Brunnstrom’s Clinical Kinesiology

5th Edition

The Wrist and Hand

Smith • Weiss • Lehmkuhl

OVCMT MS3 November 2012

Joints of the Wrist

Two joints to consider • Radiocarpal • Midcarpal The basic function of the wrist is to

control the length-tension relationship of the extrinsic hand muscles to maximize balance and control of the hand

Radiocarpal Joint

Closed pack position • Full extension with radial

deviation Capsular pattern

• Flexion=extension Typical dislocation

• Lunate moves anteriorly into carpal tunnel: most carpals move posteriorly

Joint type • Condyloid synovial

Five Main Ligaments • Ulnar/medial collateral lig • Radial/lateral collateral

lig • Ulnocarpal lig • Anterior and posterior

radiocarpal lig

Ligaments & Capsule of the Radiocarpal Joint

medial / ulnar collateral lateral / radial collateral

Ligaments & Capsule of the Radiocarpal Joint

ulnocarpal ligament (anterior and posterior)

Ligaments & Capsule of the Radiocarpal Joint

posterior & anterior radiocarpal ligament

Movements – Radiocarpal Joint motion at the wrist occurs in

combination at the radio- and mid- carpal joints

flexion - extension • occur around a medial lateral axis in the

sagittal plane • flexion > extension; ~85° flx, 75° ext

radial - ulnar deviation • occur around an anterior posterior axis in a

frontal plane • ulnar deviation > radial deviation; ~40º

ulnar, 20° radial

Intercarpal/Midcarpal Joint Closed pack position

• Extension with radial deviation Capsular pattern

• Flexion=extension Typical dislocation

• Most carpals move posteriorly Joint type

• Plane or Condyloid synovial joint (concave-convex may apply)

Boat load of ligaments • Interosseus ligaments

Intercarpal/Midcarpal Joint Articulating Surfaces

• proximal row of carpals- scaphoid, lunate, triquetrum (concave)

• distal row of carpals- trapezium, trapezoid, capitate, hamate (convex)

Classification • nonaxial plane synovial joint

Movements Permitted • gliding • intercarpal motion augments that at

the wrist

Radiocarpal Joint Motion

Relevant Muscles of the Wrist

Joints of the Hand

Three to consider: • carpometacarpal • metacarpophalangeal • interphalangeal

Carpalmetacarpal Joint Closed pack position

• thumb- full opposition; digits- full flexion Capsular pattern

• thumb- abduction > extension; digits- all motions equally

Typical dislocation • uncommon, carpal dislocation or metacarpal fracture

Joint type 1st CMC • saddle synovial • articulation between 1st MC and trapezium;

incongruence here may account for or be a result of increased incidence osteoarthritis

• three main ligaments lateral collateral lig. anterior and posterior CMC lig.s interosseous CMC lig.s

Carpometacarpal (CMC) Joint

Carpometacarpal (CMC) Joint 1st Carpometacarpal Joint Movements Permitted

• flexion – extension; anterior posterior axis, frontal plane

• abduction – adduction; medial lateral axis, sagittal plane

• opposition (combination motion of abduction and flexion)

Carpometacarpal (CMC) Joint 2nd - 5th carpometacarpal joint Joint Type- plane synovial (2nd - 4th) and saddle

synovial (5th) • base of 2nd MC with trapezoid • base of 3rd MC with capitate • base of 4th MC with capitate and hamate • base of 5th MC with hamate

• fixed carpal arch is an anterior concavity formed by the

distal row, a concavity which persists even when the palm is flattened; contributes to optimal grip

Movements Permitted • gliding as with flexion - extension and radial - ulnar

deviation • ROM available at the CMC joints increases toward the

ulnar side with the 2nd and 3rd joints being a stable point around which others move

Carpometacarpal Joint Ligaments

Metacarpophalangeal (MCP) Joint Closed pack position

• thumb- full opposition; digits- full flexion Capsular pattern

• flexion > extension Typical dislocation

• proximal phalanx moves posterosuperior, 2nd and 5th digits are most commonly dislocated

Joint type • condyloid synovial • volar fibrocartilagenous plate

limits hyperextension and prevents impingement of the flexor tendons in the joint during flexion

increases joint congruency (MC head has much larger articular surface than base of proximal phalanges)

• transverse metacarpal lig. binds MC heads together anteriorly supports CMC joints

• lateral / radial and medial / ulnar collateral lig.s limits lateral motion and holds volar plate on joint slack in MCP extension

Ligaments & Capsule

Metacarpophalangeal (MCP) Joint Articulating Surfaces

• head of metacarpal (convex) • base of proximal phalanx (concave)

Classification • (biaxial condyloid synovial joint)

Movements Permitted • flexion – extension; mediolateral axis, sagittal plane • ROM: ~90-110° flexion and extension is consistent

between MCP joints but varies between people; increases toward the ulnar side

• abduction – adduction; anteroposterior axis, frontal plane

• ROM: maximal in extension • reference point is the 3rd digit

Interphalangeal Joints Closed pack position

• Full extension

Capsular pattern • flexion > extension

Typical dislocation • posterior displacement of the phalanx

Joint type • hinge synovial • Ligaments:

volar fibrocartilagenous plate collateral lig.s

• remain taut and provides support in all joint positions

Ligaments & Capsule

Proximal and Distal Interphalengeal (PIP & DIP) Joint

Movements Permitted • flexion – extension • ROM increases ulnarly and at the PIPs versus

DIPs • total range at 2nd digit PIP ~100°, 2nd digit

DIP ~80° • 5th digit PIP ~135°, 5th digit DIP ~90° • the additional ROM at all the joints of the

ulnarly located fingers angles them toward the thumb which facilitates opposition and allows a tighter grip on the ulnar side of the hand

Relevant Muscles of the Fingers

Postures & injuries

Prehension

Power Grip

Precision Handling