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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.

Conditions

Wrist Fracture

Wrist Fracture

Wrist fractures may be caused by a fall on an outstretched arm, vehicular accidents or workplace injuries. Certain sports such as football, snowboarding or soccer may also be a cause of wrist fractures.

Fractures of the Hand and Fingers

Fractures of the Hand and Fingers

The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations, lacerations and amputations while operating machinery, bracing against a fall and during sports.

Wrist Sprain

Wrist Sprain

Injuries caused due to stretching or tearing of the ligaments in the wrist are called wrist sprains. Sprains can range from mild to severe, based on the extent of injury to the ligament.

Flexor Tendon Injuries

Flexor Tendon Injuries

Tendons are bands of fibrous connective tissue that connect muscles to bone. Tendons aid in the movement of the fingers, hand and all other body parts.

There are two types of tendons present in the hand: the extensor tendons and flexor tendons. Extensor tendons present on top of the hand help straighten the fingers, while flexor tendons that lie on the palm side of the hand help in bending the fingers.

Mallet Finger

Mallet Finger

The finger joint is a hinge-joint that allows bending and straightening of the fingers. Each finger is composed of 3 phalanges joined by 2 interphalangeal joints (IP joints). The joint near the base of the finger is called the proximal IP joint (PIP joint), and the joint near the tip of the finger is called the distal IP joint (DIP joint).

Finger Sprain

Finger Sprain

The finger joint is a hinge-joint that allows bending and straightening of the fingers. Each finger is composed of 3 phalanges joined by 2 interphalangeal joints (IP joints). The joint near the base of the finger is called the proximal IP joint (PIP joint), and the joint near the tip of the finger is called the distal IP joint (DIP joint).

Thumb Fracture

Thumb Fracture

A break or a crack in the bones of the thumb is known as a thumb fracture. Fractures may occur anywhere on the thumb, but a fracture at the base of the thumb, near the wrist, is considered the most serious.

Scaphoid Facture

Scaphoid Facture

The scaphoid bone is a small, boat-shaped bone in the wrist, which, along with 7 other bones, forms the wrist joint. It is present on the thumb side of the wrist, and is at a high risk for fractures. A scaphoid fracture is usually seen in young men aged 20 to 30 years. They can occur at two places: near the thumb or near the forearm.

Finger Dislocation

Finger Dislocation

Finger dislocation is a condition in which the bone of your finger has moved away from its normal position. Dislocation can be caused from jamming or overextending the finger during sports activities or a fall on an outstretched hand.

Adult Forearm Fractures

Adult Forearm Fractures

The forearm is made up of 2 bones, namely, the radius and ulna. The primary function of your forearm is rotation i.e., the ability to turn your palm up and down. The fracture of the forearm affects the ability to rotate your arm, as well as bend and straighten the wrist and elbow.

Arthritis of the Hand and Wrist

Arthritis of the Hand and Wrist

Arthritis is an inflammatory condition of the joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body and the arthritis in the hand affects the joint at the base of the thumb. Arthritis may also affect the joints of other digits.

Forearm Fractures in Children

Forearm Fractures in Children

The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture.

Arthritis of the Thumb

Arthritis of the Thumb

Arthritis is an inflammatory condition of the joints. There are several types of arthritis. The most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years.

Ganglion Cyst

Ganglion Cyst

Ganglion cysts are swellings that most commonly develop along the tendons or joints of wrists or hands. They can be found either at the top of the wrist, palm side of the wrist, end joint of a finger or at the base of a finger. A ganglion cyst is not cancerous and will not spread to the other parts of the body.

Boutonniere Deformity

Boutonniere Deformity

Tendons in your fingers connect the finger bones to finger muscles and help bend and straighten the finger at the joint when the muscles contract. Boutonnière deformity is a condition in which a tendon injury to the middle joint of the finger results in the inability to straighten the affected finger.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

De Quervain's Tendinosis

De Quervain's Tendinosis

Inflammation and swelling of the tendon sheaths put pressure on the adjacent nerves and leads to pain and numbness in the thumb side of the wrist. Strain on these tendons can cause swelling and irritation, and lead to a condition called De Quervain's tenosynovitis, which is characterized by inflammation.

Dupuytren's Contracture

Dupuytren's Contracture

Dupuytren’s contracture is a hand condition where thickening of the underlying fibrous tissues of the palm causes the fingers to bend inward. This makes it difficult to fully straighten the affected fingers.

Trigger Finger

Trigger Finger

The ability to bend the fingers is governed by supportive tendons that connect muscles to the bones of the fingers. The tendons run along the length of the bone and are kept in place at intervals by tunnels of ligaments called pulleys.

Congenital Defects of the Hand and Wrist

Congenital Defects of the Hand and Wrist

The hand and wrist are formed during the 8th week of gestation. This process consists of various steps and failure in any one or more of these steps may cause congenital or birth defects. The deformities may be major (absence of a bone) or minor (disproportion of a finger).

Hand Pain

Hand Pain

Injury or inflammation of any of these structures, due to a disorder or disease condition, may produce hand pain. Even compression of the nerves supplying these structures may cause hand pain.

Hand Infections

Hand Infections

Hand infections, if left untreated or treated improperly, can cause disabilities such as stiffness, contracture, weakness, and loss of tissues (skin, nerve and bone) that will persist even after the infection resolves. Therefore, prompt treatment of hand infections is important.

Wrist Injuries

Wrist Injuries

The wrist is a commonly injured joint in the body. Problems include sprains and strains as well as fractures that can occur with lifting and carrying heavy objects, while operating machinery, bracing against a fall, or from sports-related injuries.

Wrist Tumors

Wrist Tumors

A tumor is a lump or abnormal growth formed due to unregulated cell division. Wrist tumors can occur on or underneath the skin. They are most often benign (non-cancerous).

Gamekeeper's Thumb

Gamekeeper's Thumb

Gamekeeper's thumb, also known as skier's thumb, is a tear of the ulnar collateral ligament, a band of tissue that supports the joint at the base of the thumb.

Hand Tumors

Hand Tumors

Any abnormal lump or bump on the hand is considered a hand tumor. Hand tumors can occur on the skin as a mole or a wart, underneath the skin soft tissue or on the bone. Most hand tumors are benign (non-cancerous); however, they can also rarely be malignant (cancerous).

Extensor Tendon Injuries

Extensor Tendon Injuries

Tendons are bands of tissue connecting muscles to bones. The extensor tendon is a strong, smooth cord that connects finger bones to muscles in the hand. Extensor tendons are located just under the skin, directly on the bone, on the back of the hand and fingers.

Fingertip Injuries

Fingertip Injuries

A fingertip injury is a wound or damage caused to the most distal portion of the finger. It can be a crush, a sharp cut, a tear or a combination of these, and can result in damage to the skin, nail or nailbed, tendon, pulp, bone, and nerve endings.

Wrist Ligament Tear and Instability

Wrist Ligament Tear and Instability

A ligament is a strong, flexible band of fibrous tissue. The wrist has many ligaments that help to keep the wrist bones in proper position providing stability to the joint. A torn ligament causes the wrist bones to move out of their position, which in turn leads to wrist instability as the sprained (torn) ligament can no longer support the wrist bones.

Metacarpophalangeal Joint Arthritis

Metacarpophalangeal Joint Arthritis

The bones of the hand are called metacarpals and the bones of the fingers are called phalanges. The metacarpophalangeal joint or MP joint, also known as the first knuckle, is the large joint in the hand where the finger bones meet the hand bones. The MCP joint acts as a hinge joint and is vital during gripping and pinching.

Malunion of a Fracture

Malunion of a Fracture

Malunion of a fracture is a condition where the fractured ends of a bone heal in a misaligned position resulting in bone deformity. Malunions may occur in any bone fractures in the body often due to trauma.

Pediatric Forearm Fracture

Pediatric Forearm Fracture

Coming Soon

Procedures

Ligament Reconstruction and Tendon Interposition

LRTI (Ligament Reconstruction and Tendon Interposition) for Thumb CMC Arthritis

LRTI (ligament reconstruction and tendon interposition) is a surgical procedure that is most commonly conducted to treat thumb CMC (carpometacarpal) arthritis where the damaged joint surfaces are removed and replaced with a cushion of tissue that keeps the bones separated.

Wrist Open Reduction and Internal Fixation

Wrist Open Reduction and Internal Fixation

Open reduction and internal fixation of the wrist is a surgical technique employed for the treatment of severe wrist fractures to restore normal anatomy and improve range of motion and function.

Trapeziectomy

Trapeziectomy

Trapeziectomy is a surgical procedure to treat a medical condition called “thumb base arthritis”. The procedure involves removal of a small, cube-shaped bone known as the “trapezium” at the base of the thumb joint which joins your thumb to your wrist.

Peripheral Nerve Repair

Peripheral Nerve Repair

The peripheral nerves are the nerve fibers that compose the area from head to toe, connecting the brain and spinal cord with the rest of the body parts. Nerves transmit electrical impulses and signals to and from the brain.

Wrist Arthroscopy

Wrist Arthroscopy

Your wrist is a complex joint made up of eight small bones called carpal bones. These bones are supported by connecting ligaments. Various conditions can affect your wrist joint such as carpal tunnel syndrome, osteoarthritis and others.

Wrist Joint Replacement

Wrist Joint Replacement

The wrist is a complex joint made up of 8 carpal bones aligned in two rows with four bones present in each row. The carpal bones are further connected to 5 metacarpal bones that form the palm of the hand. Each small bone forms a joint with the bone next to it. Thus, the wrist joint is made up of many small joints.

Carpal Tunnel Release Surgery

Carpal Tunnel Release Surgery

Carpal tunnel syndrome is a common, painful, progressive condition that is caused by the compression of the median nerve at the wrist area.

Elective Emergency Hand Surgery

Elective Emergency Hand Surgery

Hand surgery is performed to restore the structure and functionality of the fingers, wrist and hand secondary to a traumatic injury, medical condition, severe infection, or birth defect causing pain and/or deformity of the hand. It is performed by trained and certified plastic surgeons.

Wrist Ligament Reconstruction

Wrist Ligament Reconstruction

The human wrist is made up of small bones joined together by a band of tough fibrous tissue known as ligaments. Ligaments also join the bones in our wrist to the radius, ulna, and metacarpal bones, and aid in the proper functioning of our wrist.

Total Wrist Arthrodesis

Total Wrist Arthrodesis

The wrist joint is one of the most complex joints in the human body. Numerous joints and bones contribute to the strength and stability of the wrist. The wrist is made up of eight separate small bones called carpal bones. The carpal bones connect the two bones of the forearm, the radius and the ulna, to the bones of the hand.

Sports Injury Management of Hand, Wrist and Elbow

Sports Injury Management of Hand, Wrist and Elbow

Sports injuries are injuries that most commonly occur during sports and exercises. These injuries may result from accidents, poor training practices, and use of improper protective gear, lack of conditioning, and insufficient warm-up and stretching.

Hand Fracture Surgery

Hand Fracture Surgery

The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations, lacerations and amputations while operating machinery, bracing against a fall and sports-related injuries.

Artificial Finger Joint Replacement

Artificial Finger Joint Replacement

Arthritis develops when the cartilage wears-out, resulting in pain, stiffness and inflammation in the joints. It can affect any joint in the body, but the most commonly affected joints are the small joints of the fingers.

Finger Joint Fusion

Finger Joint Fusion

Arthritis develops when the cartilage wears-out, resulting in pain, stiffness and inflammation in the joints. Arthritis can affect any joint in the body, but the most commonly affected joints are the small joints of the fingers.

Surgery for Thumb and Digit Arthritis

Surgery for Thumb and Digit Arthritis

Arthritis is an inflammatory condition of the joints. There are several types of arthritis; the most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years.

ORIF of the Forearm Fractures

ORIF of the Forearm Fractures

The forearm is made up of two bones, the radius and ulna. A break in both or either of the bones is known as forearm fracture. Forearm fractures can occur near the wrist, near the elbow, or in the middle of the forearm.

Xiapex

Xiapex

Xiapex is an injection consisting of enzymes that are used to break down stiffened tissue. It is used to treat conditions such as Dupuytren’s contracture and Peyronie’s disease.

Cartiva Implant for the Thumb

Cartiva Implant for the Thumb

Cartiva is a synthetic cartilage implant that can be used for the treatment of carpometacarpal (CMC) joint osteoarthritis of the thumb.

Wrist Fracture Fixation

Wrist Fracture Fixation

Wrist fractures are breaks in any of the bones that form your wrist joint. Your wrist is made up of 8 small bones present in your hand and the adjacent ends of the 2 long bones of the forearm.

DRUJ Arthroscopy

DRUJ Arthroscopy

The DRUJ is the joint formed by the radius and ulnar bones of the foreman in the wrist. DRUJ (Distal Radioulnar Joint) arthroscopy is a minimally invasive surgical procedure to diagnose and treat pathological problems in the DRUJ using an arthroscope, a thin, flexible scope with a camera on the end.

Hand Rejuvenation

Hand Rejuvenation

Cosmetic enhancement is generally focused only on the face, while the hands portray some of the most prominent signs of aging. With age, the hands lose their firmness and plumpness and can appear bony and fragile.

Hand Therapy

Hand Therapy

Hand therapy is a rehabilitation technique recommended to improve the strength and restore functional activity of hands in patients with upper extremity injuries. Hand therapy also helps in preventing injury.

Basal Thumb Joint Reconstruction

Basal Thumb Joint Reconstruction

Coming Soon

Endoscopic Hand Surgery

Endoscopic Hand Surgery

Coming Soon

Endoscopic Wrist Surgery

Endoscopic Wrist Surgery

Your wrist is a complex joint made up of eight small bones called carpal bones. These bones are supported by connecting ligaments. Various conditions can affect your wrist joint such as carpal tunnel syndrome, osteoarthritis and others.

Excision of Metacarpal and Carpal

Excision of Metacarpal and Carpal

Metacarpal fracture is a condition characterized by the breakage or dislocation of the long hand bones called metacarpals that form the skeleton of the palm. Metacarpal fractures can damage associated soft tissues such as cartilage, ligament, tendons, joint capsule, as well as adjoining nerves.

Hand and Wrist Dislocation Treatment

Hand & Wrist Dislocation Treatment

Coming Soon

Hand or Wrist Tendon Transfer

Hand or Wrist Tendon Transfer

Coming Soon

Hand Reconstruction

Hand Reconstruction

Coming Soon

Hand Tendon Repair

Hand Tendon Repair

Coming Soon

Wrist Replacement

Wrist Replacement

Wrist joint replacement surgery, also referred to as total wrist arthroplasty, involves the replacement of a severe arthritic wrist joint with an artificial joint made of metal and plastic components. It relieves pain and restores function when conservative treatment fails to provide relief.