Hand and Wrist Anatomy and Biomechanics: A Comprehensive Guide

117 Pages·2017·13.83 MB·English

by  Bernhard Hirt

Hand and Wrist Anatomy and Biomechanics
A Comprehensive Guide
Bernhard Hirt, MD
Professor
Institute for Clinical Anatomy
University of Tübingen
Tübingen, Germany
Harun Seyhan, MD
Assistant Medical Director
Department of Plastic Surgery
Hand Surgery – Burn Center
University of Witten/Herdecke
Cologne-Merheim Medical Center (CMMC)
Cologne, Germany
Michael Wagner, PT
Private Practice
Hannover, Germany
Rainer Zumhasch, OT
Director
Academy for Hand Rehabilitation
Bad Pyrmont, Germany
130 illustrations
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Contents
1 AnatomyandFunctionalAnatomyoftheHand ....................................... 2
1.1 Introduction .......................... 2 BloodSupplytotheWristJointandHand ..... 46
LymphaticsoftheHand ................... 47
1.2 StructureandFunctionoftheProximal
andDistalRadioulnarJoints ............ 2 1.4 Thumb .............................. 48
1.2.1 AnularLigamentoftheRadius ............. 3 1.4.1 MovementsandRangeofMotion ......... 48
1.2.2 ObliqueCord ........................... 4 MovementsoftheThumbCMCJoint ......... 48
1.2.3 InterosseousMembraneofthe RangeofMotionoftheThumbMCPand
Forearm ............................... 4 IPJoints ............................... 49
1.2.4 StructureandFunctionofthe 1.4.2 StructureandFunctionoftheThumb
TriangularFibrocartilageComplex ......... 6 CMCJoint ............................. 49
UlnocarpalDiscandMeniscalHomologue ...... 8 LigamentsoftheThumbCMCJoint .......... 51
PalmarandDorsalRadioulnarLigaments ....... 8 MusclesoftheThumbCMCJoint ............ 54
UlnolunateandUlnotriquetralLigaments ....... 8 1.4.3 StructureandFunctionoftheThumb
UlnarCollateralLigamentofWristJoint ........ 8 MCPandIPJoints ...................... 57
TendonSheathoftheExtensorCarpiUlnaris MCPJointoftheThumb .................. 58
Muscle ................................. 9 IPJointoftheThumb ..................... 59
1.2.5 MusclesoftheRadioulnarJoint—Pronation
andSupination ......................... 9 1.5 StructureandFunctionofthePalm .... 60
PronatorMuscles ......................... 9
SupinatorMuscles ....................... 10 1.5.1 StructureandFunctionoftheSecondto
FifthMetacarpals ...................... 60
1.3 WristandMovementAxes ............ 10 1.5.2 MusclesoftheMetacarpals .............. 62
DorsalandPalmarInterossei ............... 62
1.3.1 MovementAxes........................ 10 Lumbricals ............................. 63
1.3.2 StructureandFunctionoftheWrist AbductorDigitiMinimiMuscle ............. 63
Joint ................................. 12 FlexorDigitiMinimiBrevisMuscle ........... 64
CarpalBones ........................... 12 OpponensDigitiMinimiMuscle ............. 64
Joints ................................. 14 1.5.3 PalmarAponeurosis(MetacarpalArea) .... 64
1.3.3 LigamentSystemandWristStability ...... 16 LongitudinalFibers ...................... 65
SuperficialLayeroftheLigamentsoftheWrist 17 TransverseFibers ........................ 66
MiddleLayerofLigamentsoftheHand ....... 19
DeepLayeroftheLigamentsoftheHand ..... 23 1.6 StructureandFunctionoftheFinger
Conclusions ............................ 25 Joints ................................ 66
1.3.4 MusclesoftheWrist:Extension–Flexion,
RadialDeviation–UlnarDeviation,and 1.6.1 StructureandFunctionofthe
Circumduction ........................ 25 MCPJoints ............................ 66
MusclesInvolvedinFlexionandUlnarDeviation CollateralLigaments ..................... 67
oftheWrist ............................ 26 PalmarandDorsalConnectiveTissuePlate .... 68
MusclesInvolvedinExtensionandRadial DeepandSuperficialTransverseMetacarpal
DeviationoftheWrist .................... 28 Ligaments ............................. 69
1.3.5 ArthrokinematicsoftheWristJoint ....... 28 1.6.2 StructureandFunctionofthe
KinematicsoftheWrist:GeneralAspects...... 30 PIPJoints ............................. 69
ArthrokinematicsoftheWristJoint:Specific CollateralLigamentsofthePIPJoint ......... 70
Aspects ............................... 30 PalmarandDorsalFibrocartilagePlate ........ 70
1.3.6 OtherImportantAnatomicalStructures AnularandCruciateLigaments ............. 70
oftheWrist ........................... 33 DorsalDigitalExpansion .................. 72
DorsalandPalmarTendonCompartments .... 33 1.6.3 StructureandFunctionofthe
CarpalTunnel,UlnarTunnel,andInnervation DIPJoints ............................. 73
oftheHand ............................ 38 1.6.4 RangeofMotionoftheMCP,PIP,and
DIPJoints ............................. 75
v
Contents
1.6.5 ExtrinsicMusclesoftheFinger:Flexors ExtrinsicFlexorsoftheFinger .............. 76
andExtensors ......................... 75
ExtensorApparatusoftheFinger ............ 75
2 SurfaceAnatomyoftheForearm,Wrist,andHandStructures .................... 82
2.1 Introduction ......................... 82 SecondDorsalTendonCompartment ........ 88
ThirdDorsalTendonCompartment .......... 89
2.2 PracticalFoundationsofSurface FourthDorsalTendonCompartment ......... 89
Anatomy ............................ 82 FifthDorsalTendonCompartment .......... 90
SixthDorsalTendonCompartment .......... 90
2.3 PracticalProcedureforSurface 2.3.3 SurfaceAnatomyoftheExtrinsic
AnatomyoftheForearm,Wrist,and DorsalForearmMuscles ................. 91
Hand ................................ 83 2.3.4 SurfaceAnatomyofthePalmarWrist,
ThreePalmarTendonCompartments,
2.3.1 SurfaceAnatomyoftheDistal andPalmarNervesandVessels ........... 92
RadioulnarJointandWrist ............... 83 2.3.5 SurfaceAnatomyoftheExtrinsic
RadiocarpalJointLineandItsStructures ...... 83 PalmarForearmMuscles ................ 96
MetacarpophalangealJointLineandIts 2.3.6 SurfaceAnatomyofthePalm,Thumb,
Structures ............................. 84 andFingers ........................... 96
DorsalCarpalBones ...................... 84 2.3.7 SurfaceAnatomyoftheIntrinsicMuscles
2.3.2 SurfaceAnatomyoftheSixDorsal ofThenar,Palm,andHypothenarAreas .... 98
TendonCompartments .................. 86
FirstDorsalTendonCompartment ........... 87
References ............................................................................. 100
Index .................................................................................... 106
vi
Preface
Inordertodiagnoseandtreathanddisorders,medical inthetimeavailable.Asweplannedthisbook,wefelt
professionals must be intimately familiar with the thatseveralfeatureswereessential:itneededtohave
anatomical structures in question. They must also a convenient format; it should cover all important
understand their specific functions in terms of bio- aspectsofthisbroadspectrum;andcanbereferredto
mechanics and have the practical skills needed to quicklyandeasilywhereverhandinjuriesandcondi-
determine and palpate them. These skills are indis- tionsarediagnosedandtreated.
pensableforphysicians,occupationaltherapists,and WehopethatwehavemetourgoalinAnatomyand
physicaltherapistswhenchoosingthebesttreatment BiomechanicsoftheHandwithregardtobothsubject
forthepatient. matterandeaseofuse.Thisbookisintendedtohelp
Whiletherearemanybooksavailableontheanat- healthcareprofessionalsdiagnoseandtreatpatients
omy, surface anatomy, and kinematics of the hand, moreefficientlyandtoprovideasolidfoundationfor
nobooktodatehasgatheredallofthesedisciplines interdisciplinary communication among all of the
in a single volume. When practitioners work with professionals involved. “If we expect to understand
patients,theyneedtoaddresstheseaspectssimulta- eachother,weallneedtospeakthesamelanguage.”
neously.Theyareforced toconsult a numberofdif-
ferentbookswhentreatingasinglepatient.Inmany Prof.BernhardHirt,MD
cases the particular reference needed is not in the HarunSeyhan,MD
practitioner’slibrary—ortheinformationinthebook MichaelWagner,PT
tohandistoodetailedforasalientanswertobefound RainerZumhasch,OT
vii
Acknowledgments
We would like to thank Mr. Klausch for editing the requests for information on various topics that
imagesforthisbook,aswellasMs.CorneliaPariesfor inspiredustowritethisbook.
thewealthoftipsandsuggestionsforimprovingthe Wealsogratefullyacknowledgetheentirestaffof
text.Wearealsogratefultoour familymembers,to ThiemePublishers.Ourcooperationwasalwayspleas-
whom we dedicate this book, Anatomy and Bio- antandquicklygrewintoacollaborationcharacter-
mechanicsoftheHand.Theypickeduptheslackfor ized by friendship. When selecting the numerous
us, allowing us to complete this book in a timely anatomical illustrations, they respected our wishes,
manner despite all of our other professional com- worked meticulously and ensured that the images
mitments. Special thanks go to the wife of Rainer underpinnedtheindividualtextpassages.
Zumhasch,whoexhibitedagreatdealofpatienceand Particular thanks go to the Department of
understandingassheallowedustodrawtheanatom- Anatomy at the University of Tübingen, Germany,
icalstructuresonherarmsandhands.Insodoing,she whichassistedusinbothwordanddeedatalltimes.
madeavaluablecontributiontoconveyingtheknowl- Finally,wewouldalsoliketothankallofthereaders
edgeinawaythatiseasytoseeandunderstand. ofthisbook.Wethankyouforchoosingthispublica-
Furthermore, we would like to thank all of the tionandhopethatwehavebeenabletoaddressyour
participantsinourseminarsattheAcademyofHand needs.
Rehabilitation, Bad Münder, Germany. It was their
viii
Chapter 1 1.1 Introduction 2
1.2 StructureandFunctionofthe
Anatomy and Functional
ProximalandDistalRadioulnar
Anatomy of the Hand Joints 2
1.3 WristandMovementAxes 10
1.4 Thumb 48
1.5 StructureandFunctionofthe
Palm 60
11.6 StructureandFunctionofthe
FingerJoints 66