Wrist and Hand

Wrist Joint
 Wrist Joint
• Bones
– Radius, Ulna
– Carpal bones
• Pisiform, Triquetrum, Lunate, Scaphiod,
Hamate, Capitate, Trapezium, Trapeziod
 Articulations
• Distal RadioUlnar Joint
• Radiocarpal Joint
• MidCarpal Joint
• Intercarpal Joint
 Distal Radioulnar Joint
• Does not participate in
wrist movements
• Ulna has no contact
with carpals
• Seperated by
fibrocartilagenous disk
which allows ulna to
glide during pronation
and supination
 Radiocarpal Joint
• Movement of whole hand takes place here
• Articulation of:
– Distal Radius
– Scaphoid and lunate
• Condyloid-type
• Allows for flexion/extension
• 40% of flexion occurs at radiocarpal joint
• 60% of extension occurs at radiocarpal joint
Radiocarpal Joint
 Midcarpal Joint
• These joints allow for translation of joint
with wrist movements
• Contributes to wrist flexion/extension
– 60% of flexion occurs here
• 40% occurs at radiocarpal joint
– 30% of extension occurs here
• 60% of extension occurs at radiocarpal joint
 Midcarpal Joint
• Radial and Ulnar deviation
– Proximal and distal carpal rows slide across
each other
– Radial deviation
• Proximal towards ulna, distal to radius
– Ulnar deviation
• Proximal towards radius, distal to ulna
 Intercarpal joints
• Between carpal bones of proximal row
• Midcarpal joint is between two rows of
carpal bones (site of hand flexion and
abduction)
• Carpals united by anterior, posterior, and
interosseous ligaments
 Intercarpal Joints

Palmar Dorsal
 Wrist Joint Ligaments
• Ulnar Collateral
Ligament
• Radial Collateral
Ligament
• Volar Radiocarpal
• Dorsal Radiocarpal
Ligaments of Wrist

Palmar Dorsal
Flexor Retinaculum
Extensor Retinaculum
Vascular Anatomy
• Forearm Arteries
Nerve Innervation (palmar)
Nerve Innervation (dorsal)
 Movements of Wrist
• Flexion, extension, abduction (radial
deviation), adduction (ulnar deviation)
– Motion occurs mostly in proximal carpal row &
distal radius
– 70°-90° of flexion
– 70°-85° of extension
– 15°-25° of abduction (radial deviation)
– 25°-40° of adduction (ulnar deviation)
 Movement of the wrist
• Flexion
– flexor carpi radialis
– flexor carpi ulnaris
– palmaris longus
– assisted by:
• flexor digitorum superficialis
• flexor digitorum profundus
Superficial
Muscles of
Forearm
common flexor group
 Movement of the wrist

• Extension
– extensor carpi radialis longus
– extensor carpi radialis brevis
– extensor carpi ulnaris
– assisted by:
• other wrist extensor muscles
common extensor group
common extensor group
Hand and Fingers
Wrist & Hand
Palmar Aspect

Phalanges
Metacarpals
Carpals
 Carpometacarpal Joint
• Last four have very little movement-mostly
gliding joint which moves with carpals
• More movement at 4th and 5th articulation
– Up to 10-30 degrees of flexion/extension in
these fingers
 Carpometacarpal Joint
• Thumb articulation
– Saddle joint provides major portion of thumb
ROM
– 30-90 degrees of flexion
– 15 degrees of extension
– Sits at an angle of approx 60 deg.
Carpometacarpal Joints

Palmar Dorsal
 Metacarpophalangeal Joint
• Last 4 allows for flexion/extension
– Abduction/adduction
• Ligamentous support is excellent
• Can flex from 70-90 deg, with most at 5th
joint
• Can extend about 25 deg from relaxed
position
• About 20 deg of ab/adduction
 Metacarpalphalangeal Joints

Volar plate Deep Transverse Collateral

Metacarpal
 Interphalangeal Joint
• Hinge Joints
• Allow for flexion/extension
• Most dislocations occur at these joints
• Collateral Ligaments provide good
stability
• ROM
– Proximal joint--110 degrees
– Distal joint--90 degrees
Interphalangeal Joints (PIP)

Collateral Volar Plate

Interphalangeal Joints (DIP)

Collateral Volar Plate

• Fingers
Joints & Movements
– Metacarpophalangeal Joint
(MCP)
• Condyloid
• 0°-40° of extension
• 85°-100° of flexion
– Proximal interphalangeal Joint
(PIP)
• Ginglymus
• Full extension to 90°-
120° of flexion
– Distal interphalangeal Joint
(DIP)
• Ginglymus
• Flex 80°-90° from full
extension
 Thumb Joints
• 2 joints
– Metacarpophalangeal (MCP)
• Ginglymus
• Full extension into 40°-90° of flexion
– Interphalangeal (IP)
• Ginglymus
• Flex 80°-90°
• Carpometacarpal (CMC) joint
• Saddle joint
• 50°-70° of abduction
• Flex 15°-45° & extend 0°-20°
 Finger Movement
• Middle phalange is reference
point to differentiate abduction &
adduction
– Thumb, index & middle fingers
abduct when they move laterally
toward radial side of hand
– Ring & little fingers abduction when
they move medially toward ulnar
side of hand
– Medial movement of thumb, index &
middle fingers toward ulnar side of
hand is adduction
– Lateral movement of ring & little
finger toward radial side of hand is
adduction
Intrinsic Muscles of the Hand

• Thenar muscles

• Hypothenar muscles

• Midpalmar muscles
– Interossei

– Lumbrical
Palmar Interossei
Dorsal Interossei
 Thenar muscles

• Adductor pollicis

• Flexor pollicis brevis

• Abductor pollicis brevis

• Opponen pollicis
 Hypothenar muscles

• Flexor digiti minimi

• Abductor digiti minimi

• Opponen digiti minimi

 Anatomical Snuffbox
• Extensor pollicis
longus (medial side)

• Extensor pollicis
brevis (lateral side)

Medial
Lateral • Abductor pollicis
longus (lateral side)
 3 Types of Grips
• Cylindrical--Holding a bat or golf club
– Ulnar deviation enhances force of grip
• Spherical--More spread of fingers
– Holding a basketball
• Hook--Precision handling
– Holding a coffee cup or scalpel