Download Wrist Hand Presentation PTA

HAND AND WRIST
Adam Ardillo
Shannon Budworth
Rose French
Amanda Stricker
Ligaments
Palmar Aponeurosis: covers soft tissues and
flexor tendons, and consists of central, lateral,
and medial portions.
1.
2.
3.
Central portion: occupies middle of palm,
triangular in shape
Apex: continuous with the lower margin of
the extensor retinaculum, and receives the
expanded tendon of the palmaris longus.
Base: divides into four slips, one for each
finger
Ligaments
Flexor Retinaculum: aka transverse carpal
ligament. Fibrous band on the palmar side of
the hand near the wrist. Arches over carpal
bones forming the carpal tunnel.
Extensor Retinaculum: aka dorsal carpal
ligament. Holds the tendons of the extensor
ligaments in place, located on the back of the
forearm just proximal to the hand.
Ligaments
Common Flexor Sheath: contains tendons of the
flexor digitorum superficialis and the flexor
digitorum profundus.
-deep to flexor retinaculum, passes through central
compartment of the hand
Compartments and Spaces
Hypothenar compartment-muscles that
control motion of little finger
Thenar compartment-muscles that
oppose the thumb
Central compartment- flexor tendons,
digital vessels & nerves
Adductor compartment-adductor pollicis
Interosseous compartment-muscles
between metacarpals that spread
fingers
Midpalmar space-inferior to central
compartment
Thenar space-inferior to thenar
compartment
Clinical Concerns: Carpal Tunnel Syndrome
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Occurs when the median nerve is compressed within the carpal
tunnel
Symptoms are pain, tingling, numbness, and a gradual weakening
of grip strength
Occurs mostly in jobs that require compression of the tunnel
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Computer jobs
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Work that needs a strong grip
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Working mostly with vibrating tools (construction workers
Other risk factors include:
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Obesity
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Pregnancy
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Rheumatoid arthritis
Cartilage
Articular Cartilage-covers the articulating surface of bones in a synovial joint
Between:
-Radius & Ulna and carpals
-Carpals
-Metacarpals
-Phalanges
Articular Capsule
Synovial membrane:
inner layer that
secretes synovial fluid
Fibrous layer: outer
layer that attaches to
articular end of each
bone in a joint
CMC joint: thumb & trapezium articulation
Synovial Joints in the Hand and Wrist
Bones: Ulna
1) Head of the Ulna
2) Styloid Process
Head
H
Styloid
Process
Bones: Radius
1) Styloid process
2) Ulnar notch
Some lovers try positions
Bones: Wrist
that they cannot handle
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
Bones: Metacarpals
Numbered 1-5
Thumb is number 1
Bones: Phalangeal Bones
Numbered 1-5
Thumb is 1
-Proximal
-Middle (intermediate)
-Distal
Joints: Metacarpo-phalangeal joint (MP)
Joint between hand and finger
Joint: Interphalangeal joint (IP)
-Made up of Distal and
Proximal Interphalangeal
Joints
-Thumb: IP joint
Surface Anatomy: Pulse points and tendon of Palmaris
Longus
Surface Anatomy: Palmar Surface
Surface Anatomy: Tendons of Extensor Digitorum
Surface Anatomy: What Creates The “Snuff Box”
Circulation of the Hand/Wrist
Arteries of the Hand/Wrist
-Ulnar artery
-Radial artery
-Superficial Palmar Arch
-Deep Palmar Arch
-Common Palmar Digitalis
Circulation of the Hand/Wrist
Veins of the Hand/Wrist
-Cephalic Vein
-Basilic Vein
-Superficial Dorsal Venous Arch
-Deep Dorsal Venous Arch
Nerves of the Hand/Wrist
-Median Nerve
-Radial Nerve
Ulnar Nerve
-Dorsal/Palmar
Cutaneous
Branch
Median Nerve
-Roots Lateral : C5-C7
Medial: C8, T1
Gives rise to the Palmar cutaneous branch
LOAF Pneumonic for muscles innervated:
L: Lumbricals
O: Opponens Pollicis
A: Abductor Pollicis Brevis
F: Flexor Pollicis Brevis
Ulnar Nerve
Roots: C8, T1
Gives rise to Dorsal Cutaneous Branch
Innervates: Flexor Carpi Ulnaris
Flexor Digitorum Profundus
Adductor Pollicis
Radial Nerve
Roots: C5-T1
Divides to become Posterior Interosseous Nerve
Innervates: All the extensors of the back of the hand
Abductor pollicis longus
Finger movement muscles: Extensor
Digitorum
Nerve: Posterior
interosseous nerve
Root: C7, C8
O: Lateral Epicondyle
I: Extensor tendons of
medial 4 fingers
A: Extends fingers
(digits:2-5) at MCP, PIP,
DIP
S: Extension: Extensor
digiti minimi
A: Flexion: flexor
digitorum superficialis
and profundus
Finger movement muscles: Extensor digiti
minimi
Nerve: Posterior
interosseous nerve
Roots: C7, C8
O: Lateral Epicondyle
I: Extensor tendons of 5th
finger
A: Extends 5th finger at
MCP, PIP, DIP
S: Extension: Extensor
digitorum
A: Flexion: flexor digitorum
(superficialis and profundus),
Flexor digiti minimi
Finger movement muscles: Flexor Digitorum
Superficials
Nerve: Median nerve
Roots: C7-C8 &T1
O: Humero-ulnar head: Medial
Epicondyle of Humerus and Coronoid
process
Radial Head: Oblique line of Radius
I: body of middle phalanges
(digits:2-5)
A: Flexes PIP joints and MCP joints
(digits 2-5)
S: Flexion: Flexor digitorum profundus
A: Extensor (digitorum and digiti
minimi)
Intermediate layer
Finger movement muscles: Flexor Digitorum
Profundus
Nerve: Lateral fibers: Median and medial fibers: Ulnar
Roots: C8, T1
O: Proximal 3/4 of medial and anterior surfaces of ulnar and interosseous
membrane
I: Base of distal phalanges (digits:2-5)
A: Flexes DIP joint (digits:2-5), assists with wrist flexion
S: Flexion: Flexor Digitorum Profundus
A: DIP Extension: Extensor digitorum and digiti minimi
Wrist Flexion: Palmaris longus, Flexor carpi radialis, Flexor carpi ulnaris, Flexor
digitorum (superficialis and profundus)
Wrist extension: Extensor carpi radialis longus and brevis, Extensor carpi
ulnaris
Deep layer
Movements of the Thumb
Adduction
-Adductor Pollicis
Abduction
-Abductor Pollicis Brevis
-Abductor Pollicis Longus
Movements of the Thumb Continued...
Extension
Flexion
-Extensor Pollicis Brevis
-Flexor Pollicis Brevis
-Extensor Pollicis Longus
-Flexor Pollicis Longus
-Abductor Pollicis Longus
Muscles of the Thumb
Extensor Pollicis Longus
N: Posterior Interosseous Nerve
R: C7, C8
O: Post. surface of middle ⅓ of Ulna
I: Dorsal surface of distal phalanx
A: Extends all joints of the thumb Syn: (Extensor pollicis brevis, abductor pollicis
longus) Antagonists: Flexor pollicis (brevis, longus) Abducts radiocarpal joint. Syn:
Abd (abductor pollicis longus & brevis) Ant: Adductor pollicis
Muscles of the Thumb
Extensor pollicis Brevis
N: Posterior Interosseous Nerve
R: C7, C8
O: Post. surface of distal ⅓ of radius &
Interosseous membrane
I: Dorsal surface of proximal phalanx
A: Extends the joints of the thumb Syn:
(Extensor pollicis longus)
Ant: (Flexor pollicis brevis & longus)
Muscles of the Thumb
Flexor Pollicis Longus
N: Median Nerve
R: C8, T1
O: Ant. surface of radius, interosseous membrane
I: Distal phalanx of thumb
A: Flexes all digits of Pollex
pollicis (brevis & longus)
Syn: Flexor pollicis brevis Ant: Extensor
Muscles of the Thumb
Abductor Pollicis longus
N: Posterior Interosseous nerve
R: C7, C8
O: Post. surface, prox. ½ of Ulna,
radius, & interosseous membrane
I: Base of 1st Metacarpal
A: Abducts and extends thumb Syn Abd: Abductor pollicis brevis Ant Add:
Adductor pollicis Syn. Ext: Extensor pollicis (longus, brevis) Ant. Flex. (Flexor
pollicis (brevis, longus)
Flexion:
Extension:
-Flexor Carpi Radialis
-Extensor carpi radialis
(longus and brevis),
-Flexor Carpi Ulnaris
-Palmaris Longus
-Flexor Digitorum
Superficialis
-Flexor Digitorum
Profundus
-Flexor Pollicis Longus
-Extensor carpi ulnaris
Radial
Deviation:
-extensor carpi
radialis (longus
and brevis)
-flexor carpi
radialis
-extensor
pollicis (longus
and brevis)
-abductor
pollicis longus
Ulnar
Deviation:
-flexor carpi
ulnaris
-extensor carpi
ulnaris
Wrist Flexor Muscles
Palmaris Longus:
O: medial epicondyle of the humerus
I: flexor retinaculum, palmar aponeurosis
A: flexes wrist, tenses palmar aponeurosis
N: median
R: C6 & C7
Syn: Flexion-flexor carpi (ulnaris and radialis), flexor digitorum
(superficialis and profundus)
Ant: Extension-extensor carpi radialis (longus and brevis),
extensor carpi ulnaris
Wrist Flexor Muscles
Flexor Carpi Ulnaris:
O: humeral head-medial epicondyle of humerus
Ulnar head-olecranon and posterior border of ulna
I: pisiform, hamulus of hamate, base of 5th
Metacarpal
A: flexes and adducts hand at wrist (ulnar deviation)
N: ulnar
R: C7 & C8
Syn:
-flexion: palmaris longus, flexor carpi radialis,
flexor digitorum (superficialis and profundus)
-Ulnar deviation:extensor carpi ulnaris
Ant:
-extension:extensor carpi radialis (longus &
brevis), extensor carpi ulnaris
-Radial deviation:extensor carpi radialis (longus
and brevis), extensor pollicis (longus and brevis),
flexor carpi radialis, abductor pollicis longus
Wrist Flexor Muscles
Flexor Carpi Radialis:
O: medial epicondyle of the humerus
I: base of 2nd and 3rd metacarpal
A: flexes and abducts hand at wrist (radial
deviation)
N: median
R: C6 & C7
Syn:
-Flexion: palmaris longus, flexor carpi ulnaris,
flexor digitorum (superficialis and profundus)
-Radial deviation: extensor carpi radialis (longus
and brevis), extensor pollicis (longus and
brevis), abductor pollicis longus
Ant:
-Extension: extensor carpi radialis (longus &
brevis), extensor carpi ulnaris
-Ulnar deviation: flexor carpi ulnaris, extensor
carpi ulnaris
Extensor Carpi Ulnaris
O: Lateral epicondyle
I: Dorsal surface at base of 5th metacarpal
A: Extends and adducts wrist
Nerve: Posterior interosseous nerve
Roots: C7,C8
Syn: Extension- Extensor carpi radialis (longus & brevis)
Adduction- Flexor carpi ulnaris
Ant: Flexion- Palmaris longus, Flexor carpi (radialis & ulnaris). Flexor digitorum
(superficialis & profundus)
Abduction- Flexor carpi radialis
Extensor Carpi Radialis Longus
O: Lateral supra-epicondylar ridge of humerus
I: Dorsal aspect of base of 2nd metacarpal
A: Extends and abducts wrist
Nerve: Radial nerve
Roots: C6, C7
Syn: Extension- Extensor carpi radialis brevis, Extensor carpi ulnaris
Abduction- Extensor carpi radialis brevis, Extensor pollicis longus,
Abductor pollicis longus, Flexor carpi radialis
Ant: Wrist Flexion- Palmaris longus, Flexor carpi (radialis and ulnaris)
Adduction- Flexor carpi ulnaris, Extensor carpi ulnaris
Extensor Carpi Radialis Brevis
O: Lateral supra-epicondylar ridge of humerus
I: Dorsal aspect of base of 3rd metacarpal
A: extends and abducts wrist
Nerve: Radial Nerve
Roots: C7, C8
Syn: Extension- Extensor carpi radialis longus, Extensor carpi unlaris
Abduction- Flexor carpi radialis, Extensor carpi radialis (longus and
brevis), Extensor pollicis longus, Abductor pollicis longus
Ant: Wrist Flexion- Palmaris longus, Flexor carpi (radialis and ulnaris)
Adduction- Flexor carpi ulnaris, Extensor carpi ulnaris
QUESTIONS?