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Wrist and Hand.

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Presentation on theme: "Wrist and Hand."— Presentation transcript:

1 Wrist and Hand

2 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

3 Osteology

4 Osteology

5 Osteology

6 Scaphoid

7 Cross Section at Wrist

8 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

9 Wrist True Wrist = Radio-Carpal Distal radius with proximal carpals
“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

10 Radio-Carpal

11 Ligaments

12 Ligaments

13 Interactive Wrist

14 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

15 Ligaments

16 Interactive Wrist

17 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

18 Movements

19 Movements

20 Movements

21 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

22 C-M Joints

23 C-M Joints

24 C- M Thumb Trapezium with 1st met Saddle
Adds rotary component – very mobile Capsule support

25 C-M Thumb

26 Interactive Hand

27 Metacarpal – Phalangeal Joints
Ellipsoid 2 DOF Passive rotation Collateral Ligaments Deep Transverse Metacarpal Ligaments Palmar Ligaments (Plates)

28 Ligaments

29 Ligaments

30 Interactive Hand

31 Interphalangeal Joints
Hinge Collateral Ligaments Palmar Ligaments (Plates)

32 Ligaments

33 Interactive Hand

34 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

35 Finger Movements

36 Finger Movements

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

38 Vinculum Longa and Breve

39 Tunnels

40 Tunnels

41 Interactive Hand

42 Dorsal Hood

43 Dorsal Hood

44 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

45 Dorsal Hood

46 Dorsal Hood

47 Interactive Hand

48 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

49 Palmar Aponeurosis

50 Thenar Eminence Flexor Pollicus Brevis Abductor Pollicus Brevis
Opponens Pollicus

51 Thenar Muscles

52 Hypothenar Eminence Abductor Digiti Minimi Flexor Digiti Minimi
Opponens Diditi Minimi

53 Intermediate Adductor Pollicus Lumbricales Volar (Palmar) Interossei
Dorsal Interossei

54 Adductor Pollicus

55 Lumbricales

56 Lumbricales

57 Dorsal Interossei

58 1st Dorsal Interosseous

59 Volar (Palmar) Interrossei

60 Digit Movement

61 Digit Movement Cont.

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

63 Superficial Palmar Arch

64 Superficial Palmar Arch

65 Superficial Palmar Arch

66 Deep Palmar Arch

67 Deep Palmar Arch-Dorsal View

68 Deep Palmar Arch

69 Digital Supply

70 Median Cutaneous

71 Ulnar Cutaneous

72 Radial Cutaneous (Hand)

73 Common Nerve Injuries Median Symptoms Ulnar

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