Wrist and HandESAT 3600

Fundamentals of Athletic Training

Wrist AnatomyDistal end of radius

(and ulna) and the carpal bonesProximal row

Scaphoid, lunate, triquetrum, pisiform

Distal rowTrapezium, trapezoid,

capitate, hamate

Wrist JointsRadiocarpal

Midcarpal

WristWeak bony arrangement

Strong ligamentous and muscle stability

Wrist LigamentsPalmer radiocarpal

ligaments

Radial collateral ligament

Palmer ulnocarpal ligament

Palmer intercarpal ligament

Transverse carpal ligament

Wrist LigamentsUlnar collateral

ligament

Dorsal radiocarpal ligament

Dorsal intercarpal ligament

Tensing Pattern of Ligaments During RD UD

Movements of the WristFlexion

Extension

Radial deviation

Ulnar deviation

Arthrokinematics of Wrist Flexion and Extension

Arthrokinematics of RD/UD

Wrist Muscles

Wrist ExtensorsPrimary movers

Extensor carpi radialis longus and brevis

Extensor carpi ulnaris

Secondary movers Extensor digitorum

communis Extensor digiti

minimi Extensor pollicis

longus

Wrist FlexorsPrimary movers

Flexor carpi radialis Flexor carpi ulnaris Palmaris longus

Secondary movers Flexor digitorum

profundus Flexor digitorum

superficialis Flexor pollics longus

Radial and Ulnar Deviation

Carpal Instability

Carpal Tunnel

Bounded by 8 carpal bones and flexor retinaculum

Contents of tunnel9 finger flexor

tendonsMEDIAN NERVE

Carpal Tunnel SyndromeEntrapment of median nerve in the tunnel

Signs and symptoms Pain Numbness Tingling Thenar muscle atrophy Affect on strength and dexterity

Precipitating Factors of CTS

Misaligned fractures

Rheumatoid and osteoarthritis

Thickening and swelling of synovial sheath

Inflammation

Hand

Structure of Hand

5 metacarpals

Thumb

4 fingers

LigamentsRadial collateralUlnar collateralCarpometacarpals intermetacarpals

Joints of the HandCMC

MCP

PIP

DIP

Finger movementsExtension

Flexion

Adduction

Abduction

Circumduction

CMC of Thumb

Orientation of ThumbRotated 90

degrees

Thumb MovementsExtension

Flexion

Adduction

Abduction

Opposition

Arthrokinematics of the 1st CMC Joint

Arthrokinematics of the MCP and IP Joints

Cooperative Actions of Wrist and Fingers

PrehensionPower grip

CylindricalSphericalHook

Precision gripPower pinchPrecision

pinch

Muscles of the WristPalmaris Longus

O: common flexor tendon from medial epicondyle of humerus

I: flexor retinaculum and palmar aponeurosis

A: flexes hand at the wrist

Muscles of the Wrist

Flexor carpi radialisO: common flexor tendon

from medial epicondyle of humerus

I: anterior surfaces of bases of 2nd and 3rd metacarpals

A: flexes and radially deviates the hand at the wrist

Muscles of the WristFlexor carpi ulnaris

O: by 2 heads from medial epicondyle of humerus and medial border of olecranon process of ulna

I: palmer surface of pisiform and hamate and base of 5th metacarpal

A: flexes and ulnarly deviates the hand at the wrist

Muscles of the Wrist Flexor digitorum superficialis

O: humero-ulnar head – medial epicondyle of the humerus by the common flexor tendon, ulnar collateral ligament of elbow and coronoid process of ulna; radial – oblique line of radius extending from radial tuberosity to the insertion of the pronator teres

I: 4 tendons, 1 to each finger, divide fro the passage of the tendons of flexor digitorum profundus then insert as 2 slips on sides of the shaft of the middle phalanx

A: flexes the phalanx of each finger on the proximal phalanx. Flexes the proximal phalanx at the hand, flexes the hand at the wrist

Muscles of the Wrist

Flexor pollicis longus O: anterior surface of middle ½ of

radius. Adjacent interosseous membrane and slip from the coronoid process of the ulna or medial epicondyle of humerus

I: palmar surface of the base of the distal phalanx of the thumb

A: flexes the interphalangeal joint of the thumb. Flexes the metacarpophalangeal and carpometacarpal joints

Muscles of the Wrist

Flexor digitorum profundus O: upper ¾ of anterior and medial surfaces

of the ulna, interosseous membrane and deep fascia of the forearm

I: 4 tendons, 1 to each finger, to palmer surface of base of distal phalanx, after passing through tendon of flexor digitorum superficialis

A: flexes the distal phalanges of the 4 fingers. Assists in flexing metacarpophalangeal, carpometacarpal and wrist joints

Muscles of the WristExtensor carpi radialis

longusO: lower 1/3 of lateral

supracondylar ridge, and a few fibers from lateral epicondyle

I: posterior surface of base of 2nd metacarpal

A: extends and radially deviates hand at the wrist

Muscles of the WristExtensor digitorum

O: common extensor tendon from lateral epicondyle of humerus

I: by 4 tendons, 1 to each finger, each dividing into 3 slips, middle one attaches to dorsal surface of middle phalanx, the other 2 unit to attach to the dorsal surface of base of distal phalanx

A: extends phalanx at the interphalangeal joints, continued action extends the metacarpophalangeal and carpometacarpal articulations. Assists in wrist extension

Muscles of the WristExtensor digiti minimi

O: common tendon of extensor digitorum

I: tendon of the extensor digitorum at the proximal phalanx of the little finger and into the dorsal expansion of the finger extensor tendons

A: extends the proximal phalanx of the little finger at the metacarpophalangeal joint, assists extension at the wrist. Extends middle and distal phalanges especially when the proximal phalanx is held in flexion

Muscles of the WristExtensor carpi radialis

brevisO: common extensor tendon

from lateral epicondyle I: posterior surface of base of

3rd metacarpalA: extension and radial

deviation of the hand at the wrist

Muscles of the WristExtensor carpi ulnaris

O: by 2 heads from lateral epicondyle of humerus and middle 1/3 of posterior ridge of ulna

I: posterior surface of base of 5th metacarpal

A: extends and ulnarly deviates the hand at the wrist

Muscles of the Wrist

Extensor indicisO: dorsal surface of distal

half of ulna I: index finger extensor

digitorum tendonA: extension of all

phalanges of index finger. Assists in wrist extension

Extensor Pollicis Longus O: Posterior surface of the

middle 1/3 of ulna an interosseous membrane

I: Posterior surface of base of distal phalanx of thumb

A: Extends distal phalanx of thumb. Continued action, extends proximal phalanx and metacarpal, and adducts 1st metacarpal

Extensor Pollicis BrevisO: Posterior surface of

distal end of body of ulna near the middle and adjacent interosseous membrane

I: Posterior surface of the base of proximal phalanx of thumb

A: Extends proximal phalanx of thumb. Continued action extends and assists abduction of 1st metacarpal

Abductor Pollicis LongusO: Small facet of the ulnar

side of radius near its middle. On the lateral side of the dorsal surface of body of ulna just below insertion of anconeus and interosseous membrane

I: Radial surface of base of 1st metacarpal

A: Abducts and assists in extension of carpometacarpal joint of thumb

Opponens Digiti MinimiO: Hook of hamate

bone and flexor retinaculum

I: Entire length of ulnar boarder of 5th metacarpal

A: Flexes and slight lateral rotation of 5th metacarpal. Helps to cup palm of the hand.

Abductor Digiti Minimi O: Pisiform bone and from tendon

of flexor carpi ulnaris

I: 2 slips; into ulnar side of base of proximal phalanx of little finger; into ulnar border of extensor expansion of finger

A: Abducts little finger and assists in flexing its proximal phalanx at the metacarpophalangeal joint

Flexor Digiti Minimi Brevis

O: Hook of hamate and flexor retinaculum

I: Ulnar side of base of proximal phalanx of 5th finger

A: Flexes 5th digit at the metacarpophalangeal joint

Flexor Pollicis BrevisO: Superficial head – Distal

border of flexor retinaculum and tubercle of trapezium bone. Deep head – Trapezoid and capitate bones

I: Radial side of the base of proximal phalanx of tumb

A: Flexes proximal phalanx of thumb. Continued action, flexes 1st metacarpal and rotates it medially

Abductor Pollicis BrevisO: Flexor retinaculum

and tubercle of the scaphoid and trapezium

I: Radial side of the base of the proximal phalanx of the thumb

A: Abduction and medial rotation of proximal phalanx and the metacarpal of the thumb

Adductor Pollicis O: Oblique head – capitate bone,

bases of 2nd and 3rd metacarpals. Transverse head – Distal 2/3 of the palmar surface of the 3rd metacarpal bone

I: 2 heads converge to insert on the ulnar side of the base of proximal phalanx of thumb

A: adduction of thumb at the carpometacarpal joint. Adduction and assists in flexion of thumb at the MCP joint

Opponens PollicisO: Flexor retinaculum

and tubercle of trapezium bone

I: Radial side of entire length of 1st metacarpal bone

A: Flexes and abducts the first metacarpal with slight medial rotation

LumbricalsO: Tendons of flexor

digitorum profundus in center of palm

I: Around the radial side of the metacarpal bone and into extensor expansion

A: Principle extensors of interphalangeal joints. Weak flexor of the metacarpophalangeal joints