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Osteology • Radius - radial tubercle, radial styloid process • Ulna - ulnar styloid process • Carpals – Scaphoid, Lunate, Triquetrum, Pisiform Trapezium, Trapezoid, Capitate, Hamate P-A Radiograph of the Left Wrist ANTERIOR Wrist Joint L • Function - position the hand • Biaxial condyloid joint • Two functional joints withinradiocarpal and midcarpal • Radiocarpal: radius, scaphoid, lunate, triquetrum and disk (triangular fibrocartilage) • Midcarpal: irregular joint line between proximal and distal rows of carpals. • Movements - flexion and extension; radial and ulnar deviation (somewhat coupled) 1 Joints of the wrist and fibrocartilage disk 2 Osteokinematics of Wrist Osteo/Arthro-kinematics 3 Osteo/Arthro-kinematics Carpal Tunnel • Roof - transverse carpal ligament (part of flexor retinaculum); goes from pisiform and hamate to scaphoid and trapezium. • Floor - palmar radiocarpal ligament, palmar intercarpal ligs, & proximal carpal row. • Medial wall - pisiform and hook of hamate • Lateral wall - tuberosity of scaphoid and tubercle of trapezium. Carpal Tunnel • Contents Tendons of flexor digitorum superficialis, profundus, & flexor pollicis longus and median nerve. • (9 tendons & 1 nerve) Blood Vessels & Nerves • Radial and Ulnar Arteries: • Ulnar Nerve - travels with the ulnar artery to the wrist and hand. • Median Nerve - passes between the 2 heads of the pronator teres • Superficial & Deep branches of the Radial Nerve - the deep branch travels thru the supinator muscle 4 Carpal Tunnel Syndrome 5 Flexor side - Superficial • Common tendon attachment to the medial epicondyle • Pronator teres • Flexor carpi radialis • Palmaris longus: Absent in about 14% of individuals. Absent more often on left side DEEP GROUP • None of these cross the elbow. • Flexor digitorum profundus • Flexor pollicis longus • Pronator quadratus • Flexor digitorum superficialis • Flexor carpi ulnaris Extensor side - Superficial • All have a common tendon attachment that includes the lateral epicondyle • Brachioradialis • Extensor carpi radialis longus • Extensor carpi radialis brevis • Extensor digitorum • Extensor digiti minimi • Extensor carpi ulnaris DEEP GROUP • • • • • Abductor pollicis longus Extensor pollicis longus Extensor pollicis brevis Extensor indicis Supinator 6 Supinators and Pronators Radial & Ulnar Deviation (antagonists working together as agonists but also as antagonistic stabilizers; force couple?) Fig 7-30,31 Insight into Torque Production (internal moment arm length) Fig 7-24 Flexors > Extensors; RD>UD; RD>Extensors Table 7-1 7 All about GRIP All about GRIP Fig 7-26: maximal-effort grip for three different wrist positions (for three subjects). Tenodesis grip (passive insufficiency) Fig 7-27 Are these stretches different? How? Why? 8 - What is being stretched? Joint actions & Prime movers? Joint actions & Prime movers? 9