Zones of the Hand (Flexor and Extensor)

Dec 6, 2021 3 min read
Zones of the Hand (Flexor and Extensor)

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.

Summary Card


5 Key Points

  1. Origin: based on work by Kleinert and Verdan in the 1980s.
  2. Flexors: 5 volar zones described relative to soft tissue structures.
  3. Extensors: 9 dorsal zones 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
  2. Extensor Zones of the Hand
  3. 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

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:

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
Flexor Zones of the Hand

The location of flexor zones and their clinical significance are in the table below. For example:

Flexor Zones of the Hand, Volar Zones of the Hand, Zone, 1, 2, 3, 4, 5, Thumb
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
Extensor Zones of the Hand

The location of the extensor zones and their clinical significance can be seen in the table below. For example:

Extensor Zones of the Hand, Dorsal Zones of the Hand, Zone, 1, 2, 3, 4, 5, Thumb
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

2.     Donald Hugh Johnson. Practical Orthopaedic Sports Medicine and Arthroscopy. (2020) ISBN: 9781469878324

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 - Pubmed

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.

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