Hand and Wrist Anatomy and Biomechanics: A Comprehensive Guide PDF
Preview Hand and Wrist Anatomy and Biomechanics: A Comprehensive Guide
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 Thieme Stuttgart (cid:127) New York (cid:127) Delhi (cid:127) Rio de Janeiro LibraryofCongressCataloging-in-PublicationData Important note: Medicine is an ever-changing science isavailablefromthepublisher. undergoing continual development. Research and clinical This book is an authorized translation of the 3rd German experience are continually expanding our knowledge, in editionpublished andcopyrighted 2015byGeorgThieme particular our knowledge of proper treatment and drug Verlag,Stuttgart.TitleoftheGermanedition:Anatomieund therapy.Insofarasthisbookmentionsanydosageorappli- BiomechanikderHand cation,readersmay rest assuredthat theauthors,editors, andpublishershavemadeeveryefforttoensurethatsuch Translator:KarenLeube,PhD,Aachen,Germany referencesareinaccordancewiththestateofknowledgeat thetimeofproductionofthebook. Illustrator:MarkusVoll,Munich,Germany;anatomicalwater Nevertheless,thisdoesnotinvolve,imply,orexpressany colors:fromTHIEMEAtlasofAnatomy,GeneralAnatomyand guaranteeorresponsibilityonthepartofthepublishersin Musculoskeletal System. 2nd ed, © Thieme 2014, illustra- respecttoanydosageinstructionsandformsofapplications tions by M. Voll and K. Wesker; adaptations by WEYOU, stated in the book. 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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
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