Hand

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Hand

Palmar and Dorsal aspects of human right hand

X-ray of human hand Latin Vein Nerve MeSH Manus dorsal venous network of hand Ulnar, median, radial nerves Hand

A hand (med./lat.: manus, pl. mans) is a prehensile, multi-fingered extremity located at the end of an arm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each "hand" and fingerprints remarkably similar to human fingerprints) are often described as having either "hands" or "paws" on their front limbs. Fingers are some of the densest areas of nerve endings on the body, are the richest source of tactile feedback, and have the greatest positioning capability of the body; thus the sense of touch is intimately associated with hands. Like other paired organs (eyes, feet, legs), each hand is dominantly controlled by the opposing brain hemisphere, so that handedness, or the preferred hand choice for single-handed activities such as writing with a pencil, reflects individual brain functioning. Some evolutionary anatomists use the term hand to refer to the appendage of digits on the forelimb more generally for example, in the context of whether the three digits of the bird hand involved the same homologous loss of two digits as in the dinosaur hand.[1] The human hand has 27 bones, not including the sesamoid bones which number varies between people.[2] 14 of which are the phalanges (proximal, intermediate and distal) of the fingers. The metacarpals are the bones that connects the fingers and the wrist. Each human hand has 5 metacarpals[3] and 8 carpal bones.

Contents

1 Structure o 1.1 Areas o 1.2 Bones 1.2.1 Arches o 1.3 Muscles 1.3.1 Intrinsic 1.3.2 Extrinsic o 1.4 Innervation o 1.5 Skin o 1.6 Variation 2 Disorders and diseases 3 Evolution 4 Additional images 5 See also 6 Notes 7 References 8 External links

Structure

Many mammals and other animals have grasping appendages similar in form to a hand such as paws, claws, and talons, but these are not scientifically considered to be grasping hands. The scientific use of the term hand in this sense to distinguish the terminations of the front paws from the hind ones is an example of anthropomorphism. The only true grasping hands appear in the mammalian order of primates. Hands must also have opposable thumbs, as described later in the text. Humans have two hands located at the distal end of each arm. Apes and monkeys are sometimes described as having four hands, because the toes are long and the hallux is opposable and looks more like a thumb, thus enabling the feet to be used as hands. The word "hand" is sometimes used by evolutionary anatomists to refer to the appendage of digits on the forelimb such as when researching the homology between the three digits of the bird hand and the dinosaur hand.[1] "Hand" is also used when measuring the height of a horse. A hand is four inches. A horse is any height over 14.2 hands, and pony refers to a height below 14.2 hands.

Areas

Human hand parts Areas of the human hand include:

The palm (Volar), which is the central region of the anterior part of the hand, located superficially to the metacarpus. The skin in this area contains dermal papillae to increase friction, such as are also present on the fingers and used for fingerprints. The opisthenar area (dorsal) is the corresponding area on the posterior part of the hand. The heel of the hand is the area anteriorly to the bases of the metacarpal bones, located in the proximal part of the palm. It is the area that sustains most pressure when using the palm of the hand for support, such as in handstand.

There are five digits attached to the hand. The four fingers can be folded over the palm which allows the grasping of objects. Each finger, starting with the one closest to the thumb, has a colloquial name to distinguish it from the others:

index finger, pointer finger, or forefinger

middle finger or long finger, ring finger little finger, pinky finger, or small finger.

The thumb (connected to the trapezium) is located on one of the sides, parallel to the arm. A reliable way of identifying and hands is from the presence of opposable thumbs. Opposable thumbs are identified by the ability to be brought opposite to the fingers, a muscle action known as opposition.

Bones

Bones of the human hand The skeleton of the human hand consists of 27 bones:[4] the eight short bones of the wrist or carpus organized into a proximal row (scaphoid, lunate, triquetral and pisiform), which articulates with the skeleton of the forearm, and a distal row (trapezium, trapezoid, capitate and hamate), which articulates with the bases of the metacarpal bones (i.e. the bones of the palm or "hand proper"). The heads of these Metacarpal bones will each in turn articulate with the bases of the proximal phalanx of the phalanges. These articulations result in the formation of the metacarpophalangeal joints, which are colloquially referred to as the knuckles of a clenched fist. The phalanges are numbered I-V (lateral to medial), with phalange I (the pollex) being most lateral and the little finger being most medial when the hand is viewed from an anatomical position (palm facing outwards). Phalanges II-V each consist of three phalanx bones: proximal, middle, and distal. Phalange I only consists of a proximal and distal phalanx.[5] Together with the fourteen phalanx bones of the fingers these metacarpal bones form five rays or poly-articulated chains. Because supination and pronation (rotation about the axis of the forearm) are added to the two axes of movements of the wrist, the ulna and radius are sometimes considered part of the skeleton of the hand. There are numerous sesamoid bones in the hand, small ossified nodes embedded in tendons; the exact number varies between different people:[2] whereas a pair of sesamoid bones are found at virtually all thumb metacarpophalangeal joints, sesamoid bones are also common at the

interphalangeal joint of the thumb (72.9%) and at the metacarpophalangeal joints of the little finger (82.5%) and the index finger (48%). In rare cases, sesamoid bones have been found in all the metacarpophalangeal joints and all distal interphalangeal joints except that of the long finger. The articulations are:

interphalangeal articulations of hand (the hinge joints between the finger bones) metacarpophalangeal joints (where the fingers meet the palm) intercarpal articulations (where the palm meets the wrist) wrist (may also be viewed as belonging to the forearm).

Arches

Arches of the hand Red: one of the oblique arches Brown: one of the longitudinal arches of the digits Dark green: transverse carpal arch Light green: transverse metacarpal arch The fixed and mobile parts of the hand adapt to various everyday tasks by forming bony arches: longitudinal arches (the rays formed by the finger bones and their associated metacarpal bones), transverse arches (formed by the carpal bones and distal ends of the metacarpal bones), and oblique arches (between the thumb and four fingers): Of the longitudinal arches or rays of the hand, that of the thumb is the most mobile (and the least longitudinal). While the ray formed by the little finger and its associated metacarpal bone still offers some mobility, the remaining rays are firmly rigid. The phalangeal joints of the index

finger, however, offer some independence to its finger, due to the arrangement of its flexor and extension tendons.[6] The carpal bones form two transversal rows, each forming an arch concave on the palmar side. Because the proximal arch simultaneously has to adapt to the articular surface of the radius and to the distal carpal row, it is by necessity flexible. In contrast, the capitate, the "keystone" of the distal arch, moves together with the metacarpal bones and the distal arch is therefore rigid. The stability of these arches is more dependent of the ligaments and capsules of the wrist than of the interlocking shapes of the carpal bones, and the wrist is therefore more stable in flexion than in extension.[6] The distal carpal arch affects the function of the CMC joints and the hands, but not the function of the wrist or the proximal carpal arch. The ligaments that maintain the distal carpal arches are the transverse carpal ligament (part of the flexor retinaculum) and the intercarpal ligaments (also oriented transversally). These ligaments also form the carpal tunnel and contribute to the palmar arches. Several muscle tendons attaching to the TCL and the distal carpals also contribute to maintaining the carpal arch.[7] Compared to the carpal arches, the arch formed by the distal ends of the metacarpal bones is flexible due to the mobility of the peripheral metacarpals (thumb and little finger). As these two metacarpal approach each other, the palmar gutter deepens. The central-most metacarpal (index finger) is the most rigid, and it and its two neighbours are untied to the carpus by the interlocking shapes of the metacarpal bones. The thumb metacarpal only articulates with the trapezium and is therefore completely independent, while the fifth metacarpal (little finger) is semi-independent with the fourth metacarpal (ring finger) forms a transitional element to the fifth metacarpal.[6] Together with the thumb, the four ulnar fingers form four oblique arches, of which the arch of the index finger functionally is the most important, especially for precision grip, while the arch of the little finger contribute an important locking mechanism for power grip. The thumb is undoubtedly the "master digit" of the hand, giving value to all the other fingers. Together with the index and middle finger, it forms the dynamic tridactyl configuration responsible for most grips not requiring force. The ring and little fingers are more static, a reserve ready to interact with the palm when great force is needed. [6] See also: arches of the foot

Muscles

Muscles and other structures of wrist and palm The muscles acting on the hand can be subdivided into two groups: the extrinsic and intrinsic muscle groups. The extrinsic muscle groups are the long flexors and extensors. They are called extrinsic because the muscle belly is located on the forearm. Intrinsic The intrinsic muscle groups are the thenar (thumb) and hypothenar (little finger) muscles; the interossei muscles (four dorsally and three volarly) originating between the metacarpal bones; and the lumbrical muscles arising from the deep flexor (and are special because they have no bony origin) to insert on the dorsal extensor hood mechanism.[8] Extrinsic

Extensor compartments of wrist (back of hand) The fingers have two long flexors, located on the underside of the forearm. They insert by tendons to the phalanges of the fingers. The deep flexor attaches to the distal phalanx, and the superficial flexor attaches to the middle phalanx. The flexors allow for the actual bending of the fingers. The thumb has one long flexor and a short flexor in the thenar muscle group. The human thumb also has other muscles in the thenar group (opponens and abductor brevis muscle), moving the thumb in opposition, making grasping possible. The extensors are located on the back of the forearm and are connected in a more complex way than the flexors to the dorsum of the fingers. The tendons unite with the interosseous and lumbrical muscles to form the extensorhood mechanism. The primary function of the extensors is to straighten out the digits. The thumb has two extensors in the forearm; the tendons of these form the anatomical snuff box. Also, the index finger and the little finger have an extra extensor, used for instance for pointing. The extensors are situated within 6 separate compartments. Compartment Compartment Compartment Compartment Compartment 1 (Most 2 3 4 5 radial) Abductor Extensor carpi Extensor Extensor Extensor digiti pollicis longus radialis longus pollicis longus indicis minimi Extensor Extensor Extensor carpi digitorum pollicis brevis radialis brevis communis Compartment 6 (Most ulnar) Extensor carpi ulnaris

The first four compartments are located in the grooves present on the dorsum of inferior side of radius while the 5th compartment is in between radius and ulna. The 6th compartment is in the groove on the dorsum of inferior side of ulna.

Innervation

Cutaneous innervation of the upper limb

The hand is innervated by the radial, median, and ulnar nerves. Motor innervation The radial nerve innervates the finger extensors and the thumb abductor, thus the muscles that extends at the wrist and metacarpophalangeal joints (knuckles); and that abducts and extends the thumb. The median nerve innervates the flexors of the wrist and digits, the abductors and opponens of the thumb, the first and second lumbrical. The ulnar nerve innervates the remaining intrinsic muscles of the hand.[9] All muscles of the hand are innervated by the brachial plexus (C5T1) and can be classified by innervation:[10] Muscles Extensors: carpi radialis longus and brevis, digitorum, digiti minimi, carpi ulnaris, radial pollicis longus and brevis, and indicis. Other: abductor pollicis longus. Flexors: carpi radialis, pollicis longus, digitorum profundus (half), superficialis, and pollicis brevis (superficial head). median Other: palmaris longus. abductor pollicis brevis, opponens pollicis, and first and second lumbricals. Flexor carpi ulnaris, flexor digitorum profundus (half), palmaris brevis, flexor digiti ulnar minimi, abductor digiti minimi, opponens digiti minimi, adductor pollicis, flexor pollicis brevis (deep head), palmar and dorsal interossei, and third and fourth lumbricals. Cutaneous innervation The radial nerve innervates the skin the back of the hand from the thumb to the ring finger and the dorsal aspects of the index, middle, and half ring fingers as far as the proximal interphalangeal joints. The median nerve innervates the palmar side of the thumb, index, middle, and half ring fingers. Dorsal branches innervates the distal phalanges of the index, middle, and half ring fingers. The ulnar nerve innervates the ulnar third of the hand, both at the palm and the back of the hand, and the little and half ring fingers.[9] There is a considerable variation to this general pattern, except for the little finger and volar surface of the index finger. For example, in some individuals, the ulnar nerve supplies the entire ring finger and the ulnar side of the middle finger, whilst, in others, the median nerve supplies the entire ring finger.[9] Nerve

Skin

Left: papillary ridges of palm Right: sexual dimorphism The glabrous (hairless) skin on the front of the hand, the palm, is relatively thick and can be bent along the hand's flexure lines where the skin is tightly bound to the underlying tissue and bones. Compared to the rest of the body's skin, the hands' palms (as well as the soles of the feet) are usually lighter and even much lighter in dark-skinned individuals, even compared to the other side of the hand. Indeed genes specifically expressed in the dermis of palmoplantar skin inhibit melanin production and thus the ability to tan, and promote the thickening of the stratum lucidum and stratum corneum layers of the epidermis. All parts of the skin involved in grasping are covered by papillary ridges ("fingerprints") acting as friction pads. In contrast, the hairy skin on the dorsal side is thin, soft, and pliable, so that the skin can recoil when the fingers are stretched. On the dorsal side, the skin can be moved across the hand up to 3 cm (1.2 in); an important input the cutaneous mechanoreceptors.[11]

Variation
Further information: Digit ratio The average length of an adult male hand is 189 mm, while the average length of an adult female hand is 172 mm. The average hand breadth for adult males and females is 84 and 74 mm respectively.[12] The ratio of the length of the index finger to the length of the ring finger in adults is affected by the level of exposure to male sex hormones of the embryo in utero. This digit ratio is below 1 for both sex but it is lower in males than in females on average.

Disorders and diseases

X-ray of the left hand of a ten year old boy with polydactyly.

Polydactyly, more than the usual number of fingers or toes. Having more than the typical number of metacarpal bones may be caused by genetic disorders like Catel-Manzke syndrome. Syndactyly, fusion of fingers or toes. Hand infection Hand surgery Carpal tunnel syndrome Dupuytren's contracture Claw hand, paralysis of intrinsic muscles of hand.

Fractures of the hand include:

Scaphoid fracture Rolando fracture - a comminuted intra-articular fracture through the base of the first metacarpal bone Bennett's fracture - a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint.[13]