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Forearm, Wrist & Hand Anatomy

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1 Forearm, Wrist & Hand Anatomy

2 What’s the hand? Definitions of hand: verb:   place into the hands or custody of noun:   ability noun:   a card player in a game of bridge noun:   a hired laborer on a farm or ranch noun:   a member of the crew of a ship noun:   a position given by its location to the side of an object noun:   a rotating pointer on the face of a timepiece noun:   a round of applause to signify approval noun:   a unit of length equal to 4 inches; used in measuring horses noun:   one of two sides of an issue noun:   physical assistance noun:   something written by hand noun:   terminal part of the forelimb in certain vertebrates (e.g. apes or kangaroos): "the kangaroo's forearms seem undeveloped but the powerful five-fingered hands are skilled at feinting and clouting"- Springfield (Mass.) Union  noun:   the cards held in a card game by a given player at any given time noun:   the (prehensile) extremity of the superior limb

3 ¼ of the motor cortex is devoted to the hand

4 Motions of the Wrist and Hand
Forearm Flexion Extension Supination Pronation Wrist Ulnar deviation Radial deviation Circumduction Hand Flexion Extension Adduction Abduction Opposition Circumduction *Palmar and Dorsal Side

5 Bony Anatomy of the Forearm
Two Bones that articulate with the elbow (proximal) and the wrist (distal) Ulna Larger and longer bone of the two (extension of the humerus). It distally articulates with the triquetrium and lunate via the TFCC. Ulnar styloid process Radius Distal end makes up majority of the wrist articulation Two articulations -one with the carpal bones and the other with the ulna Articulates with the scaphoid and lunate Radial styloid process

6 Hand and Wrist Anatomy 14 phalanges 5 metacarpals 8 carpal bones
2 sesamoid bones (thumb) 5 metacarpals 8 carpal bones Distal Radius Forms small ulnar notch to accept the ulnar head Radial styloid process Distal Ulna Ulnar styloid process arises from medial surface Ulnar head

7 Carpals(flat bones aligned in 2 rows)
Proximal Scaphoid-most commonly fractures Lunate-most commonly dislocated Triquetrum Pisiform-acts as sesmoid bone Distal Trapezium(aligns with 1st metacarpal) Trapezoid(2nd metacarpal) Capitate(3rd metacarpal) Hamate(4th and 5th metacarpal)

8 Anatomy of the Carpal Bones
Wrist is made up of 8 carpal bones Scaphoid- name is derived from the Greek word skaphe, meaning boat. Most commonly fractured carpal bone Lunate- Poor blood supply. Triquetrum- Three sided bone Pisiform- Sesamoid bone, floating in the flexor carpi ulnaris muscle Trapezium-Lays between the scaphoid and the thumb’s metacarpal Trapezoid- Lays at the base of the second metacarpal (index or pointer finger) Capitate-Largest of the carpal bones Hamate- Latin word means “hook”. “She Looks Too Pretty; Try To Catch Her”


10 Anatomy of the Phalanges
5 Metacarpals Numbered 1-5 starting at the thumb Or named thumb, index, middle, ring and little finger Thumb = pollicus Pinky = digiti minimi Index = Indicus Joints Carpometacarpal (CMC) = carpals to metacarpals Metacarpophalangeal (MCP) = metacarpals to phalanges Proximal interphalangeal (PIP) = proximal phalanges to middlephalanges Distal Interphalangeal (DIP) = middle phalanges to distal phalanges Collateral ligaments of the IP joints

11 Articulations Distal Radioulnar Formed by ulnar head and ulnar notch
Allows 1 degree freedom of movement Pronation/supination Radius glides around the ulna

12 Radiocarpal joint Reinforced by ligamentous thickening
Formed by distal radius articulating with scaphoid, lunate and triangular fibrocartilage disk(TFCC) Ellipsoid joint (2 degrees freedom) Flexion/extension Radial/ulnar deviation

13 Intercarpal Joints Palmar/dorsal/interosseous ligaments between each carpal Very little gliding

14 Midcarpal Joints Proximal/distal carpal row separated by a single joint cavity with small fibrous projections connecting the rows Limited mobility in flex/ext, radial/ulnar deviation

15 Carpometacarpal Joint (CMC)
MC1/trapezium MC2/trapezoid MC3/capitate MC4and 5/hamate (forms 1 articulation)

16 1st CMC (thumb) Saddle joint 2 degrees of freedom(3)
Flexion/extension Abduction/adduction Accessory rotation Allows for opposition

17 2-4 CMC 5th CMC Plane/synovial joint 1 degree freedom 2 degree freedom
Flexion/extension 5th CMC 2 degree freedom Abduction/adduction

18 Metacarpophalangeal Joint (MCP)
Two degrees freedom of movement Flexion/extension Abduction/adduction Thumb can abduct at any point/fingers only when extended Collateral ligaments Varus/valgus force When fingers are in flexion they tighten and limit abduction/adduction

19 Interphalangeal Joint
One degree freedom of movement Flexion/extension Collateral ligaments


21 Muscular Anatomy Wrist Extensors (innervated by radial n.) Superficial
Extensor carpi radialis brevis/longus Extensor carpi ulnaris Extensor digitorium Abductor pollicus longus Extensor Digiti Minimi brachioradialis Deep compartment Extensor pollicus longus/brevis Extensor indices supinator Secured by extensor retinaculum

22 Wrist flexors (median n.)
Superficial Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Pronator teres - Intermediate Flexor digitorium superficialis Deep Flexor digitorium profundus Flexor pollicis longus Pronator quadratus

23 Palmar (intrinsic) Thenar Abductor pollicis brevis
Flexor pollicis brevis Opponens Pollicis Tendon FPL Adductor pollicis

24 Hypothenar Abductor digiti minimi Opponens digiti minimi
Flexor digiti minimi brevis

25 Muscles of the Forearm Anterior Muscles
Wrist and Finger Flexors and Wrist Pronators Flexors of the wrist Flexor Carpi Radialis = near carpals on radial side Flexor Carpi Ulnaris = near carpals on ulnar side Palmaris Longus (absent in about 25% of population)(thumb and little finger opposition)

26 Muscles of the Forearm Anterior Muscles
Pronators Pronator Teres Pronator Quadratus

27 Muscles of the Forearm Anterior Muscles
Digit Flexors Flexor Digitorum Superficialis (share a muscle belly with FDP, why all fingers will move) Flexor Digitorum Profundus (lumbrical muscles of fingers arise from the distal tendons) Flexor Pollicis Longus (10% of population the tip of the index and the thumb move together)

28 Muscles of the Forearm Posterior Muscles
Wrist and Finger Extensors and Wrist Supinators Wrist Extensors extensor carpi radialis brevis = posterior & radial side, short extensor carpi radialis longus = posterior & radial side, long extensor carpi ulnaris = posterior & ulnar side Finger Extensors (attach at the common extensor tendon on the lateral epicondyle) extensor digitorum = extends digits extensor indicis = extends pointer finger extensor digiti minimi = extends pinky Thumb Extensors abductor pollicis longus (Lay hand flat on table and abduct thumb) extensor pollicis brevis/longus (Lay hand flat on table and extend only the thumb)


30 Nerve Distribution of the Hand

31 Ligaments of the Forearm
Interosseus Membrane- A fibrous sheath that connects the radius and the ulna. Radiocarpal ligaments- Volar Radiocarpal ligament Dorsal Radiocarpal ligament Ulnar collateral ligaments Radial collateral ligaments

32 Dorsal Wrist ligaments
Volar Wrist Ligaments

33 Central Lumbricales Palmar aponeurosis Interossei Tendons FDS/FDP
Superficialis (PIP) Profundus (DIP) Lumbricales Radial side profundus tendon(extensor hood) Flex MP/ext PIP/DIP Palmar aponeurosis Interossei 4 palmar/4 dorsal

34 Carpal Tunnel Fibro-osseous structure Tunnel contains 10 structures
Floor is proximal carpal bones Roof is transverse carpal ligament Tunnel contains 10 structures Median n., flexor pollicis longus tendon, 4 slips of flexor digitorium superficialis, flexor digitorium profundus Compression results in paresthesia 2-4 fingers and decrease grip

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