17598562 Module on the Wrist and Hand 0910

7/31/2019 17598562 Module on the Wrist and Hand 0910

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

Prepared byEnrico C. Aguila, OTR, OTRP

College of Allied Medical ProfessionsUniversity of the Philippines

Manila


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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 Bones4. Metacarpal bones5. 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. Type2. Articulating surfaces3. Possible movements4. Axis of motion of the movements5. 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. Origin2. Insertion3. Actions4. Innervation

G. Describe the muscles that act on the carpometacarpal (CMC) joint of the thumb interms of:

1. Origin2. Insertion3. Actions4. Innervation

H. Describe the muscles that act on the metacarpophalangeal (MCP) joint of the thumbin terms of:


I. Describe the muscles that act on the interphalangeal (IP) joint of the thumb in termsof:


J. Describe the muscles that act on the metacarpophalangeal joints of the fingers interms of:


K. Describe the muscles that act on the proximal interphalangeal joints of the fingers interms of:


L. Describe the muscles that act on the distal interphalangeal joints of the fingers interms of:


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This material was developed for use by stuAllied Medical Professions, University of th


M. Classify the muscles t1. Extrinsic muscl2. Intrinsic muscl

N. Using mounted skelinsertions.

_______________________

A. Bones of the Wrist aspecimens and in the illus

1. Carpal Bonesa. Proximal row

i. ScaphoidScaphoi

ii. Lunateiii. Triquetraliv. Pisiform

b. Distal rowi. TrapeziumTubercle

ii. Trapezoidiii. Capitateiv. Hamate

Hook of2. Metacarpalsa. Heads

b. Bodiesc. Bases3. Phalangesa. Thumb (proximal

i. Headii. Body

iii. Baseb. Fingers (proximal,

i. Headii. Body

iii. Basec. Small sesamoid b

Bones

ents of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2Philippines, Manila. Please obtain permission before use.

at act on the wrist and hand in terms of:les

s

tons, attach representations of elbow o

__________________________________

d Hand: Identify the bones and landmtrations below

tubercle

of trapezium

he hamate

nd distal)

middle and distal)

nes

Carpal Boneview

Carpal Boneview

f the hand (dorsalview)

Bones of th(palmar

010), of the College of

their origins and

_____________

arks in the bone

s (dorsal)

(palmar)

e handiew)


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B. Joints of the Wrist and Hand:

Radiocarpal (wrist) Joint1. What type of joint is the radiocarpal joint?

2. What structures form the articulations at the

wrist joint? Which of the structures articulatewith one another?

1

23

4

5

3. What motions are available at the wrist

joint? (4 Answers)

1

2

3

4

4. In what planes and axes of motion do these

movements occur?Motion Axis Plane

1

2

3

45. Identify activities that use the motions of the

wrist (list 3 activities per motion)Motions Activities

1 A

B

C

2 A

B

C

3 A

B

C

4 A

B

C

Intercarpal Joints1. What joints comprise the intercarpal joints?

Which structures articulate with each

other?

1

2

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 JointsLigaments Functions and Attachments

Radial collateral

Ulnar collateral

Dorsal radioulnar

Dorsal radiocarpal

Dorsal radioulnar

Dorsal ulnocarpal

Dorsal carpometacarpal

Ligaments

Dorsal metacarpal

ligaments


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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)


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Carpometacarpal (CMC) Joint of the Thumb1. What type of joint is the CMC joint of the

thumb?

2. What structures articulate to form theCMC joint of the thumb?

3. What movements are possible in theCMC joint? 12345

4. In what axes and planes of motion dothese movements occur?

Motion Axis Plane

1

2

3

4

5

Metacarpophalangeal (MCP) Joints of the Thumb and Fingers1. What type of joint are the MCP joints?

2. What structures articulate to form theMCP joints?

12

3. What movements are possible in theMCP joints?

1234

4. In what axes and planes of motion dothese movements occur?

Motion Axis Plane1

2

3

4

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 IPjoints?

Joints Articular surfaces

IP joint of thumb

PIP joints

DIP joints

3. What movements are possible at the IPjoints?

12

4. In what axis and plane of motion dothese movements occur?

Motion Axis Plane

1

2


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C. Muscles Acting on the Wrist and Hand

Muscles Acting on the Wrist

Muscle Origin Insertion Action Nerve Supply

Extensor carpi

radialis brevisExtensor carpiradialis longus

Extensor carpiulnaris

Flexor carpiradialis

Flexor carpiulnaris

Palmaris longus

Muscles Acting on the CMC and IP Joints of the ThumbMuscle Origin Insertion Action Nerve Supply

Abductor poliicislongus

Abductor pollicisbrevis

Adductor pollicis

Extensor pollicisbrevis

Extensor pollicislongus

Flexor pollicisbrevis

Flexor pollicislongus

Opponens pollicis

Muscles Acting on the Joints of the Fingers

Muscle Origin Insertion Action Nerve Supply

Abductor digiti

minimiDorsal interossei

Extensor digitiminimi

Extensordigitorum

Extensor indicis

Flexor digitiminimi

Flexor digitorumprofundus


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Flexor digitorumsuperficialis

Lumbricales

Opponens digiti

minimiPalmar interossei

Palmaris brevis

Identify the Muscles on the Illustrations BelowForearm

SuperficialLayer

(palmar view)

ForearmIntermediate

Layer(palmar view)

ForearmDeepLayer

(palmar view)

ForearmSuperficial

Layer(dorsal view)

ForearmDeepLayer

(dorsal view)

Wrist Flexors Thumb andFinger Flexors

Thumb and FingerFlexors

Wrist andFinger

Extensors

Wrist andFinger

Extensors


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This material was developed for use by stuAllied Medical Professions, University of th

ExtensorTendons at the

Wrist

AnatoSnuff

Flexo

Classify the muscles actinHow are they different fro

Extrinsic Muscl

ents of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2Philippines, Manila. Please obtain permission before use.

icalbox

Lumbricales DorsalInterossei

Intrinsic Muscles of the Hand

r and extensor Tendons of the Finger

g on the hand between extrinsic and ieach other?

es Intrinsic Mu

010), of the College of

PalmarInterossei

ntrinsic muscles.

scles


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Small Group Activity

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.

TargetMuscles

Location Point of Stabilization

Instruction Placement ofResistance

Extensor carpiradialis brevis

Extensor carpiradialis longus

Extensor carpiulnaris

Flexor carpiradialis

Flexor carpiulnaris

Palmaris longus

Abductor poliicislongus

Abductor pollicisbrevis

Adductor pollicis

Extensor pollicisbrevis

Extensor pollicislongus

Flexor pollicisbrevis

Flexor pollicislongus

Opponenspollicis

Abductor digitiminimi

Dorsalinterossei

Extensor digitiminimi

Extensordigitorum

Extensor indicis


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Flexor digitiminimi

Flexor digitorumprofundus

Flexor digitorum

superficialisLumbricales

Opponens digitiminimi

Palmarinterossei

Palmaris brevis

II. Palpation of bony landmarks and other structures.Palpate for the following structures and mark their locations with a pen or an eyebrowpencil.

1. Capitate2. Scaphoid3. Pisiform4. Hook of the hamate5. Ulnar Styloid6. Radial styloid7. Dorsal tubercle of the radius8. CMC joint of the thumb

9. MCP joints of the thumb and thefingers

10. IP joint of the thumb11. PIP joints of the fingers12. DIP joints of the fingers13. Radial pulse14. 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 oran eyebrow pencil through them. Also mark them in the illustration provided.

1. Proximal wrist crease2. Distal wrist crease3. Thenar crease4. Proximal palmar crease5. Distal palmar crease6. Longitudinal palmar crease7. Finger creases

IV. Tenodesis Function of the HandAlternately 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? Whatare the reasons for these events?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

V. Stable and Mobile Components of the HandRapidly 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?

________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________


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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 extendedand when the MCP joints are flexed? What would account for thisdifference?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

With a finger extended, try to push the middle phalanx laterally such that it woulddeviate 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 isextended as opposed to when the PIP joint is flexed? In which position of the PIP joint isthere 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 deviatefrom 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 extendedas opposed to when the DIP joint is flexed? In which position of the DIP joint is there moreand easier lateral deviation of the distal phalanx? Why is this so?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________

VII. Prehension Patterns of the HandDescribe 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 patternbeing 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

________________________________________________________________________________________________________________________________________________________________________________________________________________________


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Inserting an ATM card into its slot________________________________________________________________________________________________________________________________________________________________________________________________________________________ Inserting a thread into the eye of a needle

________________________________________________________________________________________________________________________________________________________________________________________________________________________

VIII. Anatomical Snuff BoxPerform radial abduction of the thumb against resistance in order for the tendonscomprising the anatomical snuff box to become prominent. To which muscles do thesetendons belong to? Which tendons form the lateral border, floor and the medial border ofthe anatomical snuff box?

__________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________

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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.

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

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17598562 Module on the Wrist and Hand 0910

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