Functional Anatomy, Examination, and Functional Assessment of Hands

  • Dong HanEmail author
  • Hong An
  • Wei Wang
  • Bo Chen
  • Jianmin Yao
  • Fengjing Zhao
  • Bin Wang
  • Feng Ni
  • De Shi
Part of the Plastic and Reconstructive Surgery book series (PRS)


Human hands have very accurate and complex functions, and their relevant anatomic structures include brachial plexus and various structures from shoulder girdles to fingertips [1]. According to the features of this specialty, this section describes the functional anatomy of wrists and hands.


  1. 1.
    Chase RA. Examination of the hand and relevant anatomy. In: McCarthy JG, editor. Plastic Surgery, vol. 7. London: WB Saunders; 1990.Google Scholar
  2. 2.
    Skoog T. The transverse elements of the palmar aponeurosis in Dupuytren’s contracture. Scand J Plast Reconstr Surg. 1967;1:51.CrossRefGoogle Scholar
  3. 3.
    Brand P, Hollister A. Clinical mechanics of the hand. St. Louis: Mosby-Year Book; 1999.Google Scholar
  4. 4.
    Moberg E. Objective methods for determining the function value of sensibility in the hand. J Bone Joint Surg. 1958;40B:476.Google Scholar
  5. 5.
    Dellon AL. The moving two-point discrimination test; Clinical evaluation of the quickly-adapting fiber/receptor system. J Hand Surg. 1978;3:474–81.CrossRefGoogle Scholar
  6. 6.
    Tan JS, Oh L, Louis DS. Variations of the flexor digitorum superficialis as determined by an expanded clinical examination. J Hand Surg. 2009;34A:900–6.CrossRefGoogle Scholar
  7. 7.
    Ranade AV, Rai R, Prabhu LV, et al. Incidence of extensor digitorum brevis manus muscle. Hand (NY). 2008;3:320–3.CrossRefGoogle Scholar
  8. 8.
    Littler JW. Hand, wrist, and forearm incisions. In: Littler JW, Cramer LM, Smith JW, editors. Symposium on reconstructive hand surgery. St. Louis: C.V. Mosby; 1974.Google Scholar
  9. 9.
    Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg. 1980;5:508.CrossRefGoogle Scholar
  10. 10.
    Eaton RG, Littler JW. A study of the basal joint of the thumb. J Bone Joint Surg. 1969;51A:661.CrossRefGoogle Scholar
  11. 11.
    Dahhan P, Fischer L, Alliey Y. The trapeziometacarpal articulation. Anat Clin. 1980;2:43.CrossRefGoogle Scholar
  12. 12.
    Cooney WP, An KN, Daube JR, et al. Electromyographic analysis of the thumb: a study of isometric forces in pinch and grasp. J Hand Surg. 1985;10A:202.CrossRefGoogle Scholar
  13. 13.
    Burke F, Flatt A. Clinodactyly. A review of a series of cases. Hand. 1979;11(3):269–80.CrossRefPubMedGoogle Scholar
  14. 14.
    Zaias N. Embryology of human nail. Arch Dermatol. 1963;87:77.CrossRefGoogle Scholar
  15. 15.
    Zook EG, Van Beek AL, Russell RC, et al. Anatomy and physiology of the perionychium: a review of the literature and anatomic study. J Hand Surg Am. 1980;5:528–36.Google Scholar
  16. 16.
    Baden HP. Regeneration of the nail. Arch Dermatol. 1965;91:619–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Jones FW. The principles of anatomy as seen in the hand. 2nd ed. London: Baillière, Tindall & Cox; 1941.Google Scholar
  18. 18.
    Fleckman P. Basic science of the nail unit. In: Scher RK, Daniel CR, editors. Nails: therapy, diagnosis, surgery. 2nd ed. Philadelphia: WB Saunders; 1997. p. 36–51.Google Scholar
  19. 19.
    McGrouther DA. The microanatomy of Dupuytren’s contracture. Hand. 1982;13:215–36.CrossRefGoogle Scholar
  20. 20.
    Tubiana R, Leclerq C, Hurst L, et al. Dupuytren’s disease. London: Martin Dunitz; 2000.Google Scholar
  21. 21.
    Belusa L, Buck-Gramko D, Partecke BD. Results of interphalangeal joint arthrolyis in patients with Dupuytren’s disease. Handchir Mikrochir Plast Chir. 1997;27:158–63.Google Scholar
  22. 22.
    Kloen P. New insights in the development of Dupuytren’s contracture: a review. Br J Plast Surg. 1999;52:629–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Hollister A, Giurintano DJ, Buford WL, et al. The axes of rotation of the thumb interphalangeal and metacarpophalangeal joints. Clin Orthop Relat Res. 1995;320:188–93.Google Scholar
  24. 24.
    Youm Y, McMurtry RY, Flatt AE, et al. Kinematics of the wrist—I. An experimental study of radial-ulnar deviation and flexion-extension. J Bone Joint Surg. 1978;A60:423–31.CrossRefGoogle Scholar
  25. 25.
    Garcia-Elias M, An KN, Berglund L, et al. Extensor mechanism of the fingers: I. A quantitative geometric study. J Hand Surg (Am). 1991;16:1130–40.CrossRefGoogle Scholar
  26. 26.
    Chase RA. Surgical anatomy of the hand. Surg Clin North Am. 1964;44:1349.CrossRefGoogle Scholar
  27. 27.
    Agee J, McCarroll HR, Hollister AM. The anatomy of the flexor digitorum superficialis relevant to tendon transfers. J Hand Surg (Br). 1991;16B:68–9.CrossRefGoogle Scholar
  28. 28.
    Tubiana R, editor. The hand. Philadelphia: Saunders; 1981.Google Scholar
  29. 29.
    McFadden JA, Gordon L. Arterial repair at the digital and palmar level. In: Blair WF, editor. Techniques in hand surgery. Baltimore: Williams and Wilkins; 1996. p. 398–406.Google Scholar
  30. 30.
    Earley MJ, Milner RH. Dorsal metacarpal flaps. Br J Plast Surg. 1987;40:333–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Small JO, Brennan MD. The first dorsal metacarpal artery neurovascular island flap. J Hand Surg. 1987;13B:136–45.Google Scholar
  32. 32.
    Sunderland S. Nerves and nerve injuries. 2nd ed. New York: Churchill Livingstone; 1978.Google Scholar
  33. 33.
    Seddon HJ. Peripheral nerve injuries. Medical Research Council Special Report Series, 282. London: HMSO; 1954.Google Scholar
  34. 34.
    Zook EG, Guy RJ, Russell RC. A study of nail bed injuries: causes, treatment and prognosis. J Hand Surg Am. 1984;9:247–52.Google Scholar
  35. 35.
    Zancolli EA. Intrinsic paralysis of the ulnar nerve–physiopathology of the claw hand. In: Structural and dynamic bases of hand surgery. 2nd ed. Philadelphia: JB Lippincott; 1979. p. 159–206.Google Scholar
  36. 36.
    Littler JW. The finger extensor mechanism. Surg Clin North Am. 1967;47:415–32. Little JW, Eaton RG. Redistribution of forces in correction of boutonniere deformity. J Bone Joint Surg. 1967;49A:1267–74.Google Scholar
  37. 37.
    Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55(8):1655–66.CrossRefPubMedGoogle Scholar
  38. 38.
    Eaton RG, Malerich MM. Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years’ experience. J Hand Surg Am. 1980;5(3):260–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Sofka CM, Pavlov H. The history of clinical musculoskeletal radiology. Radiol Clin North Am. 2009;47:349–56.CrossRefPubMedGoogle Scholar
  40. 40.
    Peh WC. Modern imaging of the musculoskeletal system: is there still a role for radiography? Singapore Med J. 2002;43:385–6.PubMedGoogle Scholar
  41. 41.
    Barrett JF, Keat N. Artifacts in CT: recognition and avoidance. Radiographics. 2004;24:1679–91.CrossRefPubMedGoogle Scholar
  42. 42.
    Pretorius ES, Fishman EK. Volume-rendered threedimensional spiral CT: musculoskeletal applications1. Radiographics. 1999;19:1143–60.CrossRefPubMedGoogle Scholar
  43. 43.
    Capelastegui A, Astigarraga E, Fernandez-Canton G, et al. Masses and pseudomasses of the hand and wrist: MR findings in 134 cases. Skeletal Radiol. 1999;28:498–507.CrossRefPubMedGoogle Scholar
  44. 44.
    Teh J, Whiteley G. MRI of soft tissue masses of the hand and wrist. Br J Radiol. 2007;80:47–63.CrossRefPubMedGoogle Scholar
  45. 45.
    Smith J, Finnoff JT. Diagnostic and interventional musculoskeletal ultrasound: part 1. Fundamentals. PM R. 2009;1:64–75.CrossRefPubMedGoogle Scholar
  46. 46.
    Wong DC, Wansaicheong GK, Tsou IY. Ultrasonography of the hand and wrist. Singapore Med J. 2009;50:219–25. Quiz 26.PubMedGoogle Scholar
  47. 47.
    Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Davis AM, Beaton DE, Hudak P, et al. Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure. J Hand Ther. 1999;12:269–74.CrossRefPubMedGoogle Scholar
  49. 49.
    McDowell I, Newell C. A guide to rating scales and questionnaires. Measuring health. 2nd ed. Oxford: Oxford University Press; 1996. p. 106–15.Google Scholar
  50. 50.
    Chinese (Simplified) translation courtesy of Dr. Le Qi, Hand Surgery, China-Japan Union Hospital of Jilin University, China.Google Scholar
  51. 51.
    Conolly WB, Perko M, Prosser R. Rehabilitation of the hand and upper limb. Oxford: Butterworth-Heinemann; 2003.Google Scholar
  52. 52.
    Swanson AB, Hagert CG, Swanson GD. Evaluation of impairment of hand function. J Hand Surg Am. 1983;5(Pt 2):709–22.CrossRefGoogle Scholar
  53. 53.
    Bell-Krotosoki J, Tomancik E. The repeatability of testing with Semmes-Weinstein monofilaments. J Hand Surg. 1987;12A:155–61.CrossRefGoogle Scholar
  54. 54.
    潘达德, 顾玉东, 侍德, 寿奎水. 中华医学会手外科学会上肢部分功能评定试用标准, 中华手外科杂志. 2000;3:130–5.Google Scholar
  55. 55.
    Matthew K. AMA guides to evaluation of permanent impairment. 6th ed. 2012.Google Scholar
  56. 56.
    Moberg E. Objective methods for determining the functional value of sensibility in the hand. J Bone Joint Surg Br. 1958;3:454–76.Google Scholar
  57. 57.
    Birch R, Bonney G, Wynn Parry CB. Results. In: Surgical disorders of the peripheral nerves. London: Churchill Livingstone; 1998.Google Scholar
  58. 58.
    Withrington RH, Wynn Parry CB. The management of painful peripheral nerve disorders. J Hand Surg Br. 1984;9:24–8.CrossRefPubMedGoogle Scholar
  59. 59.
    汤锦波,侍德. 手功能的评定标准. 中华外科杂志,1991;29:137–40.Google Scholar
  60. 60.
    王炜. 手部的功能测定及功能损害的评定. 中国修复重建外科杂志, 1989;3:134–8.Google Scholar
  61. 61.
    李贵存,赵林,侍德等. 手功能评定标准专题讨论会纪要. 中华外科杂志, 1990;28:476–9.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Zhejiang Science and Technology Publishing House 2017

Authors and Affiliations

  • Dong Han
    • 1
    Email author
  • Hong An
    • 2
  • Wei Wang
    • 3
  • Bo Chen
    • 4
  • Jianmin Yao
    • 5
  • Fengjing Zhao
    • 5
  • Bin Wang
    • 3
  • Feng Ni
    • 1
  • De Shi
    • 6
  1. 1.Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
  3. 3.Department of Plastic and Reconstructive SurgeryShanghai Ninth People Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
  4. 4.Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  5. 5.Hangzhou Plastic Surgery HospitalHangzhouChina
  6. 6.Affiliated Hospital of Nantong UniversityNantongChina

Personalised recommendations