone 2

16. Flexor tendon zones Zone 1 Zone 2 Zone 3

17. Flexor tendon zones Zone 1 Zone 2 Zone 3 Zone 4

18. Flexor tendon zones Zone 1 Zone 2 Zone 3 Zone 4 Zone 5

19. Naming the bones in the hand

20. Naming the bones in the hand Proximal phalanx (P1) of index finger

21. Naming the bones in the hand Middle phalanx (P2) of ring finger

22. Naming the bones in the hand Terminal or distal phalanx (P3) of middle finger

23. Naming the bones in the hand Metacarpal of small finger

24. Naming the joints

25. Naming the joints

26. Naming the joints Metacarpo-phalangeal joint (MCPJ) of index finger

27. Naming the joints

28. Naming the joints Proximal interphalangeal joint (PIPJ) of small finger

29. Naming the joints

30. Naming the joints Distal interphalangeal joint (DIPJ) of ring finger

31. Naming the joints

32. Naming the joints Metacarpo-phalangeal joint (MCPJ) of thumb

33. Naming the joints

34. Naming the joints Interphalangeal joint (IPJ) of thumb

35. Naming the bones in the wrist

36. Naming the bones in the wrist

37. Naming the bones in the wrist Scaphoid

38. Naming the bones in the wrist Scaphoid

39. Naming the bones in the wrist Scaphoid Lunate

40. Naming the bones in the wrist Scaphoid Lunate

41. Naming the bones in the wrist Scaphoid Lunate Triquetrum

42. Naming the bones in the wrist Scaphoid Lunate Triquetrum

43. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform

44. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform

45. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate

46. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate

47. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate Capitate

48. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate Capitate

49. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate Capitate Trapezoid

50. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate Capitate Trapezoid

51. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate Capitate Trapezoid Trapezium

52. Naming the bones in the wrist Scaphoid Lunate Triquetrum Pisiform Hamate Capitate Trapezoid Trapezium

53. Surface anatomy of the wrist bones – volar

54. Surface anatomy of the wrist bones – dorsal

55. The anatomical snuffbox

56. Scaphoid tenderness?

57. Scaphoid tenderness?

58. Scaphoid tenderness

59. Flexor retinaculum Scaphoid tuberosity Ridge of trapezium Hook of hamate Pisiform “Postage stamp”

60. The dorsal aspect of the wrist

61. The extensor compartments of the wrist 6 extensor compartments

62. The extensor compartments of the wrist 6 extensor compartments Under extensor retinaculum

63. The extensor compartments of the wrist 6 extensor compartments Under extensor retinaculum Junctura tendinae

64. The extensor compartments of the wrist 1 st APL & EPB 2 nd ECRL & ECRB 3 rd EPL 4 th EDC & EIP 5 Th EDM 6 th ECU

65. The extensor tendons in the digits

66. The extensor tendons in the digits Extensor tendon

67. The extensor tendons in the digits Extensor tendon Extensor hood

68. The extensor tendons in the digits Extensor tendon Extensor hood Sagittal band

69. The extensor tendons in the digits Extensor tendon Extensor hood Sagittal band Central slip

70. The extensor tendons in the digits Extensor tendon Extensor hood Sagittal band Central slip Lateral bands

71. The volar aspect of the wrist

72. The volar aspect of the hand FDP

73. The volar aspect of the hand FDP FDS

74. The volar aspect of the hand FDP FDS Metacarpal head

75. The volar aspect of the hand FDP FDS Metacarpal head Flexor retinaculum

76. The volar aspect of the hand FDP FDS Metacarpal head Flexor retinaculum

77. The fibrous flexor sheath A1 pulley

78. The fibrous flexor sheath A1 pulley A2 pulley

79. The fibrous flexor sheath A1 pulley A2 pulley A4 pulley

80. The radial aspect of the wrist

81. Cutaneous innervation of the wrist & hand Superficial radial nerve Dorsal branch of ulnar nerve

82. Cutaneous innervation of the wrist & hand Ulnar nerve

83. Cutaneous innervation of the wrist & hand Ulnar nerve Median nerve

84. Cutaneous innervation of the wrist & hand Ulnar nerve Median nerve Motor branch of median nerve

85. Cutaneous innervation of the digits Trifurcation of the digital nerve

86. Section 9 What is an emergency referral?

87. Bleeding Practically all upper limb bleeding will stop! EXCEPTION: partially injured large artery Treat bleeding with elevation and firm dressing DO NOT attempt to tie off bleeders in A&E RARELY should a tourniquet be used

88. Amputation Proximal amputations, speed is of the essence Warm ischaemic time <6hours This is an emergency Quick purposeful action, not cutting corners

89. Replantation The decision of whether to replant lies with the surgeon in conjunction with the patient. Urgent transfer, only if the patient is stable Correct packaging of parts X-ray limb & amputated part Cold not frozen Damp not soggy

90. De-vascularised parts / doubtful vascularity Speed important Often venously congested Align digits correctly No tight bandages Resting Volar POP for comfort in transit

91. Compartment syndrome Interossei Flexor compartment forearm High index of suspicion Examine by stretching muscles of compartment

92. Hydrofluoric acid burns Lethal due to precipitation of Ca++ Calcium gluconate pain relieving Emergency transfer to regional burns unit Accept advice from patient –if they work with the stuff they probably know about it!

93. High pressure injection injuries Grease, oil, paint, hydraulic fluid, air Ischaemia/necrosis Mechanical Toxic effect Early transfer Early washout

94. Infections Calor - warmth Rubor - redness Tumor - swelling Dolor - pain Functio laesa Pus (or blood) under pressure destroys tissue (necrosis) Skin, subcutaneous fat, tendon, cartilage….

95. Infections – flexor sheath Kanavel’s signs Slight flexion Uniformly swollen Pain on passive extension Tenderness along line of sheath Management Elevation Antibiotics Surgical washout

96. Infections – Web-space/Deep Palmar Space History of FB/ gardening Fingers separated Anatomically volar, but most easily seen from dorsal Management Elevation Antibiotics Surgical washout

97. Infections Pulp-space (Felon) Paronychia Not usually an emergency May be able to treat within emergency department Herpetic Whitlow