Hands Up!

Judith Lehman

Carpals

“Some Lovers Try Positions That They Can’t Handle”

Flexor Retinaculum or Transverse Carpal Ligament

Origin: scaphoid and trapesium on thumb side

Insertion: pisiform and hamate on pinky side

Action: stretches across carpal bones creating carpal tunnel for flexor tendon and median nerve to pass

Flexor Retinaculum Tps

Trigger Points and Referrals:

No Tps as it is a ligament, though injury or compression of median nerve may cause pain, numbness, lack of mobility in hand.

Flexor Retinaculum Exercise

Stretch: place palm on table with fingers and thumb abducted and hyperflex wrist; or hold and stretch with other hand

Strengthen: curl fingers into palm and hyperflex wrist

Opponens Pollicis

Origin: flexor retinaculum and tubercle of trapezium bone

Insertion: radial side of entire length of 1st metacarpal bone.

Action: flexes and abducts the 1st metacarpal with slight medial rotation – brings thumb across palm to ring finger pad

Flexor Pollicis Brevis

Origin: superficial head: distal border of flexor retic and tubercle of trapezium; deep head: trapezoid and capitate

Insertion: radial side of base of proximal phalanx of thumb

Action: flexes proximal phalanx of thumb; flexes 1st metacarpal and rotates medially

Abductor Pollicis Brevis

Origin: Flexor retinaculum and tubercles of scaphoid and trapezium

Insertion: Lateral side of base of proximal phalanx of thumb

Action: Abducts thumb and helps oppose it

Thumb Flexor TPs

Trigger Point: in the belly of the muscle – “weeder’s thumb”

Referrals: anterior length of thumb and medial wrist (above and beneath point); lateral side of thumb for abductors

Opponens Pollicis Exercise

Stretch: Passively hyper-abduct the extended thumb with fingers of the opposite hand

Strengthen: Press thumb and pinky together

Flexor Pollicis Brevis Exercise

Stretch: Passively hyper-abduct the extended thumb with fingers of the opposite hand

Strengthen: resisted thumb flex with rubber band anchored

Abductor Pollicis Brevis Exercise

Strengthen/stretch: abduct with fingers in rubber band, then relax

Opponens digiti minimi

Origin: Hamulus or hook of the hamate bone and flexor retinaculum

Insertion: entire length of ulnar border of 5th metacarpal.

Action: flexes and slightly laterally rotates 5th metacarpal. Helps to cup the palm of the hand

Flexor Digiti Minimi Brevis

Origin: Hook of hamate and flexor retinaculum

Insertion: Medial side of base of proximal phalanx of little finger

Action: Flexes proximal phalanx of little (5th) finger

Abductor Digiti Minimi

Origin: Pisiform

Insertion: Medial side of base of proximal phalanx of little finger

Action: Abducts little (5th) finger

Abductor Digiti Minimi TPs

Trigger Point: in the belly of the muscle

Referrals: down posterior and lateral side of pinky; similar areas for Opponens and Flexor digiti minimi only anterior side

Opponens Digiti Minimi Exercise

Stretch: Passively hyper-extend the pinky with fingers of the opposite hand

Strengthen: squeeze pinky and thumb together and hold for 20 sec

Flexor Digiti Minimi Brevis Exercise

Stretch: same as thumb stretch but stretch pinky instead

Strengthen: resisted pinky flexion with rubber band

Abductor Digiti Minimi Exercise

Stretch: stretch pinky laterally

Strengthen: place rubber band around extended fingers and abduct

Palmaris Brevis

Origin: flexor retinaculum and palmar apneurosis

Insertion: skin of palm into dermis

Action: steadies and corrugates skin of palm to help with grip; contract palm

Palmaris Brevis TPs

Trigger Point: in the belly of the muscle –

Referrals: length of anterior edge of palm on pinky side and wrist

Palmaris Brevis Exercise

Stretch: stretch thumb back with other hand

Strengthen: squeeze fingers together tightly

Palmaris Longus

Origin: Common flexor tendon from medial epicondyle of humerus

Insertion:Distal half of flexor retinaculum and palmar aponeurosis

Action:Flexes hand (at wrist) and tightens palmar aponeurosis

Palmaris Longus TPs

Trigger Point: in the belly of the muscle

Referrals: distal to palm of hand and up forearm

Palmaris Longus Exercise

Stretch: passive stretch of palm by extending wrist with other hand

Strengthen: resisted wrist flexion with theraband

Triceps BrachiiOrigin: Long head:

infraglenoid tubercle of scapula; Lateral head: posterior surface of humerus, superior to radial groove; Medial head: posterior surface of humerus, inferior to radial groove

Insertion:Proximal end of olecranon process of ulna and fascia of forearm

Action:Chief extensor of forearm;

Triceps Brachii TPs 1-2TP1: in the belly of the long head

TP1 Referrals: strong referral to posterior deltoid and lateral condyle of the humerus. Spillover from base of neck, across shoulder, down posterior upper arm and forearm

TP2: lower belly of medial head

TP2 Referral: refers strongly to lateral condyle of humerus with spillover down lateral posterior forearm.

Triceps Brachii TPs 3-4TP3: upper portion of

muscle belly of medial head

TP3 Referrals: strong around itself with spillover surrounding it and down posterior forearm into posterior ring and pinky fingers

TP4: in long, dense tendonabove insertion

TP4 Referrals: strongly into olecranon process

Triceps Brachii TPs 5

Tp5: in muscle belly on anterior surface of medial head.

Tp5 Referrals: strong referral just below Tp on anterior surface of humerus – spills over down anterior forearm and anterior side of ring and pinky

Triceps Brachii Exercise

Stretch: place one hand on scapula same side and other behind back – pull towel between for stretch in upper triceps

Strengthen: with theraband anchored in front at chest level, pull down and back 20 reps.

Anconeus

Origin: Posterior surface of lateral epicondyle of humerus

Insertion:Lateral surface of olecranon and superior part of posterior surface of ulna

Action: Extension and pronation of forearm at elbow

Anconeus TPs

Trigger Point: in the belly of the muscle close to insertion of ulna

Referrals: lateral epicondyle of humerus (tennis elbow)

Anconeus Exercise

Stretch: Holding weight palm back, arm extended, flex and supinate arm across body

Strengthen: extend and pronate forearm away from body

Supinate!

Pronate!

Sources• Granger, Jocelyn. Neuromuscular Therapy Manual.

Lippencott, 2011.• Travell, J. and Simons, D. Myofascial Pain and

Dysfunction, Vol. 1. Williams and Wilkins, 1983.• Flash Anatomy flash cards: The Muscles. Bryan Edwards

Publications, 1991.• http://en.wikipedia.org/wiki/

Flexor_retinaculum_of_the_hand• http://www.rad.washington.edu/academics/academic-

sections/msk/muscle-atlas/upper-body• http://ict4us.com/r.kuijt/en_carpalbones.htm

Fini!