Download Osteology Wrist Joint

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