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Hand & Wrist

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.

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.

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.

Triscaphoid Joint Arthritis

Triscaphoid Joint Arthritis

Arthritis is an inflammatory condition of one or more joints in your body. Triscaphoid joint arthritis is the localised pain and inflammation of the shared joint between the 3 carpal bones of your wrist. These bones are called scaphoid, trapezium, and trapezoid and are present at the base of your thumb.

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.

Distal Radioulnar Joint (DRUJ) Arthritis

Distal Radioulnar Joint (DRUJ) Arthritis

Distal radioulnar joint (DRUJ) arthritis is an inflammatory condition characterized by gradual wearing away of the cartilaginous surface of the radioulnar joint resulting in significant pain, swelling, stiffness, and interference in the functioning of the wrist and/or arm.

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.

Flexor Tendon Injuries

Flexor Tendon Injuries

Deep cuts on the under surface of the wrist, hand or fingers can cut and injure the tendon, and make it unable to bend one or more joints in a finger. When a tendon gets cut, the cut ends gets pulled away from each other like a rubber band.

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.

Work Related Hand Injuries

Work Related Hand Injuries

The hand is one of the most flexible and useful parts of our body that assist us in most workplace activities. Hand injuries can range from minor cuts or burns to severe injuries.

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. They allow you to open your hands and move or straighten your wrist, fingers, and thumb.

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. It is one of the most common injuries to the hand and may occur due to accidents at home, work, or play.

Carpal Instability

Carpal Instability

Carpal instability is the loss of alignment of the carpal bones and/or radioulnar joint. The wrist is a complex joint that connects the forearm to the hand and allows it to move. It consists of 8 small bones called carpals that articulate with two long bones of the forearm (radius and ulna).

Triquetrolunate Instability

Triquetrolunate Instability

Triquetrolunate instability is the instability that takes place between the triquetrum or medial column and the lunate bones or the central column of the wrist. The triquetrum and the lunate comprise the ulnar side of the proximal carpal row at the wrist. This joint is supported by the lunotriquetral (LT) ligament.

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.

Extensor Carpi Ulnaris (ECU) Tendon Instability

Extensor Carpi Ulnaris (ECU) Tendon Instability

ECU tendon instability can occur when the sheath covering and protecting the ECU tendon at the wrist is injured. This causes the tendon to move abnormally and occupy the wrong space within the sheath.

Wrist Fracture

Wrist Fracture

The wrist is comprised of two bones in the forearm, the radius and ulna, and eight tiny carpal bones in the palm. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more of these bones.

Fractures of the Hand and Fingers

Fractures of the Hand and Fingers

A fracture is a break in the bone, which occurs when force greater than the bearable limit is applied against a bone. The most common symptoms of any fracture include severe pain, swelling, bruising or bleeding, deformity and discoloration of the skin and limited mobility of the hand.

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.

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. The breaking of the radius or ulna in the middle of the bone requires a strong force and is most commonly seen in adults.

Boxer's Fracture

Boxer's Fracture

A boxer’s fracture is a break in the neck of the fifth metacarpal bone of the hand (below the pinky finger) close to the knuckle. The hand is composed of 3 types of bones: carpal or wrist bones, metacarpals or long hand bones, and phalanges or finger bones. Metacarpals consist of five long bones that connect the carpal with the phalanges. Structurally, metacarpal bones can be divided into four parts: base, shaft, neck, and head.

Bennett's Fracture

Bennett's Fracture

Bennet’s fracture is a break at the base of the first metacarpal bone (thumb bone) that meets the wrist at the first carpometacarpal (CMC) joint. The hand is composed of 3 types of bones: carpals or wrist bones, metacarpals or long hand bones, and phalanges or finger bones. Metacarpals consist of five long bones that connect the carpals with the phalanges.

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.

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.

Finger Sprain

Finger Sprain

Injuries that involve tearing or stretching of the ligaments of your fingers are termed as sprains. Sprains in the fingers are most often caused from a fall when you extend your arms to reduce the impact of the fall, or from overuse or repetitive activity of the thumb such as with texting.

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.

Mallet Finger

Mallet Finger

A mallet finger is a condition where the end of the finger is bent and does not straighten.

Finger Joint Dislocation and Volar Plate Injury

Finger Joint Dislocation and Volar Plate Injury

Finger dislocation is a condition where the bones of your finger have moved away from its normal anatomical position.

Finger Dislocation

Finger Dislocation

Finger dislocation is a condition in which the bone of your finger has moved away from its normal position.

Distal Intersection Syndrome

Distal Intersection Syndrome

Distal intersection syndrome also referred to as tenosynovitis of the radial wrist extensors is characterized by the radial wrist and forearm pain. Distal intersection syndrome is tenosynovitis of the third extensor compartment (extensor pollicis longus) where it crosses the second extensor compartment.

Distal Biceps Avulsion

Distal Biceps Avulsion

The biceps muscle, located in the front of the upper arm, allows you to bend the elbow and rotate the arm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow.

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. It commonly occurs in the ring finger and little finger. Occasionally, the middle finger is affected, but the thumb and index finger are rarely affected.

Trigger Finger

Trigger Finger

Inflammation in the tenosynovium leads to a condition called trigger finger, also known as stenosing tenosynovitis or flexor tendonitis, where one of the fingers or thumb of the hand is caught in a bent position. The affected digit may straighten with a quick snap, like pulling and releasing the trigger on a gun, hence the name trigger finger.

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 Infections

Hand Infections

The hand becomes infected more frequently as it is one of the most commonly injured parts of our body.

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.

Skier's Thumb

Skier's Thumb

Skier's thumb, also known as, Gamekeeper's thumb is a tear of the ulnar collateral ligament, a band of tissue that supports the joint at the base of the thumb. Damage to the ulnar collateral ligament may lead to chronic instability of the thumb, creating problems in its normal functioning.

Swan Neck Deformity

Swan Neck Deformity

The finger joint is a hinge joint that allows the bending and straightening of the fingers. Each finger is composed of 3 phalange bones 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).

Kienbock's Disease

Kienbock's Disease

Kienbock's disease is a condition in which the lunate, one of the small bones of the wrist loses its blood supply leading to death of the bone. This results in pain, stiffness, and degenerative changes in the wrist joint.

Scapholunate Dissociation

Scapholunate Dissociation

Scapholunate dissociation is the abnormal orientation or movement of the small bones of your wrist: the scaphoid and lunate, in relation to one another.

Ulnar Carpal Impaction

Ulnar Carpal Impaction

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.

Triangular Fibrocartilage Complex Injury (TFCC)

Triangular Fibrocartilage Complex Injury (TFCC)

The triangular fibrocartilage complex, or TFCC, is a complex of cartilage and ligaments located near the outer region of the wrist, below the little finger. It serves to stabilize the wrist, allowing easy movement and shock-absorption. Sports activities or falls can damage or injure the TFCC, causing wrist pain and instability.

Guyon's Canal Syndrome

Guyon's Canal Syndrome

Guyon’s canal syndrome refers to compression of the ulnar nerve while it passes from the wrist into the hand through a space called the ulnar tunnel or Guyon’s canal.

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).

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.

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.

Wrist Arthroscopy

Wrist Arthroscopy

Wrist arthroscopy is a minimally invasive surgical procedure performed to view, diagnose and treat problems of your wrist joint.

Distal Radioulnar Joint Arthroscopy

Distal Radioulnar Joint Arthroscopy

The distal radioulnar joint (DRUJ) is a pivot type synovial joint located between the radius and the ulna just proximal to the wrist joint and assists in pronation and supination of the forearm.

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.

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. Peripheral nervous system disorders interrupt the transmission of signals and weaken the sensory and motor nerve functions.

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.

Total Wrist Arthrodesis

Total Wrist Arthrodesis

Total wrist arthrodesis, also known as wrist fusion, is a surgical procedure in which the wrist joint is stabilized or immobilized by fusing the forearm bone (radius) with the small bones of the wrist.

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. The sports injuries may be either acute (sprains, fractures, tears) or chronic (tendinitis, overuse injury) injuries.

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.

Finger Joint Fusion

Finger Joint Fusion

The hands are made up of 27 bones, which are grouped into carpals, metacarpals and phalanges. Each bone is separated by the articular cartilage, which helps provide smooth gliding movements 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.

Endoscopic Carpal Tunnel Surgery

Endoscopic Carpal Tunnel Surgery

The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals form the bottom and sides of the carpal tunnel and a strong band of connecting tissue, known as the transverse carpal ligament, covers the top of the carpal tunnel.

Wrist Fracture Fixation

Wrist Fracture Fixation

Wrist fractures are breaks in any of the bones that form your wrist joint.

Non-Surgical Treatment of Hand and Wrist

Non-Surgical Treatment of Hand and Wrist

The hand is one of the most flexible and useful parts of our body that enable us to perform many of our daily activities. The hands and wrists are prone to injuries or certain orthopedic conditions and can range from minor cuts or burns to severe arthritis or injuries of nerves, bones, and tendons.

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.

Atlas Orthopaedics
970 Woodstock Parkway, Suite 310, Woodstock, GA 30188