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CHAPTER 6:PART 1
THE UPPER EXTREMITY:
THE ELBOW, FOREARM, WRIST, AND
HAND
KINESIOLOGY
Scientific Basis of Human Motion, 12th edition
Hamilton, Weimar & Luttgens
Presentation Created by
TK Koesterer, Ph.D., ATC
Humboldt State University
Revised by Hamilton & Weimar
McGraw-Hill/Irwin
Copyright © 2012 by The McGraw-Hill Companies, Inc. All rights reserved.
OBJECTIVES
1. Name, locate, & describe the structure &
ligamentous reinforcements of the elbow, forearm,
wrist, and hand joints.
2. Name & demonstrate the movements possible in
these joints.
3. Name & locate muscles & muscle groups, and
name their primary actions.
4. Analyze the fundamental movements with respect
to joint & muscle actions.
5. Describe common athletic injuries.
6-2
THE ELBOW JOINT
STRUCTURE
Actually 3 joints:
 Humeroulnar
 Hinge

joint
Humeroradial
 Gliding

joint
Proximal Radioulnar
 Pivot
joint
Fig 6.1
6-3
THE ELBOW JOINT
STRUCTURE
Distal humerus -trochlea
& capitulum.
 Ulna - semilunar notch:

 Coronoid
process
 Olecranon process
Radial head
 Radial notch of ulna

Fig 6.1
6-4
THE ELBOW JOINT
STRUCTURE



All 3 joints enveloped in a capsule,
lined by synovial membrane.
Strengthened by radial & ulnar
collateral ligaments.
Annular ligament encircles the
radial head & binds it to ulna.
Fig 6.2 & 6.3
Movements of the
elbow joint
Fig 6.4a
6-5
THE RADIOULNAR JOINTS
STRUCTURE
Proximal: previously described.
Distal:
 Pivot joint
 Radius articulates with head of ulna.
 Strengthened by:
 Volar radioulnar ligament
 Dorsal radioulnar ligament
Fig 6.1
The radiolunar joints--movements
6-6
MUSCLES OF ELBOW AND RADIOULNAR
JOINTS
Location:
 Anterior (Elbow): Biceps brachii, brachialis,
brachioradialis, pronator teres
 Anterior (wrist): Pronator quadratus
 Posterior: Triceps brachii, anconeus, supinator
6-7
BICEPS BRACHII
Function:
 Flexes and supinates the
forearm.
Function:
 Flexion at the elbow.
Fig
6.5
Fig 6.7
6-8
Brachioradialis
Fig 6.8
Function:
 Contributes to elbow flexion.
Pronator Teres
Function:
 Pronates the forearm, assists
in elbow flexion.
Pronator Quadratus
Fig 6.9
Function:
 Pronation of the forearm.
6-9
TRICEPS BRACHII & SUPINATOR
Triceps Brachii
Function:
 Powerful extensor
of elbow.
Supinator
Function:
 Supination of the
forearm.
Fig 6.10
6-10
ANCONEUS
Function:
 Working with the
triceps, extends the
forearm.
Fig 6.11
6-11
MUSCULAR ANALYSIS OF THE
FUNDAMENTAL MOVEMENTS OF
FOREARM
Flexion



Biceps brachii,
brachioradialis, brachialis
Brachialis active in all
conditions.
Biceps brachii most active
with supination, least with
pronation.
supination
pronation
Fig 6.6
6-12
MUSCULAR ANALYSIS OF THE
FUNDAMENTAL MOVEMENTS OF
FOREARM
Extension
 Triceps & anconeus, against gravity.
Pronation
 Pronator teres & pronator quadratus.
Supination
 Supinator & biceps; Long head more active
with greater muscle length, while short head
more active with shorter muscle length.
6-13
THE WRIST AND HAND
Great mobility due to
generous supply of
joints:
 Radiocarpal (wrist)
joint.
 Articulation between
two rows of carpal
bones.
 Carpometacarpal joints.
Lunate
Scaphoid
Trapezoid
Triquetral
Hamate
Capitate
Trapezium
Fig 6.12
6-14
STRUCTURE OF THE WRIST
(RADIOCARPAL) JOINT


Condyloid joint
4 ligaments
 Volar radiocarpal
 Dorsal radiocarpal
 Ulnar collateral
 Radial collateral
Fig 6.14
Circumduction: fingertips
describe a circle, hand
describes a cone.
Fig 6.16
Movements of the
hand at the wrist
6-15
STRUCTURE AND MOVEMENTS OF THE
MIDCARPAL AND INTERCARPAL JOINTS
Proximal row of 4 carpal bones articulate
with four carpal bones of distal row.
 Permits only a slight gliding motion.
 However, the gliding adds up to a modified
hinge type of movement.
 Anterior surface of carpal bones are slightly
concave, referred to as the carpal tunnel.

6-16
STRUCTURE OF THE
CARPOMETACARPAL AND
INTERMETACARPAL JOINTS



The thumb is a prime
example of a saddle
joint.
Joints between bases of
metacarpal bones are
irregular.
All are enclosed in
capsules.
Fig 6.13
6-17
MOVEMENTS OF THE
CARPOMETACARPAL JOINT OF THE
THUMB
Fig 6.19
Abduction
Flexion
Hyperadduction
Hyperflexion
Extension
Opposition
6-18
MOVEMENTS OF CARPOMETACARPAL &
INTERMETACARPAL JOINTS OF
FINGERS
Because of short ligaments in this region,
motion in these joint is almost
nonexistent.
 Limited to slight gliding.
 5th carpometacarpal joint is slightly more
mobile.

6-19
STRUCTURE OF
METACARPOPHALANGEAL JOINTS



Joints at bases of four fingers,
uniting proximal phalanges with
metacarpals.
 Condyloid joints
 Encased in capsules
Protected by collateral
ligaments.
Also a dorsal ligament.
Fig 6.17

Fig 6.20
Movements of
Metacarpophalangeal
Joint of the Fingers
6-20
MOVEMENTS OF
METACARPOPHALANGEAL JOINTS
OF THE THUMB

Flexion:
 volar
surface of the thumb approaches base of
thumb.

Extension:
 return
movement from flexion.
6-21
THE INTERPHALANGEAL JOINTS
Joints between adjacent phalanges of any of
the five digits.
 All are hinge joints, permit only flexion &
extension.
 Hyperextension is slight, if present at all.
 Each enclosed in a capsule.
 Strengthen by collateral ligaments and in front
by a volar ligament .

6-22
MUSCLES
OF
THE
WRIST
Location: (table 6.1)


Anterior: Flexor carpi radialis, flexor carpi ulnaris,
palmaris longus.
Posterior: Extensor carpi radialis brevis, extensor carpi
radialis longus, extensor carpi ulnaris.
Location: (table 6.1)
 From forearm: Extensor digiti minimi, extensor digitorum,
extensor indicis, flexor digitorum profundus, flexor
digitorum superficialis.
 Intrinsic to Hand: Abductor digiti minimi, flexors digiti
minimi brevis, interossei dorsales manus, interossei
palmaris, lumbricales manus, opponens digiti minimi.
6-23
MUSCLES OF THE THUMB
Location: (table 6.1)
 From forearm: Abductor pollicis longus,
extensor pollicis brevis, extensor pollicis
longus, flexor pollicis longus.
 Intrinsic to hand: Abductor pollicis brevis,
adductor pollicis, flexor pollicis brevis,
opponens pollicis.
6-24
MUSCLES OF THE WRIST AND HAND
Flexor Carpi radialis
Function:
 Flexes wrist
 Radial deviation
Flexor Carpi Ulnaris
Function:
 Flexes wrist
 Ulnar deviation
Palmaris longus
Function:
 Weakly flexes
wrist
Extensor carpi radialis
Function:
 Extends wrist
 Radial deviation
Extensor carpi ulnaris
Function:
 Extends wrist
 Ulnar deviation
Fig 6.21
Extensor
carpi radialis
(longus)
(brevis
)
Extensor
carpi
ulnaris
Fig 6.23a
6-25
MUSCLES OF THE WRIST AND HAND
Fig 6.23b
Extensor digitorum
Function:
 Extends fingers &
wrist.
Extensor digiti
minimi
Function:
 Extends little
finger & wrist.
Extensor
digitorum
Extensor
digiti
minimi
Flexor
digitorum
superficialis
Function:
 Flexes
fingers &
wrist.
Fig
6.24
a
6-26
MUSCLES OF THE WRIST AND HAND
Flexor digitorum
profundus
Fig
6.24b
Function:
 Flexes fingers
& wrist.
Flexor pollicis
longus
Function:
 Flexes thumb.
Extensor pollicis
longus
Function:
 Extends thumb
Extensor indicis
Function:
 Extends index
finger
Abductor pollicis
longus
Function:
 Abducts thumb
Extensor pollicis
brevis
Function:
 Extends thumb
Fig
6.25
6-27
MUSCLES OF THE WRIST AND HAND
Abductor pollicis brevis
Function:
 Abducts thumb.
Flexor pollicis brevis
Function:
 Flexes thumb.
Opponens pollicis
Function:
 Opposition of thumb.
Fig 6.26
6-28
MUSCLES OF THE WRIST AND HAND
Abductor pollicis brevis
Function:
 Abducts thumb.
Flexor pollicis brevis
Function:
 Flexes thumb.
Opponens pollicis
Function:
 Opposition of thumb.
Fig 6.26
Fig 6.26
Abductor digit minimi
Function:
 Abducts little finger.
Flexor digiti minimi
Function:
 Flexes little finger.
Opponens digiti minimi
Function:
 Opposition of little finger.
6-29
MUSCULAR ANALYSIS OF THE
FUNDAMENTAL MOVEMENTS OF THE
WRIST, THUMB, AND HAND
Wrist
 Flexion
 Extension &
Hyperextension
 Radial deviation
(Abduction)
 Ulnar Deviation
(adduction)
Fingers
 Flexion
 Extension
 Abduction
 Adduction
 Opposition
6-30
MUSCULAR ANALYSIS OF THE
FUNDAMENTAL MOVEMENTS OF THE
WRIST, THUMB, AND HAND
Thumb Metacarpal Thumb Phalanges
 Flexion
 Flexion
 Extension
 Extension
 Abduction
 Adduction
 Opposition
6-31
COOPERATIVE ACTION OF WRIST AND
DIGITS
Length of Long Finger Muscles Relative
to Range of Motion in Wrist & Fingers
 Long
finger muscles do not have
sufficient length to permit full
ROM in joints of fingers & wrist
at the same time.
Example: make a tight fist, now
flex wrist, fingers loosen their
grip.
6-32
EXAMPLES OF USING HANDS FOR
GRASPING
 Power grip involves flexion of all fingers
Fig 6.30
Cylindrical
Spherical
Hook
6-33
EXAMPLES OF USING HANDS FOR
GRASPING

Precision involves thumb & two fingers,
depending on shape & size of object
Fig 6.30
6-34
COMMON INJURIES OF THE
FOREARM, ELBOW, WRIST, AND
FINGERS
FRACTURES OF THE FOREARM
Result of direct blow or falling on
outstretched hand.
 Usually both ulna & radius fracture.
 In the young usually a greenstick type.
 Immobilization of the elbow is important
to reduce movement at fracture site.

6-35
ELBOW DISLOCATION AND
FRACTURE
Results from falling on outstretched
hand with elbow extended or
hyperextended.
 Most common is backward
displacement of ulna & radius in relation
to humerus.
 Dislocation is frequently accompanied
by fracture.



Most common is to medial epicondyle.
Very serious - likely to involve blood
vessels & nerves.
6-36
SPRAINED OR STRAINED WRIST
From falling on palm of hand with wrist
hyperextended.
 Usually a sprain of ligaments.
 May be a strain to tendons.
 May be pain, weakness, limited ROM.

6-37
CARPAL TUNNEL SYNDROME

This is an overuse, repetitive stress
injury.

Long hours working with small hand tools and
keyboards.
Nerve & blood vessel compression as
they pass through carpal arch &
transverse carpal ligament.
 Indicators are pain, numbing of fingers.

6-38
AVULSION FRACTURE
External force applied to tendon pulls off
a piece of bone.
 Often from rapid pronation/supination
or high energy flexion of fingers.
 Probability for occurrence greatest
during growth and maturation.

6-39
EPICONDYLITIS
Lateral epicondylitis – “tennis elbow”
Medial epicondylitis – ‘Little League elbow”
 Both are repetitive stress injuries.

Micro-traumas or tears in muscle & soft
tissue at proximal attachments.

Indication is pain on activity.

Rest, ice, anti-inflammatory drugs,
bracing often used as treatment.
6-40