The hand is composed of nineteen bones and the muscles, tendons and ligaments that connect them. The metacarpal bones form the center of the hand. Proximally, they connect to eight carpal bones, which make up the wrist. Distally, they connect to the phalanges, or finger bones at the knuckles. Each of the four fingers has three phalanges, a proximal, middle and distal, and two joints where motion occurs. The thumb has only a proximal and distal phalynx, and one joint between them. On the back of the hand, six compartments contain the tendons that extend the fingers. The carpal tunnel is the location on the front of the hand where the median nerve and most of the tendons, which control hand and finger motion, enter the hand. The sides of the tunnel are formed by the carpal bones, and the transverse carpal ligament forms the roof. Several muscles are located inside of the hand. The thenar eminence is the group of muscles that forms the thick soft tissue found just below the thumb. The hypothenar eminence is the group of muscles found below the small finger, is composed of muscle. These muscles help to control the motion of the thumb and small finger. Finally, the interossei and lumbricals are muscles found between the metacarpals. They assist in motion of the fingers, such as spreading the fingers and closing them together.

Mechanism of Injury

Because the hand allows us to interact with, and manipulate our environment, it is commonly injured. The hand can be injured as a result of trauma, repetitive use, or degeneration that occurs with age. Trauma is a leading cause of injury in the young. Falls on to an outstretched hand, lacerations from sharp objects, crush injuries, such as slamming the fingers in a door or hitting them with a hammer, or getting the hand stuck in an object, such as a football jersey, can lead to fractures or dislocations. Striking or punching an object is a frequent source of fractures of the hand. This is so common that fractures of the neck of the fifth metacarpal are referred to as 'Boxer's Fractures'. Repetitive use is a common cause of hand injury. People whose occupations require repetitive work, such as carpenters, machinists and typists are particularly susceptible to carpal tunnel. Athletes who play collision sports, such as football, or sports with hard objects, such as baseball, frequently sustain hand injuries. Finally, normal wear and tear on the joints can accumulate over a lifetime and lead to arthritis and hand deformity.

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Dr. Subair Khan in SUN TV

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