Hand & Wrist

Hand Anatomy

The human hand is made up of the wrist, palm, and fingers and consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments and tendons, and many blood vessels and nerves.

The hands enable us to perform many of our daily activities such as driving, writing and cooking. It is important to understand the normal anatomy of the hand to learn more about diseases and conditions that can affect our hands.

Bones of the Hand

The wrist is comprised of 8 carpal bones. These wrist bones are attached to the radius and ulna of the forearm to form the wrist joint. They connect to 5 metacarpal bones that form the palm of the hand. Each metacarpal bone connects to one finger at a joint called the metacarpophalangeal joint (MCP joint). This joint is commonly referred to as the knuckle joint.

The bones in our fingers and thumb are called phalanges. Each finger has 3 phalanges separated by two interphalangeal joints, except for the thumb, which has only 2 phalanges and one interphalangeal joint.

The first joint close to the knuckle joint is called the proximal interphalangeal joint (PIP joint). The joint closest to the end of the finger is called the distal interphalangeal joint (DIP joint).

The MCP and PIP joint act like hinges when the fingers bend and straighten.

Soft Tissues of the Hand

Our hand bones are held in place and supported by various soft tissues. These include: articular cartilage, ligaments, muscles and tendons.

Articular cartilages are smooth material that act as shock absorbers and cushion the ends of bones at each of the 27 joints, allowing smooth movement of the hand.

Muscles and ligaments function to control the movement of the hand.

Ligaments are tough rope-like tissues that connect bones to other bones, holding them in place and providing stability to the joints. Each finger joint has two collateral ligaments on either side, which prevents the abnormal sideways bending of the joints. The volar plate is the strongest ligament in the hand. It joins the proximal and middle phalanx on the palm side of the joint and prevents backward bending of the PIP joint (hyperextension).

Muscles of the Hand

Muscles are fibrous tissues that help produce movement. They work by contracting.

There are two types of muscles in the hand:

• Intrinsic muscles are small muscles that originate in the wrist and hand. They are responsible for fine motor movements of the fingers during activities such as writing or playing the piano.
• Extrinsic muscles that originate in the forearm or elbow control the movement of the wrist and hand. These muscles are responsible for gross hand movements. They position the wrist and hand while the fingers perform fine motor movements.

Each finger has six muscles controlling its movement: three extrinsic and three intrinsic muscles. The index and little finger each have an extra extrinsic extensor.

Tendons of the Hand

Tendons are soft tissues that connect muscles to bones. When muscles contract, tendons pull the bones, causing the finger to move. The extrinsic muscles are attached to finger bones through long tendons that extend from the forearm through the wrist. Tendons located on the palm side help in bending the fingers and are called flexor tendons, while tendons on top of the hand called extensor tendons help in straightening the fingers.

Nerves of the Hand

Nerves of the hand carry electrical signals from the brain to the muscles in the forearm and hand, enabling movement. They also carry the senses of touch, pain and temperature back from the hands to the brain.

The three main nerves of the hand and wrist include:

• Ulnar nerve: The ulnar nerve crosses the wrist through an area called Guyon’s canal and branches to provide sensation to the little finger and half of the ring finger.
• Median nerve: The median nerve crosses the wrist through a tunnel called the carpal tunnel. The median nerve provides sensation to the palm, thumb, index finger, middle finger and part of the ring finger.
• Radial nerve: The radial nerve runs down the thumb side of the forearm and provides sensation to the back of the hand from the thumb to the middle finger.

All three nerves originate at the shoulder and travel down the arm to the hand. Each of these nerves has sensory and motor components.

Blood Vessels of the Hand

Blood vessels travel beside the nerves to supply blood to the hand. The main arteries are the ulnar and radial arteries, which supply blood to the front of the hand, fingers, and thumb. The ulnar artery travels next to the ulnar nerve through the Guyon’s canal in the wrist. The radial artery is the largest artery of the hand, traveling across the front of the wrist, near the thumb. Pulse is measured at the radial artery.

Other blood vessels travel across the back of the wrist to supply blood to the back of the hand, fingers and thumb.

Bursae of the Hand

Bursae are small fluid-filled sacs that decrease friction between tendons and bone or skin. They contain special cells called synovial cells that secrete a lubricating fluid.

You have just had surgery. The following are some general instructions that you may find helpful.

Swelling

• Swelling is natural after surgery for the first week. Reducing swelling helps speed recovery and will decrease pain.
• Elevation is the best remedy for swelling. The best way do to this is to elevate your hand above the level of your heart for 3-5 days. While sitting in a chair or lying in bed, place your arm on pillows raised above your heart.
• Ice packs can be particularly helpful to reduce swelling and inflammation for the first week after surgery.

Wound Care

• You may remove the dressing 3-5 days post-surgery but keep the stiches in until post-op visit. You may shower but do not submerge the affected limb.
• If swelling is occurring in the fingers and is not responding to elevation, you are welcome to loosen the outer compression (ace bandage), but please do not remove the entire dressing or adjust the cast or splint.
• Place a large plastic bag over your dressing/splint when you shower or bathe to prevent it from getting wet.

Medications

• Pain medications have been prescribed. Please follow the instructions regarding these medications.
• Your pharmacist may be able to provide information about drug interactions with other medications that you are taking.
• Pain medication can often cause nausea, constipation, and itching. These are common side effects of the medication. Please do not drink alcohol or drive while taking these prescribed medications.

Activities

• Some or all of your fingers may have been left free of the dressing so that you can move them. Gentle hand movement is encouraged. Finger movement can reduce stiffness and swelling.
• If physical therapy is needed, a prescription will be written for you and can be addressed at your post-op visit.

Special Instructions

Call your doctor or go to the closest emergency room if:

• You have any signs of infection. (Increased pain, drainage, redness or swelling, foul odor, fever over 101º F.)
• You have signs of dehydration. (Dry mouth, little urine, or no tears)
• You are not able to urinate by 8-12 hours after surgery.

Go to the closest emergency room right away or call 911 if:

• You have chest pain
• You have shortness of breath
• You have hard time breathing
• You have too much bleeding
• You cannot wake the patient

Follow-up appointments are scheduled for 10-14 days after surgery. Please call our office a few days after surgery to schedule an appointment.

If you had a fracture or distal bicep repair the following wound care should be followed:

Wound Care

• The postoperative dressing, splint, or cast is a very important part of your treatment. The dressing should be left alone until your postoperative visit unless specified by your surgeon.
• If swelling is occurring in the fingers and is not responding to elevation, you are welcome to loosen the outer compression (ace bandage), but please do not remove the entire dressing or adjust the cast or splint.
• Place a large plastic bag over your dressing/splint when you shower or bathe to prevent it from getting wet.

If you had a tendon repair you will need to make sure that you have a physical therapy appointment scheduled 3-5 days post surgery.

Trigger Finger Release

Endoscopic Carpal Tunnel Release Wide Awake

Pre Injection

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