Surgery of the Hand and Wrist

Leonard K. Saleh
Perceptor : Dr. dr. Roni Eka Sahputra Sp.OT (K) Spine
 Introduction

• The goal of hand surgery is to maximize mobility,

sensibility, stability, and strength while minimizing pain

• Hand surgeon intergrated components of neurologic,

orthopedic, plastic, and vascular surgery in the care of
patients with disorders of upper extremities
 Hand and Wrist’s Motion
• A : Finger Abduction (white
arrow) Finger Adduction
(black arrow)

• B : Thumb Radial (black

arrow) Palmar abduction
(white arrow)

• C : Thumb and Small finger

Opposition

• D : Hand / Wrist Pronation

(black arrow) Supination
(white arrow)
 Bone
• The hand is comprised of 19 bones arrange in 5 rays

• A Rays is define as a digit, from the metacarpal base to

the tip of the digit

• The Rays are numbered 1 to 5 : thumb, index, middle,

ring, small

• There are 5 metacarpals

• Each digit has a proximal and distal phalanx, but only

fingers have a middle phalanx
 Joint
• The Metacarpophalangeal (MP) Joint

• Typically 90° of Flexion with small amount of hyperextention

• The Proximal Interphalangeal (PIP) Joint

• The critical joint for finger mobility. Normal motion is 0° to 95° (full extension to flexion)

• The Distal Interphalangeal Joint (DIP)

• Only move in a flexion extension plane from 0° to 90° on average

• The Thumb Interphalangeal Joint (IP)

• Only move in a flexion extension plane from 0° to 80°

 Muscle Affecting the Hand
and Wrist

•The wrist is moved by multiple tendons that originate from the

forearm and elbow.

•The digits of the hand are moved by both intrinsic (originating

within the hand) and extrinsic (originating in the forearm)
muscles.

•All of these muscles are innervated by the median, radial, or

ulnar nerves (or their branches)
 Three muscles flex the wrist

( from medial epicondyle of the humerus)

▫The flexor carpi radialis

(FCR, median nerve)

▫The flexor carpi ulnaris

(FCU, ulnar nerve)

▫The palmaris longus (PL)

tendon
 All three wrist extensors
are innervated by the radial nerve or its branches

▫The extensor carpi radialis

longus (ECRL)

▫The extensor carpi radialis

brevis (ECRB)

▫The extensor carpi ulnaris

(ECU)
 The long flexors of the fingers

(from medial epicondyle of the humerus)

▫The flexor digitorum

superficialis (FDS)

▫The flexor digitorum

profundus (FDP)

▫The flexor pollicis longus

(FPL)
 The thumb has three separate extrinsic extensors that

originate from the dorsal ulna in the mid-forearm and are

innervated by the PIN.

▫The abductor pollicis longus (APL)

▫The extensor pollicis brevis (EPB)

▫The extensor pollicis longus (EPL)