Gross Anatomy
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FUNCTIONAL ANATOMY OF THE DIGITS

Required Reading - 376 - 393

The student should also look at the video FUNCTIONAL ANATOMY OF THE FINGERS AND THE THUMB available at Library Media Services

SURFACE ANATOMY OF THE WRIST AND HAND

  1. Hand
    1. Surfaces
      1. Palmar ( ventral)
      2. Dorsal
    2. Thenar eminence
      1. Fleshy (muscular) area formed by intrinsic (thenar) muscles of thumb
    3. Hypothenar eminence
      1. Fleshy (muscular) area formed by intrinsic (hypothenar) muscles of 5th digit
  2. Wrist
    1. Proximal crease
      1. The proximal portion of the wrist joint
      2. Indicates the site of articulation between the distal radius and the proximal row of carpal bones
    2. Distal crease
      1. Distal surface marking of the wrist joint
      2. Indicates the articulation between the distal row of carpal bones with the base of the of the metacarpal bones
  3. Thumb
    1. Proximal digital crease
      1. Proximal knuckle of thumb
      2. Site of the metacarpophalangeal joint of thumb
    2. Interphalangeal crease
      1. Distal knuckle of thumb
      2. Site of the interphalangeal joint of the thumb
  4. Fingers (4)
    1. Proximal digital crease
      1. Proximal knuckle of thumb
      2. Site of the metacarpophalangeal joints of fingers
    2. Proximal interphalangeal crease
      1. Middle knuckle of fingers
      2. Site of proximal interphalangeal joints (PIP) of fingers
    3. Distal interphalangeal crease
      1. Distal knuckle of fingers
      2. Site of distal interphalangeal joints (DIP) of fingers

II. BONES OF THE HAND AND DIGITS ( 378 -82)

  1. Hand
    1. Metacarpals (5)
    2. Proximal articulation - distal row of carpal bones of wrist
    3. Distal articulation - proximal phalanx of fingers
  2. Digits
    1. Fingers
      1. 3 Phalanges ( proximal, middle, distal)
    2. Thumb
      1. 2 phalanges ( proximal, distal)
  3. Digital Articulations
    1. Metacarpophalangeal ( M.P.)
      1. Condyloid joints
      2. Head of metacarpals and base of proximal phalanx
      3. Ligaments
      4. collateral
      5. palmar
      6. deep transverse metacarpal
      7. Movements
      8. Flexion / extension
      9. Abduction / Adduction
    2. Interphalangeal joints of fingers
      1. Hinge joints
        1. Proximal Interphalangeal ( P.I.P.)
        2. Proximal and middle phalanges
        3. Distal Interphalangeal ( D.I.P.)
        4. Middle and distal phalanges
      2. Ligaments
        1. palmar
        2. collateral
      3. Movements
        1. Flexion / Extension
    3. Interphalangeal joint of thumb
      1. Hinge joint
        1. Proximal and distal phalanges
      2. Movements
        1. Flexion / Extension
  4. Carpometacarpal Articulations
    1. Fingers
      1. Planar type synovial joints
      2. Very little motion
    2. 2. Thumb
      1. Saddle type synovial joint
        1. Trapezium and base of 1st. Metacarpal
        2. Ist metacarpal set at 900 angle to other metacarpals
      2. Movements
        1. Opposition
          1. Rotation of the 1st metacarpal on the trapezium
          2. Allows pad of thumb to touch pads of all other fingers
        2. Abduction

III.FASCIA AND SPACES (382 -83)

  1. Palmar Aponeurosis
    1. Continuation of the insertion of the palmaris longus muscle
    2. Acts to protect underlying structures
    3. Septa attach to metacarpal bones and divide palm into spaces and compartments
      1. Lateral septum attaches to 1st metacarpal bone
      2. Medial septum attaches to 5th metacarpal bone
      3. Intermediate septum attaches 3rd metacarpal bone
  2. Spaces & Compartments
    1. Thenar Compartment
      1. Lateral to lateral septum
      2. Contents
      3. Thenar muscles
    2. Hypothenar compartment
      1. Medial to medial septum
      2. Contents
      3. Hypothenar muscles
    3. Mid Palmar Space
      1. Between medial and intermediate septa
      2. Contents
        1. Flexor digital sheaths of digits 3 - 5
        2. Lumbricals 2-5
        3. Digital nerves 3-5 digits
    4. Thenar space
      1. Between lateral and intermediate septa
      2. Contents
        1. Flexor digital sheath for digits 1 & 2
        2. First lumbrical
        3. Digital nerves for digits 1 & 2

IV. MUSCLES ACTING ON THE DIGITS (383 - 90)

  1. Extrinsic Muscles of the Hand ( See charts on pages 358 and 361 for attachments)
    1. Muscles that arise in the forearm and insert within the hand
  2. Flexor Muscles
    1. Flexor digitorum superficialis
      1. Flexes the proximal interphalangeal joint of the fingers ( digits 2 -5)
        1. Innervated by the median nerve
    2. Flexor digitorum profundus
      1. Flexes the distal interphalangeal joints of the fingers
      2. Muscles to fingers 1 & 2 -innervated by deep branch of median nerve
        1. Muscles to fingers 1 & 2 -innervated by ulnar nerve
    3. Flexor Pollicis Longus
      1. Flexes interphalangeal joint of thumb
        1. innervated by deep branch of median nerve
  3. Extensor Muscles
    1. Extensor digitorum
      1. Extends metacarpophalangeal joints of fingers
    2. Extensor indicis
      1. Helps extends metacarpophalangeal joints 1st. finger
    3. Extensor digiti V
      1. Helps extends metacarpophalangeal joints 4th. finger
  4. Posterior Muscles of the Thumb
    1. Definition
      1. Extrinsic muscles found in the posterior compartment of the forearm that act on the thumb
    2. Extensor pollicis longus and brevis
      1. Extend the M.P. & I.P. joints of the thumb respectively
    3. Abductor pollicis longus
      1. Abduct the 1st. carpometacarpal joint
  5. Properties of Extrinsic Extensor Muscles
    1. Innervated by the deep branch of the radial nerve
    2. Insertion of finger extensors participate in the formation of the dorsal digital expansion.

Intrinsic Muscles of the Hand (382 - 387; Chart 1 of notes)

  1. Definition
    1. Muscles whose origins and insertions are within the hand
    2. See Chart Intrinsic Muscles of the Hand for attachments and functions
  2. Hypothenar
    1. Located on ulnar side of hand
    2. Act on M.P. joint of 4th finger
  3. Thenar
    1. Located on radial side of hand
    2. Responsible for opposability of thumb
      1. Flex and abduct M.P. joint of thumb
      2. Rotate 1st. metacarpal on trapezium
  4. Adductor Pollicis
    1. Fleshy prominence on palmar surface of hand between thumb and 1st. finger
    2. Adducts the M.P. joint of thumb
    3. Innervated by ulnar nerve
  5. Lumbricals
    1. Associated with tendons of flexor digitorum profundus
    2. Insert onto dorsal digital expansion
    3. Innervated by both median ( 1 & 2) and ulnar (3 & 4) nerves
    4. Flex M.P. joints of fingers while extending I.P. joints of fingers
  6. Interossei
    1. Palmar ( 3 in number)
      1. Arise from palmar surface of metacarpal bones 2,4,5
      2. Insert onto dorsal digital expansion and proximal phalanges of fingers 2, 4, 5
      3. Adduct the MP joint of fingers 2,4,5
    2. Dorsal ( 4 in number)
      1. Arise from dorsal aspect adjacent metacarpal bones
      2. Insert into dorsal digital expansion and proximal phalanges of fingers 2, 3, 4
      3. Abduct digits 2, 3, 4
    3. Interossei innervated by ulnar nerve
    4. Act as flexors of MP joint

VI. DORSAL DIGITAL EXPANSION ( 390 - 91)

  1. Definition and Purpose - Manner in which the extrinsic extensor tendons and intrinsic muscles, lumbricals and interossei, insert onto the dorsum of the fingers. The extensor tendons form a moveable hood over the MP joints of the fingers called the extensor hood . This hood moves distal to the MP joint when this joint is flexed by the extrinsic finger flexors and proximal to the MP joint when extended by the extensor finger extesnors. From this hood a central fibrous band passes to the proximal interphalangeal joint. Two lateral bands continue to the distal interphalangeal joint. The interossei muscles joint the hood at the MP joint. The lumbricals attach somewhat distal and have a greater effect on the central lateral bands. Such an arrangement enables the "uncoupling" of flexion and extension. The range of motion of flexion would be limited if extension of the fingers were accomplished by a single tendon inserting on the extensor side of the distal phalanx in the same manner in which the flexor digitorum profundus does on the flexor side. Having different components extend the MP and IP joints allows greater degree of flexion because the extensor tendons do not become taut when finger flexion occurs. This mechanism permits greater variation in extension than would be possible if a single extensor tendon was used for each joint.
  2. Components
    1. 1. Extensor Hood
    2. a. Covers the M.P. joint of each finger
    3. b. Formed by tissue connecting the tendons of the extensor digitorum, the interossei and lumbricals of each finger
    4. c. Extensor indices tendon joins hood of 2nd. finger
    5. d. Extensor digiti minimi joins hood of 4th. finger
    6. 2. Bands
    7. a. Central band extends to base of middle phalanx of each finger
    8. b. 2 lateral bands extend to distal phalanx of each finger
  3. Functions
    1. Enables extrinsic extensor tendons to strongly extend the M.P.
    2. Can extend I.P. joints when MP joints are flexed by finger flexors.
  4. Interossei and Lumbricals
    1. Participate in the formation of Dorsal Digital Expansion
    2. Interossei join hood close to MP joint
    3. Act to flex the M.P. joints
    4. Weak extenders of IP joints
    5. Ad/Aduct MP joints
    6. Lumbricals joint expansion distal to interossei and effect the central and lateral bands
    7. Strong extensors of IP joints when MP joints are flexed
    8. Can act as weak flexors of MP joint

MOVEMENTS OF THE FINGERS(Chart 2)

  1. Extension of the Fingers
    1. M.P. joints strongly extended
      1. Extensor digitorum
      2. Extensor indices
      3. Extensor digiti minimi
    2. I.P. joints extended together as a unit
      1. Extensor digitorum
        1. Weak extenders of IP joints
      2. Lumbricals
        1. act when M.P. joints are flexed position
      3. Interossei
        1. can assist lumbricals to extend IP joints\
  2. Flexion of the Fingers
    1. M.P. Joints
      1. Interossei
        1. Prime movers of MP joint flexion
      2. Lumbricals (4 )
        1. Weak flexors of M.P. joints
        2. Act when I.P. joints are simultaneously extended
      3. Proximal Interphalangeal Joints ( P.I.P.)
        1. Flexor digitorum superficialis
      4. Distal Interphalangeal Joints
        1. Flexor digitorum profundus
  3. Adduction of the Fingers
    1. Motion occurs at M.P. joints
    2. Palmer Interossei (3)
      1. 2nd finger is center of hand
      2. Fingers 1, 3 & 4 move toward 2nd. finger
  4. Abduction of the Fingers
    1. Motion occurs at M.P. joints
    2. Dorsal Interossei (4)
      1. 2nd finger is center of hand
        1. Any movement of 2nd. finger is considered abduction
      2. Fingers 1, 3 & 4 move away from 2nd. finger 2nd. finger

VII. MOVEMENTS OF THE THUMB (Chart 3)

  1. Properties
    1. Plane of thumb rotated 900 to the axis of the fingers
  2. Movements
    1. Flexion - thumb moves across the palm
    2. Extension - thumb moves away from the palm
    3. Abduction - thumb moves away from hand towards you
    4. Adduction - movement of thumb towards hand
    5. Opposition - flexion and rotation of thumb to touch pads of other fingers

IX. CLINICAL ANATOMY OF THE DIGITS

  1. Grip
    1. Power - is utilized when one wants to grasp and hold an object tightly
    2. Wrist
    3. (1) Extended and Ulnar deviated
    4. Fingers
    5. I.P. joints are flexed
    6. M.P. joints are flexed & abducted
    7. Thumb
    8. Usually strongly Adduction at M.P. joint although some opposition my also occur
    9. Variations
    10. Hook - only fingers used and they are flexed strongly at the MP and IP joints. Thumb usually not used
    11. Fist - grasping an object tightly within fist. Fingers are flexed while thumb is flexed and abducted
    12. Cylindrical - gasping a cylindrical object between pads of fingers and thumb. Digits are wrapped around an object in a flexed position. Thumb is flexed , abducted with some opposition.
    13. Synergy between wrist extensors and finger flexors.
    14. Much tighter grip when wrist is extended by wrist extensors.
    15. Puts traction on extrinsic finger flexors enabling greater strength of contraction
    16. Precision Grip is used when fine manipulation is necessary such as threading a needle, holding a writing instrument or picking up a small object such as a coin. The lumbricals and interossei act on the joints of the fingers while the thenar muscles act of the thumb and the pads of the digits are brought into contact
    17. Fingers
    18. Slight flexion at I.P. joints
    19. M.P. joints flexed
    20. Thumb
    21. Full opposition
    22. Opening the hand involves the extrinsic finger extensor muscles acting on the MP joints of the fingers and the lumbricals ( with some help from the interossei) acting on the IP joints of the fingers
  2. Carpal Tunnel Syndrome is a form of entrapment syndrome in which the median nerve is compressed within the carpal tunnel. Although this condition occurs at the wrist, the effect are felt within the hand. The symptoms of carpal tunnel syndrome are similar to that of a lesion of the median nerve at the wrist.
    1. Sensory symptoms - range from pain and redness along cutaneous distribution of median nerve to paraesthesia and ultimately anesthesia.
    2. Pain can be referred along upper limb
    3. Motor symptoms - start out as weak opposition of the thumb. In severe cases, opposition is lost and there is a wasting of the thenar eminence.
    4. Tests for median nerve entrapment at the wrist
    5. Tinel's Sign - Tapping on the area of the flexor retinaculum of the patients affected wrist will elicit tingling along the palmar surface of the thumb and fingers 1& 2.
    6. Phalen's Test - The patient flexes their wrists with the forearm prone. The patient then presses the dorsum of the hands against each other. A positive sign is to elicit tingling along the palmar surface of the thumb and fingers 1& 2.
  3. Nerve Lesions to various components of the brachial plexus can result in loss of hand function and/ or deformities of the hand. Injuries occur as a result of trauma, entrapment or neuropathies.
    Trauma
    can result in complete loss of nerve function. In such instances, all of the muscles innervated by that nerve will be paralyzed and there will be complete loss of function of the affected muscles and muscle atrophy. Anesthesia to the region(s) supplied by that nerve will likely occur.
    Entrapment
    or compression usually produces paraesthesia and muscle weakness You should be able to localize the site of a nerve lesion by understanding the functional deficits that result as well as any deformity that may ensue.
    Lesions involving the roots of the brachial plexus can result in complete loss of function if the involved roots are the only ones supplying a given muscle or weakness if roots other than those affected supply a given muscle.
    Review the Charts on Brachial Plexus Lesions and Upper and Lower Root Lesions in the Brachial Plexus Unit to understand the anatomical basis of the following lesions.
    1. Radial nerve - Usually occur as a result of trauma , a result of fracture of the humeral shaft , compression within the axilla or entrapment within the supinator muscle. The muscles within extensor compartment of the forearm are affected as well as sensation to the dorsum of the wrist.
      1. Patient has difficulty extending wrist when hand is in prone position (Drop wrist)
      2. Is not able to make a tight fist
      3. Reduced sensation from radial side of dorsum of hand
    2. Ulnar nerve-can be damaged by trauma (fracture of the "funny bone) or be entrapped while passing into the forearm by passing through the origin of the flexor digitorum superficialis muscle. The usual result is loss of function of most intrinsic muscles of the hand and loss of sensation along the ulnar side of the palm and 5th finger. The following are indications of a proximal lesion of the ulnar nerve:
      1. There is a clawing of the 4th and 5th digits due to paralysis of the 4th and 5th lumbricals and all of the interossei.
      2. The patient can not grasp object between fingers because abduction and adduction of the fingers is impossible
      3. Thumb is in an extended and abducted position as a result of paralysis of the adductor pollicis
      4. Weak flexion and ulnar deviation of wrist
      5. Difficulty making a fist and grasping objects
        Lesions of the ulnar nerve at the wrist (distal lesions) or entrapment of the deep branch of the ulnar nerve as it passes into the palm are similar to the more proximal lesions except there are not loss of wrist function and the "clawing " may not be as pronounced because the extrinsic finger flexors are not affected. There is little if any sensory loss
    3. Median Nerve can be compressed within the carpal tunnel ( Carpal Tunnel Syndrome), entrapped within the pronator teres muscle or subject to traumatic lesion. The most usual symptom concerns the thenar muscles. These muscles tend to become paralyzed and there is wasting of the thenar eminence. Paralysis of the thenar muscles result in an inability to oppose the thumb. The thumb is also rotated in the plane of the fingers. This conditions know as "Ape Thumb". In addition, a proximal lesion will have the following symptoms:
      1. Loss of sensation over the radial potion of the palm and 31/2 digits
      2. Very weak wrist flexion and radial deviation
      3. Thumb in " ape position"
      4. Papal Hand
        1. 1st and 2nd fingers are in an extended position due to loss of function of extrinsic finger flexors to those fingers
      5. Inability to make a closed fist
        The symptoms resulting from a distal lesion of the median nerve include all of the above except that for wrist functions are unaffected and Papal Hand would not occur. The reason is that with a distal lesion, only the intrinsic muscles innervated by the median nerve are affected. The extrinsic muscles would have normal function
    4. C 8 - T 1 (Klumke's Palsy) - involves loss of function of the intrinsic muscles of the hand and weakness many of the forearm muscles. Symptoms of C8,T1 lesion include:
      1. Loss of ability to use any intrinsic muscle of the hand
      2. Wasting of muscles in hand
      3. Clawing of all fingers
      4. Can not oppose thumb
      5. Can not make a fist
      6. Can not abduct or adduct the digits
      7. Loss of sensation over medial forearm , ulnar side of palm and last 1 1/2 digits


Chart 1 INTRINSIC MUSCLES OF THE HAND

MUSCLE PROXIMAL DISTAL NERVE FUNCTION
Thenar Compartment:
Abductor Pollices Brevis Flexor retinaculum & scaphoid & trapezium Base of proximal phalanx of thumb Recurrent branch of median 1. Abduct the M.P. Joint of thumb

2. Assist in opposition

Flexor Pollices Brevis 1. Superficial head Flexor retinaculum & scaphoid & trapezium

2. Deep Head -

palmar surface of 1st metacarpal

Base of proximal phalanx of thumb Recurrent branch of Median 1. Flex the thumb at the MCP and CMC joints

2. Aid in opposition

Opponens pollices Flexor retinaculum & Trapezium Lateral 1/2 1st metacarpal Recurrent branch of Median Rotate 1st metacarpal at CMC joint to allow opposition
Hypothenar Compartment:
Abductor Digiti Minimi 1. Pisiform

2. Pisohamate ligament

1.Medial side base of proximal phalanx of 5th. Digit Deep branch of Ulnar Abducts & helps flex MCP of 5th. Digit
Flexor Digiti Minimi 1.Hook of the hamate

2. Flexor retinaculum

Medial base of proximal phalanx of 5th. digit Deep branch of Ulnar Flex MCP of 5th. Digit
Opponens Digiti Minimi .Hook of the hamate

2. Flexor retinaculum

Medial 1/2 of 5th metacarpal Deep branch of Ulnar Draws the 5th MCP forward & rotates it laterally
Central Compartment :
Adductor Pollices 1. Oblique head - 2nd., 3rd. Metacarpal and Capitate

2. Transverse head - anterior 3rd metacarpal

Medial side of base of proximal phalanx of thumb Deep branch of ulnar Adduct thumb & assist in grasping tightly

MUSCLE PROXIMAL DISTAL NERVE FUNCTION
Lumbricals Tendon of flexor digitorum profundus Radial side of the extensor expansions distal to the MCP joints of the 4 fingers Lateral 2 = Median

Medial 2 = Deep Ulnar

flex the MCP while extend the I P joints of 4 fingers
Dorsal Interossei Adjacent sides of 2 metacarpal bones Extensor expansions and base of the proximal phalanges Deep ulnar 1. Abduction of 2nd., 3rd. and 4th fingers

2. Flex MP joints of fingers

Palmar Interossei Palmar surface of 2nd, 4th, & 5th metacarpals Extensor expansions and base of the proximal phalanges , 1st., 2nd., and 4th. fingers Deep ulnar 1. Adduction of 1st., 3rd. and 4th fingers

2. Flex MP joints of fingers



Chart 2 PRIME MOVERS OF THE FINGERS

ACTION JOINT MUSCLE NERVE SEGMENT
FLEXION P.I.P. Flex. digitorumsuperficialis Median C 7, 8, T 1
D.I.P. Flex. Digitorum profundus Median & Ulnar C 7, 8, T 1
M.P. Interossei Ulnar C 8 ,T 1
Lumbricals 2 Median & Ulnar C 7 ,8 ,T 1
Flexor digiti minimi Ulnar C 8 ,T 1
EXTENSION M.P. Extensor digitorum 3 Radial C 6, 7, 8
Extensor indicis 3 Radial C 6, 7, 8
Extensor digiti V 3 Radial C 6, 7, 8
I.P. Lumbricals:1st. & 2nd Median C 7 ,8 ,T 1
Lumbricals: 3rd. & 4th. Ulnar C 7 ,8 ,T 1
ABDUCTION M.P. Dorsal Interossei Ulnar C 8 ,T 1
Abductor digiti V Ulnar C 8 ,T 1
ADDUCTION M.P Palmar Interossei Ulnar C 8 ,T 1

    D.I.P. = Distal interphalangeal joint

    P.I. P. = Proximal interphalangeal joint

    I.P. = Interphalangeal joint

    M.P. = Metacarpophalangeal joint

    1 Interossei = Prime flexors of M.P. joints. Especially active in flexing the M.P. joints when the I.P. joints are in a position of flexion (making a fist).

    2 Lumbricals =Flex the M.P. joints while simultaneously extending the I.P. joints. Used mainly with the precision grip

    3 Extensor Digitorum,Indices,and Digiti V = Strong extensors of M.P. joints ; Weak extensors of I.P. joints



Chart 3-PRIME MOVERS OF THE THUMB

ACTION JOINT MUSCLE NERVE SEGMENT
FLEXION I.P. Flexor pollices longus Median Anterior Interosseous Br.) C 7, 8, T 1
M.P. Flexor pollices brevis Median( Thenar Branch) C 8, T 1
EXTENSION I.P Extensor pollices longus Radial C 6, 7, 8
M.P. Extensor. pollices brevis Radial C 6, 7, 8
ABDUCTION 1St. C.M. C. Abductor pollices longus Radial C 6, 7, 8
M.P. Abductor pollices brevis Median( Thenar Branch) C 8, T 1
ADDUCTION M.P. Adductor pollices Ulnar C 8 , T 1
OPPOSITION 1St. C.M. C. Opponens pollices Median( Thenar Branch) C 8, T 1

    M.P. = Metacarpophalangeal joint

    I.P. = Interphalangeal joint

    1st. C. M. C. = First Carpometacarpal joint


Figure 1 - Blood Supply of the Hand
1. Name each of the numbered arteries supplying the hand


Figure 2 - Bones of the Hand
1. Name the numbered bones.

2. Correctly identify the lettered joints. Include the types of movements that can take place at each joint.



Figure 3 - Palmar Surface of Hand
1.Use this diagram to indicate the insertion points of the extrinsic and intrinsic muscles of the hand. This should help you understand the joints upon which each muscle acts.


Figure 4 - Dorsal Surface of the Hand
1.Use this diagram to indicate the insertion points of the extrinsic and intrinsic muscles of the hand. This should help you understand the joints upon which each muscle acts.


X. OBJECTIVES

  1. Be able to correlate the important surface anatomical features of the wrist , hand and fingers, with the bony and or muscles forming each feature.
  2. Know the bones that comprise the hand and fingers.
  3. Know the shape and types of movements that take place at the metacarpophalangeal and interphalangeal articulations of the fingers and thumb .
    1. Understand the mechanism of action for muscles that act as prime movers for each type of motion
  4. Be able to describe the anatomy of the extensor expansion.
    1. Understand how the muscles whose tendons participate in the formation of the extensor expansion function in finger movement.
    2. Understand how the extensor expansion can "uncouple" flexion & extension.
  5. Understand the attachments, innervation and function(s) of the intrinsic muscles of the hand.
    1. Be able to localize the site(s) of peripheral nerve lesions by the functional deficits produced by such lesion
    2. Correlate deformities of the hand with the nerve lesion that produced the deformity.
    3. Know how to test from the individual functions of the intrinsic muscles of the hand.
  6. F.Understand the muscles involved in the performing different types of grips.
    1. G Understand the dermatome pattern of the hand and fingers.
  7. Be able to determine the location of a peripheral nerve lesion from the sensory deficits that result from such a lesion.
  8. H. Be familiar with the blood supply and venous drainage of the hand. Know the components that comprise the superficial and deep palmar arches.
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