1. ANATOMY OF HAND
• The human hand has a complex mechanism to perform
• Its integrity is essential for daily functions.
• Understanding of the normal hand characteristics requires
a comprehensive analysis of sensory and mechanical
• The hand, positioned at the end of the upper limb, is a
combination of complex joints whose function is to
manipulate and grasp, all made possible by the opposing
movement of the thumb.
• Some biologists believe that the development of the
human hand lead indirectly to the development of our
large and complex brain.
3. Bony anatomy
• The hand and wrist have a total of 27 bones arranged to roll, spin
• The carpus is formed from eight small bones collectively referred
to as the carpal bones.
• the metacarpals – the five bones that comprise the middle part of
• the phalanges (singular phalanx) – the 14 narrow bones that make
up the fingers of each hand.
4. Joints of the Wrist and Hand
1, Radiocarpal joint
2, Midcarpal joint
5. Ligaments of the Wrist and Hand
The stability of the wrist is
provided by ligaments
Main ligaments of hand
Volar plate ligaments
Radial and ulnar collateral
Ulnocarpal and radioulnar
6. Muscles of Hand
Thirty-four muscles act on the
• Intrinsic muscles of the hand
contain the origin and
insertions within the carpal and
• Muscles originating in the
forearm are the extrinsic
muscles of the hand.
• The intrinsic muscles of the
hand provide the fine motor
movements while the extrinsic
muscles permit strength.
There Two types of grasp are differentiated
according to the position and mobility of
thumb, CMC, and MP joints.
Palmar prehension (pulp to pulp),
Lateral prehension (pad-to-side;
8. Functional Position of the Hand
• Functional Position of the Hand provides the best balance of
resting length and force production so the hand can function
when the patient mobilizes it again.
Extended 20 degrees
Ulnarly deviated 10 degrees
Digits 2 through 5
MP joints flexed 45degrees
PIP joints flexed 30-45 degrees
DIP joints flexed 10-20 degrees
1st CMC jt partially abducted and opposed
MP joint flexed 10 degrees
IP joint flexed 5 degrees
allowing the hand to explore and control the environment and objects. Proximal region of the hand is the carpus (wrist)
The middle region the metacarpus (palm)
The distal region the phalanges (fingers). The carpal bones are bound in two groups of four bones:
1,the pisiform, triquetrum, lunate and scaphoid on the upper end of the wrist
2,the hamate, capitate, trapezoid and trapezium on the lower side of the hand.
Each finger has three phalanges (the distal, middle, and proximal); the thumb has two. the metacarpals – the five bones that comprise the middle part of the hand
The wrist has two degrees of freedom, although some say three degrees of freedom because they include the movements of pronation and supination, which occur at the the radioulnar joint. The radioulnar joint is often referred to as a joint of the forearm but it is this articulation that gives the wrist more freedom of movement.
(see table); on the palmar aspect is the flexor retinaculum which together with the carpal bones forms a canal – the carpal tunnel - which nerves, muscles and blood vessels run through, it is this area that is involved in carpal tunnel syndrome.
(The terms grasp, grip, and prehension are interchangeable.) Types of grasp. Two types of grasp are differentiated according to the position and mobility of thumb, 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.)
Cylindrical grip (fist grasp is a small diameter cylindrical grasp)
Hook grip (MP extended with flattening of transverse arch; the person may or may include the thumb in this grasp)
Lateral prehension (this can be a power grip if the thumb is adducted, a precision grip if the thumb is abducted).
PRECISION (Muscles are active that abduct or oppose the thumb; the hand's position is dynamic.)
Palmar prehension (pulp to pulp), includes 'chuck' or tripod grips
Bip-to-tip (with FDP active to maintain DIP flex)
Lateral prehension (pad-to-side; key grip)
When therapists immobilize a patient's hand, they often position it this way. During a period of immobilization, the resting lengths of the hand's ligaments and muscles change.