hand__footanatomy.pptx

8/10/2019 hand__footanatomy.pptx

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HAND ANATOMY


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HAND ANATOMY


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Some Lovers Try PositionsThat They Cant Handle

Scaphoid, Lunate, Triquetrum, Pisiform

Trapezium, Trapezoid, Capitate, Hamate


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Trapezium is under the thumb!


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LumbricalsMedian (1 & 2), Ulnar (3 & 4)Flex MCP, Extend IPs

InterosseiUlnar (Palmar - AD, Dorsal - AB)

RememberForearm muscles in the hand!!!

Nerve Supply & Action?

Musculature of the Hand

Thenar Hypothenar Adductor

Flexor Pollicis Brevis Flexor Digiti Minimi

Abductor Pollicis Brevis Abductor Digiti Minimi Adductor Pollicis

Opponens Pollicis Opponens Digiti Minimi

MEDIAN NERVE ULNAR NERVE ULNAR NERVE!!!

Superficial

Deep

Nerve Supply & Action?


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Carpal Tunnel

Contents

- 4 x Flexor Digitorum Profundus Tendons- 4 x Flexor Digitorum Superficialis Tendons

- Flexor Pollicis Longus Tendon

- Median Nerve

- Signs & Symptoms?Tingling, Pain, Thenar Wasting


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Clinical Case 1

A 30-year-old man presents to A&E with incised woundsto the anterior aspect of his wrist and forearm followinga suicide attempt. Preliminary inspection reveals that thepatient has four deep, linear incised wounds involving

the palmar region of the wrist. The thumb and medialthree fingers are noted to be gently flexed while theindex finger is held in extension.

Q - What specific anatomical structures do you think are

injured? A - FDS and FDP of the index finger


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Clinical Case 2

A 16-year old male presents to A&E after

slipping on ice. He states that he attempted to

break his fall and fell on an outstretched hand.

He complains of pain and swelling in the area

indicated by the arrow in the photograph

below.


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Q - What is the most common injury sustained by falling on an outstretched hand in

young, healthy individuals?

AScaphoid fracture

Q - What are possible complications of this condition?

AAvascular Necrosis, Osteoarthritis, Malunion, Non-union


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Colles vs Smiths #

Distal Radius Fractured

QDorsal angulation of the distal bone fragment

AColles

QPalmar angulation of the distal bone fragment

ASmiths More dangerous due to the neurovascular structures in this direction!

Dorsum

Palm


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Boutonnieres vs Swan Necking

Boutonnieres PIP & DIP

PIP flexed, DIP Hyper-extended

Swan NeckingPIP & DIP

PIP Hyper-extended, DIP Flexed


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Which nerve innervates the lateral half of the

muscle that flexes the fingers at the DIP joint?

ulnar nerve

radial nerve

median nerve

musculocutaneous nerve


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Which of the following structures does

not pass through the carpal tunnel?

Median nerve

Flexor carpi ulnaris

Flexor digitorum superficialis

Flexor digitorum profundus

Flexor pollicis longus

Whi h t f th h id i t


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Which part of the scaphoid is most

commonly affected by avascular

necrosis following a fracture? scaphoid waist

proximal pole

distal pole

whole bone


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Skiers Thumb is caused by a traumatic force

on the thumb that forces it out (radial

deviation is the anatomical direction). It often

occurs with skiing and football.

Signs and symptoms include pain in the

knuckle of the thumb, swelling, and an

unstable joint. X-rays often show a small

fragment of the metacarpal that has been

pulled off by the ligament (called an avulsion

fracture).

Treatment usually consists of bracing or

splinting of partial tears and in some cases,

surgical repair if the tear is complete.

Skiers Thumb


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This fracture results from a trauma to tip of the

finger forcing it into flexion (rapidly bending it

down toward the palm) and avulsing the

extensor tendon. This injury commonly occurs

in baseball and basketball when attempting to

catch a ball. Signs and symptoms include pain,

swelling, and an inability to straighten out thelast digit of the involved finger.

Treatment includes splinting of the finger in

the straight position for 6-8 weeks. In some

cases, surgical pinning of the finger in a

straight position along with splinting is

necessary.

Mallet Finger


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FOOT ANATOMY


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RememberLeg muscles in the foot!!!

1stLayer of Sole:

Musculature of the Foot

Medial Plantar Nerve Lateral Plantar Nerve


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2nd Layer of Sole:


1stMedial Plantar Nerve

2nd4thLateral Plantar Nerve

Lateral Plantar Nerve


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3rd Layer of Sole:



(Like Ulnar in Adductor Pollicis)

Medial PlantarLateral Plantar


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4th Layer of Sole:



PAD, DAB


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Structures Behind the Medial Malleolus

Tom

DickAnd

Nervous

Harry

&


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QWhich muscles invert the foot?

ATibialis Anterior (Deep Fibular Nerve) & Tibialis Posterior (Tibial Nerve)

FIBULAR = PERONEAL

QWhich muscles evert the foot?AFibularis Longus & Fibularis Brevis (Superficial Fibular Nerve)


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Foot DropQHow would someone with foot drop walk?

AHigh Stepping Gait

QWhere could a nerve problem be localised?

Deep fibularSupplies Ant. Compartment (Tib Ant, EDL, EHL)

Common Fibular Nerve - Affects Deep & Superficial Fibular nerves

SciaticAffects Deep & Superficial Fibular & Tibial nerves.i.e. every muscle

below the knee


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What is this?

Hallux Valgus

Bunion


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hand__footanatomy.pptx