BIOMECHANICS AND PATHOMECHANICS OF HAND

PRIYANKA SOOD Click to edit Master subtitle style

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Hand complex

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Carpometacarpal (CMC) Joints of 2-5

Composition Carpal Arch Ligament Support

Transverse Carpal Ligament Dorsal and Palmar CMC Ligaments Dorsal and Palmar Metacarpal Ligaments Metacarpal Interosseous

Metacarpophalangeal (MCP) Joints of 2-5 Fingers

Ligament Support

Capsule Volar Plate Collateral Ligaments Motions

Interphalangeal Joints of 2-5 Fingers

Hinge Joints Motions

CMC of Thumb

Saddle Joint Ligament Support

Capsule Intermetacarpal Ligament

MCP of Thumb

Ligament Support

IP Joint of Thumb

OUTLINE OF BIOMECHANICS
Types of grasp

Arches of the hand Functional position of the hand Joints of the hand Mechanism for finger flexion Mechanism for finger extension; the extensor mechanism
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Types of grasp

Two types of grasp are differentiated according to the position and mobility of the thumb's CMC and MP joints. POWER grasp (The terms grasp, grip, and prehension are interchangeable.) (The adductor pollicis stabilizes an object against the palm; the hand's position is static.) 5/26/12

Arches

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ARCHES

Three arches balance stability and mobility in the hand. The proximal transverse arch is rigid, but the other two arches are flexible, and are maintained by activity in the hand's intrinsic muscles. PROXIMAL TRANSVERSE ARCH describe this arch as a composite of two arches, the proximal and 5/26/12

DISTAL TRANSVERSE ARCH this the metacarpal arch, because it is formed by the metacarpal heads; metacarpals 2 and 3 are stable while 4 and 5 are relatively mobile. You can observe the arch's combination of "radial" stability and "ulnar" mobility by loosely closing your fist, then squeezing more tightly, 5/26/12

LONGITUDINAL ARCH Observe this arch's behaviour as you loosely close your fist. Tighten the fist and watch the fourth and fifth metacarpals. The arches provide a balance between stability and mobility for grasping. For instance, we produce the so-called "chuck grasp" by using the more stable 5/26/12

Functional position of the hand

Wrist

extended 20 degrees ulnarly deviated 10 degrees MP joints flexed 45degrees PIP joints flexed 30-45 degrees DIP joints flexed 10-20 degrees

Digits 2 through 5

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Functional position of hand

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JOINT

STRUCTURE

AXIS lateral A-P

MOTION flexion/exte nsion abduction/a dduction

CLOSE-PACKED POS first: extension 2nd-5th: flexion

Metacarpobiaxial phalangeal (condylar) (MP) Proximal Interphalang uniaxial eal (PIP) Distal Interphalang uniaxial eal (DIP)

lateral

flexion/exte extension nsion flexion/exte extension nsion

lateral

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Metacarpophalangeal (MP) condyloid, biaxial joints

joint's palmar aspect is palpable at level of distal palmar crease proximal joint surface is convex and distal surface is concave roll and glide occur in same direction

anterior with flexion posterior with extension.

Joint capsule supported by two 5/26/12

Interphalangeal (IP) uniaxial hinge joints

supported by two collateral ligaments, and by smaller versions of a volar plate.

Like MP joint, proximal joint surface is convex and distal surface is concave roll and glide occur in same direction
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anterior with flexion

Mechanism for finger flexion

Mechanism for finger flexion FDP: flexor digitorum profundus (the deeper of the two) FDS: flexor digitorum superficialis (the more superficial muscle)

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Biomechanics of Finger Flexion

Gliding mechanisms

Ligaments Bursa Digital tendon sheaths A1-A5 C1-C3

Annular Pulleys

Cruciate Ligaments

Function of Pulleys

Biomechanics of Finger Extension

Extensor Hood

EDC tendons DI and PI tendons Lumbricales Central tendon Oblique Retinacular Ligaments Sagittal Bands

Effects on MCP joints Effects on IP Joints

Mechanism for finger extension

The extensor mechanism is an elaboration of the extensor digitorum comunis (EDC) tendon on the dorsum of each phalanx. The extensor indicis (EI) and the extensor digiti minimi (EDM) insert into the extensor mechanisms of the second and fifth digits, respectively.
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Tendons helping extensor mechanism

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Muscles that transmit force to the otherwise non-contractile extensor mechanism: Dorsal interossei (DI)
PALMAR INTEROSSEI LUMBRICALS

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1.Median:

CLINICAL APPEARANCE OF PERIPHERAL NERVE INJURIES IN THE HAND

Often due to carpal tunnel sd. Wasting of thenar eminence Decreased thumb function, especially opposition

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2. Ulnar:

Damage to ulnar nerve can occur with trauma to elbow region. Ulnar neuropathy is a frequent complication of diabetes mellitus Wasting of web space and interosseous spaces.
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3. Radial:

Associated with gunshot or stab wounds, fracture of humerus, "Saturday night palsy." person demonstrates a "dropped wrist," and cannot reposition thumb. lack of wrist extension may cause hand grip to be weak.

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Boutonniere Deformity

Tear or stretch of the central extensor tendon at PIP Note: unopposed flexion at PIP Extension at DIP Trauma or inflammatory arthritis

Swan Neck Deformity

Contraction of intrinsic muscles (trauma, RA) NOTE: Extension at PIP

Osteoarthritis

Bouchards nodes: PIP Heberdens nodes: DIP

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Rheumatoid Arthritis

MCP swelling Swan neck deformities Ulnar deviation at MCP joints Nodules along tendon sheaths
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Mallet Finger

Hyperflexion injury Ruptured terminal extensor mechanism at DIP Incomplete extension of DIP joint or extensor lag Treatment:

stack splint

Dupuytrens Contractures

Palmar or digital fibromatosis Flexion contracture Painless nodules near palmar crease Male> Female Epilepsy, diabetes, pulmonary dz, alcoholism

Thank you