TABLE OF CONTENTS

1. Carpals, Metacarpals, and Phalanges

Hand 2. Wrist Joint
3. The Carpal Tunnel: Osteology and Contents
4. Muscles and Functions
5. Blood Vessels and Blood Supply
6. Nerves and Innervations
7. Practice Questions
8. Radiology - Upper Limb MRI
9. Clinical - Carpal Tunnel Syndrome
10. Clinical - Scaphoid and Boxer's Fracture
REVIEW OUTLINE
3. Arteries
1. Bones ● Ulnar

Hand ●
●
Carpals
Metacarpals
● Superficial palmar arch
○ Common palmar digital
● Phalanges ■ Proper palmar digital
● Radial
2. Muscles ○ Superficial palmar
● Palmaris brevis ● Deep palmar arch
● Abductor pollicis brevis
● Flexor pollicis brevis 4. Nerves
● Opponens pollicis ● Ulnar
● Adductor pollicis ○ Superficial
○ Oblique and transverse heads ○ Palmar digital
● Opponens digiti minimi ● Median
● Flexor digiti minimi ○ Palmar
● Abductor digiti minimi ○ Recurrent
● Lumbricals ○ Palmar digital
● Palmar interossei (PADs) ● Radial
● Dorsal interossei (DABs)
● Flexor digitorum profundus and 5. Miscellaneous
superficialis tendons ● Carpal tunnel
● Guyon’s tunnel
● Extensor expansion hood
● Anatomical snuffbox
● Cruciform ligaments
● Annular ligaments
 Hand Bootcamp.com

SO LONG TO PINKY HOW MANY ARE THERE

HERE COMES THE THUMB CARPALS
METACARPALS

D PHLANGES
SCAPHOID
m
D LUNATE
p
TRIQUETRUM
P
PISIFORM
HAMATE
CAPITATE
TRAPEZOID
TRAPEZIUM

https://commons.wikimedia.org/wiki/File:Carpus_(left_hand)_-_animation01a.gif
 Hand Bootcamp.com

CARPAL TUNNEL
FLOOR AND SIDES CARPAL BONES

TOP FLEXOR RETINACULUM

CONTENTS MEDIAN N
TENDONS

FPL
FDS
FDP

https://commons.wikimedia.org/wiki/File:815_The_Carpal_Tunnel.jpg
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ANATOMICAL SNUFFBOX
FLOOR SCAPHOID
TRAPEZIUM
RADIUS
CONTENTS RADIALA

https://commons.wikimedia.org/wiki/File:Grant_1962_75.png
Hand Bootcamp.com

USE THE THIRD DIGIT

AS THE MIDLINE

ABDUCTION ADDUCTION
Hand Bootcamp.com

THUMB FLEXION THUMB EXTENSION

Hand Bootcamp.com

THUMB ABDUCTION THUMB ADDUCTION

Hand Bootcamp.com

WHAT IS OPPOSITION OF THE THUMB

MOVEMENT OF THE TIP OF THE THUMB
TO THE TIP OF ANOTHER FINGER

THUMB OPPOSITION
 Hand Bootcamp.com

THENAR REGION
1ST DIGIT

HYPOTHENAR REGION
5TH DIGIT

PALMARIS BREVIS
NOT ALWAYS SUPER VISIBLE

Sobotta's Atlas and Text-book of Human Anatomy 1909

 Hand Bootcamp.com

THENAR REGION
OPPENENS POLLICIS
ABDUCTOR POLLICIS BREVIS
FLEXOR POLLICIS BREVIS

HYPOTHENAR REGION
ABDUCTOR DIGITI MINI MI
FLEXOR DIGITI MINI MI
OPPENENS DIGITI MINI MI

PALMARES BREVIS
TIGHTENS PALMAR APONEUROSIS

Sobotta's Atlas and Text-book of Human Anatomy 1909

 Hand Bootcamp.com

THENAR REGION
OPPENENS POLLICIS

ABDUCTOR POLLICIS BREVIS

FLEXOR POLLICIS BREVIS

OAF
L 0M

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
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 Hand Bootcamp.com

THENAR REGION
OPPENENS POLLICIS
OPPOSITION OFTHE THUMB

ABDUCTOR POLLICIS BREVIS

ABDUCTION OFTHUMB
F

J
FLEXOR POLLICIS BREVIS

0
A

k FLEXIONOFTHUMB AT MCP IP JOINTS

I.E DISTAL INTERPHALANGEAL JOINT

PROXIMALINTERPHALANGEAL
JOINT
DIP
PIP
INTERPHALANGEAL JOINT THUMB
IP
see
METACARPOPHALANGEAL JOINT MCP
CARPOMETACARPAL JOINT CMC
i r c H E
Ee
https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg s i r
(cropped,flipped, new labels)
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HYPOTHENAR REGION
ABDUCTOR DIGITI MINIMI

FLEXOR DIGITI MINI MI

OPPENENS DIGITI MINIMI

AFO
M 0L

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
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 Hand Bootcamp.com

HYPOTHENAR REGION
ABDUCTOR DIGITI MINIMI
ABDUCTION OF 5TH DIGIT AT THE MCP JOINT

FLEXOR DIGITI MINIMI

FLEXION OF 5TH DIGIT AT THE MCP JOINT

f o.PEon.E.nonsoi IsnEEIaE.maIIaEFn'Event

jift DISTALINTERPHALANGEAL JOINT DIP

PROXIMALINTERPHALANGEAL
JOINT PIP
INTERPHALANGEAL JOINT THUMB
IP
METACARPOPHALANGEAL JOINT MCP
is CARPOMETACARPAL JOINT
t r c u E CMC
https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg s i r Ee
(cropped,flipped, new labels)
 Hand Bootcamp.com

EXTENSOR EXPANSION
HOOD

LUMBRICALS

2 3 4 S M
L l

DOESN'T ATTATCH TO ANY BONES

ORIGIN TENDONS OF FDP
INSERTION EEH

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
https://commons.wikimedia.org/wiki/File:Gray416.png
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R
i l LUMBRICALS
IEIIIIY.omnmn.FIEIIEpoo nts oHow

IE DISTALINTERPHALANGEALJOINT DIP
PROXIMALINTERPHALANGEAL
JOINT PIP
INTERPHALANGEAL JOINT THUMB
IP
EE JOINT
METACARPOPHALANGEAL MCP
1 i ca E CARPOMETACARPALJOINT CMC
s i r E

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
https://commons.wikimedia.org/wiki/File:Gray416.png
 Hand Bootcamp.com

TENDONS OF FLEXOR DIGITORUM PROFUNDUS

AND FLEXOR DIGITORUM SUPERFICIALIS
SUPERFICIALIS SPLITS
PROFUNDUS DIG DEEP

CRUCIFORM V ANNULAR LIGAMENTS

CRUCIFORM

ANNULAR i

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
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ADDUCTOR POLLICIS
TWO HEADS
TRANSVERSE HEAD
OBLIQUE HEAD
ODM

OP

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
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 Hand Bootcamp.com

ADDUCTOR POLLICIS
ADDUCTION OF THUMB AT THE CMC JOINT
TRANSVERSE HEAD

L OBLIQUE HEAD
ODM
DISTALINTERPHALANGEAL JOINT DIP
jF PROXIMALINTERPHALANGEAL
JOINT PIP
INTERPHALANGEAL JOINT THUMB
IP
EEE METACARPOPHALANGEAL JOINT MCP
CARPOMETACARPAL JOINT CMC
1 i c H E
Ee
s i r

Op

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

YOUCANSEETHE PALMAR AND

DORSAL FROMTHEPALMARSIDE

x3 x4

PALMAR INTEROSSEI DORSAL INTEROSSEI

MUSCLES MUSCLES

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

YOUCANSEETHE PALMAR AND

DORSAL FROMTHEPALMARSIDE

x3 x4
PAD'S DAB'S

PALMAR INTEROSSEI DORSAL INTEROSSEI

MUSCLES MUSCLES
ADDUCTION OF DIGITS ABDUCTION OF DIGITS

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
Hand Bootcamp.com

ORIENT 7 TOTAL INTEROSSEI MUSCLES

I
3 PADS
4 DABS

M L
Hand Bootcamp.com

ORIENT LATERAL DR PEPPER

DIET DR PEPPER
a
MEDIAL DR PEPPER

M L
Hand Bootcamp.com

T t c a
p
s l t

R u
Hand Bootcamp.com

t T C H T T c H H
T T C
p p p
s l t s l t s l t

R u R u R u

SUPERFICIALPALMARARCH DEEPPALMARARCH DEEPCARPALBRANCH

DorsalSIDE
 Hand Bootcamp.com

SUPERFICIAL PALMAR ARCH

PROPERPALMAR
DIGITALArt

COMMONPALMAR
DIGITALAA

SUPERFICIAL SUPERFICIAL
PALMARARCH
PAYMARBRANYCH
RADIALA SUPERFICIAL
PALMARBRANCH
UNARA
T T c n
p
s l t
RADIALA
UNARA
R u
 Hand Bootcamp.com

DEEP PALMAR ARCH

RADIALIS
INDIESA

PALMAR
METACARPALAA
PRINCEPS
POLLICISA
DEEPPALMAR
T T C H ARCH
p
s l t

R u
 Hand Bootcamp.com

DEEP CARPAL BRANCH

DORSAL SIDE
DORSAL
DIGITALAA

DORSAL

AA
METATARSAL

DEEPCARPAL
T T C H BRANCH
DEEPCARPAL P unarm
BRANCH s l t
RADIALA

R u
 Hand Bootcamp.com

PRACTICE
CANYOULABELALLOFTHE
ARTERIES OF THEHAND
 Hand Bootcamp.com

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
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https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

PALMARINTEROSSEI DORSALINTEROSSEI

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

ULNAR N GUYON'S CANAL

MEDIAN N CARPAL TUNNEL

CARPAL LIGAMENT
TRANYSVERSE
EXORRETINACULUM

C T

https://commons.wikimedia.org/wiki/File:Sobo_1909_562.png
 Hand Bootcamp.com

PALMAR
run
DIGITAL PALMAR
run
DIGITAL

DEEP
BRANCH

Recurrenin SUPERFICIAL
T T C H Branca
MEDIANN
P
s L T unman
SUPERFICIAL
BRANCHOF PALMARN
RADIALN R u

https://commons.wikimedia.org/wiki/File:Sobo_1909_562.png
 Hand Bootcamp.com

L1
L2

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

AT WHICH JOINT DOES THE FLEXOR

DIGITI MINIMI FLEX DIGIT 5
DISTAL INTERPHALANGEAL JOINT DIP
PROXIMAL INTERPHALANGEAL PIP
JOINT
INTERPHALANGEAL JOINT IP
METACARPOPHALANGEAL JOINT MCP

CARPOMETACARPAL JOINT CMC

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

WHICH MUSCLE DOES NOT RELIEVE BLOOD

SUPPLY FROM THE DEEP PALMAR
ARCH

ADDUCTOR POLLICIS

OPPONENS POLLICIS

OPPONENS DIGITI MINIMI

https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
 Hand Bootcamp.com

MATCH THE LUMBRICAL TO THE

NERVETHAT INNERVATES IT

LUMBRICAL 1 ULNARN
LUMBRICAL 2

LUMBRICAL 3
RADIAL N
LUMBRICAL 4 MEDIAN N
https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand.jpg
(cropped,flipped, new labels)
https://commons.wikimedia.org/wiki/File:Gray416.png
REVIEW OUTLINE
3. Arteries
1. Bones ● Ulnar

Hand ●
●
Carpals
Metacarpals
● Superficial palmar arch
○ Common palmar digital
● Phalanges ■ Proper palmar digital
● Radial
Review 2. Muscles
●
○ Superficial palmar
Deep palmar arch
● What are the functions of the muscles ● Palmaris brevis
● Abductor pollicis brevis
listed?
● Flexor pollicis brevis 4. Nerves
○ Describe those functions
● Opponens pollicis ● Ulnar
● What arteries give blood supply to the
● Adductor pollicis ○ Superficial
listed muscles? ○ Palmar digital
○ Oblique and transverse heads
● What nerves innervate the listed ● Median
● Opponens digiti minimi
muscles? ● Flexor digiti minimi ○ Palmar
● Abductor digiti minimi ○ Recurrent
● Lumbricals ○ Palmar digital
● Palmar interossei (PADs) ● Radial
● Dorsal interossei (DABs)
● Flexor digitorum profundus and 5. Miscellaneous
superficialis tendons ● Carpal tunnel
● Guyon’s tunnel
● Extensor expansion hood
● Anatomical snuffbox
● Cruciform ligaments
● Annular ligaments
REVIEW OUTLINE

Radiology-
Shoulder Wrist
● Axial ● Coronal
● Sagittal- Bones ● Axial game plan

Upper Limb MRI ●

●
Y-view X-ray
Sagittal- Soft tissues
●
●
●
Ulnar structures
Radial Structures
Carpal Tunnel
Elbow ● Intro to PD-MRI
● Coronal
● Axial game plan Practice Questions
● Axial (parts 1 and 2) ● Mr. SD (shoulder)
● Mr. CT (wrist)
Upper Limb MRI oo amp om

ial o lder
● Humeral head
● Neck of scapula
● Glenohumeral joint
● Infraspinatus
● Suprascapular artery
● Deltoid
● Subscapularis
● Coracobrachialis
● Axillary artery and vein
● Brachial plexus
● Pectoralis minor
● Pectoralis major
● Serratus anterior
 Upper Limb MRI Bootcamp.com

Sagittal Shoulder- Bones (T1)

● Glenohumeral joint (dark- not
head of femur!)
● Spine of scapula
● Clavicle
● Coracoid process
Upper Limb MRI Bootcamp.com

ie -ra
● atient sits ith arm
a ainst detector to
et a sa ittal -ra
● nte rate ith our
understandin of
sa ittal
Upper Limb MRI Bootcamp.com

Sagittal Shoulder (T1)

● nferior and middle
lenohumeral li aments
● eres minor
● nfraspinatus
● Supraspinatus
● Su scapularis tendon
● illar nerve
● osterior circumfle
humeral arter C )
● riceps rachii
● eres major
● Coraco rachialis
● ectoralis major
● eltoid
 Upper Limb MRI Bootcamp.com

Coronal Elbow (T1)

● Humerus ⟶ points to the (coronoid Left elbow (mirrored
from radiograph)
process of the) ulna
○ “Pointing at U”
● Radius
● Humeroradial and humeroulnar
joints
● Lateral (radial) collateral ligament
● Extensor carpi radialis longus
● Flexor digitorum superficialis
● Supinator
● Common flexor tendon
 Upper Limb MRI Bootcamp.com

Coronal Elbow (T1)

● Humerus ⟶ points to the (coronoid Left elbow (mirrored
from radiograph)
process of the) ulna
○ “Pointing at U”
● Radius
● Humeroradial and humeroulnar
joints
● Lateral (radial) collateral ligament
● Extensor carpi radialis longus
● Flexor digitorum superficialis
● Supinator
● Common flexor tendon
Upper Limb MRI Bootcamp.com

ial Elbow (T )
● Structure differentiation can e tough on
axial el o R
● our game plan
○ et oriented
○ Loc in approximate locations of
large structures
○ Learn the relationships et een the
large structures and the small
structures that pass et een
Upper Limb MRI Bootcamp.com

ial Elbow (T ) art 1

● Humerus
○ et oriented ith asilic ein and
lateral ulnar collateral ligament
● Pronator teres
● Flexor carpi radialis
● Flexor digitorum superficialis
● edian ner e
● rachialis
● rachial arter
● edian cu ital ein
Upper Limb MRI Bootcamp.com

ial Elbow (T ) art

● lecranon
● Humeroulnar joint
● nconeus
● Flexor carpi ulnaris
● Ulnar ner e
● Extensor carpi radialis longus
● rachioradialis
● iceps rachii tendon
● Radial ner e
Upper Limb MRI Bootcamp.com

Coronal Wrist
● Radius + radial styloid
process
● Ulna
● Scaphoid
● Lunate
● Triquetrum
● Hamate
● Capitate
● Trapezoid
● Trapezium
● Metacarpals 1-4
● Extensor pollicis brevis
tendon
● ^ and abductor pollicis
longus tendons
● Brachioradialis tendon
● Extensor carpi ulnaris
tendon
Upper Limb MRI Bootcamp.com

Coronal Wrist
● Radius + radial styloid
process
● Ulna
● Scaphoid
● Lunate
● Triquetrum
● Hamate
● Capitate
● Trapezoid
● Trapezium
● Metacarpals 1-4
● Extensor pollicis brevis
tendon
● ^ and abductor pollicis
longus tendons
● Brachioradialis tendon
● Extensor carpi ulnaris
tendon
Upper Limb MRI Bootcamp.com

ial Wrist
● Lots o small muscles memorizing each location
across many cross sections has diminishing returns
● our game plan
et oriented
bones
Split into sections
ocus on relationships
rocess o elimination
Upper Limb MRI Bootcamp.com

ial Wrist rientation an Bones

● Chec palm up or do n
● Use the basilic vein to ind the pin y edge
ulnar side i unsure orientation
● Triquetrum
● Lunate
● Scaphoid
● Radial styloid process
Upper Limb MRI Bootcamp.com

ial Wrist
Ulnar tr ct res
● Basilic vein
● Ulnar collateral
ligament
● orsal radiocarpal
ligament
● lexor carpi ulnaris
● Ulnar artery
● Ulnar nerve
● Extensor carpi ulnaris
● Extensor digiti minimi
● Extensor digitorum
Upper Limb MRI Bootcamp.com

ial Wrist
Ra ial tr ct res
● Extensor pollicis longus
● Extensor carpi radialis
brevis and longus
● Cephalic vein
● Extensor pollicis brevis
● bductor pollicis longus
● Radial artery
● lexor carpi radialis
● almar radiocarpal
ligament
Upper Limb MRI Bootcamp.com

ial Wrist
e Carpal nnel
● lexor digitorum pro undus 4 tendons
● lexor digitorum super icialis 4 tendons
● lexor pollicis longus
● Median nerve
● lexor retinaculum transverse carpal
ligament
● almaris longus
Upper Limb MRI Bootcamp.com

ial Wrist roton ense MRI

● ppears li e a T1 T combo
● Measures proton density nuclei not
magnetic characteristic li e relaxation time
● reat or oints distinguish bet een luid
and types o cartilage

● hite luid and at

● rey hyaline
cartilage and muscle
bones
● ar ibrocartilage
Upper Limb MRI Bootcamp.com

e Carpal nnel MRI

Upper Limb MRI Bootcamp.com

ractice estion

Mr S is a yo man presenting to the emergency

department ith severe shoulder pain a ter a SH in ury

ou order a MR sho n at right

● escribe ho each tissue type

sho s on this MR hat do
you thin is glo ing hite
● hat structures do you see
● hat is your diagnosis
Upper Limb MRI Bootcamp.com

ractice estion
● hite luid and at oint e usion
● rey hyaline cartilage and muscle bones
● ar ibrocartilage
islocation and racture o humeral head partial
supraspinatus tendon tear
 Upper Limb MRI Bootcamp.com

Practice Question #2:

Mr. CT is a 45yo man presenting with numbness of
the palmar side of his first three fingers. He has a past
medical history of diabetes and works full-time as a violinist
in the city orchestra.
You suspect he may have carpal tunnel syndrome and
order an MRI of the wrist, which is inconclusive.

● What type of MRI is shown?

● Describe the orientation of the
patient’s hand.
● Identify the nerve that may be
causing the patient’s
symptoms.
● Which structures in the image
travel in the carpal tunnel?
Can you name them?
Upper Limb MRI Bootcamp.com

Practice Question #2

● roton Dense D MRI

● atient’s palm face down
● Median nerve
● le or digitorum profundus 4 tendons
● le or digitorum superficialis 4 tendons
● le or pollicis longus
● le or retinaculum transverse carpal
ligament
● almaris longus
● lnar nerve ma trip ou up ere
ot in the carpal tunnel
ymptoms don’t align- would be
numbness of lateral two fingers
Upper Limb MRI Bootcamp.com

Re erences
lide and lbow- Henry ray, ublic domain, via Wikimedia Commons
REVIEW OUTLINE

1. Causes

2. Nerve Affected

Carpal Tunnel 3. Sensory & Motor Deficits

Syndrome 4. Ape Hand

5. Phalen’s Maneuver
 Carpal Tunnel Syndrome oo amp om

ormal una e lo a on
↓ in size of the carpal tunnel due to inflammation, fluid
retention, infection, fractures or trauma to the wrist

Recurrent branch

Palmar cutaneous branch

 Carpal Tunnel Syndrome Bootcamp.com

Ape Hand

Phalen’s Maneuver (Wrist Flexion Test)

Unable to abduct
or oppose thumb

Digital Cutaneous Branch

Palmar Cutaneous Branch

(unaffected)

Palmar View Dorsal View

Knowledge Check Bootcamp.com

During carpal tunnel syndrome, which nerve is affected?

In the hand, which muscles receive motor innervation from that nerve and how
would deficits present in a patient with carpal tunnel syndrome?

Who is more at risk for carpal tunnel syndrome, men or women? Why?
Knowledge Check Bootcamp.com

During carpal tunnel syndrome, which nerve is affected?

Median nerve

In the hand, which muscles receive motor innervation from that nerve and how
would deficits present in a patient with carpal tunnel syndrome?

Motor: opponens pollicis, abductor pollicis brevis, flexor pollicis brevis, lumbricals 1-2
→ loss of thumb opposition & abduction, thenar atrophy, reduced grip & pinch strength

Who is more at risk for carpal tunnel syndrome, men or women? Why?
Women are 3x more likely to suffer from carpal tunnel syndrome
→ Smaller carpal tunnel
→ Hormonal changes increasing fluid retention
Re eren e oo amp om

Slide 2
• Hand/Wrist: <a href="https://commons.wikimedia.org/wiki/File:Carpal_Tunnel_Syndrome.png">BruceBlaus via Wikimedia
Commons
• X-Ray Normal: <a href="https://commons.wikimedia.org/wiki/File:X-ray_of_normal_wrist_by_lateral_projection.jpg">Mikael
Häggström</a>, CC0, via Wikimedia Commons
• X-Ray Dislocation: <a href="https://commons.wikimedia.org/wiki/File:LunatedislocationL.jpg">James Heilman, MD</a>

Slide 3
• Muscles:
<ahref="https://commons.wikimedia.org/wiki/File:1121_Intrinsic_Muscles_of_the_Hand_Superficial_sin.png">CFCF</a>, <a
href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
• Ape Hand: <a href="https://commons.wikimedia.org/wiki/File:Ape_hand.jpg">Blurrybluesky</a>, <a
href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
• Phalen’s Maneuver: <a href="https://commons.wikimedia.org/wiki/File:Phalen%27s_Maneuver.jpg">LittleT889</a>, <a
href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
• Sensory Hand: <a href="https://commons.wikimedia.org/wiki/File:Hand_INC.svg">Furfur</a>, <a
href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons
REVIEW OUTLINE

1. Causes

2. Nerve Affected

Carpal Tunnel 3. Sensory & Motor Deficits

Syndrome 4. Ape Hand

5. Phalen’s Maneuver
Scaphoid Fracture Bootcamp.com

Scaphoid Fracture

Caused by falling onto palm when wrist is abducted

• Pain in anatomical snuffbox
• Often misdiagnosed as a sprained wrist
• Avascular necrosis of proximal scaphoid

Radial a.
Boxer’s Fracture Bootcamp.com

Boxer’s Fracture

Fracture of the neck of the 4th or 5th metacarpal bone when a person hits an object with a
closed fist

Unskilled boxers: 4th or 5th metacarpal bone

Skilled boxers: 2nd or 3rd metacarpal bone
Knowledge Check Bootcamp.com

A patient falls on an outstretched hand and comes into the clinic two weeks later because of
persistent pain in the wrist/palm. Upon palpation, the patient presents with deep tenderness
in the anatomical snuffbox. You order an X-ray to confirm your diagnosis. Find the fracture
and name the carpal bone that is affected.
So
Long Trap
eziu
To Trap
ezo
m
id
Ca
Pinky Ham
ate pi
ta
te
Here
Pisiform id
Comes p ho
etru
m ca
The Triq
u
Lunate
S

Thumb
BONUS: Label the rest of the carpal
bones.
References Bootcamp.com

Slide 2
• Humerus: <a href="https://commons.wikimedia.org/wiki/File:HumerusFront.png">BDB</a>, Public domain, via Wikimedia Commons
• Arterial Supply: <a href="https://commons.wikimedia.org/wiki/File:2127_Thoracic_Upper_Limb_Arteries.jpg">OpenStax College</a>, <a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons

Slide 3
• Surgical Neck: <a href="https://commons.wikimedia.org/wiki/File:Subcap1.png">THWZ</a>, <a href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons
• Shaft: <a href="https://commons.wikimedia.org/wiki/File:MidShaftHumerousMark.png">James Heilman, MD</a>, <a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
• Supracondylar Region: <a href="https://commons.wikimedia.org/wiki/File:Supracondylar09.JPG">James Heilman, MD</a>, <a href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons
• Medial Epicondyle: <a href="https://commons.wikimedia.org/wiki/File:Medial_epicondyle_fracture_of_the_humerus.jpg">Apaul291003</a>, <a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons

Slide 4
• X-Ray: <a href="https://commons.wikimedia.org/wiki/File:Smith2019Frac.jpg">James Heilman, MD</a>, <a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
• Radius Displacement: <a href="https://commons.wikimedia.org/wiki/File:Radius_-_lateral_view2.png">Anatomography</a>, <a href="https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en">CC BY-SA 2.1 JP</a>, via Wikimedia Commons

Slide 5
• X-Ray: <a href="https://commons.wikimedia.org/wiki/File:Collesfracture.jpg">Lucien Monfils</a>, <a href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons
• Radius Displacement: <a href="https://commons.wikimedia.org/wiki/File:Radius_-_lateral_view2.png">Anatomography</a>, <a href="https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en">CC BY-SA 2.1 JP</a>, via Wikimedia Commons
• Dinner Fork Deformity: <a href="https://commons.wikimedia.org/wiki/File:Poignet_Gauche_suite_a_fracture_type_Pouteau_Colles.jpg">sylvain letuffe</a>, CC0, via Wikimedia Commons

Slide 6
• Hand: <a href="https://commons.wikimedia.org/wiki/File:Wrist_fracture_-_Scaphoid_fracture_1_--_Smart-Servier.png">Laboratoires Servier</a>, <a href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia
Commons
• X-Ray: <a href="https://commons.wikimedia.org/wiki/File:Scaphoid_fracture_with_a_radiolucent_line_after_12_days.jpg">Mohamed Jarraya, Daichi Hayashi, Frank W. Roemer, Michel D. Crema, Luis Diaz, Jane Conlin, Monica D. Marra, Nabil
Jomaah, and Ali Guermazi</a>, <a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons

Slide 7
• X-Ray: <a href="https://commons.wikimedia.org/wiki/File:Neck_Fracture_of_the_Fourth_Metacarpal_Bone.png">Louis Philippe Lessard</a>,
<a href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons

Slide 8
• <a href="https://commons.wikimedia.org/wiki/File:2016-Humerus_fracture.jpg">Ivtorov</a>,
<a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons

Slide 9
• <a href="https://commons.wikimedia.org/wiki/File:ScaphoidFracMark.png">James Heilman, MD</a>,
<a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons