Chapter 7

Although the shoulder, elbow, and wrist serve to position the hand, it is only the hand that is capable of producing a remarkable level of dexterity and precision.

Clinical
Pearl

The hand accounts for about 90% of upper limb function.1

The thumb, which is involved in 40% to 50% of hand function, is the most functionally important of the digits.1

The index finger, involved in about 20% of hand function, is the second most important, and the ring finger the least important.

The middle finger, which accounts for about 20% of all hand function, is the strongest finger, and is important for both precision and power functions.1

An understanding of the forearm, wrist, and hand requires an intimate knowledge of the respective bones, joints, soft tissues, and nerves of the hand and wrist, detailing both their individual and collective functions.

The open-packed, close-packed, and capsular patterns of the wrist and hand are outlined in Table 7-1.

Table 7-1 The Open-pack and Close-pack Positions, and Capsular Patterns for the Articulations of the Wrist and Hand
Clinical
Pearl

Proper diagnosis and management of wrist and hand injuries are vital to maintaining proper function of the hand and preventing permanent disability.

The examination of the wrist and hand requires a sound knowledge of surface anatomy and differential diagnosis, and must include an examination of the entire upper kinetic chain, and the cervical and thoracic spine.

Clinical
Pearl

Most hand and wrist problems can be diagnosed by carefully considering three factors: anatomy, mechanism of injury, and epidemiology.

### History

All relevant information must be gathered about the site, nature, behavior, and onset of the current symptoms. This should include information about the patient's age, hand dominance, avocational activities, and occupation.

Clinical
Pearl

Activities or occupations that ...

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