Download HEALTH SCIENCES 365

HEALTH SCIENCES 365
Chapter 7 – Wrist & Hand Joints
Bones of Wrist and Hand Joints
Radius & Ulna
Carpals
 Scaphoid
 Lunate
 Triquetrum
 Pisiform
 Trapezium
 Trapezoid
 Capitate
 Hamate (Hook of Hamate)
Metacarpals
 Base
 Shaft
 Head
Phalanges
 Proximal
 Middle
 Distal
Wrist Joint
Dorsal Carpal Ligament
(Extensor Retinaculum)
Attaches medially to styloid process of ulna,
trapezium, and pisiform bones, to distal lateral
radius
Palmer Aponeurosis
Superficial fascia that gives general support to
the palm of the hand
Transverse Carpal Ligament
(Flexor Retinaculum)
Attaches medially to pisiform and hamate,
And laterally to scaphoid and trapezium
Wrist and Hand Joints Movement and Range of Motion
Radioulnar (trocoidial)
 Supination 90° from neutral
 Pronation 90° from neutral
Radiocarpal (condylodial)
-Primarily articulates with scaphoid, lunate,
and triquetrum
Movement and Range of Motion
 Flexion: 80° to 90°
 Extension: 70° to 90°
 Abduction: (radial deviation) 15°to 25°
 Adduction: (ulnar deviation) 25° to 40°
Intercarpal (arthrodial)
Intermetacarpal (arthrodial)
Metacarpophalangeal (condylodial)
Movement and Range of Motion:
 Flexion: 90°
 Extension: 0° to 40°
Metacarpophalangeal of the “thumb”:
 Flexion 40° to 90° from full extension
Carpometacarpal of the thumb: (seller)
Movement and Range of Motion:
 Flexion: 15° to 45°
 Extension: 0° to 20°
 Long Abduction: 50° to 70°
 Short Abduction: 30° to 45°
 Opposition: movement of thumb across
palm to oppose any or all phalanges
 Reposition: movement of thumb back to
anatomical position
Proximal Interphalangeal (ginglymus)
 Range of Motion: Flexion 90° to 120°
from full extension
Distal Interphalangeal (ginglymus)
 Range of Motion: Flexion 80° to 90°
from full extension
Movements of the Wrist
Flexion – Movement of the palm of hand
toward the anterior or volar aspect of the
forearm
Abduction (Radial Deviation) – Movement of
the thumb side of hand toward the radial side of
the forearm
Extension – Movement of the back of the hand
toward the posterior or dorsal aspect of the
forearm
Adduction (Ulnar Deviation) – Movement of
the little finger side of the hand toward the
ulnar side of the forearm
Movements of the Hand/Fingers
Flexion – Movement of the phalanges toward
the palm
Abduction – Movement of the fingers away
the middle finger
Opposition – Movement of the thumb across
the palm to oppose any of all of the fingers
Extension – Movement of the phalanges away
from the palm
Adduction – Movement of the fingers toward
the middle finger
Reposition – Movement of the thumb as it
returns to the anatomical position from
opposition
Myotome & Cutaneous Distribution of the Ulnar Nerve
Muscles that Cross the Wrist
Wrist Flexors (Palmer side of Wrist)
 *Flexor Pollicis Longus
 *Flexor Carpi Radialis
 *Palmaris Longus
 *Flexor Digitorum Superficialis
 *Flexor Carpi Ulnaris
 Flexor Digitorum Profundus
Wrist Extensors (Dorsal side of Wrist)
 *Extensor Carpi Ulnaris
 *Extensor Digiti Minimi
 *Extensor Digitorum
 *Extensor Indicis
 *Extensor Carip Radialis Brevis
 *Extensor Carpi Radialis Longus
 *Extensor Pollicis Longus
 *Extensor Pollicis Brevis
 *Abductor Pollicis Longus
Muscles of the Wrist – “Palmer Side” of Wrist
Flexor Pollicis Longus
O. Middle anterior surface of radius,
Anterior medial border of ulna just distal to coronoid process
I. Palmer surface, base of distal phalanx of thumb
A. _________________________________________________________
_________________________________________________________
N. Median
Flexor Carpi Radialis
O. Medial epicondyle of humerus
I. Palmer surface, base of 2nd and 3rd metacarpals
A. _________________________________________________________
_________________________________________________________
N. Median
Palmaris Longus
O. Medial epicondyle of humerus
I. Palmer aponeurosis of 2nd, 3rd, 4th, 5th metacarpals
A. _________________________________________________________
_________________________________________________________
N. Median
Flexor Digitorum Superficialis
O. Medial epicondyle of humerus
Medial coronoid process
Anterior surface of radius, just below radial tuberosity
I. (4 tendons) each splits and attach to sides of base of the middle phalanx
of the four fingers (palmer surface)
A. _________________________________________________________
_________________________________________________________
N. Median
Flexor Carpi Ulnaris
O. Medial epicondyle of humerus, Posterior aspect of proximal ulna
I. Palmer surface, base of 5th metacarpal, pisiform, hamate
A. _________________________________________________________
_________________________________________________________
N. Ulnar
Flexor Digitorum Profundus
O. Proximal 3/4ths of anteromedial ulna
I. Base of distal phalanxes of the four fingers
A. _________________________________________________________
_________________________________________________________
N. Median – 2nd and 3rd fingers, Ulnar – 4th and 5th fingers
Muscles of the Wrist – “Dorsal Side” of Wrist
Extensor Carpi Ulnaris
O. Lateral epicondyle of humerus, Middle third posterior border of ulna
I. Dorsal surface, base of 5th metacarpal bone
A. _________________________________________________________
_________________________________________________________
N. Radial
Extensor Digiti Minimi
O. Lateral epicondyle of humerus
I. Dorsal surface, base of middle and distal phalanx of little finger
A. _________________________________________________________
_________________________________________________________
N. Radial
Extensor Digitorum
O. Lateral epicondyle of humerus
I. Dorsal surface, base of middle and distal phalanx of four fingers
A. _________________________________________________________
_________________________________________________________
N. Radial
Extensor Indicis
O. Distal portion of posterior ulna
I. Dorsal surface, base of middle and distal phalanx of index finger
A. _________________________________________________________
_________________________________________________________
N. Radial
Extensor Carpi Radialis Brevis
O. Lateral epicondyle of humerus
I. Dorsal surface, base of 3rd metacarpal
A. _________________________________________________________
_________________________________________________________
N. Radial
Extensor Carpi Radialis longus
O. Lateral supracondylar ridge of humerus, Lateral epicondyle of humerus
I. Dorsal surface, base of 2nd metacarpal
A. _________________________________________________________
_________________________________________________________
N. Radial
Extensor Pollicis Longus
O. Posterior lateral surface of lower ulna
I. Dorsal surface, base of distal phalanx of thumb
A. _________________________________________________________
_________________________________________________________
N. Radial
Extensor Pollicis Brevis
O. Posterior surface of lower radius
I. Dorsal surface, base of proximal phalanx of thumb
A. _________________________________________________________
_________________________________________________________
N. Radial
Abductor Pollicis Longus
O. Middle 1/3 posterior surface of radius and ulna
I. Dorsal surface, base of 1st metacarpal
A. _________________________________________________________
_________________________________________________________
N. Radial
Intrinsic Muscles of the Hand – “Thenar” Muscles
Opponens Pollicis
O. Palmer surface, transverse carpal ligament, trapezium
I. Lateral border, 1st metacarpal
A. _________________________________________________________
_________________________________________________________
N. Median
Abductor Pollicis Brevis
O. Palmer surface, transverse carpal ligament, trapezium, scaphoid
I. Base of 1st metacarpal
A. _________________________________________________________
_________________________________________________________
N. Median
Flexor Pollicis Brevis
O. Superficial Head: transverse carpal ligament, trapezium
Deep Head: Ulnar side of 1st metacarpal
I. Base of 1st metacarpal
A. _________________________________________________________
_________________________________________________________
N. Superficial Head: Median, Deep Head: Ulnar
Intrinsic Muscles of the Hand – “Intermediate” Muscles
Adductor Pollicis
O. Transverse Head: Palmer surface of 3rd metacarpal
Oblique Head: Palmer surface base of 2nd and 3rd metacarpal, capitate
I. Ulnar side, base of proximal phalanx of thumb
A. _________________________________________________________
_________________________________________________________
N. Ulnar
Palmar Interossei
O. Shaft of 2nd, 4th, and 5th metacarpals
I. Base of proximal phalanx of 2nd, 4th, and 5th fingers
A. _________________________________________________________
_________________________________________________________
N. Ulnar
Dorsal Interossei
O. Two heads on shafts of adjacent metacarpals
I. Base of proximal phalanx of 2nd, 3rd, and 4th fingers
A. _________________________________________________________
_________________________________________________________
N. Ulnar
Lumbricals
O. Tendon of flexor digitorum profundus
I. Extensor expansion on radial side of 2nd, 3rd, 4th, and 5th proximal phalanx
A. _________________________________________________________
_________________________________________________________
N. Median: 1st and 2nd, Ulnar – 3rd and 4th
Intrinsic Muscles of the Hand – “Hypothenar” Muscles
Opponens Digiti Minimi
O. Transverse carpal ligament, hook of hamate
I. Medial border of 5th metacarpal
A. _________________________________________________________
_________________________________________________________
N. Ulnar
Abductor Digiti Minimi
O. Pisiform
I. Ulnar side base of 1st phalanx of little finger
A. _________________________________________________________
_________________________________________________________
N. Ulnar
Flexor Digiti Minimi
O. Transverse carpal ligament, hook of hamate
I. Ulnar/palmar side base of 1st phalanx of little finger
A. _________________________________________________________
_________________________________________________________
N. Ulnar
Wrist position of function: ___________________________________
Carpal Tunnel Syndrome
1. Anatomy:
a. Bounds
b. Muscles/tendons
c. Nerve
d. Other
2.
3.
4.
5.
Etiology:
Symptoms:
Tests:
Intervention:
Wrist Fracture
Scaphoid
Collies Fracture
1. MOI:
2. Symptoms
Claw Hand
1. Description: Hyperextension at the MCP joint, and flexion at the IP joint
2. What causes the hand to take this position and what nerves are involved?
Ape Hand
1. Description: Atrophy of thenar emminance
2. What nerve(s) and muscles are involved?