The human hand and upper extremity represent one of the most sophisticated mechanical systems in the body, comprising 64 bones working in precise coordination. From the robust shoulder girdle to the delicate finger joints, this intricate skeletal framework enables a remarkable range of movements essential for both power grip and fine manipulation tasks.
Anatomical Labels and Their Functions:
Clavicle The clavicle serves as a strut between the sternum and scapula. It provides attachment for multiple muscles while protecting vital neurovascular structures beneath.
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Scapula The scapula is a triangular bone providing attachment for 17 muscles. It contains the glenoid fossa and forms a critical component of the shoulder girdle.
Humerus The humerus is the longest bone of the upper extremity. It articulates proximally with the glenoid and distally with the radius and ulna.
Radius and Ulna The radius and ulna form the skeletal framework of the forearm. They articulate proximally at the elbow and distally at the wrist, enabling pronation and supination movements.
Carpal Bones The eight carpal bones (Trapezium, Trapezoid, Capitate, Hamate, Triquetrum, Pisiform, Lunate, Scaphoid) form the wrist. They arrange in proximal and distal rows to enable complex wrist movements.
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Metacarpal Bones The five metacarpal bones form the palm’s framework. Each has a base, shaft, and head, providing attachment for intrinsic hand muscles.
Proximal Phalanges The proximal phalanges are the first bones of the digits. They articulate with the metacarpal heads proximally and middle phalanges distally.
Middle Phalanges The middle phalanges form the intermediate segment of digits 2-5. They provide attachment for both flexor and extensor tendons.
Distal Phalanges The distal phalanges form the fingertips. They support the nail bed and contain specialized sensory endings for touch and pressure.
Upper Extremity Biomechanics and Function
The upper extremity functions through coordinated movements across multiple joints. The integration of skeletal elements with neuromuscular control enables both precise movements and power activities.
Shoulder Complex
The shoulder girdle demonstrates remarkable mobility through:
- Three degrees of freedom at glenohumeral joint
- Synchronized scapulothoracic motion
- Complex clavicular movements
Hand Biomechanics
Grip Patterns
Hand function involves specialized grip patterns:
- Precision grip
- Power grip
- Hook grip
- Key pinch
- Spherical grip
Clinical Applications
Common Pathologies
Upper extremity disorders include:
- Carpal tunnel syndrome
- De Quervain’s tenosynovitis
- Trigger finger
- Dupuytren’s contracture
- Rheumatoid arthritis
Diagnostic Approaches
Modern evaluation techniques include:
- Advanced imaging (MRI/CT)
- Electrodiagnostic studies
- Dynamic ultrasound
- Motion analysis
- Grip strength testing
Surgical Considerations
Approach Selection
Surgical planning requires assessment of:
- Neurovascular structures
- Tendon relationships
- Joint biomechanics
- Tissue planes
- Surgical landmarks
Microsurgical Techniques
Advanced procedures include:
- Digital replantation
- Tendon repair
- Nerve reconstruction
- Joint arthroplasty
- Complex tissue transfer
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