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Wrist and Hand

Wrist is the most
complex joints of
the body due to
the numerous
joints combined to
create one.
Wrist and Hand Anatomy

Carpal bones- Create a Mnemonic for
them. S-L-T-P-T-T-C-H
Wrist and Hand Anatomy
Two rows of bones starting on the thumb
side.
 Scaphoid, lunate, triquetrum, pisiform

Palpate the Scaphoid

You would palpate the scaphoid in the
anatomical snuff box.
Wrist and Hand Anatomy
Second row of carpals bones, is more
proximal
 Trapezium, trapezoid, capitate, Hamate.

Wrist and Hand Anatomy

Medial and Lateral epicondyle are where
many of the wrist and hand muscles
originate.
Wrist and Hand Anatomy

Styloid process- projection at distal end of
radius and ulna where the collateral
ligaments attach.
Wrist and Hand Joints

Radiocarpal Joint- distal end of the radius
and scaphoid, lunate, and triquetrum.
There is a radioulnar disk in between the
radius and other bones. It is a condyloid
joint.
Wrist and Hand Joints

Midcarpal joint- between the two rows of
carpal bones. Plane joints that allow
gliding motion, but assist with wrist
motions.
Wrist and Hand Joints

Carpometacarpal joint- between the distal
row of carpal bones and proximal end of
the metacarpal bones. Provide more
stability than mobility.
Ligaments of hand

Palmar radiocarpal
ligament-broad band
attaches anterior surface
of distal radius and ulna
to anterior surface of the
proximal carpal bones
and the capitate. Limits
wrist extension. So
repeated falls in
extension would injur it.
Wrist and Hand Injuries

Fractures of the Wrist and Hand
 Finger

Fractures
Boxer’s Fracture- fracture of 5th metacarpal. Hitting
something with fisted hand.
Wrist and Hand Injuries

Fractures of the Wrist
and Hand
 Finger

Fractures
Scaphoid Fracturefracture of scaphoid
which you call palpate
in anatomical snuffbox.
Occurs with fall on hand
in extension.
Wrist and Hand Injuries
Wrist Fractures

Colles’s fracture- fracture of
the radius just above the wrist.
A result of a fall with wrist
extended.
Tendon Injuries
Mallet Finger- hitting
something with the tip of a
finger and causing the
extensor tendon to tear.
 Jersey Finger- grabbing
something and tearing the
flexor tendon.

Tendon Injuries
Boutonniere deformityextensor tendon injury affecting
two joints of the finger. It is
an injury to the central tendon
on top of the finger.

 It
may appear as a “jammed finger” that cannot
be extended from the PIP joint.
 Treatment should be in an extended position so
the tendon can heal.
Dislocations/Subluxations
Dislocations occur in the
fingers and wrist bones.
 Point tenderness and swelling,
possible deformity.
 Physician
intervention
may be
necessary.

Wrist and Hand Muscles

Extensor Carpi Ulnaris- superficial muscle
that arises from the common extensor
tendon on the lateral epicondyle. It runs
the medial side of the posterior arm and
attaches to the fifth metcarpal. What does
it do?
Wrist and Hand Muscles

Flexor carpi radialissuperficial muscle running
from the medial epicondyle
diagonaly across the
anterior forearm to attach
to lateral base of second
and third metacarpal. What
is the motions?
Wrist and Hand Muscles
Palmaris Longus- superficial muscle
running down the anterior surface of the
forearm from common flexor attachment of
medial epicondyle to the midline of the
palmar fascia.
 Missing in 21%
of people.
 Flexor

Wrist and Hand Muscles

Flexor Digitorum superficialisdeep to the wrist flexors and
palmaris longus muscle.
Starts at the common flexor
tendon of medial epicondyle
and coranoid process, inserts
to the sides of digits 2-5.
Wrist and Hand Muscles

Abductor pollicis brevisproximal attachment is
the scaphoid, trapezium
and inserts to the base
of the proximal
phalange of the thumb.
Hand Grips

Grasps
 Power
grip is when an object needs to be held
forcefully and then moved by more proximal
muscles.
 Precision Grip is when an object is
manipulated with fingers
Hand Grips

Power grips
 Cylindrical
grip is fingers flexed around an
object. Thumb on one side fingers on other,
like gripping a hammer or racquet.
 Spherical grip is fingers and thumb are
together around an
 object. Like grabbing
 an apple or doorknob.
Hand Grips

Power Grip
 Hook
grip involves the second through fifth
fingers flexed around an object in a hooklike
manner. Thumb is extended and not involved
at all. Only possible grip for
 someone with no thumb or
 median nerve ability.
Hand Grips
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Precision Grips Pad
to pad
Pinch grip is the thumb and one finger gripping
 Three jaw chuck is holding a pencil, three fingers
and thumb.
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Hand Grips
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Precision Grips
 Tip

to Tip grip
Pincer grip is tip of thumb against tip of a finger,
like to pick up a coin. Difficult with long fingernails
Hand Grips

Precision Grips
 Lumbrical
grip or plate grip has the MCP and
PIP joint flexed and the DIP extended. The
thumb opposes and this grip is used to hold
something horizontal like a plate. Lumbricals
is used they flex the MCP joint.
Wrist Strengthening
Flexion
 Extension
 Ulnar Deviation
 Radial Deviation
 Pronation
 Supination
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