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Hand
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"Hands" redirects here. For other uses, see Hand (disambiguation) and Hands (disambiguation).
Hand
Human left hand
X-ray of human hand
Details
Vein
dorsal venous network of hand
Nerve
Ulnar, median, radial nerves
Identifiers
Latin
Manus
MeSH
D006225
TA
A01.1.00.025
FMA
9712
Anatomical terminology
[edit on Wikidata]
A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each "hand" and fingerprints extremely similar to human fingerprints) are often described as having "hands" instead of paws on their front limbs. The raccoon is usually described as having "hands" though opposable thumbs are lacking.[1]
Some evolutionary anatomists use the term hand to refer to the appendage of digits on the forelimb more generally — for example, in the context of whether the three digits of the bird hand involved the same homologous loss of two digits as in the dinosaur hand.[2]
The human hand normally has five digits: four fingers plus one thumb;[3][4] these are often referred to collectively as five fingers, however, whereby the thumb is included as one of the fingers.[3][5][6] It has 27 bones, not including the sesamoid bone, the number of which varies between people,[7] 14 of which are the phalanges (proximal, intermediate and distal) of the fingers and thumb. The metacarpal bones connect the fingers and the carpal bones of the wrist. Each human hand has five metacarpals[8] and eight carpal bones.
Fingers contain some of the densest areas of nerve endings in the body, and are the richest source of tactile feedback. They also have the greatest positioning capability of the body; thus, the sense of touch is intimately associated with hands. Like other paired organs (eyes, feet, legs) each hand is dominantly controlled by the opposing brain hemisphere, so that handedness—the preferred hand choice for single-handed activities such as writing with a pencil, reflects individual brain functioning.
Among humans, the hands play an important function in body language and sign language. Likewise the ten digits of two hands, and the twelve phalanges of four fingers (touchable by the thumb) have given rise to number systems and calculation techniques.
Contents
1 Structure
1.1 Areas
1.2 Bones
1.2.1 Arches
1.3 Muscles
1.3.1 Intrinsic
1.3.2 Extrinsic
1.4 Nerve supply
1.5 Skin
1.6 Variation
2 Clinical significance
3 Evolution
4 Additional images
5 See also
6 Notes
7 References
8 External links
Structure[edit]
Many mammals and other animals have grasping appendages similar in form to a hand such as paws, claws, and talons, but these are not scientifically considered to be grasping hands. The scientific use of the term hand in this sense to distinguish the terminations of the front paws from the hind ones is an example of anthropomorphism. The only true grasping hands appear in the mammalian order of primates. Hands must also have opposable thumbs, as described later in the text.
The hand is located at the distal end of each arm. Apes and monkeys are sometimes described as having four hands, because the toes are long and the hallux is opposable and looks more like a thumb, thus enabling the feet to be used as hands.
The word "hand" is sometimes used by evolutionary anatomists to refer to the appendage of digits on the forelimb such as when researching the homology between the three digits of the bird hand and the dinosaur hand.[2]
An adult male's hand weighs about a pound.[9]
Areas[edit]
Human hand parts
Areas of the human hand include:
The palm (Volar), which is the central region of the anterior part of the hand, located superficially to the metacarpus. The skin in this area contains dermal papillae to increase friction, such as are also present on the fingers and used for fingerprints.
The opisthenar area (dorsal) is the corresponding area on the posterior part of the hand.
The heel of the hand is the area anteriorly to the bases of the metacarpal bones, located in the proximal part of the palm. It is the area that sustains most pressure when using the palm of the hand for support, such as in handstand.
There are five digits attached to the hand, notably with a nail fixed to the end in place of the normal claw. The four fingers can be folded over the palm which allows the grasping of objects. Each finger, starting with the one closest to the thumb, has a colloquial name to distinguish it from the others:
index finger, pointer finger, forefinger, or 2nd digit
middle finger or long finger or 3rd digit
ring finger or 4th digit
little finger, pinky finger, small finger, baby finger, or 5th digit
The thumb (connected to the first metacarpal bone and trapezium) is located on one of the sides, parallel to the arm. A reliable way of identifying human hands is from the presence of opposable thumbs. Opposable thumbs are identified by the ability to be brought opposite to the fingers, a muscle action known as opposition.
Bones[edit]
Bones of the human hand
Hand-bone animation
The skeleton of the human hand consists of 27 bones:[10] the eight short carpal bones of the wrist are organized into a proximal row (scaphoid, lunate, triquetral and pisiform) which articulates with the bones of the forearm, and a distal row (trapezium, trapezoid, capitate and hamate), which articulates with the bases of the five metacarpal bones of the hand. The heads of the metacarpals will each in turn articulate with the bases of the proximal phalanx of the fingers and thumb. These articulations with the fingers are the metacarpophalangeal joints known as the knuckles. The fourteen phalanges make up the fingers and thumb, and are numbered I-V (thumb to little finger) when the hand is viewed from an anatomical position (palm up). The four fingers each consist of three phalanx bones: proximal, middle, and distal. The thumb only consists of a proximal and distal phalanx.[11] Together with the phalanges of the fingers and thumb these metacarpal bones form five rays or poly-articulated chains.
Because supination and pronation (rotation about the axis of the forearm) are added to the two axes of movements of the wrist, the ulna and radius are sometimes considered part of the skeleton of the hand.
There are numerous sesamoid bones in the hand, small ossified nodes embedded in tendons; the exact number varies between people:[7] whereas a pair of sesamoid bones are found at virtually all thumb metacarpophalangeal joints, sesamoid bones are also common at the interphalangeal joint of the thumb (72.9%) and at the metacarpophalangeal joints of the little finger (82.5%) and the index finger (48%). In rare cases, sesamoid bones have been found in all the metacarpophalangeal joints and all distal interphalangeal joints except that of the long finger.
The articulations are:
interphalangeal articulations of hand (the hinge joints between the bones of the digits)
metacarpophalangeal joints (where the digits meet the palm)
intercarpal articulations (where the palm meets the wrist)
wrist (may also be viewed as belonging to the forearm).
Arches[edit]
Arches of the hand
Red: one of the oblique arches
Brown: one of the longitudinal arches of the digits
Dark green: transverse carpal arch
Light green: transverse metacarpal arch
The fixed and mobile parts of the hand adapt to various everyday tasks by forming bony arches: longitudinal arches (the rays formed by the finger bones and their associated metacarpal bones), transverse arches (formed by the carpal bones and distal ends of the metacarpal bones), and oblique arches (between the thumb and four fingers):
Of the longitudinal arches or rays of the hand, that of the thumb is the most mobile (and the least longitudinal). While the ray formed by the little finger and its associated metacarpal bone still offers some mobility, the remaining rays are firmly rigid. The phalangeal joints of the index finger, however, offer some independence to its finger, due to the arrangement of its flexor and extension tendons.[12]
The carpal bones form two transversal rows, each forming an arch concave on the palmar side. Because the proximal arch simultaneously has to adapt to the articular surface of the radius and to the distal carpal row, it is by necessity flexible. In contrast, the capitate, the "keystone" of the distal arch, moves together with the metacarpal bones and the distal arch is therefore rigid. The stability of these arches is more dependent of the ligaments and capsules of the wrist than of the interlocking shapes of the carpal bones, and the wrist is therefore more stable in flexion than in extension.[12] The distal carpal arch affects the function of the CMC joints and the hands, but not the function of the wrist or the proximal carpal arch. The ligaments that maintain the distal carpal arches are the transverse carpal ligament and the intercarpal ligaments (also oriented transversally). These ligaments also form the carpal tunnel and contribute to the deep and superficial palmar arches. Several muscle tendons attaching to the TCL and the distal carpals also contribute to maintaining the carpal arch.[13]
Compared to the carpal arches, the arch formed by the distal ends of the metacarpal bones is flexible due to the mobility of the peripheral metacarpals (thumb and little finger). As these two metacarpals approach each other, the palmar gutter deepens. The central-most metacarpal (middle finger) is the most rigid. It and its two neighbors are tied to the carpus by the interlocking shapes of the metacarpal bones. The thumb metacarpal only articulates with the trapezium and is therefore completely independent, while the fifth metacarpal (little finger) is semi-independent with the fourth metacarpal (ring finger) which forms a transitional element to the fifth metacarpal.[12]
Together with the thumb, the four fingers form four oblique arches, of which the arch of the index finger functionally is the most important, especially for precision grip, while the arch of the little finger contribute an important locking mechanism for power grip. The thumb is undoubtedly the "master digit" of the hand, giving value to all the other fingers. Together with the index and middle finger, it forms the dynamic tridactyl configuration responsible for most grips not requiring force. The ring and little fingers are more static, a reserve ready to interact with the palm when great force is needed.[12]
See also: arches of the foot
Muscles[edit]
Main article: Muscles of the hand
Muscles and other structures of wrist and palm
The muscles acting on the hand can be subdivided into two groups: the extrinsic and intrinsic muscle groups. The extrinsic muscle groups are the long flexors and extensors. They are called extrinsic because the muscle belly is located on the forearm.
Intrinsic[edit]
The intrinsic muscle groups are the thenar (thumb) and hypothenar (little finger) muscles; the interosseous muscles (four dorsally and three volarly) originating between the metacarpal bones; and the lumbrical muscles arising from the deep flexor (and are special because they have no bony origin) to insert on the dorsal extensor hood mechanism.[14]
Extrinsic[edit]
Extensor compartments of wrist (back of hand)
The fingers have two long flexors, located on the underside of the forearm. They insert by tendons to the phalanges of the fingers. The deep flexor attaches to the distal phalanx, and the superficial flexor attaches to the middle phalanx. The flexors allow for the actual bending of the fingers. The thumb has one long flexor and a short flexor in the thenar muscle group. The human thumb also has other muscles in the thenar group (opponens and abductor brevis muscle), moving the thumb in opposition, making grasping possible.
The extensors are located on the back of the forearm and are connected in a more complex way than the flexors to the dorsum of the fingers. The tendons unite with the interosseous and lumbrical muscles to form the extensorhood mechanism. The primary function of the extensors is to straighten out the digits. The thumb has two extensors in the forearm; the tendons of these form the anatomical snuff box. Also, the index finger and the little finger have an extra extensor, used, for instance, pointing. The extensors are situated within 6 separate compartments.
Compartment 1 (Most radial)
Compartment 2
Compartment 3
Compartment 4
Compartment 5
Compartment 6 (Most ulnar)
Abductor pollicis longus Extensor carpi radialis longus Extensor pollicis longus Extensor indicis Extensor digiti minimi Extensor carpi ulnaris
Extensor pollicis brevis Extensor carpi radialis brevis Extensor digitorum communis
The first four compartments are located in the grooves present on the dorsum of inferior side of radius while the 5th compartment is in between radius and ulna. The 6th compartment is in the groove on the dorsum of inferior side of ulna.
Nerve supply[edit]
Cutaneous innervation of the upper limb
The hand is innervated by the radial, median, and ulnar nerves.
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]
Nerve
Muscles
radial Extensors: carpi radialis longus and brevis, digitorum, digiti minimi, carpi ulnaris, pollicis longus and brevis, and indicis.
Other: abductor pollicis longus.
median Flexors: carpi radialis, pollicis longus, digitorum profundus (half), superficialis, and pollicis brevis (superficial head).
Other: palmaris longus. abductor pollicis brevis, opponens pollicis, and first and second lumbricals.
ulnar Flexor carpi ulnaris, flexor digitorum profundus (half), palmaris brevis, flexor digiti minimi, abductor digiti minimi, opponens digiti minimi, adductor pollicis, flexor pollicis 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 bone fracture 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 shrew and 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 paleolithic stone 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 gestures — the expressions of our personalities.[25]
A gorilla, a large extant primate with small thumbs, and the hand skeleton of Ardipithecus ramidus, a large Pliocene primate with relatively human-like thumbs
There are nevertheless several primitive features left in the human hand, including pentadactyly (having five fingers), the hairless skin of the palm and fingers, and the os centrale found in human embryos, prosimians, and apes. Furthermore, the precursors of the intrinsic muscles of the hand are present in the earliest fishes, reflecting that the hand evolved from the pectoral fin and thus is much older than the arm in evolutionary terms.[20]
The proportions of the human hand are plesiomorphic (shared by both ancestors and extant primate species); the elongated thumbs and short hands more closely resemble the hand proportions of Miocene apes than those of extant primates.[26] Humans did not evolve from knuckle-walking apes,[27] and chimpanzees and gorillas independently acquired elongated metacarpals as part of their adaptation to their modes of locomotion.[28] Several of primitive hand features most likely present in the chimpanzee-human last common ancestor (CHLCA) and absent in modern humans are still present in the hands of Australopithecus, Paranthropus, and Homo floresiensis. This suggests that the derived changes in modern humans and Neanderthals did not evolve until 2.5 to 1.5 million years ago or after the appearance of the earliest Acheulian stone tools, and that these changes are associated with tool-related tasks beyond those observed in other hominins.[29] The thumbs of Ardipithecus ramidus, an early hominin, are almost as robust as in humans, so this may be a primitive trait, while the palms of other extant higher primates are elongated to the extent that some of the thumb's original function has been lost (most notably in highly arboreal primates such as the spider monkey). In humans, the big toe is thus more derived than the thumb.[28]
There is a hypothesis suggesting the form of the modern human hand is especially conducive to the formation of a compact fist, presumably for fighting purposes. The fist is compact and thus effective as a weapon. It also provides protection for the fingers.[30] However, this is not widely accepted to be one of the primary selective pressures acting on hand morphology throughout human evolution, with tool use and production being thought to be far more influential.[22][31][32][33]
Additional images[edit]
Illustration of Hand and Wrist Bones.
Bones of the left hand. Volar surface.
Bones of the left hand. Dorsal surface.
Static adult human physical characteristics of the hand.
Cuban doctor checks the hand of a patient. Sara, Guinea-Bissau, liberated zones, 1974
Hard hands of a young girl in Algeria.
See also[edit]
This article uses anatomical terminology; for an overview, see Anatomical terminology.
Dactylonomy
Dermatoglyphics
Finger-counting
Finger tracking
Handstand
Hand strength
Hand walking
Human skeletal changes due to bipedalism
Knuckle-walking
Palmistry – fortune-telling based on lines in hand palms.
Manus (anatomy)
Mudra – Hindu term for hand gestures.
Notes[edit]
Jump up ^ Thomas, Dorcas MacClintock ; illustrated by J. Sharkey (2002). A natural history of raccoons. Caldwell, N.J.: Blackburn Press. p. 15. ISBN 978-1-930665-67-5.
^ Jump up to: a b Xu et al. 2009
^ Jump up to: a b Mark L. Latash (18 March 2008). Synergy. Oxford University Press, USA. pp. 137–. ISBN 978-0-19-533316-9.
Jump up ^ Tracy L. Kivell; Pierre Lemelin; Brian G. Richmond; Daniel Schmitt (10 August 2016). The Evolution of the Primate Hand: Anatomical, Developmental, Functional, and Paleontological Evidence. Springer. pp. 7–. ISBN 978-1-4939-3646-5.
Jump up ^ Goldfinger, Eliot (1991). Human Anatomy for Artists : The Elements of Form: The Elements of Form. Oxford University Press. pp. 177, 295.
Jump up ^ O'Rahilly,, Ronan; Müller, Fabiola (1983). Basic Human Anatomy: A Regional Study of Human Structure. Saunders. p. 93.
^ Jump up to: a b Schmidt & Lanz 2003, p. 105
Jump up ^ Marieb 2004, p. 237
Jump up ^ https://www.exrx.net/Kinesiology/Segments
Jump up ^ Tubiana, Thomine & Mackin 1998, p. 4
Jump up ^ [Saladin, Kenneth S. Anatomy & Physiology: The Unity of Form and Function. New York, NY: McGraw-Hill, 2007. Print.]
^ Jump up to: a b c d Tubiana, Thomine & Mackin 1998, pp. 9–14
Jump up ^ Austin 2005, pp. 319–320
Jump up ^ "Medical mnemonics". LifeHugger. Archived from the original on 2011-07-13. Retrieved 2009-12-19.
^ Jump up to: a b c Jones & Lederman 2006, pp. 16–18
Jump up ^ Ross & Lamperti 2006, p. 257
Jump up ^ Jones & Lederman 2006, pp. 18–21
Jump up ^ "Web". Oxford English Dictionary (3rd ed.). Oxford University Press. September 2005. (Subscription or UK public library membership required.)
Jump up ^ "web of fingers/ toes". Farlex Medical Dictionary. Farlex Partner Medical Dictionary. Retrieved 14 March 2016.
^ Jump up to: a b Schmidt & Lanz 2003, p. 1
Jump up ^ Key and Lycett (2011) Technology based evolution? A biometric test.... Journal of Archaeological Science
^ Jump up to: a b Rolian et al., 2011
Jump up ^ Marzke 2009
Jump up ^ Flanagan & Johansson 2002
Jump up ^ Putz & Tuppek 1999
Jump up ^ Almécija 2009
Jump up ^ Kivella & Schmitt 2009
^ Jump up to: a b Lovejoy et al. 2009, Abstract, pp. 101–102
Jump up ^ Tocheri et al. 2008
Jump up ^ Reardon 2012, Knight 2012, Morgan & Carrier 2013
Jump up ^ Key and Lycett, 2011
Jump up ^ williams et al., 2012
Jump up ^ Key, 2013
References[edit]
Almécija, Sergio (2009). "Evolution of the hand in Miocene apes: implications for the appearance of the human hand (PhD Thesis)" (PDF). Universitat Autònoma de Barcelona.
Austin, Noelle M. (2005). "Chapter 9: The Wrist and Hand Complex". In Levangie, Pamela K.; Norkin, Cynthia C. Joint Structure and Function: A Comprehensive Analysis (4th ed.). Philadelphia: F. A. Davis Company. ISBN 0-8036-1191-9.
Flanagan, J Randall; Johansson, Roland S (2002). "Hand Movements". Encyclopedia of the human brain (PDF). Elsevier Science.
Jones, Lynette A.; Lederman, Susan J. (2006). "Structure of the Skin". Human hand function. Oxford University Press. ISBN 978-0-19-517315-4.
Kivella, Tracy L.; Schmitt, Daniel (August 25, 2009). "Independent evolution of knuckle-walking in African apes shows that humans did not evolve from a knuckle-walking ancestor". PNAS. 106 (34): 14241–14246. Bibcode:2009PNAS..10614241K. doi:10.1073/pnas.0901280106. PMC 2732797. PMID 19667206.
Knight, Kathryn (2012). "Fighting Shaped Human Hands". Journal of Experimental Biology. doi:10.1242/jeb.083725.
Lovejoy, C. Owen; Suwa, Gen; Simpson, Scott W.; Matternes, Jay H.; White, Tim D. (October 2009). "The Great Divides: Ardipithecus ramidus Reveals the Postcrania of Our Last Common Ancestors with African Apes". Science. 326 (5949): 73, 100–106. Bibcode:2009Sci...326..100L. doi:10.1126/science.1175833. PMID 19810199.
Marieb, Elaine N (2004). Human Anatomy & Physiology (Sixth ed.). Pearson PLC. ISBN 0-321-20413-1.
Marzke, Mary. "Evolution of the hand and bipedality". Massey University, NZ. Retrieved September 21, 2017.
Morgan, Michael H.; Carrier, David R. (January 2013). "Protective buttressing of the human fist and the evolution of hominin hands". J Exp Biol. 216: 236–244. doi:10.1242/jeb.075713. Retrieved September 21, 2017.
Putz, RV; Tuppek, A. (November 1999). "Evolution of the hand". Handchir Mikrochir Plast Chir. 31 (6): 357–61. doi:10.1055/s-1999-13552. PMID 10637723. | accessdate =
Reardon, Sara (December 19, 2012). "Human hands evolved so we could punch each other". New Scientist. Retrieved September 21, 2017.
Ross, Lawrence M.; Lamperti, Edward D., eds. (2006). Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme. ISBN 1-58890-419-9.
Schmidt, Hans-Martin; Lanz, Ulrich (2003). Surgical Anatomy of the Hand. Thieme. ISBN 1-58890-007-X.
Tocheri, Matthew W.; Orr, Caley M.; Jacofsky, Marc C.; Marzke, Mary W. (2008). "The evolutionary history of the hominin hand since the last common ancestor of Pan and Homo". J. Anat. (212): 544–562. doi:10.1111/j.1469-7580.2008.00865.x. PMC 2409097. PMID 18380869. (Abstract, PubMed) (PDF, Smithsonian)
Tubiana, Raoul; Thomine, Jean-Michel; Mackin, Evelyn (1998). Examination of the Hand and Wrist (2nd ed.). Taylor & Francis. ISBN 978-1-85317-544-2.
Xu, X; Clark, JM; Mo, J; Choiniere, J; Forster, CA; Erickson, GM; Hone, DWE; Sullivan, C; Eberth, DA; Nesbitt, S; Zhao, Q; Hernandez, R; Jia, CK; Han, FL; Guo, Y (2009). "A Jurassic ceratosaur from China helps clarify avian digital homologies". Nature. 459 (7249): 940–944. Bibcode:2009Natur.459..940X. doi:10.1038/nature08124. PMID 19536256. CS1 maint: Multiple names: authors list (link)
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Hand anatomy (eMedicine)
Film Board of Canada documentary Faces of the Hand (Requires Adobe Flash)
The Common Hand article in the May 2012 National Geographic
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flexor carpi radialis
flexor carpi ulnaris
flexor digitorum superficialis
deep:
pronator quadratus
flexor digitorum profundus
flexor pollicis longus
posterior
superficial:
mobile wad
brachioradialis
extensor carpi radialis longus and brevis
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
deep:
supinator
anatomical snuff box
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus
extensor indicis
fascia
bicipital aponeurosis
common tendons
extensor
flexor
antebrachial fascia
other
cubital tunnel
Hand
lateral volar
thenar
opponens pollicis
flexor pollicis brevis
abductor pollicis brevis
adductor pollicis
medial volar
hypothenar
opponens digiti minimi
flexor digiti minimi brevis
abductor digiti minimi
palmaris brevis
intermediate
lumbrical
interossei
dorsal
palmar
fascia
posterior:
extensor retinaculum
extensor expansion
anterior:
flexor retinaculum
palmar aponeurosis
Authority control
GND: 4023207-4
NDL: 00572746
Retrieved from "https://en.wikipedia.org/w/index.php?title=Hand&oldid=865298806"
Categories:
Upper limb anatomy
Hand
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text:
Alex Karev
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Alex Karev
Grey's Anatomy character
The season nine promotional photograph of Justin Chambers as Dr. Alex Karev
First appearance
"A Hard Day's Night" (1.01)
March 27, 2005
Created by
Shonda Rhimes
Portrayed by
Justin Chambers
Information
Full name
Alexander Michael Karev
Aliases
Alexander Michael Evans
Occupation
Chief of Pediatric Surgery M.D.
F.A.C.S. at Grey-Sloan Memorial Hospital
Title
Chief of Pediatric Surgery M.D.
F.A.C.S.
Family
Aaron Karev (brother)
Amber Karev (sister)
Helen Karev (mother)
Jimmy Evans (father, deceased)
Nicky Evans (half-brother)
Spouse(s)
Izzie Stevens (divorced)
Significant other(s)
Olivia Harper
Addison Montgomery
Lexie Grey
Rebecca "Ava" Pope
Callie Torres
Lucy Fields
Leah Murphy
Jo Wilson (engaged)
Heather Brooks
Relatives
Naomi Evans (stepmother)
Alexander "Alex" Michael Karev,[1] M.D. is a fictional character on the ABC television series Grey's Anatomy, portrayed by actor Justin Chambers.[2] Introduced as a surgical intern at the fictional Seattle Grace Hospital. Karev eventually obtained the position of resident, later becoming a pediatric surgical fellow. His relationships with colleagues Meredith Grey (Ellen Pompeo), Cristina Yang (Sandra Oh), Izzie Stevens (Katherine Heigl), and George O'Malley (T. R. Knight) formed a focal point of the series.
The character is initially disliked by his fellow interns, and is often accused of being brusque[2] and dismissive with his patients and co-workers. As a resident, Karev's negative attitude, temper and rudeness has occasionally earned the ire of the attendings, with former neonatal surgeon Addison Montgomery requesting him on her service as punishment for his rudeness to her and neurosurgeon Derek Shepherd, amongst others, throwing him out of their service for his inappropriate comments about patients. He demonstrates profound skill for the specialty which prompts praise from Montgomery and contributes to Karev's interest in pediatric surgery for the rest of the series. As the character developed, he displayed more empathy for patients and is shown to have a gift for connecting with young children, despite his repeated claims to dislike them.
Although Karev and Stevens had an on-off romantic history in previous seasons, it was not until the fifth season that the two formed a lasting relationship. Despite Stevens' advanced skin cancer, the two marry. Justin Chambers commented on his character's inability to tell Stevens that he loves her in the beginning of their relationship, saying that Karev has difficulty expressing himself.[3] Though Stevens departs in season 6, series creator Shonda Rhimes has said that she would like the chance to create closure for both Karev and Stevens.[4] Rhimes later retracted her comments and stated that she has no plans to ever re-approach Izzie's storyline again. In the ninth season, Karev befriends intern Jo Wilson. They begin a relationship in the tenth season until their break-up in the twelfth season. However, they get back together again in the fourteenth season.
Contents
[hide]
1 Storylines
2 Development
2.1 Casting and creation
2.2 Characterization
3 Reception
4 References
5 External links
Storylines[edit]
His mother had a mental illness, and his father was often absent, as well as often becoming violent towards Alex and his mother. Alex began wrestling in high school,[5] and eventually physically confronted his father - after this, his father did not return. Alex has a younger brother, Aaron, and a younger sister, Amber; they were all placed in foster care for 5 years. Though Aaron and Amber only had a few foster families, Alex went through 17 foster families in 5 years before he reunited with his siblings. It is revealed in later seasons that Aaron was diagnosed with schizophrenia and tried to kill Amber. Alex was present when Aaron had to be committed to a psychiatric ward.
Alex secured a position in the surgical residency program at Seattle Grace Hospital after graduating from the University of Iowa. He initially makes a poor impression on his fellow interns meeting fellow interns Meredith Grey (Ellen Pompeo), Cristina Yang (Sandra Oh), George O'Malley (T.R. Knight), and Izzie Stevens (Katherine Heigl) whom he later taunts when he discovers she used to be a lingerie model. After initial disagreements, Alex reveals to Izzie that his father was a heroin addict who used to beat his mother. He became a wrestler so he could defend his mother, and attended university on a wrestling scholarship. He and Izzie begin a friendship. At the end of the first season, George contracts syphilis from Alex through nurse Olivia Harper, causing animosity between the two.
Alex asks Izzie out on a date, but he is thrown by the news that he has failed his medical board exams. Izzie is offended since he pays no attention to her during their date and so informs him that she no longer wants to go out with him. He later freezes during an emergency operation, needing George to take over from him. Alex's relationship with Izzie is damaged when he experiences erectile dysfunction with her. He goes on to sleep with Olivia again, and is caught by Izzie and they break up. After retaking his exams, Alex manages a pass, and reunites with Izzie after a bomb scare in the hospital. They break up again, however, when Izzie falls for cardiothoracic patient Denny Duquette.
Alex helps Izzie recover from Denny's death and advances Izzie but Izzie backs away since she is still in the process of getting over her loss and they remain friends. Alex spends a period of time working under neonatal surgeon Dr. Addison Montgomery (Kate Walsh), and though he is later released to work for plastic surgeon Dr. Mark Sloan (Eric Dane), he finds his interest returning to Addison's firm. Addison is attracted to Alex, and the two share a kiss and later sleep together. In the aftermath of a ferry accident, Alex rescues a pregnant woman (Elizabeth Reaser) who awakes with amnesia, and grows close to Alex as he helps her forging an identity for herself, picking out the name Ava. After she gives birth to her daughter, Ava's memory eventually returns, although she tries to hide it from Alex as she had recently left a bad marriage. He convinces her to tell him her true identity, and she reveals herself to be Rebecca Pope. Alex turns her down after realizing she's married, feeling that he is not good enough for her.
Rebecca returns and she and Alex sleep together before she goes back to her husband. Alex has a brief relationship with intern Lexie Grey (Chyler Leigh), but chooses to be with Rebecca when she returns and tells him she is pregnant. After Rebecca attempted suicide, Izzie convinces Alex to admit her for psychiatric help due to Rebecca's hallucinations of her pregnancy. Alex later breaks down in Izzie's arms, and the two kiss.
Later in their relationship, Izzie begins hallucinating about Denny, and uncovers the fact she has metastatic melanoma (Stage IV) with an estimated chance of 5% survival. It is revealed that Izzie's hallucinations of Denny are, in fact, caused by her tumor. Alex is shocked by the news, but finds the strength to stay by her side. Izzie plans a wedding for Meredith and Derek, but when Derek finds Izzie has another inoperable tumor in her brain, they give the wedding to Izzie and Alex, who marry in front of all their friends. Izzie debates whether or not she should undergo a risky surgery to remove her tumor and Alex supports her, but eventually insists that she should have the surgery. Alex performs CPR on Izzie after she flatlines.
Izzie regains a heartbeat but is soon fired leaving Alex a Dear John letter and no clue as to her whereabouts. She later returns to the hospital and says to Alex, thinking he had a hand in getting her fired, that she could not forgive him for talking to the Chief. Alex says he could not forgive her either for not giving him the benefit of the doubt and leaving without talking to him first. Alex re-kindles an old flame with Lexie. Alex seems to have recently found that his calling is actually Peds and not Plastics as he had decided in the earlier seasons. Seeing Alex's ability to handle child patients, Dr. Arizona Robbins shows an interest in mentoring him for that specialization. Alex's brother Aaron comes to Seattle Grace for surgery, and lots of painful memories resurface because of this. Meredith discovers Alex, along with Aaron and their sister Amber, had been in foster care for five years when their mother could not take care of them. Alex is also served with divorce papers from Izzie. Alex is shot in the hospital by a deceased patient's husband, but survives with the help of Lexie and Mark. While undergoing treatment, he mistakes Lexie for Izzie.
Following the shooting, Lexie has a mental breakdown in front of Alex and he walks away. Dr. Bailey bars Alex from surgery until he has the bullet removed, which he later allows her to do. Alex realizes that his passion lies in Pediatric Surgery. He is further shown to be excellent with children, comforting with a young patient while growing her a new trachea. He immediately gets on the wrong side of new Pediatric attending Stark while Arizona is on leave. Alex then attempts to sleep with virgin April Kepner after visiting his mom in Iowa when his brother was diagnosed schizophrenia. Alex and Meredith perform an emergent surgery on a young boy by themselves during the night shift, dealing with the angry fallout from Stark (who would not answer his pager) but gaining the wordless approval of the Chief. Alex is thrilled when Arizona returns from Africa and hopes she will come to work for the hospital again. In the meantime, Alex falls for the new OBGYN attending, Lucy Fields, and they start a relationship after she kisses him. Alex finds out about Meredith sabotaging her Alzheimer's clinical trial and rats her out in attempt to get Chief Resident.
The adoption counselor takes away Zola, the child Meredith wanted to adopt. Realizing his mistake, Alex apologizes to Meredith who forgives him shortly after. As the end of the fifth year of residency is near, the surgical residents, including Alex, prepare for their board exams for the different fellowships they plan on joining. Though Alex is late for his exam because he had to treat a patient, he ends up passing. Dr. Webber tells him that Johns Hopkins Hospital, which has the top program in the country, has been very impressed with him and has decided to create a position in pediatrics surgery for him and accepts the position. After finding out his decision, his current boss, Dr. Arizona Robbins, yells at him and takes his place on a plane that later crashes.
Following the rescue of his colleagues, Robbins' health deteriorates and amputates her leg. He extends his stay at Seattle Grace until a replacement for Robbins is found, but when he learns that the replacement will send the exchange program to UCLA, he decides not to leave. Karev buys Meredith's old house from her, and Cristina becomes his roommate. Karev forms a friendship with new intern, Jo Wilson that eventually develops into romantic feelings towards each other. Alex admits his love for Jo, and the two kiss and become a couple.
Alex's estranged father, Jimmy, who he hasn't seen in 18 years, is admitted to the ER as a patient. After being discharged, Jimmy plays with his band at a bar, and Alex spends several nights watching his father perform onstage. Unknowing that Alex is his son, Jimmy confides in Alex that he had another family that he hasn't seen in years. This made Alex upset and he punched Jimmy at the bar. Once returning home, Alex unleashes his hurt and anger on Jo for having encouraged him to reconnect with his father. His father returns suffering from symptoms of withdrawal and hallucinations of the past where more is revealed about Alex's childhood. Jimmy tells Alex he knows that he is his son and Alex yells at his dad stating that "I WAS THE DAD". His dad later goes into cardiac arrest and is brought into surgery, fate unknown. Alex kisses Jo at April's wedding wanting to start a family with her. That night his dad died, due to a mistake by intern, Shane Ross, and Alex is upset. He punches Ross and is later comforted by Meredith.
Upon the completion of his fellowship in Pediatric Surgery, Alex is given an offer to work at Dr. Oliver Lebackes' private practice office, claiming that he will have more flexible hours and "a big fat paycheck". Alex takes this offer happily. Robbins is initially angered by this decision and thinks that Alex is choosing money over substance. Eventually she realizes that he has become a wonderful surgeon and that she is happy to see him go. He later discovers that he isn't happy working at the private practice and expresses a desire to return full-time to Grey Sloan. When Cristina leaves for Switzerland, she leaves Alex her share of the board, including her seat.
Alex is fired by Dr. Lebackes when Maggie Pierce accidentally reveals to him that Karev was thinking about leaving the job. Webber recommended Bailey to fill Yang's board seat after she left, so Bailey and Alex fight over the chair. They both make presentations to the board and eventually Bailey wins, with a unanimous vote in her favor. He is hired back as an attending Peds surgeon and takes over full-time as Arizona pursues a fellowship with Dr. Herman. Alex continues to date Jo and his friendship with Meredith grows stronger than ever, with him taking on the role of her new person. When Derek dies and Meredith runs away, Alex is upset by her leaving without telling him where she went and calls her everyday. Eventually she calls him, tells him she is okay, and to stop calling. When she goes into labor and gives birth to Ellis Shepherd, Alex goes to see her since he is her emergency contact. He brings Meredith and her kids back to her house. She asks to move back in with him in her old house. Alex sells Meredith back the house and he and Jo rent a loft.
Alex and Jo continue to struggle with their relationship. Alex wants to settle down, marry Jo, and have kids. However, Jo continues to resist. When Karev proposes to her, Jo tells him she can't marry him, so he breaks up with her. Later, Alex realizes that he misses Jo and gets her back. They seem to be doing well for some time, until Alex brings up marriage again and the two fight, as Jo still continues to argue that she cannot marry him. Alex storms out, leaving their relationship uncertain. During Owen and Amelia's wedding, Alex realizes that even though she won't marry him, he loves Jo and goes back to her again. However, when he arrives at their loft, he finds Jo highly intoxicated, wearing nothing but her bra and underwear, and surgical intern, Andrew Deluca lying on top of her. Alex assumes that Deluca was attempting to take advantage of Jo while she was inebriated and is filled with rage. He beats Deluca to a pulp with his bare hands.
Andrew is badly injured, with his face bruised beyond recognition. He is unconscious and on the verge of dying. Alex realizes what he's done and quickly rushes Deluca to the hospital. There, the doctors call the police as they struggle to save Andrew and discover who did this to him. Alex lies to everyone and says that he found Andrew in this state and brought him to Grey Sloan. However, Ben Warren is suspicious of Karev. Meredith also quickly realizes that Alex was in fact the one who beat Deluca. She covers for him and the two continue to lie to everyone in the hospital about Alex's actions. Soon, Karev learns that Andrew wasn't doing anything wrong and that he had beaten up a good guy. Meredith decides that even though she loves Alex, she needs to turn him in. She goes to Bailey and tells her the truth. But, when the two rush to the police they find Alex being arrested for aggravated assault, as he had turned himself in. He is taken to jail and Meredith bails him out. While they wait for a trial, Bailey suspends Alex as an attending and makes him work in the clinic. Eventually, Jo finally tells Alex that the reason she couldn't marry Alex is because she is already married. Her husband is abusive and so she ran away and changed her name to Jo Wilson so that he wouldn't find her. Alex realizes that when Jo is called to the stand as a witness in the trial, this information about her past and lack of records under the name Jo Wilson may be revealed, and when the information goes public, her husband may find her. To keep her safe, he decides to take the plea deal without a trial, ensuring that he goes to jail for 2 years. However, when Alex tells Meredith this, she begs him not to and tells him that she can't lose him too because she's already lost everyone else important in her life. Alex struggles to decide whether or not to take the plea deal.
Meredith searches for Alex's case online, to find that the trial had been put off indefinitely. She assumes that he took the plea, and began calling and visiting various local jails to find him. After a full day of searching without finding him, she goes home to sleep, and discovers him sleeping in her bed. He explains he slept there all day. He explains that during his meeting with the D.A. Deluca came in and dropped all charges. Alex was then free to continue being Alex.
After returning to work, Alex and Jo try to ignore each other and eventually build up a tolerance of sorts towards each other. Deluca and Alex continue to be at odds, especially when he becomes closer to Jo. However, nothing comes of it and they both keep their distance. At the end of the season, Alex hires an investigator to look for Jo's abusive husband. The investigator finds him and tells Alex that he will be at a conference. Meredith tells him it's a horrible idea and that he shouldn't go, especially considering Jo doesn't know about the situation. Alex flies out to the conference with the intention of telling him to get out of her life, no matter the means. When he meets him, Alex decides against confronting him over Jo, avoiding exposing her current identity and location and potentially stopping himself from assaulting someone yet again. He returns to Seattle, leaving the convention early.
At the start of season 14, Alex and Jo start to warm to each other. Jo tells Deluca that she is still in love with Alex. Because Stephanie has left the hospital after an explosion that almost killed her, Jo turns to Warren to confide in. After she tells him her true feelings about whole situation with Alex, Warren tells him that Jo is scared that he might hurt her. Alex goes to Jo and tells her that he could never abuse her like her husband did because he dealt with the same trauma as a kid as his father was abusive. He then tells her that he found her husband. Jo is taken back by this but when Alex tells her that he didn't kill or injure him in anyway, she is relieved and finally trusts him again. They then restart their relationship and Jo is now encouraged to file for divorce against her abusive husband.
Development[edit]
Casting and creation[edit]
This section is empty. You can help by adding to it. (July 2012)
Characterization[edit]
This section needs expansion. You can help by adding to it. (September 2012)
The American Broadcasting Company (ABC) characterized Karev as "honest", "always tells it like it is", while also citing his mouth, his punctuality and him being a "smart-ass" as his weaknesses.[6] Shonda Rhimes said of Karev: "I love that we have a character who can do something wonderful but still be a selfish cranky ass about it. Alex gets to be complex in ways most characters don't because even though he’s got a moral code, his moral code is totally twisted and dark. But he's essentially good – deep down inside."[7] Carolina Paiz, one of the writers of the series, wrote: "He has so much going on inside... you think you've got him figured out but then he just reveals this whole other side to him."[8]
"He is superficial sleazeball who turns out to be a nice guy and a talented doctor with an amazing bedside manner, as well as the budding love interest of Katherine Heigl's character Isobel."[9] DVD Verdict wrote of the character's development in the fourth season: "Love him, hate him, or both, Karev speaks his mind, rough edges and all. But ultimately his cold heart seems to be softened by his blossoming relationship with Jane Doe/Ava/Rebecca."[10] Rhimes felt that the 100th episode during which Karev marries Stevens showed how he had grown up: "Look at him. Standing at the altar and saying those vows like a man. (...) He's become a man who can step up. And I love him for it."[11]
Reception[edit]
Analyzing Alex Karev, Rachel Simon called him "underrated;" she pointed out that Alex’s personal growth never seems to get acknowledged, as "Alex begins Grey’s as an arrogant, obnoxious intern who pushes away anyone who tries to care about him. He breaks Izzie’s heart 1,000 times, and then acts surprised when she falls for someone else. He sleeps with any girl who will have him, insults everyone who doesn’t, and generally enjoys being the hospital asshole. Yet, over the course of 10 seasons Alex has evolved, slowly and realistically, into a genuinely good person whose faults don’t miraculously disappear, but take a backseat to much better qualities."
Former television columnist for The Star-Ledger Alan Sepinwall disapproved of Karev's flirt with Addison as "he should take interest in a woman's speciality and respect his boss without getting in her pants."[12] Reviewing the fifth season, Chris Monfette of IGN wrote: "Alex, who'd become simply the cast's angry outcast, was uplifted as his relationship with Izzie became more and more substantial, and his bedside scenes with her toward the end were some of his character's best material yet."[13]
On his career path as a Pediatric Surgeon Examiner wrote, "Despite his rough exterior, Alex has a certain child-like innocence and need for acceptance. He is keen in recognizing these traits in kids, as well. He reaches out to kids on many levels." and added, "Alex has major trust issues. Maybe it was the constant beatings from his father. Or, his mother’s mental illness. Or, being shuffled through 17 foster homes over a 5 year period. Who wouldn’t have issues with a childhood like that?"
References[edit]
Specific
Jump up ^ "What a Difference a Day Makes". Grey's Anatomy. Season 5. Episode 22. 2009-05-07. ABC.
^ Jump up to: a b "Character Bios". ABC.com. [dead link]
Jump up ^ "About.com Interviews Justin Chambers". tvfanatic.com. Retrieved December 13, 2011.
Jump up ^ Ausiello, Michael (October 29, 2010). "Exclusive: 'Grey's Anatomy' boss vetoes controversial Alex/Izzie plot". Entertainment Weekly. Time Inc. Retrieved December 13, 2011.
Jump up ^ ABC - Alex Karev bio, archived from the original on March 3, 2011, retrieved December 13, 2011
Jump up ^ "Alex Karev (Justin Chambers) Bio". Grey's Anatomy. American Broadcasting Company. Archived from the original on March 3, 2011. Retrieved June 13, 2013.
Jump up ^ Rhimes, Shonda (May 7, 2006). "Shonda on "Damage Case"". Grey Matter. American Broadcasting Company. Archived from the original on May 15, 2009. Retrieved June 13, 2013.
Jump up ^ Paiz, Carolina (November 30, 2006). "Carolina Paiz on "Don't Stand So Close To Me"". Grey Matter. American Broadcasting Company. Archived from the original on July 2, 2013. Retrieved June 13, 2013.
Jump up ^ "Justin Chambers Biography". Yahoo. Yahoo! Movies. Retrieved February 27, 2013.
Jump up ^ "Buy Grey's Anatomy: Season Four (Blu-ray) at Amazon Grey's Anatomy: Season Four (Blu-ray)". DVD Verdict. Retrieved September 3, 2012.
Jump up ^ Rhimes, Shonda (May 8, 2009). "Shonda Rhimes on "What a Difference a Day Makes"..." Grey Matter. American Broadcasting Company. Archived from the original on July 2, 2013. Retrieved September 3, 2013.
Jump up ^ Sepinwall, Alan (January 19, 2007). "Grey's Anatomy: Break like the wind". What's Alan Watching. Blogpsot. Retrieved June 13, 2013.
Jump up ^ Monfette, Chris (May 29, 2009). "Grey's Anatomy: Season 5 Review". IGN. Retrieved June 22, 2012.
General
"Grey's Anatomy: Episode Recap Guide". ABC. Retrieved June 19, 2012.
External links[edit]
Grey's Anatomy portal
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This page was last edited on 16 March 2018, at 03:23.
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