Motor

The radial nerve supplies the finger extensors and the thumb abductor, thus the muscles that extends
at the wrist and metacarpophalangeal joints (knuckles); and that abducts and extends the thumb. The
median nerve supplies the flexors of the wrist and digits, the abductors and opponens of the thumb,
the first and second lumbrical. The ulnar nerve supplies the remaining intrinsic muscles of the
hand.[15]
All muscles of the hand are innervated by the brachial plexus (C5–T1) and can be classified by
innervation:[16]

Ner
Muscles
ve

Extensors: carpi radialis longus and brevis, digitorum, digiti minimi, carpi ulnaris, pollicis
radi
longus and brevis, and indicis.
al
Other: abductor pollicis longus.

Flexors: carpi radialis, pollicis longus, digitorum profundus (half), superficialis, and pollicis
med brevis (superficial head).
ian Other: palmaris longus. abductor pollicis brevis, opponens pollicis, and first and
second lumbricals.

Flexor carpi ulnaris, flexor digitorum profundus (half), palmaris brevis, flexor digiti
ulna
minimi, abductor digiti minimi, opponens digiti minimi, adductor pollicis, flexor pollicis
r
brevis (deep head), palmar and dorsal interossei, and third and fourth lumbricals.

Sensory
The radial nerve supplies the skin on the back of the hand from the thumb to the ring finger and the
dorsal aspects of the index, middle, and half ring fingers as far as the proximal interphalangeal joints.
The median nerve supplies the palmar side of the thumb, index, middle, and half ring fingers. Dorsal
branches innervates the distal phalanges of the index, middle, and half ring fingers. The ulnar nerve
supplies the ulnar third of the hand, both at the palm and the back of the hand, and the little and half
ring fingers.[15]
There is a considerable variation to this general pattern, except for the little finger and volar surface
of the index finger. For example, in some individuals, the ulnar nerve supplies the entire ring finger
and the ulnar side of the middle finger, whilst, in others, the median nerve supplies the entire ring
finger.[15]
Skin[edit]
 Left: papillary ridges of palm
Right: sexual dimorphism

The glabrous (hairless) skin on the front of the hand, the palm, is relatively thick and can be bent
along the hand's flexure lines where the skin is tightly bound to the underlying tissue and bones.
Compared to the rest of the body's skin, the hands' palms (as well as the soles of the feet) are usually
lighter — and even much lighter in dark-skinned individuals, compared to the other side of the hand.
Indeed, genes specifically expressed in the dermis of palmoplantar skin inhibit melanin production
and thus the ability to tan, and promote the thickening of the stratum lucidum and stratum
corneum layers of the epidermis. All parts of the skin involved in grasping are covered by papillary
ridges (fingerprints) acting as friction pads. In contrast, the hairy skin on the dorsal side is thin, soft,
and pliable, so that the skin can recoil when the fingers are stretched. On the dorsal side, the skin can
be moved across the hand up to 3 cm (1.2 in); an important input the
cutaneous mechanoreceptors.[17]
The web of the hand is a "fold of skin which connects the digits"[18]. These webs, located between
each set of digits, are known as skin folds (interdigital folds or plica interdigitalis). They are defined
as "one of the folds of skin, or rudimentary web, between the fingers and toes".[19]
Variation[edit]
Further information: Digit ratio
The ratio of the length of the index finger to the length of the ring finger in adults is affected by the
level of exposure to male sex hormones of the embryo in utero. This digit ratio is below 1 for both
sexes but it is lower in males than in females on average.

Clinical significance[edit]

X-ray of the left hand of a ten-year-old boy with polydactyly.

A number of genetic disorders affect the hand. Polydactyly is the presence of more than the usual
number of fingers. One of the disorders that can cause this is Catel-Manzke syndrome. The fingers
may be fused in a disorder known as syndactyly. Or there may be an absence of one or more central
fingers—a condition known as ectrodactyly. Additionally, some people are born without one or
both hands (amelia).
There are several cutaneous conditions that can affect the hand including the nails.
The autoimmune disease rheumatoid arthritis can affect the hand, particularly the joints of the
fingers.
Some conditions can be treated by hand surgery. These include carpal tunnel syndrome, a painful
condition of the hand and fingers caused by compression of the median nerve, and Dupuytren's
contracture, a condition in which fingers bend towards the palm and cannot be straightened. A
similar condition[clarification needed] to this is where some of the fingers cannot be flexed due to injury
to the ulnar nerve.
A common fracture of the hand is a scaphoid fracture—a fracture of the scaphoid bone, one of the
carpal bones. This is the commonest carpal bonefracture and can be slow to heal due to a limited
blood flow to the bone. There are various types of fracture to the base of the thumb; these are known
as Rolando fractures, Bennet's fracture, and Gamekeeper's thumb. Another common fracture,
known as Boxer's fracture, is to the neck of a metacarpal.

Evolution[edit]

"Hands" of a Javanese tree shrewand a human

The prehensile hands and feet of primates evolved from the mobile hands of semi-arboreal tree
shrews that lived about 60 million years ago. This development has been accompanied by important
changes in the brain and the relocation of the eyes to the front of the face, together allowing the
muscle control and stereoscopic vision necessary for controlled grasping. This grasping, also
known as power grip, is supplemented by the precision grip between the thumb and the distal finger
pads made possible by the opposable thumbs. Hominidae (great apes including humans) acquired
an erect bipedal posture about 3.6 million years ago, which freed the hands from the task of
locomotion and paved the way for the precision and range of motion in human hands.[20] Functional
analyses of the features unique to the hand of modern humans have shown that they are consistent
with the stresses and requirements associated with the effective use of paleolithicstone
tools.[21][22] It is possible that the refinement of the bipedal posture in the earliest hominids evolved
to facilitate the use of the trunk as leverage in accelerating the hand.[23]
While the human hand has unique anatomical features, including a longer thumb and fingers that
can be controlled individually to a higher degree, the hands of other primates are anatomically
similar and the dexterity of the human hand can not be explained solely on anatomical factors. The
neural machinery underlying hand movements is a major contributing factor; primates have evolved
direct connections between neurons in cortical motor areas and spinal motoneurons, giving the
cerebral cortex monosynaptic control over the motoneurons of the hand muscles; placing the hands
"closer" to the brain.[24] The recent evolution of the human hand is thus a direct result of the
development of the central nervous system, and the hand, therefore, is a direct tool of our
consciousness — the main source of differentiated tactile sensations — and a precise working organ
enabling g