OTPT102: Applied Anatomy and Kinesiology

Prepared by Enrico C. Aguila, OTR, OTRP College of Allied Medical Professions University of the Philippines Manila

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Small Group Discussion Objectives: A. Describe the bones that comprise the wrist and hand. 1. Distal segment of the radius (refer to Module on the Elbow and Forearm) 2. Distal segment of the ulna (refer to Module on the Elbow and Forearm) 3. Carpal Bones 4. Metacarpal bones 5. Phalanges B. Identify and locate the landmarks on the bones of the wrist and hand. C. Describe the different joints of the wrist and hand in terms of: 1. Type 2. Articulating surfaces 3. Possible movements 4. Axis of motion of the movements 5. Factors and structures that limit the motions. D. Identify and locate the ligaments that are present in the wrist joint. E. Identify and locate the ligaments that are present in the joints of the hand. F. Describe the muscles that act on the wrist and describe them in terms of: 1. Origin 2. Insertion 3. Actions 4. Innervation G. Describe the muscles that act on the carpometacarpal (CMC) joint of the thumb in terms of: 1. Origin 2. Insertion 3. Actions 4. Innervation H. Describe the muscles that act on the metacarpophalangeal (MCP) joint of the thumb in terms of: 1. Origin 2. Insertion 3. Actions 4. Innervation I. Describe the muscles that act on the interphalangeal (IP) joint of the thumb in terms of: 1. Origin 2. Insertion 3. Actions 4. Innervation J. Describe the muscles that act on the metacarpophalangeal joints of the fingers in terms of: 1. Origin 2. Insertion 3. Actions 4. Innervation K. Describe the muscles that act on the proximal interphalangeal joints of the fingers in terms of: 1. Origin 2. Insertion 3. Actions 4. Innervation L. Describe the muscles that act on the distal interphalangeal joints of the fingers in terms of:
This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

1. Origin 2. Insertion 3. Actions 4. Innervation M. Classify the muscles that act on the wrist and hand in terms of: 1. Extrinsic muscles 2. Intrinsic muscles N. Using mounted skeletons, attach representations of elbow on their origins and

insertions.
____________________________________________________________ _______________________________________________________ _________________ A. Bones of the Wrist and Hand Identify the bones and landmarks in the bone Hand: specimens and in the illustrations below Carpal Bones (dorsal 1. Carpal Bones view) a. Proximal row i. Scaphoid Scaphoid tubercle Scaphoid ii. Lunate iii. Triquetral iv. Pisiform b. Distal row i. Trapezium Tubercle of trapezium Tubercle ii. Trapezoid iii. Capitate iv. Hamate Hook of the hamate Hook 2. Metacarpals Carpal Bones (palmar a. Heads view) b. Bodies c. Bases 3. Phalanges a. Thumb (proximal and distal) i. Head ii. Body iii. Base b. Fingers (proximal, middle and distal) i. Head ii. Body iii. Base c. Small sesamoid bones Bones of the hand (dorsal view) Bones of the hand (palmar view)

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010 of the College of 2010), Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

B. Joints of the Wrist and Hand:

1. What type of joint is the radiocarpal joint? 2. What structures form the articulations at the 1 wrist joint? Which of the structures articulate 2 with one another? 3 4 5 3. What motions are available at the wrist 1 joint? (4 Answers) 2 3 4 4. In what planes and axes of motion do these movements occur? 1 2 3 4 5. Identify activities that use the motions of the wrist (list 3 activities per motion) 1 2 3 4

Radiocarpal (wrist) Joint

Motion

Axis

Plane

Motions

A B C A B C A B C A B C

Activities

Intercarpal Joints 1. What joints comprise the intercarpal joints? 1 Which structures articulate with each 2 other? 3 2. What type of joint are the different intercarpal joints? 3. What type of movements are available at these joints?

Ligaments of the Radiocarpal and Intercarpal Joints

Ligaments Radial collateral Ulnar collateral Dorsal radioulnar Dorsal radiocarpal Dorsal radioulnar Dorsal ulnocarpal Dorsal carpometacarpal Ligaments Dorsal metacarpal ligaments Functions and Attachments

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Palmar radioulnar Palmar Ulnocarpal (ulnolunate part) Palmar Ulnocarpal (ulnotriquetral part) Palmar Radiocarpal (radioscapulohamate part) Palmar Radiocarpal (radiotriquetral part) Palmar Radiocarpal (radiocapitate part) Capitotriquetral Pisohamate Pisometacarpal Palmar carpometacarpal Ligaments Palmar metacarpal Ligaments

Label the ligaments on the illustrations below.

Ligaments of the wrist (dorsal view) Ligaments of the wrist (palmar view)

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Carpometacarpal (CMC) Joint of the Thumb 1. What type of joint is the CMC joint of the thumb? 2. What structures articulate to form the CMC joint of the thumb? 3. What movements are possible in the 1 CMC joint? 2 3 4 5 4. In what axes and planes of motion do Motion Axis these movements occur? 1 2 3 4 5 Metacarpophalangeal (MCP) Joints of the Thumb and Fingers 1. What type of joint are the MCP joints? 2. What structures articulate to form the 1 MCP joints? 2 3. What movements are possible in the 1 MCP joints? 2 3 4 4. In what axes and planes of motion do Motion Axis these movements occur? 1 2 3 4

Plane

Plane

Interphalangeal Joints of the Thumb (IP joint) and Fingers (PIP and DIP joints) 1. What type of joint are the interphalangeal joints? 2. What structures articulate to form the IP Joints Articular surfaces joints? IP joint of thumb PIP joints DIP joints 3. What movements are possible at the IP 1 joints? 2 4. In what axis and plane of motion do Motion these movements occur? 1 2

Axis

Plane

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Ligaments of the Joints of the Fingers Ligaments Functions and Attachments Dorsal metacarpal ligaments Palmar metacarpal ligaments Collateral ligaments of the MCP joints Collateral ligaments of the thumb IP joint Collateral ligaments of the PIP joints Collateral ligaments of the DIP joints Deep transverse metacarpal ligaments Palmar ligaments Joint Capsules Label the ligaments on the illustrations below.

Ligaments of the finger joints (palmar view)

Ligaments of the finger joints (lateral view)

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

C. Muscles Acting on the Wrist and Hand Muscle Extensor carpi radialis brevis Extensor carpi radialis longus Extensor carpi ulnaris Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Muscles Acting on the Wrist Origin Insertion Action Nerve Supply

Muscles Acting on the CMC and IP Joints of the Thumb Muscle Origin Insertion Action Nerve Supply Abductor poliicis longus Abductor pollicis brevis Adductor pollicis Extensor pollicis brevis Extensor pollicis longus Flexor pollicis brevis Flexor pollicis longus Opponens pollicis Muscles Acting on the Joints of the Fingers Origin Insertion Action

Muscle Abductor digiti minimi Dorsal interossei Extensor digiti minimi Extensor digitorum Extensor indicis Flexor digiti minimi Flexor digitorum profundus

Nerve Supply

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Flexor digitorum superficialis Lumbricales Opponens digiti minimi Palmar interossei Palmaris brevis Identify the Muscles on the Illustrations Below
Forearm Superficial Layer (palmar view) Forearm Intermediate Layer (palmar view) Forearm Deep Layer (palmar view) Forearm Superficial Layer (dorsal view) Forearm Deep Layer (dorsal view)

Wrist Flexors

Thumb and Finger Flexors

Thumb and Finger Flexors

Wrist and Finger Extensors

Wrist and Finger Extensors

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Extensor Tendons at the Wrist

Anatomical Snuffbox

Lumbricales

Dorsal Interossei

Palmar Interossei

Intrinsic Muscles of the Hand

Flexor and extensor Tendons of the Finger

Classify the muscles acting on the hand between extrinsic and intrinsic muscles. How are they different from each other? Extrinsic Muscles Intrinsic Muscles

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010 of the College of 2010), Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Small Group Activity

I. Palpation of Muscles
Instructions: A. Identify the approximate locations of the muscles that act on the elbow and forearm. B. Place your hand on the bulk/body of the muscle that you are aiming to palpate. C. Stabilize the body segment proximal to the joint that you are going to instruct your partner to move. D. Instruct your partner to perform the necessary action in order for the target muscle to contract. E. Provide resistance to the motion in order to strengthen the contraction and make the muscle more palpable. F. Indicate your procedures on the table provided below. *These are the same items that are going to be the components of your grade for the next palpation exam. Target Location Point of Instruction Placement of Muscles Stabilization Resistance Extensor carpi radialis brevis Extensor carpi radialis longus Extensor carpi ulnaris Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Abductor poliicis longus Abductor pollicis brevis Adductor pollicis Extensor pollicis brevis Extensor pollicis longus Flexor pollicis brevis Flexor pollicis longus Opponens pollicis Abductor digiti minimi Dorsal interossei Extensor digiti minimi Extensor digitorum Extensor indicis
This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Flexor digiti minimi Flexor digitorum profundus Flexor digitorum superficialis Lumbricales Opponens digiti minimi Palmar interossei Palmaris brevis II. Palpation of bony landmarks and other structures. Palpate for the following structures and mark their locations with a pen or an eyebrow pencil. 1. 2. 3. 4. 5. 6. 7. 8. Capitate Scaphoid Pisiform Hook of the hamate Ulnar Styloid Radial styloid Dorsal tubercle of the radius CMC joint of the thumb 9. MCP joints of the thumb and the fingers 10. IP joint of the thumb 11. PIP joints of the fingers 12. DIP joints of the fingers 13. Radial pulse 14. Ulnar pulse

III. Creases of the Hand: Creases are lines or folds on the skin. Locate for the following creases and mark their locations by drawing lines using a pen or an eyebrow pencil through them. Also mark them in the illustration provided. 1. 2. 3. 4. 5. 6. 7. Proximal wrist crease Distal wrist crease Thenar crease Proximal palmar crease Distal palmar crease Longitudinal palmar crease Finger creases

IV. Tenodesis Function of the Hand Alternately flex and extend the wrist with the fingers relaxed. What happens to the fingers when the wrist is extended? What happens to the fingers when the wrist is flexed? What are the reasons for these events? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ V. Stable and Mobile Components of the Hand Rapidly and alternately open and close the hand. Are all parts of the hand moving? If not, which parts remain stable? Why do they remain stable? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

VI. Collateral Ligaments of the MCP, PIP and DIP Joints Extend the fingers with the wrist extended and then abduct the fingers. Flex the MCP joints fully (close the hand). Abduct the fingers. Is there a difference in finger abduction when the MCP joints are extended and when the MCP joints are flexed? What would account for this difference? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ With a finger extended, try to push the middle phalanx laterally such that it would deviate from the PIP joint. Attempt to do the same with the PIP joint fully flexed. Is there a difference in lateral deviation of the middle phalanx when the PIP joint is extended as opposed to when the PIP joint is flexed? In which position of the PIP joint is there more and easier lateral deviation of the middle phalanx? Why is this so? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ With a finger extended, try to push the distal phalanx laterally such that it would deviate from the DIP joint. Attempt to do the same with the DIP joint fully flexed. Is there a difference in lateral deviation of the distal phalanx when the DIP joint is extended as opposed to when the DIP joint is flexed? In which position of the DIP joint is there more and easier lateral deviation of the distal phalanx? Why is this so? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ VII. Prehension Patterns of the Hand Describe the positions of the hand, thumb and fingers when doing the following activities. Which components of the hand are involved? How do you refer to the prehension pattern being used? Give at least three more activities that use the same pattern. Carrying groceries in a grocery bag ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Drinking from a glass of water ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Throwing a baseball ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Writing a sentence using a pen ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

 Inserting an ATM card into its slot ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Inserting a thread into the eye of a needle ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ VIII. Anatomical Snuff Box Perform radial abduction of the thumb against resistance in order for the tendons comprising the anatomical snuff box to become prominent. To which muscles do these tendons belong to? Which tendons form the lateral border, floor and the medial border of the anatomical snuff box? ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________

References: Published: McMinn. R.M.H., Hutchings, R.T., Pegington, J., Abrahams, P. (1993). Color Atlas of Human Anatomy, Third Edition. St. Louis MO. Mosby Year Book, Inc. Pedretti, L.W., Early, M.B. (2001). Occupational Therapy Practice Skills for Physical Dysfunctions, Fifth Edition. St. Louis, MO. Mosby, Inc. Snell, R.S. (2004). Clinical Anatomy for Medical Students (7th ed.). USA: Lippincott Williams & Wilkins. Electronic: DxR Development Group. (1999). F. Netter, M.D. Interactive Atlas of Human Anatomy. East Hanover, NJ. Novartis Medical Foundation Rarey, K. E., Romrell, L.J., Pawlina, W., Rathe, R.J., Rosenberg, J. (1990). Human Anatomy, An Interactive Tutorial and Reference. Florida. University of Florida and Gold Standard Multimedia, Inc.
This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College of Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.