Wrist and Hand

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Wrist and Hand
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Wrist

• Wrist is a joint complex consisting of
  radio-carpal joint and many relationships between
  the carpal bones
• Review of carpals
• Proximal row Pisiform, Triquetrum, Lunate, and
  Scaphoid
• Distal row Hamate, Capitate, Trapezoid, and
  Trapezium
• Scaphoid has a notoriously poor blood supply and
  recovers poorly following injury

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Osteology
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Osteology
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Osteology
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Scaphoid
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Cross Section at Wrist
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Wrist

• All carpal bones articulate via gliding or plane
  joints
• A more or less joint exists between proximal row
  and distal row of bones called mid-carpal truly
  is a series of gliding joints
• Scaphoid, Lunate and Triquetrum with Trapezium,
  Trapezoid, Capitate and Hamate
• Pisiform is not involved

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Wrist

• True Wrist Radio-Carpal
• Ulnar-Carpal interposed disc
• Distal radius with proximal carpals
• Condyloid joint 2 degrees of freedom
• Major Ligaments
• Palmar radio-carpal, palmar ulnocarpal, dorsal
  radio-carpal, dorsal ulno-carpal, radial and
  ulnar collateral

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Radio-Carpal
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Ligaments
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Ligaments
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Interactive Wrist
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Wrist

• Mid-Carpal
• Proximal row of carpals with distal row
• A series of gliding joints 3 DOF
• MAJOR Ligaments Capsule plus
• Pisohamate, pisometacarpal, capitotriquetral,
  palmar and dorsal carpometacarpal

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Ligaments
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Interactive Wrist
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Wrist

• Movements
• Flexion/Extension about 70-80 degrees of ROM
• Radiocarpal v. Mid Carpal
• Flexion is initiated in mid carpal joint and 60
  occurs there
• Extension is also initiated at mid carpal but
  most occurs in radio-carpal. Need 35 degrees for
  good function at least 10 for any significant
  function.
• Abduction/Adduction about 15 to 20 degrees
• Intercarpal proximal row slides over distal row

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Movements
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Movements
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Movements
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Carpo-Metacarpal Joints

• 2-5
• Hamate with 4 and 5
• Capitate with 3
• Trapezoid with 2
• Gliding joints with limited range mostly
  passive
• Palmar and Dorsal carpometacarpal ligaments

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C-M Joints
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C-M Joints
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C- M Thumb

• Trapezium with 1st met
• Saddle
• Adds rotary component very mobile
• Capsule support

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C-M Thumb
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Interactive Hand
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Metacarpal Phalangeal Joints

• Ellipsoid
• 2 DOF
• Passive rotation
• Collateral Ligaments
• Deep Transverse Metacarpal Ligaments
• Palmar Ligaments (Plates)

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Ligaments
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Ligaments
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Interactive Hand
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Interphalangeal Joints

• Hinge
• Collateral Ligaments
• Palmar Ligaments (Plates)

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Ligaments
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Interactive Hand
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Definition of Finger Movements

• Reference is imaginary line through the middle of
  long (3rd) finger
• Adduction of 2-5 towards that point
• Abduction away 1, 4, and 5
• Thumb
• Flexion
• Extension
• ABD
• ADD
• Rotation
• Opposition flexion with adduction and rotation

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Finger Movements
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Finger Movements
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Flexor Tendons

• Tenosynovium (AKA Fibro-Osseous Tunnels)
• Anular Pulleys AKA Vaginal Ligaments
• Anular and Cruciform
• Relationship to Palmar Plates

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Vinculum Longa and Breve
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Tunnels
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Tunnels
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Interactive Hand
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Dorsal Hood
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Dorsal Hood
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Dorsal Hood Mechanism

• Insertion of Long Extensor Tendons
• Ext. Dig. Communis
• Ext. Indicis Proprius
• Ext. Digiti Minimi
• Extensor Expansion MP Joints
• Central Band Middle Phalanx
• Lateral Band Distal Phalanx
• Relationship to Intrinsic Muscles

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Dorsal Hood
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Dorsal Hood
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Interactive Hand
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Intrinsic Muscles

• Thenar Eminence - median
• Hypothernar Eminence - ulnar
• Intermediate ulnar and some median
• There are NO muscles in the hand innervated by
  the Radial nerve

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Palmar Aponeurosis
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Thenar Eminence

• Flexor Pollicus Brevis
• Abductor Pollicus Brevis
• Opponens Pollicus

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Thenar Muscles
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Hypothenar Eminence

• Abductor Digiti Minimi
• Flexor Digiti Minimi
• Opponens Diditi Minimi

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Intermediate

• Adductor Pollicus
• Lumbricales
• Volar (Palmar) Interossei
• Dorsal Interossei

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Adductor Pollicus
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Lumbricales
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Lumbricales
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Dorsal Interossei
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1st Dorsal Interosseous
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Volar (Palmar) Interrossei
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Digit Movement
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Digit Movement Cont.
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Blood Supply

• Ulnar aa
• Superficial Palmar Arch
• Common Palmar aa
• Proper palmar digital aa
• Radial aa
• Deep Palmar Arch
• Dorsal digital aa
• Princeps Pollicus
• Radialis Indicis

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Superficial Palmar Arch
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Superficial Palmar Arch
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Superficial Palmar Arch
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Deep Palmar Arch
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Deep Palmar Arch-Dorsal View
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Deep Palmar Arch
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Digital Supply
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Median Cutaneous
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Ulnar Cutaneous
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Radial Cutaneous (Hand)
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Common Nerve Injuries

• Median
• Symptoms
• Ulnar
• Symptoms