1. Chapter 7
Wrist & Hand Joints

2. Hand Distal Middle Phalanges Proximal Head Shaft Metacarpals Hamate
Base
Trapezoid
Pisiform
Carpals
Trapezum
Triquetrum
Scaphoid
Label
Capitate
Lunate

3. Joints Radioulnar (Pivot) Radiocarpal (Condylodial)
Supination and pronation
Radiocarpal (Condylodial)
Primarily articulates with scaphoid, lunate, and triquetrum
Movement and Range of Motion
Flexion: 80°-90°
Extension: 70°-90°
Abduction: 15°-25°
Adduction: 25°-40°

4. Joints Intercarpal (Arthrodial) Intermetacarpal (Arthrodial)
Metacarpophalangeal (Condylodial)
Movement and ROM
Flexion: 90°
Extension: 0-40°
Metacarpophalangeal of the thumb:
40º to 90º from full extension

5. Joints Carpometacarpal of the thumb: (seller)
Movement and ROM
Flexion: 15º to 45º
Extension: 0º to 20º
Abduction: 50º to 70º
Opposition:
movement of thumb across palmer aspect to oppose any or all of the phalanges
Reposition:
movement of thumb back to anatomical position
Proximal Interphalangeal (ginglymus)
ROM:
Flexion: 90º to 120º from full extension
Distal Interphalangeal (ginglymus)
Flexion: 80º to 90º from full extension

6. Cutaneous Distribution

7. Muscles Wrist Flexors Flexor Carpi Radialis Palmaris Longus
Flexor Carpi Ulnaris
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Flexor Pollicis Longus
Label

8. Muscles Wrist Extensors Extensor Carpi Radialis Longus
Extensor Carpi Ulnaris
Extensor Carpi Radialis Brevis
Extensor Digitorum
Extensor Indicis
Extensor Digiti Minimi
Abductor Pollicis Longus
Extensor Pollicis Brevis
Extensor Pollicis Longus
Not Shown?
Label

9. Muscles
Flexor Carpi Radialis
Strengthening
Stretching

10. Muscles
Palmaris Longus
Strengthening
Stretching

11. Muscles
Flexor Carpi Ulnaris
Strengthening
Stretching

12. Muscles
Extensor Carpi Ulnaris
Strengthening
Stretching

13. Muscles
Strengthening
Stretching
Extensor Carpi Radialis Brevis

14. Muscles
Strengthening
Stretching
Extensor Carpi Radialis Longus

15. Muscles
Strengthening
Stretching
Flexor Digitorum Superficialis

16. Muscles
Flexor Digitorum Profundus
Strengthening
Stretching

17. Muscles
Extensor Indicis
Strengthening
Stretching

18. Muscles
Extensor Digiti Minimi
Strengthening
Stretching

19. Muscles
Strengthening
Stretching
Extensor Pollicus Longus

20. Muscles
Strengthening
Stretching
Extensor Pollicus Brevis

21. Muscles
Abductor Pollicus Longus
Strengthening
Stretching

22. Thenar Muscles
Opponens Pollicis

23. Thenar Muscles
Abductor Pollicis Brevis

24. Thenar Muscles
Flexor Pollicis Brevis

25. Intermediate Muscles
Adductor Pollicis

26. Intermediate Muscles
Palmar Interossei
Drawn illustration

27. Intermediate Muscles
Dorsal Interossei
Drawn illustration

28. Intermediate Muscles
Lumbricals

29. Hypothenar Muscles
Opponens Digiti Minimi

30. Hypothenar Muscles
Abductor Digiti Minimi

31. Hypothenar Muscles
Flexor Digiti Minimi Brevis

32. Injuries of the Wrist Scaphoid Fracture Carpel Tunnel Claw Hand
Ape Hand

33. Carpal Tunnel Syndrome
Anatomy
Bounds
Muscles/Tendons
Nerve
Other

34. Carpel Tunnel Syndrome
Common Causes:
Pregnancy
Rheumatoid Arthritis
Diabetes
Wrist Trauma
Occupational (typing)

35. Carpel Tunnel Syndrome
THUMB ABDUCTION TEST
Carpel Tunnel Syndrome
Symptoms
Tests:
TINEL’S SIGN
STRIKE THE PATIENT’S WRIST AS SHOWN. A TINGLING SENSATION RADIATING DOWN THE WRIST TO THE HAND IN THE DISTIBUTION OF THE MEDIAN NERVE IS A POSITIVE SIGN.
PHALEN TEST
HAVE THE PATIENT HOLD THEIR WRISTS AS SHOWN FOR ONE MINUTE. NUMBNESS AND PARAESTHESIA IN THE DISTRIBUTION OF THE MEDIAN NERVE IS A POSITIVE TEST.
Tinel’s Sign
Phalen Test
TESTS THE STRENGTH OF THE ABDUCTOR POLLICIS BREVIS WHICH IS INERVATED BY THE MEDIAN NERVE.
HAVE THE PATIENT PLACE THEIR PALM UP WITH THEIR THUMB PERPENDICULAR TO IT.
APPLY DOWNWARD PRESSURE ON THE THUMB. WEAKNESS IS ASSOCIATED WITH CARPAL TUNNEL SYNDROME.
JAMA 2000;283:
MOSBY’S GUIDE TO THE PHYSICAL EXAMINATION 5TH ED.
Thumb Abduction Test

36. Claw Hand
Description: Hyperextension at the MCP joint, and flexion at the IP joint
Etiology?

37. Ape Hand Description: atrophy of the thenar eminence
What nerves and muscles are involved and how?