Hand surface anatomy
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Hand anatomy by examination, surface anatomy of hand, hand surgery examination, hand surgery
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Hand surface anatomy
- 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
- 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
- 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
- 26. Naming the joints Metacarpo- phalangeal joint (MCPJ) of index finger
- 28. Naming the joints Proximal interphalangeal joint (PIPJ) of small finger
- 30. Naming the joints Distal interphalangeal joint (DIPJ) of ring finger
- 32. Naming the joints Metacarpo- phalangeal joint (MCPJ) of thumb
- 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
- 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 1st APL & EPB 2nd ECRL & ECRB 3rd EPL 4th EDC & EIP 5Th EDM 6th 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 fibrous flexor sheath • A1 pulley
- 77. The fibrous flexor sheath • A1 pulley • A2 pulley
- 78. The fibrous flexor sheath • A1 pulley • A2 pulley • A4 pulley
- 79. The radial aspect of the wrist
- 80. Cutaneous innervation of the wrist & hand • Superficial radial nerve • Dorsal branch of ulnar nerve
- 81. Cutaneous innervation of the wrist & hand • Ulnar nerve
- 82. Cutaneous innervation of the wrist & hand • Ulnar nerve • Median nerve
- 83. Cutaneous innervation of the wrist & hand • Ulnar nerve • Median nerve • Motor branch of median nerve
- 84. 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