The anatomy of the hand and upper extremity has been studied for centuries. A vast amount of human anatomical knowledge was added by the anatomist-surgeons in the 17th and 18th centuries. Masters of anatomy like Galen, Fabrica, Vesalius, Willis, Harvey, Hunter, Cline, Cooper, Dupuytren, Velpeau, LisFranc and Goyrand did thousands of human dissections. This work markedly extended the understanding of human anatomy. Modern anatomists like Stark, Cleland, Grayson, Gray, Netter and many others have since made significant additions to this initial anatomic data. This Hand Surgery Source diagnostic guide highlights the anatomy of the hand and upper extremity. The guide reviews the anatomy of the upper extremity with multiple system-based sections. The structure of normal skin is diagramed. Layers of the skin include the epidermis with 5 layers (stratum basale, stratum spinosum, stratum granulosum, stratum lucidum [not shown], & stratum corneum); Dermis with the papillary layer and the reticular layer; Hypodermis or subcutaneous fatty layer; and the Fascia. Epidermis has 5 layers. The deepest layer is the stratum basale which includes the dermal papilla and is separated from the dermis by the basement membrane. The next layer is the stratum spinosum which is also known as the prickle cell layer. Moving close to the surface the stratum granulosum layer is next followed by the stratum lucidum (not shown in drawing) which is a thin clear layer seen in the palm of the hand and sole of the foot. The layer on the surface is the stratum corneum which contains dead keratinocytes (anucleate squamous cells). The cell of the epidermis includes keratinocytes (the most common skin cell type) which produces keratin; the melanocytes which are in the stratum basale and produce melanin and, therefore, provide the pigment of the skin; the Langerhans’ cells are in the stratum spinosum and take up antigens in the skin and the Merkel’s cells are in the stratum basale and function as mechanoreceptors. Dermis is deep to the epidermis and contains two parts; the papillary layer and the reticular layer. The dermis attaches to the epidermis by a basement membrane. The dermis contains hair follicles; arrector pili muscle; sensory nerve endings and blood vessels. Beneath the dermis is the hypodermis or subcutaneous fatty layer. This layer contains adipose tissue, follicles, neurons, and blood vessels. The three layers of the skin rest on the fascia which separates the skin and the muscle.
The major nerves, the brachial plexus, and the cervical roots are illustrated in detail. The muscle section has images and content describing the muscles of the hand and forearm. The vascular section describes the major arteries and veins in the upper extremity. The finger section provides detailed descriptions of the extrinsic and intrinsic tendons of the finger along with a diagram of the flexor pulley system. In addition, hand sections with information on the fascial structures (retention ligaments), the wrist, joint cartilage, potential spaces of the hand and osteology are included. Finally, there is a video dissection library with eight new videos. These videos highlight the important anatomical structures of the hand, wrist, and forearm. There are two new volar forearm dissections videos, three palm dissections videos, two finger dissections videos and one video highlighting the thenar and hypothenar compartments of the hand.
