Wrist and Hand

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Wrist and Hand
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Wrist Joint (Radiocarpal)

• Condyloid joint
• Articulation between the distal radius and the
  proximal row of carpal bones

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Ligaments of the Wrist

• Volar radiocarpal ligament
• Dorsal radiocarpal ligament
• Radial collateral ligament
• Ulnar collateral ligament

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Wrist Movements

• Flexion/extension/hyperextension
• Radial deviation/ulnar deviation
• Circumduction

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Joints and Movements of the Hand
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1st Carpo-metacarpal Joint

• Saddle Joint
• Abduction/Adduction
• Flexion/Extension
• Circumduction
• Opposition

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Movements of Carpometacarpal
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Metacarpophalangeal Joints (MP)

• First MP - hinge
• Flexion/extension
• 2-5 MP - condyloid
• Flexion/Extension
• Abduction/Adduction
• Circumduction

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Movements of MP Joints
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Interphalangeal Joints

• Proximal Interphalangeal Joints (PIP) - hinge
• Distal Interphalangeal Joints (DIP) - hinge
• Thumb does not have a middle phalanx so there is
  no DIP
• Movements
• Flexion/extension

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Wrist Flexors

• 3 Flexors
• proximal attachment for all is the medial
  epicondyle
• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris Longus

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Wrist Extensors

• 3 Extensors
• proximal attachment for all is the lateral
  epicondyle
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor carpi ulnaris

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Flexor carpi radialis

• Distal attachment
• anterior surface of 2nd metacarpal
• Movements
• Flexion
• Radial deviation

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Flexor carpi ulnaris

• Distal attachment
• anterior surface of 5th metacarpal
• Movements
• Flexion
• Ulnar deviation

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Palmaris longus

• Distal attachment
• palmar aponeurosis
• Movements weak flexion
• Approximately 9 of the population does not have
  this muscle

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Extensor carpi radialis longus

• Distal attachment
• posterior surface of 2nd metacarpal
• Movements
• Extension
• Radial deviation

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Extensor carpi radialis brevis

• Distal attachment
• posterior surface of 3rd metacarpal
• Movements
• Extension
• Radial deviation

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Extensor carpi ulnaris

• Distal attachment
• posterior surface of 5th metacarpal
• Movements
• Extension
• Ulnar deviation

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Extrinsic Finger and Thumb Muscles

• Extrinsic muscles originate outside the hand and
  insert in the hand
• Most anterior extrinsic muscles originate from
  the anterior forearm
• Most posterior extrinsic muscles originate from
  the posterior forearm

• Intrinsic muscles originate inside the hand and
  insert in the hand

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Anterior Line of Pull
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Flexor digitorum profundus

• Distal attachment
• 2 - 5 distal phalanx
• Movements
• flexion of distal phalanx
• flexion of wrist

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Flexor digitorum superficialis

• Proximal attachment (3 heads)
• Main head (Medial Epicondyle)
• Ulnar Head
• Radial Head
• Distal attachment
• 2 - 5 middle phalanx
• Movements
• flexion of MP and proximal IP joints
• flexion of wrist

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Flexor pollicis longus

• Pollicis thumb
• Distal attachment
• distal phalanx of thumb
• Movements
• thumb flexion
• wrist flexion

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Posterior Line of Pull
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Extensor digiti minimi

• Minimi 5th finger
• Proximal attachment
• Lateral epicondyle
• Distal attachment
• 5th finger extensor digitorum tendon
• Movement
• 5th finger extension
• wrist extension

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Extensor digitorum

• Proximal attachment
• Lateral epicondyle
• Distal attachment
• 2 - 5 middle and distal phalanx
• Movement
• finger extension
• wrist extension

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Extensor indicis

• Indicis index finger
• Distal attachment
• Extensor digitorum tendon of index finger
• Movement
• index finger extension
• wrist extension

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Extensor pollicis brevis

• Distal attachment
• base of the 1st phalanx
• Movement
• thumb and wrist extension

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Extensor pollicis longus

• Distal attachment
• distal 1st phalanx
• Movement
• thumb and wrist extension

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Lateral Line of Pull
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Abductor pollicis longus

• Proximal attachment
• posterior forearm
• Distal attachment
• lateral base of 1st metacarpal
• Movement
• thumb abduction
• radial deviation of wrist

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Range of Motion

• Elbow
• Flexion 150 deg.
• Extension 0 deg.
• Pronation 80 deg.
• Supination 80 deg.
• Wrist
• Flexion 80 deg.
• Extension 70 deg.
• Radial dev 30 deg.
• Ulnar dev 70 deg.

• 2-5 MP Jt.
• Flexion 90 deg.
• Extension 45 deg.
• 2-5 PIP Jt.
• Flexion 100 deg
• Extension 0 deg
• 2-5 DIP Jt.
• Flexion 90 deg
• Extension 0 deg

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Range of Motion Cont.

• 1st CM Jt.
• Flexion 15 deg
• Extension 0 deg
• Abduction 70 deg
• 1st MP Jt.
• Flexion 50 deg
• Extension 0 deg

• 1st DIP Jt.
• Flexion 80 deg
• Extension 0 deg