The human hand is a marvel of biological engineering—finely tuned for both strength and precision. It enables everything from forceful grips to delicate manipulations, thanks to its complex interplay of bones, joints, muscles, tendons, nerves, and blood vessels. Understanding this intricate structure is essential, especially when exploring conditions like carpal tunnel syndrome, which can severely impact hand function.
Figure 1 Nail anatomy (Lane et al., 2023)
Bones: The Framework of Dexterity
The skeletal architecture of the hand begins with the carpal bones, a cluster of eight small bones forming the wrist. These bones are arranged in two rows and act as the foundation for hand movement. The proximal row includes the scaphoid, lunate, triquetrum, and pisiform, articulating with the radius and ulna of the forearm. The distal row connects to the five metacarpal bones, which extend into the palm and link to the phalanges, or finger bones.
Each finger—except the thumb—has three phalanges (proximal, middle, and distal), while the thumb has only two. These bones not only support movement but are integral to hand stability and function.
Figure 2 Carpal anatomy (Lane et al., 2023)
Figure 3 Osseous anatomy of the hand (Lane et al., 2023)
Figure 4 Schematic drawing of the carpal bones (Abzug et al., 2023)
Joints: Points of Precision
The hand’s range of motion depends on numerous joints. Intercarpal joints allow slight gliding between carpal bones, while carpometacarpal (CMC) joints connect the wrist to the metacarpals. Notably, the thumb’s saddle-shaped CMC joint enables its unique oppositional movement, which is critical for gripping and pinching.
Further along the digits, interphalangeal (IP) joints—including proximal (PIP) and distal (DIP) joints—enable finger flexion and extension. The thumb contains a single IP joint due to its two-phalange structure.
Figure 5 Carpometacarpal, metacarpophalangeal, and interphalangeal joint anatomy (Lane et al., 2023)
Figure 6 Schematic drawing of the joints of the hand (Abzug et al., 2023)
Muscles and Tendons: The Engines of Movement
Two major groups of muscles power hand movement: extrinsic muscles, which originate in the forearm, and intrinsic muscles, which reside within the hand itself.
Extrinsic flexors like the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enable finger bending.
Extensors help straighten the fingers and are housed in compartments under the extensor retinaculum, a stabilizing band at the wrist.
Intrinsic muscles include the thenar and hypothenar muscles, lumbricals, and interossei, which fine-tune finger movements, especially for grasping and manipulating objects.
Tendons run through pulley systems in fibrous sheaths that allow for smooth gliding during movement. In the carpal tunnel—a narrow passageway at the wrist—these tendons share space with the median nerve, making the area vulnerable to compression.
Figure Digital extensor mechanism (Lane et al., 2023)
Nerve Supply: The Control Center
Three main nerves power the hand:
The ulnar nerve governs fine motor control in the ring and small fingers.
The median nerve supplies sensation to the thumb, index, middle, and part of the ring finger. It also innervates the thenar muscles—crucial for thumb movement.
The radial nerve primarily controls wrist and finger extension.
Compression of the median nerve within the carpal tunnel can lead to carpal tunnel syndrome, a condition marked by numbness, tingling, and weakness in the hand—especially affecting thumb function.
Blood Supply: Keeping the Hand Alive
The hand’s rich vascular network is supported by the radial and ulnar arteries, which form both dorsal and palmar arches. These arches distribute blood to the fingers through digital arteries, ensuring that the hand’s many tissues receive necessary oxygen and nutrients.
Figure 7 Schematic drawing of the vascular supply of the hand (Abzug et al., 2023)
Bone Development and Growth Plates
In children, the hand bones undergo a process known as endochondral ossification, where cartilage gradually transforms into bone. This occurs in growth zones called physes, or growth plates, which are susceptible to injury. Damage to these areas can lead to long-term issues like growth arrest or deformity if not managed promptly.
Fractures involving the growth plate (physeal fractures) are particularly common in children and must be treated with urgency and precision. Fortunately, younger bones have a high capacity for remodeling, especially when diagnosed early.
Functional Development: More Than Just Mechanics
Beyond structure, the hand is both an executive tool and a sensory organ. Even before birth, fetuses begin using their hands to explore their environment. In infancy, reflexive grasping evolves into intentional, skilled hand use. Over time, children develop prehension—the ability to grasp objects—followed by refined haptic perception, allowing them to identify textures, shapes, and sizes purely through touch.
As they grow, children shift from relying on feedback-driven movement to more anticipatory control. By the age of 4 to 7, most children can match objects by feel alone, and by 11 months, many begin to develop a preferred hand—a precursor to dominant-hand use in adulthood.
Setting the Stage for Carpal Tunnel Syndrome
With this complex yet elegant design, the human hand is vulnerable to a variety of conditions—especially where multiple systems converge. One such vulnerable site is the carpal tunnel, through which the median nerve and flexor tendons pass. When pressure builds up in this narrow space—due to swelling, repetitive motion, or anatomical anomalies—carpal tunnel syndrome (CTS) can develop.
In the next section, we’ll explore how this condition affects the finely tuned harmony of the hand, who’s at risk, and how modern medicine addresses it—especially in growing children.
The human body is an astonishingly complex and fascinating marvel, a genuine “Body Odyssey” that continues to captivate and challenge our understanding. From the visible mechanics of digestion to the microscopic worlds within, there’s always something new to learn, even for those deeply immersed in medical studies.
Making Learning Fun (and Gross!)
Educational exhibitions and books are making the wonders of the human body accessible and engaging for all ages. One popular exhibit featured video footage of the digestive system with charming sound effects and a graphic explanation of what happens to a hamburger, much to children’s delight. Visitors could even climb into a model mouth, crawl down a throat, and choose a path to either the digestive system or the lungs, with computer screens providing information on each section. Another part of the exhibition allowed children to play in a giant model of skin, complete with pink foam for epidermis, black spikes for hair, and plastic spheres for sweat bubbles. It also showcased how much skin a person sheds monthly (a full rubbish bag!) and encouraged sun protection.
Beyond physical exhibits, books like the Gross and Ghastly: Human Body series offer answers to “burning questions” about the body’s more disgusting features, such as making a candle from earwax or why farts smell differently. These brightly colored guides, filled with pop-eyed characters and animated body parts, jump “gleefully from vomit to poop to blood and back to poop again”. Other books provide “weird but true” facts about the human body, covering everything from the speed of a sneeze to the high percentage of bones in hands and feet.
Even medical students are constantly surprised by discoveries. Two students gained viral fame on TikTok for sharing facts they learned in medical school, including that urine is blood filtered by the kidneys and is sterile, that bones produce blood, and that bone marrow is found in all bones, not just the spine. Perhaps most surprisingly, they discovered that there is more bacterial DNA inside our bodies than our DNA, and these bacteria help digest food and produce vitamins.
The Hidden World: Our Vast Virome
Beyond the macroscopic and familiar, the human body hosts an incredibly vast and diverse population of viruses, collectively known as the virome. While centuries of research linked specific viruses to diseases, the significance of entire viral populations was only truly appreciated with the development of advanced DNA sequencing methods in the early 2000s. It’s estimated that there are approximately 1013 viral particles per human individual, exhibiting immense heterogeneity.
The human virome comprises:
• Bacteriophages (phages): Viruses that infect bacteria.
• Viruses that infect other cellular microorganisms like archaea.
• Viruses that infect human cells.
• Transient viruses found in food.
Viral populations vary significantly across the human body, with the gastrointestinal tract containing the most abundant populations, often reaching around 109 virus-like particles (VLPs) per gram of intestinal contents. Other sites like the oral cavity (~108 VLPs per millilitre of saliva), blood (~108 VLPs per millilitre), skin, urogenital system, and even the nervous system (~104 VLPs per millilitre of cerebrospinal fluid) also host diverse viral communities. Most identifiable viruses in the gut are phages, particularly Caudovirales (tailed phages) and spherical Microviridae. Notably, the healthy human gut typically has low proportions of eukaryotic viruses, and most resident viruses are non-enveloped, which makes sense given the harsh conditions of the gut and the need for faecal-oral transmission.
The virome’s establishment is a stepwise process. Healthy neonates typically lack a detectable virome at birth but are rapidly colonised after delivery. The first detectable viruses are mainly phages from families like Siphoviridae, Podoviridae, and Myoviridae, often from pioneering bacteria in the infant gut. Later in life, lytic phages become more common, and viruses that replicate in human cells, which can cause gastroenteritis, also appear.
As pictured in The human virome: assembly, composition and host interactions by Guanxiang Liang and Frederic D. Bushman (2021)
Numerous factors influence the virome’s structure, including diet, age, geographic location, and disease. Breastfeeding, for example, is linked to a lower accumulation of animal cell viruses in infants’ guts. While host genetics has a less clear influence on the virome in healthy individuals, they are well-established in inherited diseases like primary immunodeficiencies, where conditions like epidermodysplasia verruciformis allow viruses to replicate aggressively. Studies also show that geography strongly impacts human virome variation, with differences seen across regions and between Western and non-Western populations.
The virome isn’t just a collection of pathogens; it actively interacts with the human host, affecting health in various ways. Phages can influence bacterial communities, and there’s increasing interest in phage therapy to treat drug-resistant bacterial infections. Phages may also directly interact with the host immune system, triggering immune responses. Alterations in virome populations have been associated with diseases like inflammatory bowel disease, type 1 diabetes, hypertension, and even colorectal cancer.
The Body Ages: The Aorta Story
As we age, the human body undergoes progressive changes, some of which are visible, while others occur at a microscopic level. The aorta, the largest artery in the human body, is a prime example of an organ that undergoes significant age-related changes. Its primary function is to transport oxygenated blood from the heart to all organs and cells.
With advancing age, the aorta’s morphology changes:
• The luminal diameter and overall length of the aorta progressively increase in both sexes.
• The thickness of the aortic wall, specifically the tunica intima and tunica media, increases. The tunica intima, the innermost layer, thickens with age due to the accumulation of myointimal cells that store lipids.
• The microstructural components of the aortic wall also change. There’s a decrease in elastic fibres and smooth muscle cells in the tunica media, while the amount of collagen fibres tends to increase. This leads to elastin fragmentation and fibrosis.
• These changes can result in increased blood pressure and reduced elasticity of the vessel.
Age is a significant risk factor for degenerative changes and diseases affecting the aorta, such as atherosclerosis. Atherosclerosis is characterised by the accumulation of plaque (fats, cholesterol, fibres, cells) in the intima layer, leading to conditions like thrombosis and lumen obstruction. Understanding these age-associated changes in the aorta is crucial for future clinical therapies and can even be applied for age determination.
Broader Health Context: From Local to Global
Beyond individual anatomical and physiological changes, public health initiatives play a vital role in human well-being. Exhibitions also address topics like immunisation, explaining it through cartoons and video games like “Champion Game: Your Body Against the Germs!”. The exhibit even featured equipment from the 1950s polio epidemic, including a modified tricycle used to help children maintain muscle strength. Health camps, some of which still operate in New Zealand, teach children life skills, personal hygiene, and self-care. The “Body Odyssey” exhibition also focused on local health issues like skin cancer and asthma, exploring allergic reactions and different treatment types, and even featuring a look at a smoker’s lung.
On a global scale, tackling health issues requires concerted efforts. In Nigeria, for instance, despite a sound education system and strong media networks, discussions around HIV/AIDS remain taboo, and misinformation is widespread due to government inaction. Against this backdrop, groups like Nigerian Journalists Against AIDS (JAAIDS) are tackling the issue with energy. Their website aims to educate Nigerian journalists on HIV/AIDS, enabling them to inform the public. The site is interactive, featuring an excellent AIDS e-forum where hundreds of members, not just journalists, exchange vital information and discuss health issues. JAAIDS founder Omolulu Falobi won an award for innovative internet use, and the site’s homepage provides hourly updates on new HIV cases and AIDS deaths in Nigeria, underscoring the urgency of information dissemination. As one source states, in the fight against AIDS, “information is everything”.
Finally, global health concerns like landmines also highlight the body’s vulnerability and the need for support. A benefit concert for the Campaign for a Landmine Free World brought together leading musicians like Emmylou Harris, Steve Earle, John Prine, and Elvis Costello to raise funds. Bobby Muller, president of Vietnam Veterans of America Foundation (VVAF), noted how crucial such support is for their work. The concert raised significant funds, with Harris and Nancy Griffith auctioning scarves made in a VVAF-sponsored rehabilitation centre, enough to clear landmines from about eight football pitches.
In conclusion, from the intricate workings of our cells and organs to the broad challenges of public health, the human body remains a source of endless discovery and a central focus of scientific and societal endeavour.
References
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2. Archer, K. (2002) ‘Immunisation is well explained in a cartoon and video game, Champion Game: Your Body Against the Germs!’, The Lancet, 359(9303), pp. 364–365.
3. Archer, K. (2002) ‘Burps, scabs, sunburn, and other pressing issues are examined in Body Odyssey, an exhibition that aims to explain to children the wonders of the human body’, The Lancet, 359(9303), pp. 364.
4. Archer, K. (2002) ‘The first exhibit looks at skin, and children can play in a giant model of skin, with pink pieces of foam to represent the epidermis, black spikes as hair, and plastic spheres for bubbles of sweat’, The Lancet, 359(9303), pp. 364.
5. Archer, K. (2002) ‘Only since the death from AIDS in 1997 of Fela Kuti, the popular Nigerian musician, did the issue of HIV/AIDS become a reality for many Nigerians’, The Lancet, 359(9303), pp. 364.
6. Archer, K. (2002) ‘Although the government now finally acknowledges that Nigeria has an HIV problem, critics would say their attempts to address the issues are too late and mostly, so far, incomplete’, The Lancet, 359(9303), pp. 364.
7. Archer, K. (2002) ‘Against this backdrop, it is inspirational to see groups such as Nigerian Journalists Against AIDS tackling this momentous task with so much energy and positivity’, The Lancet, 359(9303), pp. 364.
8. Archer, K. (2002) ‘The site is interactive and comprehensive’, The Lancet, 359(9303), pp. 364.
9. Archer, K. (2002) ‘In the fight against AIDS, information is everything’, The Lancet, 359(9303), pp. 364.
10. Hargreaves, S. (2002) ‘Leading American alt country musicians joined with the more traditional John Prine and the UK player and songwriter, Elvis Costello, for a benefit concert in aid of the Campaign for a Landmine Free World’, The Lancet, 359(9303), pp. 364.
11. Hargreaves, S. (2002) ‘Bobby Muller, president of VVAF (see page 273), spoke from the stage: “Nothing has enabled me to garner more support for our work than Emmylou Harris and her friends”’, The Lancet, 359(9303), pp. 365.
12. Archer, K. (2002) ‘The asthma exhibit explores allergic reactions with models of healthy and asthmatic airways and a Vaudeville-style cartoon, Pollen vs Asthma: an Allergic Drama’, The Lancet, 359(9303), pp. 364.
13. Archer, K. (2002) ‘A model of a blood vessel entered down a slide and complete with cushions for red and white blood cells attracted plenty of interest from toddlers’, The Lancet, 359(9303), pp. 365.
14. Archer, K. (2002) ‘Children can also have a play with “Dexter”, the Endoscope Dexterity Trainer’, The Lancet, 359(9303), pp. 365.
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16. Liang, G. and Bushman, F.D. (2021) ‘Abstract | The human body hosts vast microbial communities, termed the microbiome’, Nature Reviews Microbiology, 19, pp. 415–425.
17. Liang, G. and Bushman, F.D. (2021) ‘Viral populations vary greatly across the human body’, Nature Reviews Microbiology, 19, pp. 415–425.
18. Liang, G. and Bushman, F.D. (2021) ‘Recent studies have uncovered numerous factors that show associations with virome structure in addition to anatomical location, such as diet, age, and geographic location of the individual sampled’, Nature Reviews Microbiology, 19, pp. 415–425.
19. Liang, G. and Bushman, F.D. (2021) ‘Viruses that are found in humans can be categorised by various features’, Nature Reviews Microbiology, 19, pp. 415–425.
20. Liang, G. and Bushman, F.D. (2021) ‘Most constituents of the human virome are inferred to be phages’, Nature Reviews Microbiology, 19, pp. 415–425.
21. Liang, G. and Bushman, F.D. (2021) ‘Table 1 | Examples of viral population alterations in human disorders’, Nature Reviews Microbiology, 19, pp. 415–425.
22. Liang, G. and Bushman, F.D. (2021) ‘Viruses that infect human cells are also an important part of the human virome’, Nature Reviews Microbiology, 19, pp. 415–425.
23. Liang, G. and Bushman, F.D. (2021) ‘Virome of different body sites Numerous recent studies have characterized the human virome at different body sites, revealing rich populations at numerous locations (fig. 2)’, Nature Reviews Microbiology, 19, pp. 415–425.
24. Liang, G. and Bushman, F.D. (2021) ‘Metagenomic sequencing of the human gut virome also indicated that Caudovirales is commonly predominant, along with the spherical Microviridae (reviewed in refs9,10,35–38)’, Nature Reviews Microbiology, 19, pp. 415–425.
25. Liang, G. and Bushman, F.D. (2021) ‘A notable pattern in viruses of the gut is that most residents, including both phages and human viruses, are not enveloped’, Nature Reviews Microbiology, 19, pp. 415–425.
26. Liang, G. and Bushman, F.D. (2021) ‘Oral cavity ~10^8 VLPs per millilitre of saliva’, Nature Reviews Microbiology, 19, pp. 415–425.
27. Liang, G. and Bushman, F.D. (2021) ‘Gastrointestinal tract ~10^9 VLPs per gram of faeces’, Nature Reviews Microbiology, 19, pp. 415–425.
28. Liang, G. and Bushman, F.D. (2021) ‘Vagina Eukaryotic viruses Anelloviridae Herpesviridae’, Nature Reviews Microbiology, 19, pp. 415–425.
29. Liang, G. and Bushman, F.D. (2021) ‘Urinary system ~10^7 VLPs per millilitre of urine’, Nature Reviews Microbiology, 19, pp. 415–425.
30. Liang, G. and Bushman, F.D. (2021) ‘Oral cavity. The human oral cavity contains diverse viral communities as well as complex microbial populations’, Nature Reviews Microbiology, 19, pp. 415–425.
31. Liang, G. and Bushman, F.D. (2021) ‘Respiratory tract. Virome analyses have been performed on respiratory tract samples including sputum, nasopharyngeal swabs and bronchoalveolar lavage, showing that the healthy human lung and respiratory tract can be populated by large viral communities29,58–62’, Nature Reviews Microbiology, 19, pp. 415–425.
32. Liang, G. and Bushman, F.D. (2021) ‘Blood. Viruses of blood have been studied closely, to understand human health and also to assess the safety of donor blood supplies’, Nature Reviews Microbiology, 19, pp. 415–425.
33. Liang, G. and Bushman, F.D. (2021) ‘Skin. Compared with other body sites, the skin has a relatively low microbial biomass, which can, for some samples, make it difficult to distinguish the resident microbiome and virome from various forms of contamination’, Nature Reviews Microbiology, 19, pp. 415–425.
34. Liang, G. and Bushman, F.D. (2021) ‘Urogenital system. Urine samples from healthy humans have been reported to contain viruses in the region of 10^7 VLPs per millilitre72’, Nature Reviews Microbiology, 19, pp. 415–425.
35. Liang, G. and Bushman, F.D. (2021) ‘Nervous system. Little information is available on virome populations in the nervous system in healthy humans’, Nature Reviews Microbiology, 19, pp. 415–425.
36. Liang, G. and Bushman, F.D. (2021) ‘To summarize the virome over multiple human body sites, the human gut contains the most abundant viruses and has been the most frequently studied’, Nature Reviews Microbiology, 19, pp. 415–425.
37. Liang, G. and Bushman, F.D. (2021) ‘Establishment of the human virome Timing of the first microbial colonization’, Nature Reviews Microbiology, 19, pp. 415–425.
38. Liang, G. and Bushman, F.D. (2021) ‘The virome at delivery. An early study of virome colonization sampled meconium shortly after delivery, and failed to find VLPs using epifluorescent microscopy but did report ~108 VLPs per gram at 1 week of life, suggesting that the neonate lacked a virome at birth but was quickly colonized93’, Nature Reviews Microbiology, 19, pp. 415–425.
39. Liang, G. and Bushman, F.D. (2021) ‘The first detectable viruses — a predominance of phages’, Nature Reviews Microbiology, 19, pp. 415–425.
40. Liang, G. and Bushman, F.D. (2021) ‘A recent study investigated the production of the virome in gut samples of infants at 1 month of life and concluded that lytic phages were relatively rare49’, Nature Reviews Microbiology, 19, pp. 415–425.
41. Liang, G. and Bushman, F.D. (2021) ‘Later evolution of the paediatric virome. The paediatric virome continues to mature with age’, Nature Reviews Microbiology, 19, pp. 415–425.
42. Liang, G. and Bushman, F.D. (2021) ‘Colonization of infants with viruses infecting human cells. The viruses that replicate in human cells are also detected in metagenomic surveys of samples taken in early life’, Nature Reviews Microbiology, 19, pp. 415–425.
43. Liang, G. and Bushman, F.D. (2021) ‘Thus, recent data suggest that healthy infants are colonized in a stepwise fashion’, Nature Reviews Microbiology, 19, pp. 415–425.
44. Liang, G. and Bushman, F.D. (2021) ‘Diet. The infant virome, including both phages and eukaryotic viruses, can be affected by diet’, Nature Reviews Microbiology, 19, pp. 415–425.
45. Liang, G. and Bushman, F.D. (2021) ‘Host genetics and immunity. Intense interest has focused on the potential influence of human genetics on the microbiome, raising the linked question of the role of human genetics in programming the virome’, Nature Reviews Microbiology, 19, pp. 415–425.
46. Liang, G. and Bushman, F.D. (2021) ‘However, in inherited diseases such as primary immunodeficiencies, the effects of genetics on the virome are well established’, Nature Reviews Microbiology, 19, pp. 415–425.
47. Liang, G. and Bushman, F.D. (2021) ‘Diet, Medication, Disease, Geography, Ageing, Genetics, Cohabitation, Fig. 4 | Factors that shape the human virome’, Nature Reviews Microbiology, 19, pp. 415–425.
48. Liang, G. and Bushman, F.D. (2021) ‘Geography and stochastics of colonization. Large-scale virome studies have provided evidence that geographic location and stochastics of colonization have strong impacts on human virome variation’, Nature Reviews Microbiology, 19, pp. 415–425.
49. Liang, G. and Bushman, F.D. (2021) ‘Additional factors. Additional factors have been tested and reported to influence the human virome’, Nature Reviews Microbiology, 19, pp. 415–425.
50. Liang, G. and Bushman, F.D. (2021) ‘The virome in health and disease Virome populations can influence their human hosts in numerous ways’, Nature Reviews Microbiology, 19, pp. 415–425.
51. Liang, G. and Bushman, F.D. (2021) ‘Interactions between bacteria, phage and their human hosts. Relatively little is known about the impact of phage predation on human bacterial communities’, Nature Reviews Microbiology, 19, pp. 415–425.
52. Liang, G. and Bushman, F.D. (2021) ‘Recent in vitro and animal studies indicated that phages may interact with the host immune system directly’, Nature Reviews Microbiology, 19, pp. 415–425.
53. Liang, G. and Bushman, F.D. (2021) ‘Human disease-associated virome signatures. Studies of interactions between the virome with human diseases are just starting’, Nature Reviews Microbiology, 19, pp. 415–425.
54. Liang, G. and Bushman, F.D. (2021) ‘Conclusions and perspectives The virome field has come a long way since the first paper in 2002 that reported metagenomic sequencing of a viral specimen’, Nature Reviews Microbiology, 19, pp. 415–425.
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You need to memorise the names of the bones in the human hand. What to do to achieve it quickly?
The best technique depends on your learning style, but the most effective ones are usually:
Mnemonic Acronyms or Phrases (Acronyms/Reverse Acronyms)
These are widely used in anatomy because they’re quick, memorable, and easy to recall under exam pressure.
Carpal Bones (wrist, proximal and distal rows):
There are 8 carpal bones:
Proximal row (lateral to medial): Scaphoid, Lunate, Triquetrum, Pisiform
Distal row (lateral to medial): Trapezium, Trapezoid, Capitate, Hamate
Mnemonic Example:
“Some Lovers Try Positions That They Can’t Handle”
Each first letter corresponds to a carpal bone:
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
Make it personally vivid or funny to improve recall.
Memory Palace (Method of Loci)
Use this if you’re more visual-spatial and need to learn locations and relationships between bones.
Example:
Visualize a hallway with 8 rooms (or stops).
Associate each room with an exaggerated image:
Room 1: A scarf (for Scaphoid) wrapped around a wrist
Room 2: A glowing moon (Lunate) on the floor
Room 3: A triangle shaped sculpture (Triquetrum)
Room 4: A cat purring loudly (Pisiform)
Room 5: A gymnast on a trapeze (Trapezium)
Room 6: A puzzle (pieces fitting perfectly like Trapezoid)
Room 7: A cap worn on a statue (Capitate)
Room 8: A hammer smashing something (Hamate)
Then mentally walk through this “palace” when recalling.
Peg Method (Rhyme-Based Association)
This can be adapted if you want to learn both names and order, especially useful for numbered bones like metacarpals or phalanges.
Example pegs:
1 is a bun: imagine a bun with a scaphoid inside.
2 is a shoe: shoe made of lunate, etc.
Less common for anatomy, but good if you’re already familiar with peg systems.
Best Pick for Most Students:
Acronym + Spatial Diagram Sketching
Start with mnemonic phrases like “Some Lovers Try Positions That They Can’t Handle”, then reinforce it by drawing hand diagrams repeatedly, labelling each bone. This builds both verbal and spatial memory.
Region
Elements
Mnemonic
Carpals
8 named bones
“Some Lovers Try Positions That They Can’t Handle”
Metacarpals
Thumb to Little (I–V)
“Tall Individuals Make Real Leaders”
Phalanges Order
Proximal → Middle → Distal
“Please Make Dinner”
Thumb Phalanges
Proximal → Distal only
“Thumbs Prefer Dessert”
Rerefences:
Iftikhar, N. (2019). Important Joints: Hand and Wrist Bones. [online] Healthline. Available at: https://www.healthline.com/health/wrist-bones.
National Library of Medicine (2018). How do hands work? [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279362/.
Do you ever feel like your brain is a sieve, with important information constantly slipping through? You’re not alone! From studying for exams to remembering crucial professional protocols, retaining knowledge can be a challenging. The good news is that we don’t have to rely solely on our innate memory capacity. A growing body of research into the science of learning offers powerful, evidence-based strategies to make knowledge stick. Central among these are mnemonic devices and related cognitive strategies that can profoundly enhance your ability to learn and remember.
The Secret Weapon: Mnemonic Devices
At their core, mnemonic devices are mental tools that assist individuals in remembering specific words, lists, or even complex concepts by categorising information into smaller, more manageable chunks. They act as “learning strategies which can often enhance the learning and later recall of information,” serving as effective procedures for remembering. But these aren’t just “tricks of memory”; when used correctly, they can be invaluable organising systems for retrieving information.
Beyond Rote: How Mnemonics Conquer Complex Information
Mnemonic devices are far more versatile than simple acronyms. They primarily aim to convey information across several broad categories, especially in high-stakes fields like medicine and emergency response.
• Clinical and Anatomical Information: In the medical world, mnemonics are widely used to simplify the memorisation of complex details. For instance, an “easy” mnemonic might describe the position of anatomical features like the conoid tubercle (medial) relative to the trapezoid line (lateral). For “medium complexity,” a mnemonic can outline the contents of the submandibular region, famously described as a “normal sandwich” with muscles as “bread” and a nerve (CN XII) as “ham”. Advanced methods use acronyms for intricate details, such as the branches of the maxillary artery. Beyond anatomy, mnemonics are vital for relaying a patient’s medical condition, medical history, evaluation results, and diagnoses, as well as for care planning and identifying outstanding tasks. The well-known SOAP mnemonic (Subjective, Objective, Assessment, Plan) is a prime example, ensuring all relevant information is included during patient assessments and clinical note-taking.
• Procedural and Protocol Information: In high-stress, time-sensitive environments, recalling sequences of actions or steps is critical. Mnemonics are crucial for clinical handover processes, ensuring essential elements for patient safety are covered during the transfer of patient information and responsibilities among healthcare providers. Mnemonics like 4W1H (“Who, What, Where, When, How”) and GRRRR (Greeting, Respectful listening, Review, Recommend or request more information, Reward) are exclusively focused on guiding effective communication processes during these handovers. In emergency response, mnemonics are used to teach and recall critical tasks. The Paris Fire Brigade uses “I AM THOR” (or “DUST DAHO” in French) to help first responders remember the chemical, biological, radiological, and nuclear (CBRN) chain of survival. Similarly, the US military has used the “MARCH” mnemonic in Tactical Combat Casualty Care (TCCC) for diagnosis and treatment protocols for war-injured individuals.
• General Academic and Everyday Learning:
◦ Memory Palaces (Method of Loci): This ancient Greek technique involves associating mental images with a series of physical locations you know well, like your home. By taking an imaginary walk through this space, you can retrieve countless memories cued by its prominent features. Psychology students in Oxford, for example, visit different cafés to construct “memory palaces” for their exam essays, linking key ideas to vivid characters and locations within the café. Mark Twain used a similar visual approach, sketching rough outlines of his speeches to remember the sequence of his remarks, finding them far more effective than snippets of text.
◦ Acronyms and Rhyme Schemes: Simple yet powerful, acronyms like “ROY G BIV” for rainbow colours are widely taught. The “peg method” uses rhyming concrete images (e.g., “1 is bun, 2 is shoe”) to help remember lists of items.
◦ Songs and Stories: Even complex historical information can be embedded in songs. The Mongol “Long Song,” for instance, is thought to have been used to communicate movements across vast distances, with varying tones and trills conveying specific locations. In a broader sense, rock art itself served as a mnemonic trigger for cultural knowledge and narratives across time for Indigenous communities.
Supercharge Your Learning: Strategies Beyond Simple Tricks
While mnemonics are powerful, effective memory improvement involves several other key cognitive strategies, often referred to as “desirable difficulties” because they feel harder in the moment but lead to much stronger, more durable learning.
• Embrace Effortful Retrieval Practice: Recalling facts or concepts from memory is a more effective learning strategy than simply rereading material. This “retrieval practice” tells you what you know (and don’t know) and, crucially, reconsolidates the memory, strengthening its connections to prior knowledge and interrupting forgetting. The more effort required for retrieval, the stronger the benefit.
◦ Real-life example: Neurosurgeon Mike Ebersold constantly practises complex surgical procedures that rarely occur, ensuring his skills remain sharp through repeated retrieval. Similarly, business jet pilot Matt Brown undergoes regular tests and flight simulations that require him to retrieve essential information and manoeuvres, keeping his knowledge fresh.
• Space Out Your Practice: Cramming for exams might yield immediate results, but the advantage quickly fades. Instead, spaced practice – studying information multiple times with considerable time between sessions – allows for a process of “consolidation,” where memory traces are strengthened and connected to prior knowledge over hours or days.
◦ Real-life example: Medical residents whose surgical training was spaced out over weeks showed better retention and application of techniques compared to those who crammed it into one intensive session. A simple Leitner box system for flashcards exemplifies this: the better you know a card, the less often you review it, but it’s never completely removed from practice.
• Mix It Up with Interleaving: Instead of studying one topic until mastered before moving to the next, interleaving involves mixing the practice of different but related topics or skills. This forces your brain to continually “reload” what it knows, building more flexible mental models and increasing the versatility with which you can apply your learning.
◦ Real-life example: In ice hockey, a coach might vary the starting positions for one-touch passes rather than always practising from the same spot, preparing players for diverse game scenarios.
• Elaborate and Generate:
◦ Elaboration means finding additional layers of meaning in new material, such as explaining it in your own words, relating it to what you already know, or discovering a metaphor or visual image for it. This strengthens learning by multiplying mental cues for later recall.
◦ Generation is the act of attempting to answer a question or solve a problem before being shown the solution. This effort primes the mind, making it more receptive to the answer when it is finally provided, forging deeper connections.
◦ Real-life example: When facing writer’s block, acclaimed author John McPhee would write a letter to his mother explaining his topic as if describing it to her, then remove the conversational parts, leaving behind the core ideas. This “awful blurting” (generation) helps the mind “knit” at the problem, making sense of unfamiliar material.
• The Power of Reflection: Reflection is a structured form of retrieval and elaboration. It involves asking yourself: “What did I do? How did it work? What would I do differently next time?”. This practice cultivates self-awareness and continuous improvement.
◦ Real-life example: Mike Ebersold, the neurosurgeon, uses reflection to improve his operating room skills by thinking through his actions and outcomes, leading him to devise innovative surgical solutions.
The Brain That Learns
These strategies work because our brains are remarkably plastic. All knowledge and memory are physiological phenomena, held in our neurons and neural pathways. The brain constantly reorganises itself with each new task, and effortful learning, in particular, strengthens and expands these neural pathways. This means that our intellectual abilities are not fixed; they are largely within our own control and can be increased through deliberate practice.
Start Remembering More Today
Many common study habits, like simply rereading texts or highlighting passages, are largely ineffective and create an “illusion of mastery”. The key is to be proactive and engage in active learning. By incorporating mnemonic devices and embracing retrieval practice, spaced learning, interleaving, elaboration, generation, and reflection into your daily routine, you can significantly enhance your memory and learning capabilities, whether you’re a student, a professional, or a lifelong learner.
It’s time to stop wishing for a better memory and start building one!
References
• Behrens, V., Osten, J., Herrler, A., Behrens, S., & Clarner, T. (2025). Presentation number: P8.09 Topic: Latest developments in undergraduate and postgraduate training Role of Examination Format, Teaching Material and Methods in Anatomical Courses for Dental Students. Retrieved from https://doi.org/10.1016/j.aanat.2025.152647
• Brown, P.C., Roediger, H.L., & McDaniel, M.A. (2014). Make It Stick: The Science of Successful Learning. The Belknap Press of Harvard University Press.
• Giaume, L., Daniel, Y., Calamai, F., Derkenne, C., Kedzierewicz, R., Demeny, A., Bertho, K., Travers, S., Prunet, B., & Dorandeu, F. (2021). “I AM THOR/DUST DAHO”: mnemonic devices used by the Paris Fire Brigade to teach initial measures in undertaking a CBRN event. Critical Care, 25(116). https://doi.org/10.1186/s13054-021-03539-z
• Kurc-Darak, B., Domagala, D., Muzyka-Wozniak, M., & Domagala, Z. (2025). Anatomy learning is a key factor for becoming a medical professional. Anatomical features retaining is a challenging matter. Retrieved from https://doi.org/10.1016/j.aanat.2025.152649
• Yung, A.H.W., Pak, C.S., & Watson, B. (2023). A scoping review of clinical handover mnemonic devices. International Journal for Quality in Health Care, 35(3), mzadd065. https://doi.org/10.1093/intqhc/mzad065
• Zubieta, L.F. (Ed.). (2022). Rock Art and Memory in the Transmission of Cultural Knowledge. Springer Nature Switzerland AG. https://doi.org/10.1007/978-3-030-96942-4
Thyroid hormones (TH) are essential for a wide array of physiological processes, including growth, development, differentiation, and metabolism. The body’s ability to maintain flexible homeostatic equilibria of TH in response to environmental challenges is a key indicator of a healthy state. While traditional understanding focused on a proportional negative feedback control between the thyroid and pituitary glands, recent research indicates a more complex and dynamic system. This updated view highlights that homeostatic equilibria are governed by intricate inter-relationships between thyroid hormones and pituitary thyrotropin (TSH), displaying significant individuality, a hierarchical structure based on thyroid state, and adaptive conditionality.
Homeostatic Control of the Thyroid-Pituitary Axis A basic understanding of thyroid control, mediated by pituitary TSH, has been extensively utilised in the diagnosis of thyroid disorders. As a result, TSH measurement, despite being an indirect marker of thyroid homeostasis, has become a central component of modern thyroid function testing.
The concept of a feedback control loop between the thyroid and the pituitary was first proposed in 1940 and experimentally confirmed by 1950. Early models posited an inverse linear correlation between TSH and T4, which was later revised to a log-linear relationship and adopted as the standard model. However, current knowledge suggests this simplistic log-linear concept requires reconsideration due to the inherent complexity of the underlying system.
More detailed analyses reveal that the TSH-FT4 relationship is curvilinear and exhibits a damped response in the middle portion of the euthyroid range, with steeper gradients observed at the hypothyroid or hyperthyroid extremes. This non-linear characteristic facilitates a dampened response, which is more effective at maintaining the controlled parameter at a stable level with minimal fluctuation. This adaptable response is thought to originate from the integrated action of multiple feedback loops operating at various levels of biological organisation.
The integrated control system of thyroid homeostasis incorporates several major feedback loops:
• Negative Feedback Control: Thyroid hormones exert a repressive action on pituitary TSH and hypothalamic TRH.
• Positive Stimulatory Control: TRH actively stimulates TSH secretion.
• Ultrashort Feedback: TSH is involved in a feedback loop that suppresses its own secretion.
• Feedforward Control: TSH directly influences deiodinase activity, thereby regulating the conversion of T4 to T3.
Molecular Mechanisms Involved in Feedback Control The complexity and non-proportional nature of thyroid homeostasis are underpinned by various molecular mechanisms:
• Thyroid Hormone Receptors (TRs): Both T3 and T4 (after its conversion to T3) bind to specific intracellular TR receptors, leading to the repression of several genes, including TSHβ and, to a lesser extent, α-subunit. The TRβ2 isoform, found in the central nervous system, hypothalamus, and pituitary, exhibits up to a 10-fold enhanced sensitivity to thyroid hormones compared to TRβ1, which allows central tissues to anticipate T3/T4 oversupply before it affects less sensitive peripheral tissues.
• Deiodinases: These enzymes are crucial for regulating T3 conversion and provide a sophisticated mechanism for sensitive responses to changes in FT4 within the feedback loop. Specifically, type 2 deiodinase (D2) ubiquitination is critical for hypothalamic negative feedback regulation and is expressed non-uniformly across different tissues. D2 facilitates the conversion of the pro-hormone thyroxine (T4) into its active metabolite, T3, particularly in glial cells and tanycytes in the hypothalamus, while type 3 deiodinase (D3) inactivates both T4 and T3. This local enzymatic activity can result in tissue-specific states of hypothyroidism or thyrotoxicosis, even when systemic euthyroidism is maintained.
• Thyroid Hormone Transporters: T3 and T4 do not freely diffuse across cell membranes but are actively transported by specialised proteins such as MCT8, MCT10, and OATP1C1. Intracellular trafficking also involves internal binding substrates (IBS) of thyroid hormones. These transporters are essential components of the feedback control system.
• TRH and TSH: Thyrotropin-releasing hormone (TRH) functions as a potent defensive mechanism against thyroid hormone undersupply, stimulating pituitary TSH secretion and modulating its bioactivity. TSH stimulation of thyroid hormone production is vital, as the basal capacity of the thyroid gland is limited without it. Tissue-specific glycosylation of TSH also contributes to targeted signalling. Long feedback control of TRH release by TH involves both hypophysiotropic TRH neurons and tancytes, which can adjust the set point and integrate energy metabolism and thyroid function.
• Pulsatility of TSH Secretion: TSH is secreted in a pulsatile manner, with rapid oscillations superimposed on a circadian rhythm that typically peaks shortly after midnight. This pulsatile release may be advantageous by preventing homologous desensitisation of the thyrotropin receptor. Furthermore, a direct link between TSH and deiodinase activity may partly explain the circadian rhythm observed in T3 levels that parallels TSH.
• Non-Classical Thyroid Hormones: Emerging research suggests an active physiological role for less recognised non-classical thyroid hormones, including reverse triiodothyronine (rT3), 3,5-diiodothyronine (T2), iodothyroacetates, and thyronamines. Some of these molecules, such as 3,5-T2, TRIAC, and TETRAC, exert thyromimetic effects at TR-β receptors, leading to TSH-suppressive actions, which implies their role as important modulators of the overall control system.
• Other Modulating Influences: A multitude of physiological and pathophysiological factors, including age, body mass index (BMI), genetic polymorphisms, and conditions like non-thyroidal illness (NTI) syndrome, modulate the relationship between TSH and thyroid hormones and influence the position of the set point in both health and disease.
Consequences for Thyroid Function Testing and Treatment The traditional paradigm of TSH as the sole and primary diagnostic parameter for thyroid function is increasingly being challenged.
• Limitations of TSH Measurement: TSH is fundamentally an indirect measure of thyroid hormone homeostasis and a controlling element, not a simple, isolated statistical parameter. Its interpretation is complicated by its non-proportional (non-log-linear) and conditional relationship with thyroid hormones, as well as its high degree of individuality. Consequently, the same TSH value can be considered “normal” for one individual but “pathological” for another.
• Controversy over Reference Ranges: There is ongoing debate regarding the appropriate reference limits for TSH, particularly its upper limit used to define subclinical hypothyroidism. Conventional methods for establishing these ranges may be insufficient, leading to exploration of more personalised and multivariate approaches for TSH referencing. Furthermore, circadian and ultradian rhythms of TSH levels can reduce diagnostic accuracy unless reference intervals are adjusted or blood sampling is restricted to specific times, such as morning.
• Subclinical Thyroid Dysfunction: Current definitions of subclinical hypothyroidism and hyperthyroidism, which are based on abnormal TSH levels while FT3 and FT4 remain within their reference ranges, may not consistently and accurately classify disease states. Patients diagnosed with subclinical hypothyroidism, for instance, are identified as a heterogeneous population comprising both truly dysfunctional and truly euthyroid subjects.
• Challenges in L-T4 Treatment: The assumption that a patient’s own pituitary gland is a reliable determinant for establishing the correct dosage of L-T4 treatment has been challenged. In athyreotic patients receiving L-T4, the intricate inter-relationships between FT3, FT4, and TSH are not rigidly fixed but are instead conditionally and homeostatically determined. Three significant phenomena have been observed in L-T4-treated patients:
1. A dissociation between FT3 and FT4 concentrations.
2. A discernible disjoint between TSH and FT3 levels. Approximately 15% of athyreotic patients may experience a chronically low-T3 state, even if their TSH levels are normalised.
3. An L-T4-related conversion inefficiency. This means that increasing the L-T4 dose may not always resolve T3 deficiency and could, in fact, impede its attainment. Rodent models further suggest that these disequilibria may indicate widespread tissue hypothyroidism in various organs, despite normal TSH levels.
• Re-evaluating TSH’s Role: The sources propose that the use of TSH, while valuable in certain situations, should be relegated to a supporting role that more accurately reflects its conditional interaction with peripheral thyroid hormones. It is underscored that the measurement and consideration of FT3 and conversion efficiency are equally important, especially in scenarios where TSH and FT3 levels diverge.
• Need for Standardisation and New Biomarkers: The discussion around measuring free thyroid hormones is re-opened, and the identification of suitable biomarkers is encouraged. While TSH assays are traceable to a single WHO standard, methods for FT4 and particularly FT3 urgently require equivalent standardisation and harmonisation to play a clinically acceptable role within an integrated diagnostic concept.
Summary and Future Outlook The concept of thyroid homeostasis offers fresh perspectives for optimising the interpretation of thyroid function tests and mitigating the inappropriate diagnostic reliance on an isolated statistical interpretation of TSH. TSH is not considered a precise marker of euthyroidism nor is it optimal for fine-tuning thyroid control, and TSH levels defined for optimum health may not be applicable to many L-T4-treated patients. The observed disjoint between FT3 and TSH concentrations in athyreotic patients indicates that T4 monotherapy may be insufficient to adequately meet their therapeutic needs, as FT3 levels become unstably dependent on exogenous T4 supply.
Homeostatic principles advocate for a more personalised approach to diagnosis and a consideration of thyroid function within a more conditional, adaptive context, thereby challenging the isolated interpretation and disease-defining value of TSH measurements. Future research should prioritise exploring multivariate reference limits, personalised set point reconstructions, and the additional clinical value of FT3 in defining thyroid status and assessing the adequacy of thyroid hormone replacement therapy. Furthermore, the potential adverse effects and long-term risks associated with the unphysiological FT3-FT4 ratio, FT3-TSH disjoint, and impaired deiodinase activity seen with current L-T4 replacement warrant careful investigation. This supports the potential role of combined T3 and T4 treatment for selected patients who exhibit poor conversion efficiency. It remains general good clinical practice to interpret laboratory test results in conjunction with a comprehensive clinical assessment of the patient’s history and symptoms.
Hypothyroid treatment
The sources indicate that while T3 is crucial for physiological processes, it is not as widely considered in hypothyroid treatment as TSH for several reasons, primarily stemming from historical diagnostic practices and the perceived limitations in its measurement and interpretation:
• Historical Reliance on TSH: The discovery that pituitary Thyrotropin (TSH) responds inversely and with exaggerated sensitivity to underlying thyroid hormone concentrations greatly influenced clinical thyroid testing. This led to TSH becoming the central and dominant parameter in contemporary thyroid function testing, largely due to its ease of measurement and cost-effectiveness. The clinical community embraced TSH as a simple and efficient diagnostic tool, which inadvertently obscured the complex relationship between TSH and the hormonal milieu. It was widely assumed that the patient’s own pituitary gland would reliably determine the adequate dosage of L-T4 treatment, making TSH a sufficient target for therapy.
• Complexity and Individuality of Homeostasis: The long-held, simpler concept of a log-linear relationship between TSH and Free T4 (FT4) has been challenged by more recent studies. Research now shows the TSH-FT4 relationship is curvilinear and damped in the middle portion of the euthyroid range, with steeper gradients at the extremes, allowing for a more flexible and robust defense of the thyroid state. TSH is understood to be an indirect measure and a controlling element, not a simple isolated statistical parameter. TSH values are highly individual; the same TSH value might be considered “normal” for one person but “pathological” for another. This individuality and the complex, conditional nature of thyroid homeostasis complicate relying solely on TSH as a precise marker of euthyroidism or for fine-tuning treatment.
• Limitations in L-T4 Monotherapy and T3 Stability: In patients treated with L-Thyroxine (L-T4) monotherapy, the intricate inter-relationships between Free Triiodothyronine (FT3), FT4, and TSH are often not fixed as in healthy individuals but are conditionally determined. The sources highlight several issues in L-T4-treated patients:
◦ A dissociation between FT3 and FT4 concentrations.
◦ A discernible disjoint between TSH and FT3 levels. Approximately 15% of athyreotic patients (those without a thyroid gland) receiving L-T4 may experience a chronically low-T3 state, even if their TSH levels are normalised.
◦ An L-T4-related conversion inefficiency, meaning that increasing the L-T4 dose may not resolve T3 deficiency and could even hinder its attainment.
◦ Rodent models suggest that these observed disequilibria may indicate widespread tissue hypothyroidism in various organs (e.g., brain, liver, skeletal muscle) despite normal TSH levels.
◦ L-T4 treatment, which lacks the approximately 10% naturally secreted T3 component, is described as an “unphysiological treatment modality,” where homeostatic responses differ from normality.
◦ The quality of life for a substantial portion of hypothyroid patients on levothyroxine may be reduced, even with normal TSH levels.
• Lack of Standardization for FT3 Measurement: While TSH assays are traceable to a single WHO standard, methods for FT4 and especially FT3 urgently require equivalent standardisation and harmonisation to be clinically acceptable in an integrated diagnostic concept. This lack of standardisation significantly limits the widespread clinical utility and reliability of FT3 measurements compared to TSH.
• Limited Human Data on Tissue T3: There is a general lack of corresponding data on tissue T3 levels in humans, which hinders a full understanding of T3 adequacy at the cellular level despite circulating hormone levels.
In light of these findings, the sources advocate for TSH to be scaled back to a supporting role, emphasizing that the measurement and consideration of FT3 and conversion efficiency are equally important, especially when TSH and FT3 levels diverge. This approach pushes for a more personalised and adaptive context for diagnosing and treating thyroid dysfunction, moving away from an isolated interpretation of TSH measurements.
References:
• Hoermann, R., Midgley, J.E.M., Larisch, R. and Dietrich, J.W. (2015) ‘Homeostatic Control of the Thyroid–Pituitary Axis: Perspectives for Diagnosis and Treatment’, Frontiers in Endocrinology, 6, p.177. doi: 10.3389/fendo.2015.00177.
◦ This primary source was instrumental in detailing the complexities of the thyroid-pituitary axis, the limitations of TSH as a sole diagnostic marker, and the issues arising from L-T4 monotherapy, particularly concerning T3 stability and conversion efficiency.
• McAninch, E.A. and Bianco, A.C. (2014) ‘Thyroid hormone signaling in energy homeostasis and energy metabolism’, Annals of the New York Academy of Sciences, 1311, pp. 77–87. doi: 10.1111/nyas.12374.
◦ This source provided supporting context on the physiological roles of thyroid hormones, particularly T3, in energy homeostasis, cellular metabolism, and the activity of deiodinases at the tissue level, reinforcing the idea that T3’s actions are highly regulated at the cellular and organismal levels.
Whether you’re starting a research paper or polishing a university essay, understanding how to find and use credible academic sources is essential. By the end of this guide, you’ll have the tools to confidently navigate the world of academic research and referencing.
What Makes a Source Credible? Not all sources are created equal. Credible sources are typically written by experts, backed by evidence, and published by reputable organizations or academic publishers. Learn to evaluate sources by asking:
Who is the author?
Is it peer-reviewed?
Is the information current and relevant?
How to Find Reliable Academic Sources Knowing where to look is just as important as knowing what to look for. University libraries, online academic databases (like JSTOR, Google Scholar, or PubMed), and institutional repositories are great starting points. Understanding search strategies will help you find high-quality materials efficiently.
Referencing: Getting It Right Referencing isn’t just about avoiding plagiarism—it’s about showing academic integrity and giving credit to others’ ideas. Whether you’re using APA, MLA, or Harvard style, consistency and accuracy are key. Learn the rules of your required citation style and apply them carefully throughout your work.
Quoting, Summarising, and Paraphrasing: Know the Difference Quoting involves copying a passage word for word with quotation marks. Summarising means giving a brief overview of a larger text. Paraphrasing is rewording someone else’s idea in your own words. Each serves a different purpose, and knowing when to use which is essential for strong academic writing.
How to Paraphrase Effectively Effective paraphrasing means more than just changing a few words—it’s about truly understanding the original idea and expressing it in your own voice. Practice by reading a passage, setting it aside, and then writing the idea in your own words. Always follow up with proper citation.
By mastering these skills, you’ll not only improve your academic writing but also build confidence in your ability to research and engage critically with scholarly material.
Dupuytren’s contracture (DC) is a progressive fibroproliferative disorder of the palmar fascia, characterized by nodules, cords, and eventual flexion contractures of the fingers. Its management presents persistent challenges—not only due to its progressive nature but also because of the variability in treatment outcomes and recurrence definitions. Recent research has aimed to clarify these issues, contributing to more standardized clinical care.
Dupuytren’s contracture is named after Baron Guillaume Dupuytren (1777–1835), a renowned French surgeon. He was the first to describe and surgically treat the condition in detail in 1831.
Figure 1 Trigger finger from Dupuytren’s (Rella, 2019)
Using the Delphi method, a structured communication process, an international panel of 21 experts from ten countries defined recurrence as:
“An increase in joint contracture in any treated joint of at least 20 degrees at one year post-treatment compared to six weeks post-treatment”
Key features of this definition include:
Focus on angular measurement (contracture) rather than the presence of nodules or cords.
Use of the six-week post-treatment measurement as a baseline, rather than intraoperative metrics.
Emphasis on joint-specific recurrence rather than global recurrence across the hand.
This provides a more objective and reproducible benchmark for comparing treatment modalities and enables clinicians to better understand long-term outcomes.
One of the most critical developments in the field has been the consensus-based definition of recurrence, presented by Kan et al. in PLOS ONE (2017). Historically, recurrence rates for DC have varied dramatically across studies—from as low as 0% to nearly 100%—due in large part to the lack of a unified definition.
A recent letter published in the New England Journal of Medicine critically examined the trial results from Dias et al., which compared collagenase injections with limited fasciectomy. The trial had concluded that collagenase was “not noninferior” to surgery, prompting debate.
In response, Blazar and Atroshi argued that:
Collagenase injections showed superior short-term functional outcomes.
Surgeons had more experience with surgery than with collagenase, possibly biasing results.
While recurrence rates were similar (17.2% for collagenase vs. 13.8% for surgery), reintervention was higher in the collagenase group—possibly due to differing thresholds for action, rather than actual treatment failure.
Moreover, the complication profile favored collagenase:
Surgery carried risks including nerve damage (14.2%), infection, CRPS, and even amputation.
In contrast, collagenase avoided many of these risks and required less downtime from work or daily activities.
The Importance of Accurate Diagnosis Another key point raised by Rayan and Porembski is the potential misclassification of non-Dupuytren’s palmar fibromatosis as Dupuytren’s disease in clinical trials. Non-Dupuytren’s fibromatosis:
Lacks genetic predisposition
Is often non-progressive
May not recur after treatment
Their concern is that inclusion of such patients may artificially skew trial outcomes, particularly recurrence and complication rates.
With a standardized recurrence definition and more comparative data on treatments, clinicians can now better tailor interventions to individual patient needs. However, challenges remain:
There is still no objective biomarker or imaging standard to detect early recurrence.
Long-term data comparing treatments beyond the 1-year mark is limited.
Patient-reported outcomes, while valuable, are still underutilized in determining success.
As the field continues to evolve, studies like Kan et al.’s consensus on recurrence and the ongoing debates around collagenase efficacy and diagnosis accuracy reflect a broader move toward evidence-based, patient-centered care in Dupuytren’s disease. By aligning treatment goals, recurrence definitions, and patient expectations, we move closer to more consistent and meaningful outcomes.
Bumbasirevic, M., Palibrk, T., Lesic, A. and Djurasic, L. (2011). Baron Gijom Dipitren, Guillaume Dupuytren (1777-1835). Acta chirurgica iugoslavica, 58(3), pp.15–19. doi:https://doi.org/10.2298/aci1103015b.
Kan, H.J., Verrijp, F.W., Hovius, S.E.R., van Nieuwenhoven, C.A. and Selles, R.W. (2017). Recurrence of Dupuytren’s contracture: A consensus-based definition. PLOS ONE, 12(5), p.e0164849. doi:https://doi.org/10.1371/journal.pone.0164849.
As we move beyond the first year of our university studies, we’ve realized something important: learning sticks best when it’s active, not passive.
Our initial modules were genuinely interesting — the topics had real potential to inspire us. But in practice, what made them truly engaging wasn’t the material itself. It was the personality, passion, and real-world experience of our individual tutors that brought the content to life. On days when a substitute lecturer stepped in, we often felt like we lost an entire day of learning. Without that personal spark, the material alone just didn’t hold our attention.
That’s why we’ve decided to take things into our own hands.
We’re creating our own quizzes, tests, and activities — not just to review the content, but to exercise our brains and keep our minds sharp. It’s our way of making sure we don’t mentally check out during those long four-hour lectures. By actively engaging with the material, we’re turning passive learning into something more dynamic and memorable.
This blog is part of that process: a space to share our thoughts, build tools for each other, and make learning something we drive — not just receive.
Stay tuned for more challenges, resources, and reflections as we put our knowledge to the test!
