Movements of the Thumb-Diseases of the Hand and Preservation of Function-

Movements of the Thumb

Flexion is the movement of the thumb across the palm in such a manner as to maintain the plane of the thumbnail at right angles to the plane of the other fingernails.

The movement takes place between the trapezium and the1st metacarpal bone, at the metacarpophalangeal and interphalangeal joints. The muscles producing the movement are the flexor pollicis longus and brevis and the opponens pollicis.

Extension is the movement of the thumb in a lateral or coronal plane away from the palm in such a manner as to maintain the plane of the thumbnail at right angles to the plane of the other fingernails. The movement takes place between the trapezium and the 1st metacarpal bone, at the metacarpophalangeal and interphalangeal joints. The muscles producing the movement are the extensor pollicis longus and brevis.

Abduction is the movement of the thumb in an anteroposterior plane away from the palm, the plane of the thumbnail being kept at right angles to the plane of the other nails. The movement takes place mainly between the trapezium and the 1st metacarpal bone; a small amount of movement takes place at the metacarpophalangeal joint. The muscles producing the movement are the abductor pollicis longus and brevis.

Adduction is the movement of the thumb in an anteroposterior plane toward the palm, the plane of the thumbnail being kept at right angles to the plane of the other fingernails. The movement takes place between the trapezium and the 1st metacarpal bone.

The muscle producing the movement is the adductor pollicis.

Opposition is the movement of the thumb across the palm in such a manner that the anterior surface of the tip comes into contact with the anterior surface of the tip of any of the other fingers. The movement is accomplished by the medial rotation of the 1st metacarpal bone and the attached phalanges on the trapezium.
The plane of the thumbnail comes to lie parallel with the plane of the nail of the opposed finger. The muscle producing the movement is the opponens pollicis.

 

Diseases of the Hand and Preservation of Function

From the clinical standpoint, the hand is one of the most important organs of the body. Without a normally functioning hand, the patient’s livelihood is often in jeopardy. To students who doubt this statement, I would suggest that they place their right (or left) hand in a pocket for 24 hours. They will be astonished at the number of times they would like to use it if they could.

From the purely mechanical point of view, the hand can be regarded as a pincer-like mechanism between the thumb and fingers, situated at the end of a multijointed lever. The most important part of the hand is the thumb, and it is the physician’s responsibility to preserve the thumb, or as much of it as possible, so that the pincer-like mechanism can be maintained. The pincer- like action of the thumb largely depends on its unique ability to be drawn across the palm and opposed to the other fingers.

This movement alone, although important, is insufficient for the mechanism to work effectively. The opposing skin surfaces must have tactile sensation—and this explains why median nerve palsy is so much more disabling than ulnar nerve palsy.

If the hand requires immobilization for the treatment of disease of any part of the upper limb, it should be immobilized (if possible) in the position of function. This means that if loss of movement occurs at the wrist joint, or at the joints of the hand or fingers, the patient will at least have a hand that is in a position of mechanical advantage, and one that can serve a useful purpose.

Physicians should also remember that when a finger (excluding the thumb) is normally flexed into the palm, it points to the tubercle of the scaphoid; individual fingers requiring immobilization in flexion, on a splint or within a cast, should therefore always be placed in this position.

Always refer to the patient’s fingers by name: thumb, index, middle, ring, and little finger. Numbering the fingers is confusing (is the thumb a finger?) and has led to such disastrous results as amputating the wrong finger.

Diseases of Blood Vessels-Disease of the Lymphatic System

Diseases of Blood Vessels

Diseases of blood vessels are common. The surface anatomy of the main arteries, especially those of the limbs.
 The collateral circulation of most large arteries should be understood, and a distinction should be made between anatomic end arteries and functional end arteries. All large arteries that cross over a joint are liable to be kinked during movements of the joint. However, the distal flow of blood is not interrupted because an adequate anastomosis is usually between branches of the artery that arise both proximal and distal to the joint. The alternative blood channels, which dilate under these circumstances, form the collateral circulation. Knowledge of the existence and position of such a circulation may be of vital importance should it be necessary to tie off a large artery that has been damaged by trauma or disease. Coronary arteries are functional end arteries, and if they become blocked by disease (coronary arterial occlusion is common), the cardiac muscle normally supplied by that artery will receive insufficient blood and undergo necrosis. Blockage of a large coronary artery results in the death of the patient

Disease of the Lymphatic System

The lymphatic system is often de-emphasized by anatomists on the grounds that it is difficult to see on a cadaver.
 However, it is of vital importance to medical personnel, since lymph nodes may swell as the result of metastases, or primary tumor. For this reason, the lymphatic drainage of all major organs of the body, including the skin, should be known. A patient may complain of a swelling produced by the enlargement of a lymph node. A physician must know the areas of the body that drain lymph to a particular node if he or she is to be able to find the primary site of the disease. Often, the patient ignores the primary disease, which may be a small, painless cancer of the skin. Conversely, the patient may complain of a painful ulcer of the tongue, for example, and the physician must know the lymph drainage of the tongue to be able to determine whether the disease has spread beyond the limits of the tongue