Wrist and Hand Anatomy

1
Wrist and Hand Anatomy
2
Bone Anatomy

• Scapoid
• Lunate
• Triquetrium
• Pisiform
• Trapeziod
• Trapezium
• Capitate
• Hamate

3
Wrist Articulations

• Radiocarpal Joint
• Proximal portion
• Distal portion
• Most surface contact found

4
Articulations

• Midcarpal Joint
• Articulation between proximal and distal row of
  carpals
• Not an uninterupted joint
• Distal Row
• 2 degrees of freedom
• Moves as a fixed unit

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Ligament Support

• Volar Carpal Ligaments
• Volar Radiocarpal Ligament
• Three bands
• Volar Ulnocarpal Ligament
• Scapholunate Interosseous Ligament
• Lunotriquetral Ligament

6
Ligament Support

• Dorsal Carpal Ligaments
• Dorsal Radiocarpal Ligament
• Dorsal Intercarpal Ligament
• Radial Collateral Ligament
• Ulnar Collateral Ligament

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Triangular Fibrcartilage Complex

• Composition
• Role

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Hand
9
Carpometacarpal (CMC) Joints of 2-5

• Composition
• Carpal Arch

10
Carpometacarpal (CMC) Joints of 2-5

• Composition
• Carpal Arch
• Ligament Support
• Transverse Carpal Ligament
• Dorsal and Palmar CMC Ligaments
• Dorsal and Palmar Metacarpal Ligaments
• Metacarpal Interosseous Ligaments

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Carpometacarpal (CMC) Joints of 2-5

• Composition
• Carpal Arch
• Ligament Support
• Transverse Carpal Ligament
• Dorsal and Palmar CMC Ligaments
• Dorsal and Palmar Metacarpal Ligaments
• Metacarpal Interosseous Ligaments
• Movement of CMC Joints

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Metacarpophalangeal (MCP) Joints of 2-5 Fingers

• Ligament Support
• Capsule
• Volar Plate
• Collateral Ligaments
• Motions

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Interphalangeal Joints of 2-5 Fingers

• Hinge Joints
• Motions

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Thumb
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CMC of Thumb

• Saddle Joint
• Ligament Support
• Capsule
• Intermetacarpal Ligament

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MCP of Thumb

• Ligament Support
• IP Joint of Thumb

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Extrinsic Hand Muscles
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(No Transcript)
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Extensor Indicis

• O
• Dorsal surface lower ½ body of ulna
• Interosseus membrane
• I
• Ulnar side of index fingers EDC tendon
• N
• Radial (posterior interosseus)
• F
• MCP and IP Ext of 2nd digit

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Extensor Pollicis Longus

• O
• Posterior 1/3 ulna
• Interosseus membrane
• I
• Posterior surface of base of thumb distal phalanx
• N
• Radial (posterior interosseus)
• F
• CMC, MCP and IP Ext of 1st digit

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Extensor Pollicis Brevis

• O
• Dorsal 2/3 of radius
• I
• Dorsal surface of base of proximal 1st phalanx
• N
• Radial (posterior interosseus)
• F
• CMC MCP Ext of thumb
• CMC ABD of thumb

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Abductor Pollicis Longus

• O
• Posterior distal 2/3 of ulna
• Posterior middle 1/3 of radius
• Interosseus membrane
• I
• Radial side of base of 1st metacarpal
• N
• Radial (posterior interosseus)
• F
• CMC ABD Ext of thumb

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Flexor Pollicis Longus

• O
• Anterior middle ½ of radius
• Interosseus membrane
• I
• Palmar surface of base of distal 1st phalanx
• N
• Median (anterior interosseus)
• F
• IP Flexion of thumb

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Extensor Digiti Minimi

• O
• Lateral epicondyle of humerus
• I
• Extensor expansion of 5th digit
• N
• Radial (posteior interosseus)
• F
• MCP and IP extension of 5th digit

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Flexor Digitorum Superficialis

• O
• Medial epicondyle of humerus
• Coronoid process
• Middle ½ anterior radius
• I
• Four tendons separating into two parts that
  insert into sides of bases of middle 2-5
  phalanxes
• N
• Median
• F
• MCP flexion digits 2-5
• PIP flexion digits 2-5

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Flexor Digitorum Profundus

• O
• Anteriomedial surface of ulna
• Interosseus membrane
• I
• Four tendons inserting into distal phalanxes of
  digits 2-5
• N
• Media 2-3 digits
• Ulna 4-5 digits
• F
• DIP flexion of 2-5 digits

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Intrinsic Hand Muscles

• Thenar Eminance

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Abductor Pollicis Brevis

• O
• Scaphoid tuberosity
• Trapezium ridge
• Transverse carpal ligament
• I
• Lateral base f proximal 1st phalanx
• N
• Median
• F
• CMC MCP ABD of thumb

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Flexor Pollicis Brevis

• O
• Superficial head trapezium
• Deep head trapezoid, capitate and palmar
  ligaments of distal carpal bones
• I
• Base of prximal 1st phalanx on radial side
• Extensor expansion
• N
• Superficial median
• Deep Ulnar
• F
• CMC MCP Flexion of thumb

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Opponens Pollicis

• O
• Trapezium
• Transverse Carpal Ligament
• I
• Radial side of 1st metacarpal shaft
• N
• Median
• F
• Opposition

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Intrinsic Hand Muscles

• Hypothenar Eminence

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Abductor Digiti Minimi

• O
• Pisiform
• I
• Ulnar side base of 5th proximal phalanx
• N
• Ulnar
• F
• MCP ABD of 5th digit

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Opponen Digiti Minimi

• O
• Hook of hamate
• Transverse carpal ligament
• I
• Ulnar border of entire 5th metacarpal bone
• N
• Ulnar
• F
• MCP flexion rotation of 5th digit

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Flexor Digiti Minimi

• O
• Hamate bone
• Transverse carpal ligament
• I
• Ulnar side of proximal 5th phalanx
• N
• Ulnar
• F
• MCP Flexion of 5th digit

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Other Intrinsic Hand Muscles
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Adductor Pollicis

• O
• Oblique Head
• Capitate bone
• Bases of 2-3 metacarpals
• Transverse Head
• Proximal 2/3 of palmar surface of 3rd metacarpal
• I
• Ulnar side of base of 1st proximal phalanx
• N
• Ulnar
• F
• CMC ADD of thumb

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Palmar Interossei

• O
• 1st ulnar side base of 1st metacarpal bone
• 2nd ulnar side of 2nd MC bone
• 3rd radial side of 4th MC bone
• 4th radia side of 5th MC bone
• I
• Extensor expansion of 2,4 and 5th digits
• N
• Ulnar
• F
• ADD of 1st, 2nd, 4th and 5th digits toward
  midline of hand

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Dorsal Interossei

• O
• 1st lateral head ulnar side of 1st metacarpal
  bone
• 1st medial head radial side of 2nd metacarpal
  bone
• 2nd, 3rd, 4th space between metacarpal bones
• I
• 1st radial side 2nd proximal phalanx
• 2nd radial side of 3rd
• 3rd ilnar side of 3rd
• 4th ulnar side of 4th
• N
• Ulnar
• F
• ABD of 2nd, 3rd, and 5th finger from midline

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Lumbricales

• O
• Tendons of FDP
• I
• Extensor expansion on dorsal aspect of each
  digits radial side
• N
• 1 and 2 median
• 3 and 4 ulnar
• F
• MCP flexion 2-5 digits
• DIP PIP ext 2-5 digits

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Palmaris Brevis

• O
• Flexor retinaculum
• I
• Palmar surface skin on ulnar side of hand
• N
• Ulnar
• F
• Wrinkles skin of hand on ulnar side

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Biomechanics of Hand
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Biomechanics of Finger Flexion

• Gliding mechanisms
• Retinaculae
• Ligaments
• Bursa
• Digital tendon sheaths
• Annular Pulleys
• A1-A5
• Cruciate Ligaments
• C1-C3
• Function of Pulleys

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Biomechanics of Finger Extension

• Extensor Hood
• EDC tendons
• DI and PI tendons
• Lumbricales
• Central tendon
• Oblique Retinacular Ligaments
• Sagittal Bands
• Effects on MCP joints
• Effects on IP Joints