2Objectives1. Name, locate, & describe the structure & ligamentous reinforcements of the elbow, forearm, wrist, and hand joints. 2. Name & demonstrate the movements possible in these joints. 3. Name & locate muscles & muscle groups, and name their primary actions. 4. Analyze the fundamental movements with respect to joint & muscle actions. 5. Describe common athletic injuries.
5THE ELBOW JOINT Structure Fig 6.2 & 6.3THE ELBOW JOINT StructureAll 3 joints enveloped in a capsule, lined by synovial membrane.Strengthened by radial & ulnar collateral ligaments.Annular ligament encircles the radial head & binds it to ulna.Fig 6.4aMovements of the elbow joint
6THE RADIOULNAR JOINTS Structure Fig 6.1Proximal: previously described.Distal:Pivot jointRadius articulates with head of ulna.Strengthened by:Volar radioulnar ligamentDorsal radioulnar ligamentThe radiolunar joints--movements
8Biceps Brachii Function: Function: Flexes and supinates the forearm. Flexion at the elbow.Fig 6.7Fig 6.5
9Brachioradialis Pronator Teres Pronator Quadratus Fig 6.8BrachioradialisFunction:Contributes to elbow flexion.Pronator TeresPronates the forearm, assists in elbow flexion.Pronator QuadratusPronation of the forearm.Fig 6.9
10Triceps Brachii & Supinator Fig 6.10Triceps BrachiiFunction:Powerful extensor of elbow.SupinatorSupination of the forearm.
11Anconeus Function: Working with the triceps, extends the forearm. Fig 6.11Function:Working with the triceps, extends the forearm.
12MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM pronationsupinationFlexionBiceps brachii, brachioradialis, brachialisBrachialis active in all conditions.Biceps brachii most active with supination, least with pronation.Fig 6.6
13MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM ExtensionTriceps & anconeus, against gravity.PronationPronator teres & pronator quadratus.SupinationSupinator & biceps; Long head more active with greater muscle length, while short head more active with shorter muscle length.
14THE WRIST AND HAND Great mobility due to generous supply of joints: Radiocarpal (wrist) joint.Articulation between two rows of carpal bones.Carpometacarpal joints.Fig 6.12TrapezoidTrapeziumHamateCapitateLunateTriquetralScaphoid
15Structure of the Wrist (Radiocarpal) Joint Fig 6.14Condyloid joint4 ligamentsVolar radiocarpalDorsal radiocarpalUlnar collateralRadial collateralCircumduction: fingertips describe a circle, hand describes a cone.Fig 6.16Movements of the hand at the wrist
16Structure and Movements of the Midcarpal and Intercarpal Joints Proximal row of 4 carpal bones articulate with four carpal bones of distal row.Permits only a slight gliding motion.However, the gliding adds up to a modified hinge type of movement.Anterior surface of carpal bones are slightly concave, referred to as the carpal tunnel.
17Structure of the Carpometacarpal and Intermetacarpal Joints Fig 6.13The thumb is a prime example of a saddle joint.Joints between bases of metacarpal bones are irregular.All are enclosed in capsules.
18Movements of the Carpometacarpal Joint of the Thumb Fig 6.19AbductionHyperadductionExtensionFlexionHyperflexionOpposition
19Movements of Carpometacarpal & Intermetacarpal Joints of Fingers Because of short ligaments in this region, motion in these joint is almost nonexistent.Limited to slight gliding.5th carpometacarpal joint is slightly more mobile.
20Structure of Metacarpophalangeal Joints Fig 6.17Joints at bases of four fingers, uniting proximal phalanges with metacarpals.Condyloid jointsEncased in capsulesProtected by collateral ligaments.Also a dorsal ligament.Fig 6.20Movements of Metacarpophalangeal Joint of the Fingers
21Movements of Metacarpophalangeal Joints of the Thumb Flexion:volar surface of the thumb approaches base of thumb.Extension:return movement from flexion.
22The Interphalangeal Joints Joints between adjacent phalanges of any of the five digits.All are hinge joints, permit only flexion & extension.Hyperextension is slight, if present at all.Each enclosed in a capsule.Strengthen by collateral ligaments and in front by a volar ligament .
24MUSCLES OF THE THUMB Location: (table 6.1) From forearm: Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, flexor pollicis longus.Intrinsic to hand: Abductor pollicis brevis, adductor pollicis, flexor pollicis brevis, opponens pollicis.
25Muscles of the wrist and hand Extensor carpi radialis(longus)(brevis)Extensor carpi ulnarisFig 6.23aFig 6.21Flexor Carpi radialisFunction:Flexes wristRadial deviationFlexor Carpi UlnarisUlnar deviationPalmaris longusWeakly flexeswristExtensor carpi radialisFunction:Extends wristRadial deviationExtensor carpi ulnarisUlnar deviation
26Muscles of the wrist and hand Extensor digitorumExtensor digiti minimiFig 6.23bFlexor digitorum superficialisFunction:Flexes fingers & wrist.Extensor digitorumFunction:Extends fingers & wrist.Extensor digiti minimiExtends little finger & wrist.Fig 6.24a
27Muscles of the wrist and hand Fig 6.24bExtensor pollicis longusFunction:Extends thumbExtensor indicisExtends index fingerAbductor pollicis longusAbducts thumbExtensor pollicis brevisFig 6.25Flexor digitorum profundusFunction:Flexes fingers & wrist.Flexor pollicis longusFlexes thumb.
28Muscles of the wrist and hand Abductor pollicis brevisFunction:Abducts thumb.Flexor pollicis brevisFlexes thumb.Opponens pollicisOpposition of thumb.Fig 6.26
29Muscles of the wrist and hand Abductor pollicis brevisFunction:Abducts thumb.Flexor pollicis brevisFlexes thumb.Opponens pollicisOpposition of thumb.Fig 6.26Abductor digit minimiFunction:Abducts little finger.Flexor digiti minimiFlexes little finger.Opponens digiti minimiOpposition of little finger.Fig 6.26
30Muscular analysis of the fundamental movements of the wrist, thumb, and hand FlexionExtension & HyperextensionRadial deviation (Abduction)Ulnar Deviation (adduction)FingersFlexionExtensionAbductionAdductionOpposition
31Thumb Metacarpal Thumb Phalanges Flexion Flexion Extension Extension Muscular analysis of the fundamental movements of the wrist, thumb, and handThumb MetacarpalFlexionExtensionAbductionAdductionOppositionThumb PhalangesFlexionExtension
32Cooperative action of wrist and digits Length of Long Finger Muscles Relative to Range of Motion in Wrist & FingersLong finger muscles do not have sufficient length to permit full ROM in joints of fingers & wrist at the same time.Example: make a tight fist, now flex wrist, fingers loosen their grip.
33Examples of Using Hands for Grasping Power grip involves flexion of all fingersFig 6.30CylindricalSphericalHook
34Examples of Using Hands for Grasping Precision involves thumb & two fingers, depending on shape & size of objectFig 6.30
35COMMON INJURIES OF THE FOREARM, ELBOW, WRIST, AND FINGERS Fractures of the ForeArm Result of direct blow or falling on outstretched hand.Usually both ulna & radius fracture.In the young usually a greenstick type.Immobilization of the elbow is important to reduce movement at fracture site.35
36Elbow Dislocation and Fracture Results from falling on outstretched hand with elbow extended or hyperextended.Most common is backward displacement of ulna & radius in relation to humerus.Dislocation is frequently accompanied by fracture.Most common is to medial epicondyle.Very serious - likely to involve blood vessels & nerves.
37Sprained or Strained Wrist From falling on palm of hand with wrist hyperextended.Usually a sprain of ligaments.May be a strain to tendons.May be pain, weakness, limited ROM.
38Carpal Tunnel Syndrome This is an overuse, repetitive stress injury.Long hours working with small hand tools and keyboards.Nerve & blood vessel compression as they pass through carpal arch & transverse carpal ligament.Indicators are pain, numbing of fingers.
39Avulsion FractureExternal force applied to tendon pulls off a piece of bone.Often from rapid pronation/supination or high energy flexion of fingers.Probability for occurrence greatest during growth and maturation.
40Epicondylitis Lateral epicondylitis – “tennis elbow” Medial epicondylitis – ‘Little League elbow”Both are repetitive stress injuries.Micro-traumas or tears in muscle & soft tissue at proximal attachments.Indication is pain on activity.Rest, ice, anti-inflammatory drugs, bracing often used as treatment.