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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?