Hands Up!
Judith Lehman
Carpals
“Some Lovers Try Positions That They Can’t Handle”
Flexor Retinaculum or
Transverse Carpal Ligament
Origin: scaphoid and
trapesium on thumb
side
Insertion: pisiform and
hamate on pinky side
Action: stretches across
carpal bones creating
carpal tunnel for
flexor tendon and
median nerve to pass
Flexor Retinaculum Tps
Trigger Points and
Referrals:
No Tps as it is a
ligament, though
injury or compression
of median nerve may
cause pain, numbness,
lack of mobility in
hand.
Flexor Retinaculum Exercise
Stretch: place palm on
table with fingers and
thumb abducted and
hyperflex wrist; or
hold and stretch with
other hand
Strengthen: curl fingers
into palm and
hyperflex wrist
Opponens Pollicis
Origin: flexor retinaculum
and tubercle of trapezium
bone
Insertion: radial side of
entire length of 1st
metacarpal bone.
Action: flexes and abducts
the 1st metacarpal with
slight medial rotation –
brings thumb across palm
to ring finger pad
Flexor Pollicis Brevis
Origin: superficial head:
distal border of flexor retic
and tubercle of trapezium;
deep head: trapezoid and
capitate
Insertion: radial side of base
of proximal phalanx of
thumb
Action: flexes proximal
phalanx of thumb; flexes
1st metacarpal and rotates
medially
Abductor Pollicis Brevis
Origin: Flexor
retinaculum and
tubercles of scaphoid
and trapezium
Insertion: Lateral side of
base of proximal
phalanx of thumb
Action: Abducts thumb
and helps oppose it
Thumb Flexor TPs
Trigger Point: in the
belly of the muscle –
“weeder’s thumb”
Referrals: anterior
length of thumb and
medial wrist (above
and beneath point);
lateral side of thumb
for abductors
Opponens Pollicis Exercise
Stretch: Passively
hyper-abduct the
extended thumb with
fingers of the opposite
hand
Strengthen: Press thumb
and pinky together
Flexor Pollicis Brevis Exercise
Stretch: Passively
hyper-abduct the
extended thumb with
fingers of the opposite
hand
Strengthen: resisted
thumb flex with
rubber band anchored
Abductor Pollicis Brevis Exercise
Strengthen/stretch:
abduct with fingers in
rubber band, then
relax
Opponens digiti minimi
Origin: Hamulus or hook of
the hamate bone and
flexor retinaculum
Insertion: entire length of
ulnar border of 5th
metacarpal.
Action: flexes and slightly
laterally rotates 5th
metacarpal. Helps to cup
the palm of the hand
Flexor Digiti Minimi Brevis
Origin: Hook of hamate
and flexor retinaculum
Insertion: Medial side of
base of proximal
phalanx of little finger
Action: Flexes proximal
phalanx of little (5th)
finger
Abductor Digiti Minimi
Origin: Pisiform
Insertion: Medial side of
base of proximal
phalanx of little finger
Action: Abducts little
(5th) finger
Abductor Digiti Minimi TPs
Trigger Point: in the
belly of the muscle
Referrals: down
posterior and lateral
side of pinky; similar
areas for Opponens
and Flexor digiti
minimi only anterior
side
Opponens Digiti Minimi
Exercise
Stretch: Passively
hyper-extend the
pinky with fingers of
the opposite hand
Strengthen: squeeze
pinky and thumb
together and hold for
20 sec
Flexor Digiti Minimi Brevis
Exercise
Stretch: same as thumb
stretch but stretch
pinky instead
Strengthen: resisted
pinky flexion with
rubber band
Abductor Digiti Minimi Exercise
Stretch: stretch pinky
laterally
Strengthen: place rubber
band around extended
fingers and abduct
Palmaris Brevis
Origin: flexor
retinaculum and
palmar apneurosis
Insertion: skin of palm
into dermis
Action: steadies and
corrugates skin of
palm to help with grip;
contract palm
Palmaris Brevis TPs
Trigger Point: in the
belly of the muscle –
Referrals: length of
anterior edge of palm
on pinky side and
wrist
Palmaris Brevis Exercise
Stretch: stretch thumb
back with other hand
Strengthen: squeeze
fingers together tightly
Palmaris Longus
Origin: Common flexor
tendon from medial
epicondyle of humerus
Insertion:Distal half of
flexor retinaculum and
palmar aponeurosis
Action:Flexes hand (at
wrist) and tightens
palmar aponeurosis
Palmaris Longus TPs
Trigger Point: in the
belly of the muscle
Referrals: distal to palm
of hand and up
forearm
Palmaris Longus Exercise
Stretch: passive stretch
of palm by extending
wrist with other hand
Strengthen: resisted
wrist flexion with
theraband
Triceps Brachii
Origin: Long head:
infraglenoid tubercle of
scapula; Lateral head:
posterior surface of humerus,
superior to radial groove;
Medial head: posterior
surface of humerus, inferior
to radial groove
Insertion:Proximal end of
olecranon process of ulna
and fascia of forearm
Action:Chief extensor of
forearm;
Triceps Brachii TPs 1-2
TP1: in the belly of the long head
TP1 Referrals: strong referral to
posterior deltoid and lateral
condyle of the humerus.
Spillover from base of neck,
across shoulder, down posterior
upper arm and forearm
TP2: lower belly of medial head
TP2 Referral: refers strongly to
lateral condyle of humerus with
spillover down lateral posterior
forearm.
Triceps Brachii TPs 3-4
TP3: upper portion of
muscle belly of medial
head
TP3 Referrals: strong around
itself with spillover
surrounding it and down
posterior forearm into
posterior ring and pinky
fingers
TP4: in long, dense
tendonabove insertion
TP4 Referrals: strongly into
olecranon process
Triceps Brachii TPs 5
Tp5: in muscle belly on
anterior surface of
medial head.
Tp5 Referrals: strong
referral just below Tp
on anterior surface of
humerus – spills over
down anterior forearm
and anterior side of
ring and pinky
Triceps Brachii Exercise
Stretch: place one hand on
scapula same side and
other behind back – pull
towel between for stretch
in upper triceps
Strengthen: with theraband
anchored in front at chest
level, pull down and back
20 reps.
Anconeus
Origin: Posterior surface
of lateral epicondyle of
humerus
Insertion:Lateral surface
of olecranon and
superior part of posterior
surface of ulna
Action: Extension and
pronation of forearm at
elbow
Anconeus TPs
Trigger Point: in the
belly of the muscle
close to insertion of
ulna
Referrals: lateral
epicondyle of humerus
(tennis elbow)
Anconeus Exercise
Stretch: Holding weight
palm back, arm
extended, flex and
supinate arm across
body
Strengthen: extend and
pronate forearm away
from body
Supinate!
Pronate!
Sources
• Granger, Jocelyn. Neuromuscular Therapy Manual.
Lippencott, 2011.
• Travell, J. and Simons, D. Myofascial Pain and
Dysfunction, Vol. 1. Williams and Wilkins, 1983.
• Flash Anatomy flash cards: The Muscles. Bryan Edwards
Publications, 1991.
• http://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_h
and
• http://www.rad.washington.edu/academics/academicsections/msk/muscle-atlas/upper-body
• http://ict4us.com/r.kuijt/en_carpalbones.htm
Fini!