Hand and Wrist Joint
Tana Pearson
Galina Nesenchuk
Vira Iatchenko
BONES: Ulna, Radius
The ulna is a long bone,
prismatic in form, placed
at the medial side of
the forearm, parallel with
the radius.
• Radius
Bones: Ulna
• Head of ulna – small, rounded
surface at distal end of bone
• Styloid process of ulna
– small, medial projection from
head region; forms medial
portion of wrist joint
Bones: Radius
• Styloid process of radius
- pointed lateral projection
at distal end of bone;
forms lateral portion of
wrist joint
• Ulnar notch of radius
- slight depression at
mediodistal end; area of
articulation with ulna
Bones and Joints
There are 15 bones that form connections from the end of the forearm to
the hand. The wrist itself contains eight small bones, called carpal bones.
These bones are grouped in two rows across the wrist. The proximal row
is where the wrist creases when you bend it. Beginning with the thumbside of the wrist, the proximal row of carpal bones is made up of the
scaphoid, lunate, and triquetrum. The second row of carpal bones, called
the distal row, meets the proximal row a little further toward the fingers.
The distal row is made up of the trapezium, trapezoid, capitate, hamate,
and pisiform bones.
The proximal row of carpal bones connects the two bones of the forearm,
the radius and the ulna, to the bones of the hand. The bones of the hand
are called the
metacarpal bones. These are the long bones that lie within the palm of the
hand. The metacarpals attach to the phalanges, which are the bones in the
fingers and thumb.
WRIST
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Carpals
1. Scaphoid
2. Lunate
3. Triquetrum
4. Pisiform
5. Trapezium
6. Trapezoid
7. Capitate
8. Hamate
WRIST
• Metacarpal bones:
Nambered 1-5
(thumb side is #1)
• Phalangeal bones:
Fingers numbered 1-5
(thumb is #1)
Proximal
Middle (intermediate)
Distal
Joints
• Distal interphalangeal
joint (DIP)
• Proximal interphalangeal
joint (PIP)
• Metacarpo-phalangeal
joint (MP)
Joint and capsule
Synovial Joint:
Joints where the articulating
bones are separated by a fluidcontaining joint cavity.
Allows freedom of movement.
Articular Capsule:
Fibrous Capsule
Synovial Membrane
Joint Cavity
Articular cartilage
ORIGIN:
Attachment of a muscle tendon to the stationary bone.
INSERTION:
Attachment of the other muscle tendon to the movable bone.
ACTION:
The movement that occurs at the joint due to muscle
contraction.
EXTENSOR MUSCLES
ORGIN, INSERTION & ACTION OF
EXTENSOR MUSCLES
Extensor carpi radialis longus:
Extensor carpi radialis brevis:
O: lateral epicondyle of humerus
I: base of 3rd metacarpal
A: wrist extension
Extensor carpi ulnaris:
O: lateral epicondyle of humerus
I: medial side of base of 5th
metacarpal
A: extends & adducts wrist
O: supracondylar ridge of humerus
I: base of 2nd metacarpal
A: wrist extension, radial deviation
Extensor digitorum:
O: lateral epicondyle of the humerus
I: base of distal phalanx of the 2nd-5th
fingers
A: extends all 3 joints of the fingers
EXTENSOR MUSCLES CONT.
Extensor digiti minimi:
O: lateral epicondyle of humerus
I: base of distal phalanx of 5th finger
A: extends all joints of 5th finger
Extensor pollicis brevis:
O: posterior distal radius
I: base of the proximal phalanx of pollex
A: extends MP joint of thumb
Extensor pollicis longus:
O: middle posterior ulna & interosseous membrane
I: base of distal phalanx of pollex
A: extends MP & IP joints of the thumb
FLEXOR MUSCLES
ORGIN, INSERTION & ACTION OF
FLEXOR MUSCLES
Flexor carpi radialis:
O: medial epicondyle of the humerus
I: base of 2nd & 3rd metacarpals
A: wrist flexion, radial deviation
Flexor carpi ulnaris:
O: medial epicondyle of humerus
I: pisiform & base of 5th metacarpal
A: wrist flexion , ulnar deviation
Flexor digitorum superficialis:
O: common flexor tendon, coronoid process & radius
I: sides of the middle phalanx of the 4 fingers
A: flexes MP & PIP joints of the fingers
FLEXOR MUSCLES CONT.
Flexor digitorum profundus:
O: upper ¾ of ulna
I: distal phalanx of the 4 fingers (2-5)
A: flexes all 3 joints of the fingers
Flexor pollicis longus:
O: radius, anterior surface
I: distal phalanx of pollex
A: flexes all joints of the pollex or thumb
Abductor pollicis longus:
O: post. radius , interosseous membrane, middle ulna
I: base of the 1st metacarpal
A: abducts pollex
Palmaris longus:
O: medial epicondyle of humerus
I: palmar fascia
A: assistive in wrist flexion
Ligaments Tendons and Sheaths
• Articular Ligaments
▫
▫
▫
▫
Fibrous dense regular connective tissue.
Connect bones to other bones.
They act as mechanical reinforcements.
Within synovial joints, act as a stabilizer to prevent excessive or
undesirable motion.
• Tendons and aponeurosis
▫ Tendon – ropelike connection anchoring muscle to the connective tissue
covering of a skeletal element (bone or cartilage)
▫ Aponeurosis – sheetlike tendon
▫ Durable, withstand abrasion of rough bony projections, and relatively
small size conserve space.
• Sheaths
▫ An elongated/flattened sac, lined with synovial fluid, that wraps
completely around a tendon subjected to friction.
▫ They are common where several tendons are crowded together within
narrow canals, ie wrist.
Ligaments and sheaths
Palmar Aponeurosis
Flexor retinaculum – anterior
Extensor retinaculum – posterior
Commom flexor sheath
Tendons
Anterior:
•Palmaris longus
•Flexor carpi longus
•Flexor retinaculum
•Palmar aponeurosis
Posterior:
• Extensor carpi ulnaris
• Extensor digitorum
• Extensor pollicis brevis
• Extensor longus
• Extensor retinaculum
• Flexor carpi ulnaris
Anterior View
Posterior View
Arteries
Two arteries enter the hand:
• Ulnar Artery
• Radial Artery
Together, the branches of
these arteries form two
arterial arches:
• Superficial palmar arch
• Deep palmar arch
Branching distally off
superficial palmar arch:
• Common palmar digitals
Palmar View
Veins
Dorsal view
The veins of the upper extremity
are divided into two sets,
superficial and deep; the two
sets anastomose frequently with
each other.
Cephalic Vein
Basilic Vein
Superficial dorsal venous arch
Deep dorsal venous arch
Dorsal View
Nerves
• Ulnar Nerve
• Radial Nerve
• Median Nerve
Palmar View
Cutaneous Innervation
Palmar cutaneous branch
Ulnar, Radial, Median
Dorsal cutaneous branch
Ulnar, Radial
Veins Arteries and Nerve Summary
Innervations
Muscle
Nerve
Artery
Flexor carpi ulnaris
Ulnar nerve
Ulnar artery
Flexor digitorum profundus
Median and ulnar nerves
Ulnar Artery
Flexor digitorum superficialis Median nerve
Ulnar artery
Palmaris longus
Median nerve
Ulnar artery
Flexor carpi radialis
Median nerve
Radial and Ulnar arteries
Flexor pollicis longus
Median nerve
Radial artery
Innervations
Muscle
Nerve
Artery
Abductor pollicis longus
Radial nerve
Posterior interosseous artery
Extensor pollicis brevis
Radial nerve
Posterior interosseous artery
Extensor pollicis longus
Radial nerve
Posterior interosseous artery
Extensor carpi radialis longus Radial nerve
Radial artery
Extensor carpi radialis brevis Radial nerve
Radial artery
Extensor carpi ulnaris
Deep radial nerve
Ulnar artery
Extensor digitorum
Radial nerve
Recurrent interosseous artery
Extensor digiti minimi
Radial nerve
Recurrent interosseous artery
Surface Anatomy
Compartments and Spaces
Surface Anatomy
Surface Anatomy
Surface Anatomy
Carpal Tunnel Syndrome
• Condition caused by compression or
stretching of the medial nerve.
• Common disorder with people whose
occupation require a great deal of wrist
flexion or prolonged extension
Writers
Typists
Pianists
Computer professions
Carpal tunnel syndrome
Symptoms
• Needles and pins sensation to the
index and middle finger of the
wrist.
• Pain in the middle area of the
wrist, swelling of wrist,
• Numbness or tingling in index
and middle fingers,
• Loss of function of hand in severe
cases.
Carpal tunnel syndrome
Cures
• Splints applied to dorsiflex the wrist occasionally help keep the wrist
in a resting position.
▫ In this position, the carpal tunnel is as big as it can be, so the nerve has
as much room as possible inside the carpal tunnel.
• Cortisone injections may help
• Surgery to strip away build-up adhesive tissue may be required.
• This condition can recur even after treatment and tends to worsen
in the evening and night.