Hand and Wrist JointTana PearsonGalina NesenchukVira Iatchenko

BONES: Ulna, RadiusThe ulna is a long bone,prismatic in form, placed at the medial side of the forearm, parallel with the radius.•Radius

Bones: Ulna

•Head of ulna – small, rounded surface at distal end of bone

•Styloid process of ulna – small, medial projection from

head region; forms medial portion of wrist joint

Bones: Radius • Styloid process of radius- pointed lateral projection at distal end of bone; forms

lateral portion of wrist joint

•Ulnar notch of radius- slight depression at

mediodistal end; area of articulation with ulna

Bones and Joints There are 15 bones that form connections from the end of the forearm to the hand. The wrist itself contains eight small bones, called carpal bones. These bones are grouped in two rows across the wrist. The proximal row is where the wrist creases when you bend it. Beginning with the thumb-side of the wrist, the proximal row of carpal bones is made up of the scaphoid, lunate, and triquetrum. The second row of carpal bones, called the distal row, meets the proximal row a little further toward the fingers. The distal row is made up of the trapezium, trapezoid, capitate, hamate, and pisiform bones.The proximal row of carpal bones connects the two bones of the forearm, the radius and the ulna, to the bones of the hand. The bones of the hand are called the metacarpal bones. These are the long bones that lie within the palm of the hand. The metacarpals attach to the phalanges, which are the bones in the fingers and thumb.

WRIST Carpals•1. Scaphoid•2. Lunate•3. Triquetrum•4. Pisiform•5. Trapezium•6. Trapezoid•7. Capitate•8. Hamate

WRIST•Metacarpal bones: Nambered 1-5 (thumb side is #1)

•Phalangeal bones: Fingers numbered 1-

5 (thumb is #1) Proximal Middle

(intermediate) Distal

Joints

• Distal interphalangealjoint (DIP)

• Proximal interphalangeal joint (PIP)

• Metacarpo-phalangealjoint (MP)

Joint and capsule

Articular Capsule:Fibrous CapsuleSynovial Membrane

Joint Cavity Articular cartilage

Synovial Joint:Joints where the articulating bones are separated by a fluid-containing joint cavity.

Allows freedom of movement.

ORIGIN: Attachment of a muscle tendon to the stationary bone. INSERTION: Attachment of the other muscle tendon to the movable bone.ACTION: The movement that occurs at the joint due to muscle

contraction.

EXTENSOR MUSCLES

ORGIN, INSERTION & ACTION OF EXTENSOR MUSCLES

O: supracondylar ridge of humerus

I: base of 2nd metacarpalA: wrist extension, radial

deviation

O: lateral epicondyle of humerus

I: base of 3rd metacarpal A: wrist extension

O: lateral epicondyle of the humerus

I: base of distal phalanx of the 2nd-5th fingers

A: extends all 3 joints of the fingers

O: lateral epicondyle of humerus

I: medial side of base of 5th metacarpal

A: extends & adducts wrist

Extensor digitorum:

Extensor carpi radialis brevis:

Extensor carpi ulnaris:

Extensor carpi radialis longus:

EXTENSOR MUSCLES CONT.

O: lateral epicondyle of humerusI: base of distal phalanx of 5th fingerA: extends all joints of 5th finger

O: posterior distal radiusI: base of the proximal phalanx of pollexA: extends MP joint of thumb

O: middle posterior ulna & interosseous membraneI: base of distal phalanx of pollexA: extends MP & IP joints of the thumb

Extensor pollicis brevis:

Extensor digiti minimi:

Extensor pollicis longus:

FLEXOR MUSCLES

ORGIN, INSERTION & ACTION OF FLEXOR MUSCLES

O: medial epicondyle of the humerusI: base of 2nd & 3rd metacarpals A: wrist flexion, radial deviation

O: medial epicondyle of humerusI: pisiform & base of 5th metacarpal A: wrist flexion , ulnar deviation

O: common flexor tendon, coronoid process & radiusI: sides of the middle phalanx of the 4 fingersA: flexes MP & PIP joints of the fingers

Flexor carpi ulnaris:

Flexor digitorum superficialis:

Flexor carpi radialis:

FLEXOR MUSCLES CONT.O: upper ¾ of ulnaI: distal phalanx of the 4 fingers (2-5)A: flexes all 3 joints of the fingers

O: radius, anterior surfaceI: distal phalanx of pollex A: flexes all joints of the pollex or thumb

O: post. radius , interosseous membrane, middle ulnaI: base of the 1st metacarpalA: abducts pollex

O: medial epicondyle of humerusI: palmar fasciaA: assistive in wrist flexion

Flexor digitorum profundus:

Flexor pollicis longus:

Abductor pollicis longus:

Palmaris longus:

Ligaments Tendons and Sheaths• Articular Ligaments

▫ Fibrous dense regular connective tissue.▫ Connect bones to other bones. ▫ They act as mechanical reinforcements.▫ Within synovial joints, act as a stabilizer to prevent excessive or undesirable

motion.• Tendons and aponeurosis

▫ Tendon – ropelike connection anchoring muscle to the connective tissue covering of a skeletal element (bone or cartilage)

▫ Aponeurosis – sheetlike tendon▫ Durable, withstand abrasion of rough bony projections, and relatively small

size conserve space.• Sheaths

▫ An elongated/flattened sac, lined with synovial fluid, that wraps completely around a tendon subjected to friction.

▫ They are common where several tendons are crowded together within narrow canals, ie wrist.

Ligaments and sheaths

Palmar Aponeurosis

Flexor retinaculum – anteriorExtensor retinaculum –

posteriorCommom flexor sheath

Tendons

Anterior View Posterior View

Anterior:•Palmaris longus•Flexor carpi longus•Flexor retinaculum•Palmar aponeurosis

Posterior:•Extensor carpi ulnaris•Extensor digitorum•Extensor pollicis brevis•Extensor longus•Extensor retinaculum• Flexor carpi ulnaris

ArteriesTwo arteries enter the hand:•Ulnar Artery•Radial Artery

Together, the branches of these arteries form two arterial arches: •Superficial palmar arch•Deep palmar arch

Branching distally off superficial palmar arch:•Common palmar digitals

Palmar View

VeinsDorsal viewThe veins of the upper extremity are divided into two sets, superficial and deep; the two sets anastomose frequently with each other.

Cephalic Vein Basilic Vein

Superficial dorsal venous arch

Deep dorsal venous arch

Dorsal View

Nerves

• Ulnar Nerve• Radial Nerve• Median Nerve

Palmar View

Cutaneous Innervation

Palmar cutaneous branch Ulnar, Radial, Median

Dorsal cutaneous branch Ulnar, Radial

Veins Arteries and Nerve Summary

InnervationsMuscle Nerve Artery

Flexor carpi ulnaris Ulnar nerve Ulnar artery

Flexor digitorum profundus Median and ulnar nerves Ulnar Artery

Flexor digitorum superficialis Median nerve Ulnar artery

Palmaris longus Median nerve Ulnar artery

Flexor carpi radialis Median nerve Radial and Ulnar arteries

Flexor pollicis longus Median nerve Radial artery

InnervationsMuscle Nerve Artery

Abductor pollicis longus Radial nerve Posterior interosseous artery

Extensor pollicis brevis Radial nerve Posterior interosseous artery

Extensor pollicis longus Radial nerve Posterior interosseous artery

Extensor carpi radialis longus Radial nerve Radial artery

Extensor carpi radialis brevis Radial nerve Radial artery

Extensor carpi ulnaris Deep radial nerve Ulnar artery

Extensor digitorum Radial nerve Recurrent interosseous artery

Extensor digiti minimi Radial nerve Recurrent interosseous artery

Surface AnatomyCompartments and Spaces

Surface Anatomy

Surface Anatomy

Surface Anatomy

Carpal Tunnel Syndrome

• Condition caused by compression or stretching of the medial nerve.

• Common disorder with people whose occupation require a great deal of wrist flexion or prolonged extension

WritersTypistsPianists

Computer professions

Carpal tunnel syndromeSymptoms

• Needles and pins sensation to the index and middle finger of the wrist.

• Pain in the middle area of the wrist, swelling of wrist,

• Numbness or tingling in index and middle fingers,

• Loss of function of hand in severe cases.

Carpal tunnel syndromeCures

• Splints applied to dorsiflex the wrist occasionally help keep the wrist in a resting position.▫ In this position, the carpal tunnel is as big as it can be, so the

nerve has as much room as possible inside the carpal tunnel. • Cortisone injections may help• Surgery to strip away build-up adhesive tissue may be

required.• This condition can recur even after treatment and tends to

worsen in the evening and night.