Hand Functions

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// ─── SLIDE 1: TITLE ──────────────────────────────────────────────
titleSlide(pres, "Hand Functions", "Anatomy, Kinesiology & Occupational Performance");

// ─── SLIDE 2: OUTLINE ────────────────────────────────────────────
contentSlide(pres, "Outline", [
  "01  Overview of Hand Function",
  "02  Bones & Joints of the Hand",
  "03  Extrinsic Muscles – Flexors",
  "04  Extrinsic Muscles – Extensors",
  "05  Intrinsic Muscles – Thenar & Hypothenar",
  "06  Intrinsic Muscles – Lumbricals & Interossei",
  "07  Nerve Supply of the Hand",
  "08  Functional Movements & Prehension Patterns",
  "09  Grip & Pinch Types (Pedretti's Classification)",
  "10  Clinical Correlates & OT Assessment",
]);

// ─── SLIDE 3: SECTION 1 ──────────────────────────────────────────
sectionHeader(pres, 1, "Overview of Hand Function", "The hand as a tool of occupational performance");

// ─── SLIDE 4: OVERVIEW ───────────────────────────────────────────
contentSlide(pres, "Overview of Hand Function", [
  "The hand is the primary end-organ for manipulation and occupational performance",
  "Two categories of hand use:",
  "  Prehensile – grasping, holding, pinching (power or precision)",
  "  Non-prehensile – pushing, pressing, tapping",
  "Hand function depends on:",
  "  Intact musculoskeletal framework (bones, joints, tendons)",
  "  Normal neuromuscular control (peripheral nerve integrity)",
  "  Sensory feedback (touch, proprioception, pain, temperature)",
  "  Coordinated interplay of extrinsic and intrinsic muscles",
  "OT perspective (Pedretti): hand function assessed within context of ADL, productivity, and leisure",
]);

// ─── SLIDE 5: BONES & JOINTS ─────────────────────────────────────
sectionHeader(pres, 2, "Bones & Joints of the Hand", "Structural framework enabling mobility and stability");

contentSlide(pres, "Bones & Joints of the Hand", [
  "27 bones in the hand and wrist:",
  "  8 carpal bones (proximal & distal rows)",
  "  5 metacarpal bones (MC1–MC5)",
  "  14 phalanges: 3 per finger (proximal, middle, distal), 2 for thumb",
  "Key joints:",
  "  Radiocarpal (wrist) joint – flexion, extension, radial/ulnar deviation",
  "  Carpometacarpal (CMC) joints – saddle joint of thumb allows opposition",
  "  Metacarpophalangeal (MCP) joints – flexion, extension, abduction, adduction",
  "  Proximal interphalangeal (PIP) joints – hinge, flexion/extension only",
  "  Distal interphalangeal (DIP) joints – hinge, flexion/extension only",
]);

// ─── SLIDE 6: EXTRINSIC FLEXORS ──────────────────────────────────
sectionHeader(pres, 3, "Extrinsic Muscles – Flexors", "Origin in forearm, insertion in hand");

contentSlide(pres, "Extrinsic Flexor Tendons", [
  "9 flexor tendons pass through the carpal tunnel:",
  "Flexor Digitorum Superficialis (FDS) ×4:",
  "  Inserts: volar surface of middle phalanx (digits 2–5)",
  "  Action: Flexes PIP and MCP joints",
  "  Nerve: Median nerve (C7, C8, T1)",
  "Flexor Digitorum Profundus (FDP) ×4:",
  "  Inserts: volar base of distal phalanx (digits 2–5)",
  "  Action: Primarily flexes DIP; also PIP and MCP",
  "  Nerve: Median (digits 2–3) / Ulnar (digits 4–5)",
  "Flexor Pollicis Longus (FPL) ×1:",
  "  Inserts: distal phalanx of thumb",
  "  Action: Flexes thumb IP joint",
  "  Nerve: Anterior interosseous branch of median nerve",
]);

// ─── SLIDE 7: EXTRINSIC EXTENSORS ────────────────────────────────
sectionHeader(pres, 4, "Extrinsic Muscles – Extensors", "Nine extensors in 6 compartments under extensor retinaculum");

contentSlide(pres, "Extrinsic Extensor Tendons", [
  "9 extensor tendons divide under extensor retinaculum into 6 compartments",
  "Extensor Digitorum Communis (EDC): extends fingers at MCP, PIP, DIP",
  "  Adjacent tendons connected by juncturae tendinum",
  "  Laceration proximal to juncture may still allow extension via neighbor",
  "Extensor mechanism in the finger divides into:",
  "  Central slip → inserts on middle phalanx → extends PIP joint",
  "  Two lateral bands → join lumbrical/interosseous tendons",
  "  Terminal tendon (lateral bands) → inserts on distal phalanx → extends DIP",
  "Other extensors: EIP (index), EDM (little finger), EPL/EPB/APL (thumb)",
  "Nerve supply: Radial nerve / Posterior interosseous nerve (PIN)",
]);

// ─── SLIDE 8: THENAR & HYPOTHENAR ────────────────────────────────
sectionHeader(pres, 5, "Intrinsic Muscles – Thenar & Hypothenar", "Both origin and insertion within the hand");

twoColSlide(pres,
  "Thenar Muscles (Median Nerve C8, T1)",
  "Thenar Muscles",
  [
    "Abductor pollicis brevis",
    "  → Thumb abduction",
    "  → Median nerve (C8, T1)",
    "Opponens pollicis",
    "  → CMC opposition (thumb)",
    "  → Median nerve (C8, T1)",
    "Flexor pollicis brevis",
    "  → Superficial head: Median nerve",
    "  → Deep head: Ulnar nerve",
    "Adductor pollicis",
    "  → Thumb adduction & MCP flexion",
    "  → Ulnar nerve (C8, T1)",
  ],
  "Hypothenar Muscles (Ulnar Nerve C8, T1)",
  [
    "Abductor digiti minimi",
    "  → Little finger abduction",
    "  → MCP flexion; PIP/DIP extension",
    "Flexor digiti minimi brevis",
    "  → Little finger MCP flexion",
    "Opponens digiti minimi",
    "  → Little finger opposition",
    "All three innervated by Ulnar nerve",
    "Origin: flexor retinaculum & carpal bones",
    "Lesion → loss of little finger opposition",
  ]
);

// ─── SLIDE 9: LUMBRICALS & INTEROSSEI ────────────────────────────
sectionHeader(pres, 6, "Intrinsic Muscles – Lumbricals & Interossei", "The key to combined MCP flexion + IP extension");

twoColSlide(pres,
  "Lumbricals & Interossei",
  "Lumbrical Muscles (×4)",
  [
    "Origin: FDP tendons (radial side)",
    "Insertion: Dorsal digital expansion",
    "Action (intrinsic-plus position):",
    "  → Flex MCP joints (digits 2–5)",
    "  → Extend PIP and DIP joints",
    "Innervation:",
    "  1st & 2nd → Median nerve (C8, T1)",
    "  3rd & 4th → Ulnar nerve (C8, T1)",
    "OT significance: essential for writing, pinch",
  ],
  "Interossei Muscles",
  [
    "Dorsal interossei (×4) – Ulnar nerve C8/T1",
    "  → Abduct fingers from midline (DAB)",
    "  → Also flex MCP + extend PIP/DIP",
    "Palmar interossei (×3) – Ulnar nerve C8/T1",
    "  → Adduct fingers to midline (PAD)",
    "  → Also flex MCP + extend PIP/DIP",
    "Midline reference = middle (3rd) finger",
    "OT significance: precision grip, typing, ADLs",
  ]
);

// ─── SLIDE 10: NERVE SUPPLY ───────────────────────────────────────
sectionHeader(pres, 7, "Nerve Supply of the Hand", "Median, Ulnar, and Radial nerve territories");

tableSlide(pres, "Nerve Supply – Motor Functions", 
  ["Nerve", "Key Structures Innervated", "Functional Deficit if Lost"],
  [
    ["Median nerve\n(C6–T1)", "Thenar muscles (APB, OP, FPB-superficial)\n1st & 2nd lumbricals\nFDS, FDP (digits 2–3), FPL", "Loss of thumb opposition\n'Ape hand' deformity\nWeak precision pinch"],
    ["Ulnar nerve\n(C8–T1)", "All interossei (dorsal & palmar)\n3rd & 4th lumbricals, hypothenar\nFDP (digits 4–5), adductor pollicis", "Claw hand (ring & little)\nLoss of finger abduction/adduction\nWeak power grip"],
    ["Radial nerve\n(C5–C8)", "All wrist & finger extensors\nNo intrinsic hand muscles", "Wrist drop\nInability to extend fingers\nNo intrinsic hand loss"],
  ]
);

// ─── SLIDE 11: FUNCTIONAL MOVEMENTS ──────────────────────────────
sectionHeader(pres, 8, "Functional Movements & Prehension", "Movement analysis for occupational performance");

contentSlide(pres, "Functional Movements of the Hand", [
  "Wrist positioning provides the stable base for all hand function:",
  "  Wrist extension (30°–35°) = optimal tenodesis position",
  "  Wrist flexion weakens grip force significantly",
  "Key finger movements:",
  "  DIP flexion – FDP (AIN/median or ulnar nerve)",
  "  PIP flexion – FDS (median nerve)",
  "  MCP flexion + IP extension – Intrinsic muscles (combined)",
  "  Finger abduction – Dorsal interossei (ulnar nerve)",
  "  Finger adduction – Palmar interossei (ulnar nerve)",
  "Thumb movements:",
  "  Palmar abduction, opposition, adduction – critical for pinch",
  "  Composite opposition (O-ring test) requires median + ulnar nerve integrity",
]);

// ─── SLIDE 12: GRIP & PINCH ───────────────────────────────────────
sectionHeader(pres, 9, "Grip & Pinch Patterns", "Pedretti's classification of prehension patterns");

contentSlide(pres, "Prehension Patterns (Pedretti's Classification)", [
  "POWER GRIPS (large force; whole hand; extrinsic + intrinsic):",
  "  Cylindrical grip – holding a hammer, jar, glass",
  "  Spherical grip – holding a ball, orange",
  "  Hook grip – carrying a briefcase (FDP dominant)",
  "  Lateral (key) pinch – may be classified under power",
  "PRECISION GRIPS (fine control; fingertips; intrinsic-dominant):",
  "  Tip-to-tip pinch (pulp pinch) – threading a needle",
  "  Lateral (key) pinch – turning a key, holding card",
  "  Three-jaw chuck (tripod pinch) – holding a pen",
  "Tenodesis grip: passive functional grip for C6 spinal cord injury",
  "  Wrist extension → passive finger flexion (natural tenodesis)",
  "  Wrist flexion → fingers open",
]);

// ─── SLIDE 13: OT ASSESSMENT ─────────────────────────────────────
sectionHeader(pres, 10, "Clinical Correlates & OT Assessment", "Nerve injuries, deformities, and functional evaluation");

twoColSlide(pres,
  "Hand Dysfunction – OT Assessment & Intervention",
  "Common Clinical Deformities",
  [
    "Claw hand (ulnar nerve palsy)",
    "  → MCP hyperextension, PIP/DIP flexion",
    "  → Ring & little fingers worst affected",
    "Ape hand (median nerve palsy)",
    "  → Thenar wasting, no opposition",
    "Wrist drop (radial nerve palsy)",
    "  → Loss of wrist & finger extension",
    "Boutonnière deformity",
    "  → Central slip rupture → PIP flexion + DIP extension",
    "Mallet finger",
    "  → Terminal tendon avulsion → DIP drop",
    "Swan-neck deformity",
    "  → PIP hyperextension + DIP flexion",
  ],
  "OT Evaluation & Approach",
  [
    "Range of motion (goniometry) – MCP, PIP, DIP",
    "Grip strength – Jamar dynamometer (5 positions)",
    "Pinch strength – Pinch gauge (tip, lateral, tripod)",
    "Sensory testing – Semmes-Weinstein monofilaments, 2PD",
    "Functional assessments:",
    "  → DASH, COPM, Jebsen-Taylor Hand Function Test",
    "  → Box & Block Test, Purdue Pegboard",
    "OT intervention strategies:",
    "  → Splinting for deformity prevention/correction",
    "  → Tendon gliding exercises (FDS/FDP differentiation)",
    "  → ADL retraining, adaptive equipment",
    "  → Sensory re-education, desensitization",
  ]
);

// ─── SLIDE 14: SUMMARY ───────────────────────────────────────────
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    "Hand function = extrinsic muscle power + intrinsic muscle precision + intact sensation",
    "Intrinsic muscles (lumbricals & interossei) enable the intrinsic-plus position: MCP flexion + IP extension — key for fine motor tasks",
    "Median nerve → opposition and precision pinch; Ulnar nerve → grip strength and finger abduction/adduction; Radial nerve → extension",
    "Pedretti classifies prehension into power grips (cylindrical, spherical, hook) and precision grips (tip, lateral, three-jaw chuck)",
    "OT assessment must address ROM, strength, sensation, and performance in meaningful occupations",
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