Download Chapter 18

The Forearm, Wrist, Hand, and Fingers
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1
Objectives
 When you finish with this chapter you should be able
to:
 Review the structural and functional anatomy of the
forearm, wrist, hand and fingers.
 Outline the process of assessment for injuries to the
forearm, wrist, hand and fingers.
 Incorporate management techniques for dealing with
injuries to the forearm, wrist, hand, and fingers.
 Implement the appropriate rehabilitation techniques for
dealing with injuries to the forearm, wrist, hand, and
fingers.
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Anterior
Radius
and
Ulna
Parts to know:
• Radius:
• Head of the radius
• Neck of the radius
• Radial tuberosity
• Shaft of the radius
• Ulnar notch of the radius
• Styloid process of the radius
• Ulna
• Trochlear notch of the ulna
• Coronoid process of the ulna
• Ulnar tuberosity
• Radial notch of the ulna
• Styloid process of the ulna
• Olecranon process of the ulna
• Head of the ulna
• Shaft of the Ulna
• Interosseous membrane
• Distal radioulnar joint
• Proximal radioulnar joint
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Sports Medicine
- Mr. Cronin
Posterior Radius and Ulna
Parts to know:
• Radius:
• Head of the radius
• Neck of the radius
• Shaft of the radius
• Ulnar notch of the radius
• Styloid process of the radius
• Ulna
• Radial notch of the ulna
• Styloid process of the ulna
• Olecranon process of the ulna
• Head of the ulna
• Shaft of the ulna
• Interosseous membrane
• Distal radioulnar joint
• Proximal radioulnar joint
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Sports Medicine Mr. Cronin
Articulations of the Forearm
 Proximal (Superior)
Radioulnar Joint
 Middle Radioulnar
Joint
 Distal (Inferior)
Radioulnar Joint
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Forearm Musculature
 Flexor Carpi Radialis
 Origin

Medial epicondyle of the
humerus.
 Insertion
 Ventral surface (palm side) of
the second and third
metacarpals.
 Action
 Flexes the wrist and abducts the
hand (radial deviation); aids in
flexion of the elbow and
pronation of the forearm.
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Forearm Musculature
 Palmaris Longus
 Origin

Medial epicondyle of the
humerus.
 Insertion
 Palmar aponeurosis (a sheet of
pearly-white fibrous tissue that
takes the place of a tendon in
sheet-like muscles having a wide
area of attachment).
 Action
 Flexes the wrist.
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Forearm Musculature
 Flexor Carpi Ulnaris
 Origin

Medial epicondyle of the
humerus, olecranon process,
and the proximal two-thirds
of the posterior surface of
the ulna.
 Insertion
 Pisiform, hamate, and fifth
metacarpal.
 Action
 Flexes the wrist and adducts
the hand (ulnar deviation).
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Forearm Musculature
 Flexor Digitorum
Superficialis
 Origin
 Medial epicondyle of the
humerus, coronoid process
of the ulna, and the
anterior radius.
 Insertion
 Ventral surface (palm side)
of the middle phalanges of
the second through fifth
fingers
 Action
 Flexes the wrist and
phalanges.
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Forearm Musculature
 Flexor Digitorum Profundus
 Origin

Medial epicondyle of the
humerus, the coronoid process
of the ulna, the interosseous
membrane, and the ventral
(anterior) side of the ulna.
 Insertion
 Ventral (palm side) of the base
of the distal phalanges of the
second through fifth fingers.
 Action
 Flexes the wrist and the
phalanges.
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Forearm Musculature
 Flexor Pollicis Longus
 Origin

Ventral surface of the
radius (anterior) and the
interosseous membrane.
 Insertion
 Ventral surface (palm
side) of the base of the
distal phalanx of the
thumb.
 Action
 Flexes the thumb and
aids in flexing the wrist.
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Forearm Musculature
 Pronator Quadratus
 Origin

Distal ventral surface
(anterior side) of the
ulna.
 Insertion
 Distal ventral surface
(anterior side) of the
radius.
 Action
 Pronates the forearm
and hand.
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Forearm Musculature
 Extensor Carpi Radialis
Longus
 Origin
 Lateral supracondylar
ridge of the humerus.
 Insertion
 Dorsal surface (posterior)
of the base of the second
metacarpal.
 Action
 Extends the wrist and
abducts (radial deviation)
the hand.
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Forearm Musculature
 Extensor Carpi Radialis
Brevis
 Origin
 Lateral epicondyle of the
humerus.
 Insertion

Dorsal surface (posterior) of
the base of the third
metacarpal.
 Action
 Extends the wrist and
abducts (radial deviation) the
hand.
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Forearm Musculature
 Extensor Digitorum
(Communis)
 Origin
 Extends the wrist and
abducts (radial deviation)
the hand.
 Insertion
 Dorsal surface (posterior) of
the phalanges of the second
through fifth fingers.
 Action
 Extends the fingers and
wrist.
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Forearm Musculature
 Extensor Digiti Minimi
 Origin

Tendon of the extensor
digitorum communis.
 Insertion
 Tendon of the extensor
digitorum communis on
the dorsum (posterior) of
the little finger.
 Action
 Extends the little finger.
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Forearm Musculature
 Extensor Carpi Ulnaris
 Origin

Lateral epicondyle of the
humerus.
 Insertion
 Base of the fifth
metacarpal.
 Action
 Extends the wrist and
adducts (ulnar deviation)
the hand.
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Forearm Musculature
 Abductor Pollicis Longus
 Origin

Posterior surface of the
middle of the radius and
ulna and the interosseous
membrane.
 Insertion
 Base of the first metacarpal.
 Action
 Abducts the thumb and
hand (radial deviation).
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Forearm Musculature
 Extensor Pollicis Brevis
 Origin

Posterior surface of the
middle of the radius and
the interosseous
membrane.
 Insertion
 Base of the first phalanx of
the thumb.
 Action
 Extends thumb and wrist,
abducts the hand (radial
deviation).
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Forearm Musculature
 Extensor Pollicis Longus
 Origin
•
Posterior surface of the
middle of the ulna and the
interosseous membrane.
 Insertion
 Base of the distal phalanx
of the thumb.
 Action
 Extends the thumb and
abducts the hand (radial
deviation).
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Forearm Musculature
 Extensor Indicis
 Origin

Posterior surface of the
distal end of the ulna
and the interosseous
membrane.
 Insertion
 Tendon of the extensor
digitorum communis to
the index finger.
 Action
 Extends the index
finger.
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Muscle Groups of the Forearm
 Extensors
 (Posterolateral)
 Extensor Carpi Radialis
Longus
 Extensor Carpi Radialis
Brevis
 Extensor Carpi Ulnaris
 Brachioradialis
 Extensor Pollicis Longus
 Extensor Pollicis Brevis
 Abductor Pollicis Longus
 Extensor Indicis
 Supinator
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 Flexors
 (Anteromedial)
 Flexor Carpi Radialis
 Flexor Carpi Ulnaris
 Palmaris Longus
 Flexor Digitorum
Superficialis
 Flexor Digitorum
Profundus
 Flexor Pollicis Longus
 Pronator Quadratus
 Pronator Teres
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Common Forearm Injuries
 Forearm Splints
 Forearm Fractures
 Colles’ Fracture
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Forearm Splints
 Etiology
 Signs/Symptoms
 Management
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Forearm Fractures
 Etiology
gymnastics injury
 Signs/Symptoms
 Management
 Colles’ Fracture
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Anatomy of the Wrist, Hand, and
Fingers
 Bones of the Wrist
 Carpals (8)








Scaphoid
Lunate
Triquetral
Pisiform
Hamate
Capitate
Trapezoid
Trapezium
 Metacarpals (5)
 1st
 2nd
 3rd
 4th
 5th
 Phalanges (14)
 Proximal
 Intermediate
 Distal
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Articulations
 Radiocarpal Joint
 (Inter)Carpal Joints
 Metacarpal Phalangeal
Joints (MCP)
 (Inter)Phalangeal Joints
 Proximal
Interphalangeal Joint
(PIP)
 Distal Interphalangeal
Joint (DIP)
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Musculature of the Wrist, Hand,
and Fingers
 Palmar Muscles
 Lumbricales (4)
 Dorsal Interossei (4)
 Palmar Interossei (3)
 Thenar Muscles
 Abductor Pollicis Brevis
 Opponens Pollicis
 Flexor Pollicis Brevis
 Adductor Pollicis
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 Hypothenar Muscles
 Palmaris Brevis
 Abductor Digiti Minimi
 Flexor Digiti Minimi
Brevis
 Opponens Digiti
Minimi
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Musculature of the Wrist, Hand,
and Fingers
 Lumbricals
 Origin – Tendons of the
flexor digitorum
profundus.
 Insertion – Tendons of
the extensor digitorum
communis.
 Action – Flexes the
metacarpophalangeal
joints.
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Musculature of the Wrist, Hand,
and Fingers
 Dorsal Interossei (4)
 Origin – Adjacent sides of all of
the metacarpals.
 Insertion – Proximal phalanx of
the second, third, and fourth
fingers.
 Action – Abducts the fingers
from the middle finger.
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Musculature of the Wrist, Hand,
and Fingers
 Palmar Interossei (3)
 Origin – Medial side of the second
metacarpal and lateral side of the
fourth and fifth metacarpals.
 Insertion – Proximal phalanx of
the same finger.
 Action – Adducts the fingers
toward the middle finger.
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Musculature of the Wrist, Hand,
and Fingers
 Abductor Pollicis Brevis
 Origin – Flexor Retinaculum,
scaphoid, and trapezium.
 Insertion – Proximal phalanx
of the thumb.
 Action – Abduct the thumb.
 Abductor pollicis brevis
video
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Musculature of the Wrist, Hand,
and Fingers
 Opponens Pollicis
 Origin – Flexor
retinaculum, and
trapezium.
 Insertion – Lateral border
of the metacarpal of the
thumb.
 Action – Pulls the thumb
in front of the palm to
meet the little finger.
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Musculature of the Wrist, Hand,
and Fingers
 Flexor Pollicis Brevis
 Origin – Flexor
retinaculum, trapezium,
and first metacarpal.
 Insertion – Base of the
proximal phalanx of the
thumb.
 Action – Flexes and
adducts the thumb.
 Flexor Pollicis Brevis
Video
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Musculature of the Wrist, Hand,
and Fingers
 Adductor Pollicis
 Origin – Capitate, and
second and third
metacarpals.
 Insertion – Proximal
phalanx of the thumb.
 Action – Adducts the
thumb.
 Adductor Pollicis Video
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Musculature of the Wrist, Hand,
and Fingers
 Palmaris Brevis
 Origin – Flexor
retinaculum.
 Insertion – Skin on the
ulnar border of the
hand.
 Action – Pulls the skin
toward the middle of
the palm.
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Musculature of the Wrist, Hand,
and Fingers
 Abductor Digiti Minimi
 Origin – Pisiform and
the tendon of the flexor
carpi ulnaris.
 Insertion – Base of the
proximal phalanx of the
little finger.
 Action – Abducts the
little finger.
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Musculature of the Wrist, Hand,
and Fingers
 Flexor Digiti Minimi Brevis
 Origin – Flexor
retinaculum and hamate.
 Insertion – Base of the
proximal phalanx of the
little finger.
 Action – Flexes the little
finger.
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Musculature of the Wrist, Hand,
and Fingers
 Opponens Digiti Minimi
 Origin – Flexor
retinaculum and hamate.
 Insertion – Metacarpal of
the little finger.
 Action – Brings the little
finger our to meet the
thumb.
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Joint Movements Fingers and
Thumb
 Finger Extension
 Finger Flexion
 Finger Abduction
 Finger Adduction
 Thumb Abduction
 Thumb Adduction
 Thumb Extension
 Thumb Opposition
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Nerve Supply
 Two major nerves:
(motor and sensory)
 Ulnar Nerve
 Median Nerve
 Additional nerve (mostly
sensory)
 Radial Nerve
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Blood Supply
 Radial Artery
 Ulnar Artery
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Special Tests
 Finkelstein’s Test
 Circulatory and
Neurological Evaluation
 Tinel’s Sign
 Dermatomes and
 Phalen’s Test
 Valgus/Varus and Glide
Myotomes
 Nailbed Pinch
Tests for the Wrist, MCP
 Functional Evaluation
and IP Joints
 Luntriquetral Ballotment
Test
 Allen’s Test
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Common Injuries to the Wrist,
Hand, and Fingers











Wrist Sprains
Tenosynovitis
Tendinitis
Nerve Compression,
Entrapment, Palsy
Carpal Tunnel Syndrome
deQuervain’s Syndrome
Dislocation of the Lunate
Scaphoid Fracture
Hamate Fracture
Wrist Ganglion
Trigger Finger or Thumb
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 Extensor Tendon Avulsion






(Mallet Finger)
Boutonniere Deformity
Flexor Digitorum Profundus
Rupture (Jersey Finger)
Gamekeeper’s Thumb
MCP Dislocation
Bennett’s Fracture
Metacarpal Fracture (Boxer’s
Fracture)
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Wrist Sprains
 Etiology
 Signs/Symptoms
 Management
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Wrist Tenosynovitis vs. Tendonitis
 Etiology
 Tenosynovitis = repetitive
wrist accelerations and
decelerations; repetitive
use and overuse of the
wrist tendons and their
sheaths
 Tendonitis = repetitive
wrist flexion; overuse of
the wrist
 Signs/Symptoms
 Management
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Carpal Tunnel Syndrome
 Etiology
 Signs/Symptoms
 Management
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deQuervian’s Syndrome
Aka Hoffman’s disease
 Etiology
 Signs/Symptoms
 Management
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Lunate Dislocation
 Etiology
 Signs/Symptoms
 Management
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Scaphoid Fracture
 Etiology
 Signs/Symptoms
 Management
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Hamate Fracture
 Etiology
 Signs/Symptoms
 Management
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Wrist Ganglion
 Etiology
 Signs/Symptoms
 Management
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Trigger Finger/Thumb
 Etiology
 Signs/Symptoms
 Management
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Mallet Finger
 Etiology
 Baseball
finger/basketball finger
 Signs/Symptoms
 Management
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Boutonniere Deformity
 Etiology
 Buttonhole deformity
 Signs/Symptoms
 Management
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Jersey Finger
 Etiology
 Signs/Symptoms
 Management
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Gamekeeper’s Thumb
 Etiology
 Skier's thumb
 Signs/Symptoms
 Management
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MCP Dislocation
 Etiology
 Signs/Symptoms
 Management
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Bennett’s Fracture
 Etiology
 Signs/Symptoms
 Management
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Metacarpal Fracture (Boxer’s Fracture)
 Etiology
 Signs/Symptoms
 Management
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