Wrist and Hand
CREATED BY:
BRIANA OCHOA
ELIZABETH RICH
DAVID SNYDER
Surface Anatomy
Ulnar Styloid Process
Pisiform
Ulnar Pulse
Radial Pulse
Surface Anatomy
Distal Wrist Crease
Tendon of Flexor
Carpi Ulnaris
Radial Artery
Tendon of Flexor
Carpi Radialis
Tendon of Palmaris
Longus
Surface Anatomy
Hypothenar Eminence
Thenar Eminence
Surface Anatomy
•
•
Anatomical Snuff Box
Tendons of:
• Extensor Digitorum
• Extensor Pollicis
Longus (EPL)
• Abductor Pollicis
Longus (APL)
Median Nerve
Bones
Head
Ulna
Ulnar Notch
Radius
Styloid Process
Bones
• Fingers numbered 1-5
• Thumb side is always #1
Carpals
Carpals
 Some Lovers Try Positions That They Can’t Handle
Joints
Bones of Wrist and Hand
Articular Capsule
 Synovial Membrane
 Produces synovial fluid for lubrication and shock absorption
 Fibrous Layer
 Enclose synovial sheaths
(outer membrane)
 May contain ligaments
Membrane and Cartilage
Articular Cartilage
Ligaments
 Common Flexor Sheath
 Through carpal canal to cover flexor tendons of digits
 Palmar Aponeurosis
 Insertion of palmaris longus
Common Flexor Sheath
Ligaments
 Extensor Retinaculum
 Connects lateral margin of radius to medial margin of ulna
 Flexor Retinaculum
 Crosses over carpal bones
Extensor Retinaculum
Wrist Movement
 Actions
 Actions
 Extension
 Adduction aka Ulnar



Extensor carpi ulnaris
Extensor carpi radialis brevis
Extensor carpi radialis longus
Deviation


Extensor carpi ulnaris
Flexor carpi ulnaris
 Assist in Extension


Extensor digitorum
Extensor indicis
 Flexion





Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Flexor digitorum superficialis
Flexor digitorum profundus
 Abduction Deviation aka
Radial Deviation



Extensor carpi radialis brevis
Extensor carpi radialis longus
Flexor carpi radialis
 Pronation

Pronator quadratus
Extrinsic Extensor Muscles
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris muscle
Extrinsic Muscles: Anatomical Snuff Box
Extensor
pollicis longus
Extensor
indicis
Abductor pollicis longus
Extensor pollicis
longus
brevis
Extrinsic Flexor Muscles
Extrinsic Muscles of the 1st Digit
 Extensors
 Extensor pollicis longus
 Extensor pollicis brevis
 Abductors
 Abductor pollicis longus
 Flexors
 Flexor pollicis longus
Extrinsic Pollicis Muscles
 Abduction, Extension, and Flexion
Movements of the Pollicis at the MCP and
CMC Joints
Movements of the Pollicis at the CMC Joint
 Abduction


Abductor pollicis longus
Abductor pollicis brevis
 Adduction

Adductor pollicis: transverse and oblique heads
Thumb Movement
 Extension
 Extensor pollicis longus
 Extensor pollicis brevis
 Flexion
 Flexor pollicis brevis
Thumb Movement
 Opposition
 Opponens pollicis
 Reposition
 Abductor pollicis
Compartments and Spaces-Intrinsic Muscles
Thenar Compartment
Flexor pollicis brevis
Abductor pollicis brevis
Opponens pollicis
Hypothenar Compartment
Opponens digiti minimi
Flexor digiti minimi
Abductor digiti minimi
Compartments and Spaces of Hand
 Adductor Compartment
 Central Compartment
Adductor
pollicis
palp
Contents: long flexor tendons, digital nerves, su
Thenar and Midpalmer Spaces
 Thenar Space


1st lumbrical muscle
Flexor digitorum profundus
tendon of digit 2
 Midpalmer Space


Lumbricals 2-4
Flexor digitorum profundus
tendons of digits 3-5
 Actions of Lumbrical Muscles:
 Flex MCP joints
 Extend IP joints (PIP & DIP)
Interosseous Compartment
 Dorsal Interossei



Arise from 4 medial metacarpal
bones
Action: Abduction
Mnemonic: DAB
Dorsal: Abduction
 Palmer Interossei



Arise from metacarpal bones 2,
4, 5
Action: Adduction
Mnemonic: PAD
Palmar: Adduction
Movement of Medial Digits at the MCP Joints
 Extension
 Extensor digitorum
 Extensor indicis
 Extensor digiti minimi
 Flexion
 Flexor digitorum superficialis
 Flexor digitorum profundus
 Flexor digiti minimi
 Lumbricals
Medial Digit Movement
 Abduction
 Abductor digiti minimi
 Dorsal interossei (digits 2-4)
 Adduction
 Palmer interossei (digits 2,4,5)
 Opposition
 Opponens digiti minimi
Digital Movement
Opponens digiti minimi
Flexor digiti minimi
Abductor digiti minimi
Digital Movement-Abduction and Adduction
 Dorsal Interossei (4)



Arise from 4 medial metacarpal
bones
Action: Abduction
Mnemonic: DAB
Dorsal: Abduction
 Palmer Interossei (3)



Arise from metacarpal bones 2,
4, 5
Action: Adduction
Mnemonic: PAD
Palmar: Adduction
Digital Movement at PIP and DIP Joints

Flexion
D1
IP: Flexor pollicis longus
D2-5
PIP: Flexor digitorum
superficialis
DIP: Flexor digitorum
profundus

Extension
D1: Extensor pollicis longus
D2-D4
PIP: Lumbricals, Interossei
and Extensor digitorum
DIP: Lumbricals, Interossei
and Extensor digitorum
D2: Extensor indicis
D3: Dorsal interosseus
D5
PIP – Palmar interosseus and
Extensor digiti minimi
DIP - Palmar interosseus and
Extensor digiti minimi
Nerves
Nerves
Nerves
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome:
Condition in which the median nerve
is pinched inside of the carpal tunnel
Carpal Tunnel Syndrome
Common Causes:
-frequent or extreme use of wrist
-vibration of wrist
-excessive force with use of fingers
Carpal Tunnel Syndrome
Arteries
Arteries
Arteries
Veins
Veins
Cadaver Video Hand Dissection
http://www.youtube.com/watch?feature=
player_detailpage&v=WfXTehI1PWo