wrist anatomy distal end of radius (and ulna) and the carpal bones proximal row scaphoid, lunate,...
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Wrist and HandESAT 3600
Fundamentals of Athletic Training
Wrist AnatomyDistal end of radius
(and ulna) and the carpal bonesProximal row
Scaphoid, lunate, triquetrum, pisiform
Distal rowTrapezium, trapezoid,
capitate, hamate
Wrist JointsRadiocarpal
Midcarpal
WristWeak bony arrangement
Strong ligamentous and muscle stability
Wrist LigamentsPalmer radiocarpal
ligaments
Radial collateral ligament
Palmer ulnocarpal ligament
Palmer intercarpal ligament
Transverse carpal ligament
Wrist LigamentsUlnar collateral
ligament
Dorsal radiocarpal ligament
Dorsal intercarpal ligament
Tensing Pattern of Ligaments During RD UD
Movements of the WristFlexion
Extension
Radial deviation
Ulnar deviation
Arthrokinematics of Wrist Flexion and Extension
Arthrokinematics of RD/UD
Wrist Muscles
Wrist ExtensorsPrimary movers
Extensor carpi radialis longus and brevis
Extensor carpi ulnaris
Secondary movers Extensor digitorum
communis Extensor digiti
minimi Extensor pollicis
longus
Wrist FlexorsPrimary movers
Flexor carpi radialis Flexor carpi ulnaris Palmaris longus
Secondary movers Flexor digitorum
profundus Flexor digitorum
superficialis Flexor pollics longus
Radial and Ulnar Deviation
Carpal Instability
Carpal Tunnel
Bounded by 8 carpal bones and flexor retinaculum
Contents of tunnel9 finger flexor
tendonsMEDIAN NERVE
Carpal Tunnel SyndromeEntrapment of median nerve in the tunnel
Signs and symptoms Pain Numbness Tingling Thenar muscle atrophy Affect on strength and dexterity
Precipitating Factors of CTS
Misaligned fractures
Rheumatoid and osteoarthritis
Thickening and swelling of synovial sheath
Inflammation
Hand
Structure of Hand
5 metacarpals
Thumb
4 fingers
LigamentsRadial collateralUlnar collateralCarpometacarpals intermetacarpals
Joints of the HandCMC
MCP
PIP
DIP
Finger movementsExtension
Flexion
Adduction
Abduction
Circumduction
CMC of Thumb
Orientation of ThumbRotated 90
degrees
Thumb MovementsExtension
Flexion
Adduction
Abduction
Opposition
Arthrokinematics of the 1st CMC Joint
Arthrokinematics of the MCP and IP Joints
Cooperative Actions of Wrist and Fingers
PrehensionPower grip
CylindricalSphericalHook
Precision gripPower pinchPrecision
pinch
Muscles of the WristPalmaris Longus
O: common flexor tendon from medial epicondyle of humerus
I: flexor retinaculum and palmar aponeurosis
A: flexes hand at the wrist
Muscles of the Wrist
Flexor carpi radialisO: common flexor tendon
from medial epicondyle of humerus
I: anterior surfaces of bases of 2nd and 3rd metacarpals
A: flexes and radially deviates the hand at the wrist
Muscles of the WristFlexor carpi ulnaris
O: by 2 heads from medial epicondyle of humerus and medial border of olecranon process of ulna
I: palmer surface of pisiform and hamate and base of 5th metacarpal
A: flexes and ulnarly deviates the hand at the wrist
Muscles of the Wrist Flexor digitorum superficialis
O: humero-ulnar head – medial epicondyle of the humerus by the common flexor tendon, ulnar collateral ligament of elbow and coronoid process of ulna; radial – oblique line of radius extending from radial tuberosity to the insertion of the pronator teres
I: 4 tendons, 1 to each finger, divide fro the passage of the tendons of flexor digitorum profundus then insert as 2 slips on sides of the shaft of the middle phalanx
A: flexes the phalanx of each finger on the proximal phalanx. Flexes the proximal phalanx at the hand, flexes the hand at the wrist
Muscles of the Wrist
Flexor pollicis longus O: anterior surface of middle ½ of
radius. Adjacent interosseous membrane and slip from the coronoid process of the ulna or medial epicondyle of humerus
I: palmar surface of the base of the distal phalanx of the thumb
A: flexes the interphalangeal joint of the thumb. Flexes the metacarpophalangeal and carpometacarpal joints
Muscles of the Wrist
Flexor digitorum profundus O: upper ¾ of anterior and medial surfaces
of the ulna, interosseous membrane and deep fascia of the forearm
I: 4 tendons, 1 to each finger, to palmer surface of base of distal phalanx, after passing through tendon of flexor digitorum superficialis
A: flexes the distal phalanges of the 4 fingers. Assists in flexing metacarpophalangeal, carpometacarpal and wrist joints
Muscles of the WristExtensor carpi radialis
longusO: lower 1/3 of lateral
supracondylar ridge, and a few fibers from lateral epicondyle
I: posterior surface of base of 2nd metacarpal
A: extends and radially deviates hand at the wrist
Muscles of the WristExtensor digitorum
O: common extensor tendon from lateral epicondyle of humerus
I: by 4 tendons, 1 to each finger, each dividing into 3 slips, middle one attaches to dorsal surface of middle phalanx, the other 2 unit to attach to the dorsal surface of base of distal phalanx
A: extends phalanx at the interphalangeal joints, continued action extends the metacarpophalangeal and carpometacarpal articulations. Assists in wrist extension
Muscles of the WristExtensor digiti minimi
O: common tendon of extensor digitorum
I: tendon of the extensor digitorum at the proximal phalanx of the little finger and into the dorsal expansion of the finger extensor tendons
A: extends the proximal phalanx of the little finger at the metacarpophalangeal joint, assists extension at the wrist. Extends middle and distal phalanges especially when the proximal phalanx is held in flexion
Muscles of the WristExtensor carpi radialis
brevisO: common extensor tendon
from lateral epicondyle I: posterior surface of base of
3rd metacarpalA: extension and radial
deviation of the hand at the wrist
Muscles of the WristExtensor carpi ulnaris
O: by 2 heads from lateral epicondyle of humerus and middle 1/3 of posterior ridge of ulna
I: posterior surface of base of 5th metacarpal
A: extends and ulnarly deviates the hand at the wrist
Muscles of the Wrist
Extensor indicisO: dorsal surface of distal
half of ulna I: index finger extensor
digitorum tendonA: extension of all
phalanges of index finger. Assists in wrist extension
Extensor Pollicis Longus O: Posterior surface of the
middle 1/3 of ulna an interosseous membrane
I: Posterior surface of base of distal phalanx of thumb
A: Extends distal phalanx of thumb. Continued action, extends proximal phalanx and metacarpal, and adducts 1st metacarpal
Extensor Pollicis BrevisO: Posterior surface of
distal end of body of ulna near the middle and adjacent interosseous membrane
I: Posterior surface of the base of proximal phalanx of thumb
A: Extends proximal phalanx of thumb. Continued action extends and assists abduction of 1st metacarpal
Abductor Pollicis LongusO: Small facet of the ulnar
side of radius near its middle. On the lateral side of the dorsal surface of body of ulna just below insertion of anconeus and interosseous membrane
I: Radial surface of base of 1st metacarpal
A: Abducts and assists in extension of carpometacarpal joint of thumb
Opponens Digiti MinimiO: Hook of hamate
bone and flexor retinaculum
I: Entire length of ulnar boarder of 5th metacarpal
A: Flexes and slight lateral rotation of 5th metacarpal. Helps to cup palm of the hand.
Abductor Digiti Minimi O: Pisiform bone and from tendon
of flexor carpi ulnaris
I: 2 slips; into ulnar side of base of proximal phalanx of little finger; into ulnar border of extensor expansion of finger
A: Abducts little finger and assists in flexing its proximal phalanx at the metacarpophalangeal joint
Flexor Digiti Minimi Brevis
O: Hook of hamate and flexor retinaculum
I: Ulnar side of base of proximal phalanx of 5th finger
A: Flexes 5th digit at the metacarpophalangeal joint
Flexor Pollicis BrevisO: Superficial head – Distal
border of flexor retinaculum and tubercle of trapezium bone. Deep head – Trapezoid and capitate bones
I: Radial side of the base of proximal phalanx of tumb
A: Flexes proximal phalanx of thumb. Continued action, flexes 1st metacarpal and rotates it medially
Abductor Pollicis BrevisO: Flexor retinaculum
and tubercle of the scaphoid and trapezium
I: Radial side of the base of the proximal phalanx of the thumb
A: Abduction and medial rotation of proximal phalanx and the metacarpal of the thumb
Adductor Pollicis O: Oblique head – capitate bone,
bases of 2nd and 3rd metacarpals. Transverse head – Distal 2/3 of the palmar surface of the 3rd metacarpal bone
I: 2 heads converge to insert on the ulnar side of the base of proximal phalanx of thumb
A: adduction of thumb at the carpometacarpal joint. Adduction and assists in flexion of thumb at the MCP joint
Opponens PollicisO: Flexor retinaculum
and tubercle of trapezium bone
I: Radial side of entire length of 1st metacarpal bone
A: Flexes and abducts the first metacarpal with slight medial rotation
LumbricalsO: Tendons of flexor
digitorum profundus in center of palm
I: Around the radial side of the metacarpal bone and into extensor expansion
A: Principle extensors of interphalangeal joints. Weak flexor of the metacarpophalangeal joints