The Intrinsic Muscles of the Hand

Abstract

This article reviews the functional anatomy of the intrinsic muscles of the fingers (palmar interossei, dorsal interossei, hypothenar and lumbrical muscles) and discusses the pathokinesiology of the hand with intrinsic muscle paralysis and its consequences for Activities for Daily Living. The assessment of muscle strength: manual and instrumental and principles for therapeutic intervention are also discussed.

Zusammenfassung

Die Arbeit bietet einen Überblick über die Anatomie der tiefen Handmuskel (Mm. interossei palmares et dorsales, Hypothenar- und Lumbrikalmuskel) und diskutiert die pathologische Kinesiologie der Hand mit Parese der tiefen Muskulatur und die Konsequenzen für die Aktivitäten des täglichen Lebens. Darüber hinaus werden manuelle und apparative Methoden der Handkraftmessung diskutiert sowie therapeutische Prinzipien bei Verletzungen der tiefen Handmuskulatur erörtert.

Key words

hand muscles - muscular function - assessment - anatomy - rehabilitation

Schlüsselwörter

Handmuskel - Muskelfunktion - Assessment - Anatomie - Rehabilitation

References

• 1 Eyler DL, Markee JE. The anatomy and function of the intrinsic musculature of the fingers.  J Bone Joint Surg. 1954;  36-A 1-10
• 2 Eladoumikdachi F, Valkov PL, Thomas J, Netscher DT. Anatomy of the intrinsic hand muscles revisited: part II. Lumbricals.  Plast Reconstr Surg. 2002;  110 ((5)) 1225-1231
• 3 Eladoumikdachi F, Valkov PL, Thomas J, Netscher DT. Anatomy of the intrinsic hand muscles revisited: part I. Interossei.  Plast Reconstr Surg. 2002;  110 ((5)) 1211-1224
• 4 Schroeder HP, von Botte MJ. The dorsal aponeurosis, intrinsic, hypothenar, and thenar musculature of the hand.  Clin Orthop Relat Res. 2001;  ((383)) 97-107
• 5 Dell PC, Sforzo CR. Ulnar intrinsic anatomy and dysfunction.  J Hand Ther. 2005;  18 ((2)) 198-207
• 6 Landsmeer JM, Long C. The mechanism of finger control, based on electromyograms and location analysis.  Acta Anat. 1965;  60 ((3)) 330-347
• 7 Srinivasan H. Patterns of movement of totally intrinsic-minus fingers based on a study of one hundred and forty-one fingers.  J Bone Joint Surg Am. 1976;  58 ((6)) 777-785
• 8 Linscheid RL. Historical perspective of finger joint motion: the hand- me-downs of our predecessors. The Richard J. Smith Memorial Lecture.  J Hand Surg [Am]. 2002;  27 ((1)) 1-25
• 9 Lauer RT, Kilgore KL, Peckham PH, Bhadra N, Keith MW. The function of the finger intrinsic muscles in response to electrical stimulation.  IEEE Trans Rehabil Eng. 1999;  7 ((1)) 19-26
• 10 Li ZM, Zatsiorsky VM, Latash ML. Contribution of the extrinsic and intrinsic hand muscles to the moments in finger joints.  Clin Biomech (Bristol, Avon). 2000;  15 ((3)) 203-211
• 11 Jacobson MD, Raab R, Fazeli BM, Abrams RA, Botte MJ, Lieber RL. Architectural design of the human intrinsic hand muscles.  J Hand Surg [Am]. 1992;  17 ((5)) 804-809
• 12 Ketchum LD, Thompson D, Pocock G, Wallingford D. A clinical study of forces generated by the intrinsic muscles of the index finger and the extrinsic flexor and extensor muscles of the hand.  J Hand Surg [Am]. 1978;  3 ((6)) 571-578
• 13 Brandsma JW. Intrinsic minus hand: (patho) kinesiology, rehabilita tion and reconstruction. [Thesis] Utrecht: University of Utrecht 1993
• 14 Kozin SH, Porter S, Clark P, Thoder JJ. The contribution of the intrinsic muscles to grip and pinch strength.  J Hand Surg [Am]. 1999;  24 ((1)) 64-72
• 15 ASHT, editor .Clinical Assessment Recommendations. 2^nd ed. Garner, NC: American Society of Hand Therapists 1992
• 16 Bendz P. Systematization of the grip of the hand in relation to finger motor systems. A kinesiologic study using a new method for recording finger joint motions.  Scand J Rehabil Med. 1974;  6 ((4)) 158-165
• 17 Sollerman C, Ejeskar A. Sollerman hand function test. A standardized method and its use in tetraplegic patients.  Scand J Plast Reconstr Surg Hand Surg. 1995;  29 ((2)) 167-176
• 18 Light CM, Chappell PH, Kyberd PJ. Establishing a standardized clinical assessment tool of pathologic and prosthetic hand function: normative data, reliability, and validity.  Arch Phys Med Rehabil. 2002;  83 ((6)) 776-783
• 19 Landsmeer JMF. Anatomical and functional investigation on the articulation of the human finger.  Acta Anat. 1955;  60 330-347
• 20 Stack HG. Muscle function in the fingers.  J Bone and J Surg. 1962;  44B 899-909
• 21 Zancolli EA. Structural and Dynamic Bases of Hand Surgery. 2^nd ed. Philadelphia: Lippincott 1979
• 22 Sollerman C, Sperling L. Evaluation of ADL-function - especially hand function.  Scand J Rehabil Med Suppl. 1978;  6 139-143
• 23 Mannerfelt L. Studies on the hand in ulnar nerve paralysis. A clinical-experimental investigation in normal and anomalous innervation.  Acta Orthop Scand. 1966;  ((87)) 61-86
• 24 Neu BR, Murray JF, MacKenzie JK. Profundus tendon blockage: quadri ga in finger amputations.  J Hand Surg [Am]. 1985;  10 878-883
• 25 Leijnse JN, Kalker JJ. A two-dimensional kinematic model of the lum brical in the human finger.  J Biomech. 1995;  28 ((3)) 237-249
• 26 Bourrel P. The metacarpophalangeal stabilization test beevor or bouvier?.  Ann Chir Main. 1985;  4 ((1)) 31-35
• 27 Tubiana R. The Hand Vol II. In Philadelphia: WB Saunders 1985: 518
• 28 Brand PW. Clinical Mechanics of the Hand. St. Louis: CV Mosby 1999
• 29 Pinal F Del, Herrero F, Jado E, Garcia-Bernal FJ, Cerezal L. Acute hand compartment syndromes after closed crush: a reappraisal.  Plast Re constr Surg. 2002;  110 ((5)) 1232-1239
• 30 Bunnell S. Surgery of the Hand. 2^nd ed. Philadelphia: J. B. Lippincott Company 1948
• 31 Hueston JT, Wilson WF. The role of the intrinsic muscles in the produc tion of metacarpophalangeal subluxation in the rheumatoid hand.  Plast Reconstr Surg. 1973;  52 ((4)) 342-345
• 32 Smith PJ, Ross DA. The central slip tenodesis test for early diagnosis of potential boutonniere deformities.  J Hand Surg [Br]. 1994;  19 ((1)) 88-90
• 33 Daniels C, Worhtingham L. Muscle Testing: Techniques of Manual Ex amination. 4^th ed. Philadelphia: WB Saunders 1980
• 34 Kendall FP, McCreary EK. Muscles: Testing and Function. 3^rd edition ed. Baltimore: Williams & Wilkins 1983
• 35 Brandsma JW, Schreuders TAR, Birke JA, Piefer A, Oostendorp R. Manual muscle strength testing: intraobserver and interobserver reliabilities for the intrinsic muscles of the hand.  J Hand Ther. 1995;  8 ((3)) 185-190
• 36 Brandsma JW, Schreuders TAR. Sensible manual muscle strength testing to evaluate and monitor strength of the intrinsic muscles of the hand: a commentary.  J Hand Ther. 2001;  14 ((4)) 273-278
• 37 Janda DH, Geiringer SR, Hankin FM, Barry DT. Objective evaluation of grip strength.  J Occup Med. 1987;  29 ((7)) 569-571
• 38 Schreuders TAR, Roebroeck M, Kar TJ van der, Soeters JN, Hovius SE, Stam HJ. Strength of the intrinsic muscles of the hand measured with a hand-held dynamometer: reliability in patients with ulnar and median nerve paralysis.  J Hand Surg [Br]. 2000;  25 ((6)) 560-565
• 39 Schreuders TAR, Roebroeck ME, Jaquet JB, Hovius SE, Stam HJ. Measuring the strength of the intrinsic muscles of the hand in patients with ulnar and median nerve injuries: reliability of the Rotterdam Intrinsic Hand Myometer(RIHM).  J Hand Surg [Am]. 2004;  29 ((2)) 318-324
• 40 Mannerfelt LG. Studies on ulnar nerve compression neuropathies with a new computerised instrument - the intrins-o-meter.  Scand J Plast Reconstr Surg Hand Surg. 1997;  31 ((3)) 251-260
• 41 Fischer T, Nagy L, Buechler U. Restoration of pinch grip in ulnar nerve paralysis; extensor carpi radialis longus to adductor pollicis and abductor polhcis longus to first dorsal interosseus tendon transfers.  J Hand Surg [Br]. 2003;  28 ((1)) 28-32
• 42 Ranney D, Wells R. Lumbrical muscle function as revealed by a new and physiological approach.  Anat Rec. 1988;  222 ((1)) 110-114
• 43 Ranney DA, Wells RP, Dowling J. Lumbrical function; interaction of lumbrical contraction with the elasticity of the extrinsic finger muscles and its effect on metacarpophalangeal equilibrium.  J Hand Surg (Am). 1987;  12 ((4)) 110-114
• 44 Backhouse KM, Catton WT. An experimental study of the function of the lumbrical muscles in the human hand.  J Anat. 1954;  88 ((5)) 133-141
• 45 Devanandan MS, Ghosh S, John KLT. A quantitative study of the muscle spindles and tendon organs in some intrinsic muscles of the hand.  Anat Rec. 1983;  207 263-266
• 46 Rabischong P. Basic problems in the restoration of prehension.  Ann Chir. 1971;  25 ((19)) 927-933
• 47 Leijnse JN. Why the lumbrical muscle should not be bigger - a force model of the lumbrical in the unloaded human finger.  J Biomech. 1997;  30 1107-1114
• 48 Schreuders TAR, Stam HJ. Strength measurements of the lumbrical muscles.  J Hand Ther. 1996;  9 ((4)) 303-305
• 49 Parkes A. The ‘lumbrical plus’ finger.  J Bone Joint Surg Br. 1971;  53 ((2)) 236-239
• 50 Colditz JC. Lumbrical tightness: testing and stretching. In: FESSH 8th & EFSHT 7th congress; 2002. Amsterdam: Churchill Livingstone 2002: 64
• 51 Schreuders TAR, Stam HJ. Strength measurements of the lumbrical muscles.  J Hand Ther. 1996;  9 ((4)) 303-305
• 52 Brandsma JW. Manual muscle strength testing and dynamometry for bilateral ulnar neuropraxia in a surgeon.  J Hand Ther. 1995;  8 ((3)) 191-194
• 53 Akuthota V, Plastaras C, Lindberg K, Tobey J, Press J, Garvan C. The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy.  Am J Sports Med. 2005;  33 ((8)) 1224-1230
• 54 Blacker GJ, Lister GD, Kleinert MD. The abducted little finger in low ulnar nerve palsy.  J Hand Surg [Am]. 1976;  1 ((3)) 190-196
• 55 Videler AJ, Beelen A, Aufdemkampe G, Groot IJ de, Leemputte M Van. Hand strength and fatigue in patients with hereditary motor and sensory neuropathy (types I and II).  Arch Phys Med Rehabil. 2002;  83 ((9)) 1274-1278
• 56 Brooke MH, Miller R. Fatigue testing.  Muscle Nerve. 1990;  13 35-37
• 57 Lindeman E, Leffers P, Reulenj, Spaans F, Drukker J. Reduction of kneetorques and leg-related functional abilities in hereditary motor and sensory neuropathy.  Arch Phys Med Rehabil. 1994;  75 ((11)) 1201-1205
• 58 Bruyns CN, Jaquet JB, Schreuders TAR, Kalmijn S, Kuypers PD, Hovius SE. Predictors for return to work in patients with median and ulnar nerve injuries.  J Hand Surg [Am]. 2003;  28 ((1)) 28-34
• 59 Rosen B. Recovery of sensory and motor function after nerve repair. A rationale for evaluation.  J Hand Ther. 1996;  9 ((4)) 315-327
• 60 Rosen B. The sensational hand. Clinical assessment after nerve repair. (Thesis) Malmo: Lund University 2000
• 61 Rajkumar P, Premkumar R, Richard J. Grip and pinch strength in relation to function in denervated hands.  Indian J Lepr. 2002;  74 ((4)) 319-328
• 62 Jaquet JB, Luijsterburg AJ, Kalmijn S, Kuypers PD, Hofman A, Hovius SE. Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity.  J Trauma. 2001;  51 ((4)) 687-692
• 63 Jaquet JB, Schreuders TAR, Stam HJ, Hovius SER. , Relationship between DASH and functional recovery after nerve injury, to be submitted
• 64 Solway S, Beaton DE, McConnell S, Bombardier C. The DASH Outcome Measure User's Manual. Second Edition, ed. Toronto 2002
• 65 Selles RW, Ginneken B van, Schreuders TAR, Janssen WGM, Stam HJ. , Comparing strength measurements of the arm and hand muscles in Hereditary Motor and Sensory Neuropath: the usefulness of dyna mometer measurement of the intrinsic hand muscles, submitted
• 66 WHO .International classification of functioning, disability, and health (ICF). Geneva: World Health Organization 2001

Korrespondenzadresse