> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # Zones of the Hand (Flexor and Extensor) - URL: https://www.theplasticsfella.com/zones-of-the-hand/ - Published: 2021-12-06T10:26:41.000Z - Updated: 2021-12-06T23:03:24.000Z - Description: There are 5 Flexor and 9 Extensor Zones of the Hand. They are used to describe the location of a tendon injury, guide post-operative therapy and predict prognosis. - Author: PlasticsFella - Tags: Upper Limb #### **Summary Card** **5 Key Points** 1. **Origin:** based on work by Kleinert and Verdan in the 1980s. 2. **Flexors:** 5 [volar zones](https://www.theplasticsfella.com/zones-of-the-hand/#flexor-zones-of-the-hand) described relative to soft tissue structures. 3. **Extensors:** 9 [dorsal zones](https://www.theplasticsfella.com/zones-of-the-hand/#extensor-zones-of-the-hand) described relative to bony structures. 4. **Thumbs**: Different zones of the hand, referred to as "T". 5. **Use**: describe injuries**,** guide rehabilitation, predict prognosis **Quick Find** 1. [Flexor Zones of the Hand](https://www.theplasticsfella.com/zones-of-the-hand/#flexor-zones-of-the-hand) 2. [Extensor Zones of the Hand](https://www.theplasticsfella.com/zones-of-the-hand/#extensor-zones-of-the-hand) 3. [References](https://www.theplasticsfella.com/zones-of-the-hand/#references) --- ## Flexor Zones of the Hand 💡 Kleinert and Verdan in 1983, first described the flexor (volar) zones of the hand, *for simplifying the management of flexor tendon injuries3*. ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/12/Zones-of-the-Hand-5.png) 1983 Publication by "Committee of Tendon Injuries"3 There are in total 5 flexor (volar) zones on the volar aspect of the hand1,2,3: - **Zone 1:** Distal to FDP Insertion - **Zone 2:** Proximal A2 Pulley to FDP Insertion - **Zone 3:** [Carpal Tunnel](https://www.theplasticsfella.com/carpal-tunnel-syndrome/) to Proximal A2 Pulley - **Zone 4:** [Carpal Tunnel](https://www.theplasticsfella.com/carpal-tunnel-syndrome/) - **Zone 5:** Proximal to [Carpal Tunnel](https://www.theplasticsfella.com/carpal-tunnel-syndrome/) - **T1:** Distal to A2 Pulley - **T2:** A2 Pulley to A1 Pulley - **T3:** A1 Pulley to [Carpal Tunnel](https://www.theplasticsfella.com/carpal-tunnel-syndrome/) These flexor zones of the hand are illustrated below. ![Flexor Zones of the Hand, Volar Zones of the Hand, Zone, 1, 2, 3, 4, 5, Thumb](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/12/Zones-of-the-Hand.png) Flexor Zones of the Hand The location of flexor zones and their clinical significance are in the table below. For example: - Zone II injuries are often explored through a [Bruner's](https://www.theplasticsfella.com/volar-incisions-bruner-mid-lateral-others/#bruner-incision) or [mid-lateral incision](https://www.theplasticsfella.com/volar-incisions-bruner-mid-lateral-others/#midlateral-incision). - Zone I [finger replants](https://www.theplasticsfella.com/finger-replant/) often have better post-operative outcomes ![Flexor Zones of the Hand, Volar Zones of the Hand, Zone, 1, 2, 3, 4, 5, Thumb](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/12/Zones-of-the-Hand-2.png) Location of Flexor Zones of the Hand --- ## Extensor Zones of the Hand 💡 Kleinert and Verdan in 1983 classified the Extensor (dorsal) zones of the hand into 8 anatomic regions3. The original publication had 7 zones. **Hint: odd-numbers** **\=** **joints** **& even-numbers = bone** **.** - **Zone 1:** Distal Interphalangeal Joint (DIPJ) - **Zone 2:** Middle Phalanx - **Zone 3:** Proximal Interphalangeal Joint (PIPJ) - **Zone 4:** Proximal Phalanx - **Zone 5:** Metacarpophalangeal Joint (MCPJ) - **Zone 6:** Metacarpals - **Zone 7:** Wrist Joint - **Zone 8:** Distal 1/3 of the arm. - **Zone 9:** Proximal 2/3 of the arm. These extensor (dorsal) zones of the hand are illustrated below. ![Extensor Zones of the Hand, Dorsal Zones of the Hand, Zone, 1, 2, 3, 4, 5, Thumb](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/12/Zones-of-the-Hand-4.png) Extensor Zones of the Hand The location of the extensor zones and their clinical significance can be seen in the table below. For example: - Zone 3 injury often involves central slip & results in a [Boutonniere Deformity](https://www.theplasticsfella.com/swan-neck-deformity-vs-boutonnieres/). - Patients with [hand compartment syndrome](https://www.theplasticsfella.com/hand-compartment-syndrome/) will require incisions in zone 6\. ![Extensor Zones of the Hand, Dorsal Zones of the Hand, Zone, 1, 2, 3, 4, 5, Thumb](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/12/Zones-of-the-Hand-3.png) Location of Extensor/Dorsal Zones --- ## References **Chief Contributor: Dr Harsh Shah** 1\. William R. Walsh. Repair and Regeneration of Ligaments, Tendons, and Joint Capsule. (2007) [ISBN: 9781592599424](https://books.google.co.uk/books?vid=ISBN9781592599424&ref=theplasticsfella.com) 2\. Donald Hugh Johnson. Practical Orthopaedic Sports Medicine and Arthroscopy. (2020) [ISBN: 9781469878324](https://books.google.co.uk/books?vid=ISBN9781469878324&ref=theplasticsfella.com) 3\. Kleinert HE, Verdan C. Report of the committee on tendon injuries. J Hand Surg. 1983;8:794. 4\. Kotwal PP, Ansari MT. Zone 2 flexor tendon injuries: Venturing into the no man's land. (2012) Indian journal of orthopaedics. 46 (6): 608-15\. [doi:10.4103/0019-5413.104183](https://doi.org/10.4103/0019-5413.104183?ref=theplasticsfella.com) \- [Pubmed](https://www.ncbi.nlm.nih.gov/pubmed/23325961?ref=theplasticsfella.com) 5\. Wilhelmi BJ, Snyder N, Verbesey JE, Ganchi PA, Lee WPA. Trigger finger release with hand surface landmark ratios: an anatomic and clinical study.*Plast Reconstr Surg*. 2001;108(4):908-915.