1. Wrist and Hand Anatomy

2. Bone Anatomy Scapoid Lunate Triquetrium Pisiform Trapeziod Trapezium
Capitate
Hamate

3. 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

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

5. 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

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

7. 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

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

9. 1st CMC (thumb) Saddle joint 2 degrees of freedom(3)
Flexion/extension
Abduction/adduction
Accessory rotation
Allows for opposition

10. 2-4 CMC 5th CMC Plane/synovial joint 1 degree freedom 2 degree freedom
Flexion/extension
5th CMC
2 degree freedom
Abduction/adduction

11. 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

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

13. Ligament Support Volar Carpal Ligaments Volar Radiocarpal Ligament
Three bands
Volar Ulnocarpal Ligament
Scapholunate Interosseous Ligament
Lunotriquetral Ligament

14. Ligament Support Dorsal Carpal Ligaments Dorsal Radiocarpal Ligament
Dorsal Intercarpal Ligament
Radial Collateral Ligament
Ulnar Collateral Ligament

15. 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, 4 flexor digitorium profundus
Compression results in paresthesia 2-4 fingers and decrease grip

17. Hand

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

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

20. Hypothenar Abductor digiti minimi Opponens digiti minimi
Flexor digiti minimi brevis

21. 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

22. Extrinsic Hand Muscles

23. Extensor Indicis O I N F Dorsal surface lower ½ body of ulna
Interosseus membrane I
Ulnar side of index finger’s EDC tendon N
Radial (posterior interosseus) F
MCP and IP Ext of 2nd digit

24. Extensor Pollicis Longus
Posterior 1/3 ulna
Interosseus membrane I
Posterior surface of base of thumb distal phalanx N
Radial (posterior interosseus) F
CMC, MCP and IP Ext of 1st digit

25. Extensor Pollicis Brevis
Dorsal 2/3 of radius I
Dorsal surface of base of proximal 1st phalanx N
Radial (posterior interosseus) F
CMC & MCP Ext of thumb
CMC ABD of thumb

26. Abductor Pollicis Longus
Posterior distal 2/3 of ulna
Posterior middle 1/3 of radius
Interosseus membrane I
Radial side of base of 1st metacarpal N
Radial (posterior interosseus) F
CMC ABD & Ext of thumb

27. Flexor Pollicis Longus
Anterior middle ½ of radius
Interosseus membrane I
Palmar surface of base of distal 1st phalanx N
Median (anterior interosseus) F
IP Flexion of thumb

28. Extensor Digiti Minimi
Lateral epicondyle of humerus I
Extensor expansion of 5th digit N
Radial (posteior interosseus) F
MCP and IP extension of 5th digit

29. Flexor Digitorum Superficialis
Medial epicondyle of humerus
Coronoid process
Middle ½ anterior radius I
Four tendons separating into two parts that insert into sides of bases of middle 2-5 phalanxes N
Median F
MCP flexion digits 2-5
PIP flexion digits 2-5

30. Flexor Digitorum Profundus
Anteriomedial surface of ulna
Interosseus membrane I
Four tendons inserting into distal phalanxes of digits 2-5 N
Media 2-3 digits
Ulna 4-5 digits F
DIP flexion of 2-5 digits

31. Intrinsic Hand Muscles
Thenar Eminance

32. Abductor Pollicis Brevis
Scaphoid tuberosity
Trapezium ridge
Transverse carpal ligament I
Lateral base f proximal 1st phalanx N
Median F
CMC & MCP ABD of thumb

33. Flexor Pollicis Brevis
Superficial head – trapezium
Deep head – trapezoid, capitate and palmar ligaments of distal carpal bones I
Base of prximal 1st phalanx on radial side
Extensor expansion N
Superficial – median
Deep – Ulnar F
CMC & MCP Flexion of thumb

34. Opponens Pollicis O I N F Trapezium Transverse Carpal Ligament
Radial side of 1st metacarpal shaft N
Median F
Opposition

35. Intrinsic Hand Muscles
Hypothenar Eminence

36. Abductor Digiti Minimi
Pisiform I
Ulnar side base of 5th proximal phalanx N
Ulnar F
MCP ABD of 5th digit

37. Opponen Digiti Minimi O I N F Hook of hamate
Transverse carpal ligament I
Ulnar border of entire 5th metacarpal bone N
Ulnar F
MCP flexion & rotation of 5th digit

38. Flexor Digiti Minimi O I N F Hamate bone Transverse carpal ligament
Ulnar side of proximal 5th phalanx N
Ulnar F
MCP Flexion of 5th digit

39. Other Intrinsic Hand Muscles

40. Adductor Pollicis O I N F Oblique Head Transverse Head
Capitate bone
Bases of 2-3 metacarpals
Transverse Head
Proximal 2/3 of palmar surface of 3rd metacarpal I
Ulnar side of base of 1st proximal phalanx N
Ulnar F
CMC ADD of thumb

41. Palmar Interossei O I N F 1st – ulnar side base of 1st metacarpal bone
2nd – ulnar side of 2nd MC bone
3rd – radial side of 4th MC bone
4th – radia side of 5th MC bone I
Extensor expansion of 2,4 and 5th digits N
Ulnar F
ADD of 1st, 2nd, 4th and 5th digits toward midline of hand

42. Dorsal Interossei O I N F
1st lateral head – ulnar side of 1st metacarpal bone
1st medial head – radial side of 2nd metacarpal bone
2nd, 3rd, 4th space between metacarpal bones I
1st – radial side 2nd proximal phalanx
2nd – radial side of 3rd
3rd – ilnar side of 3rd
4th – ulnar side of 4th N
Ulnar F
ABD of 2nd, 3rd, and 5th finger from midline

43. Lumbricales O I N F Tendons of FDP
Extensor expansion on dorsal aspect of each digits radial side N
1 and 2 – median
3 and 4 – ulnar F
MCP flexion 2-5 digits
DIP & PIP ext 2-5 digits

45. Palmaris Brevis O I N F Flexor retinaculum
Palmar surface skin on ulnar side of hand N
Ulnar F
Wrinkles skin of hand on ulnar side

46. Cords Give off Branches!! (in axilla)
Lateral Musculocutaneous
Median
Medial Ulnar
Posterior Radial Axillary (thoracodorsal) (subscapular)

47. PUT IT ALL TOGETHER…...
pg 416

48. Innervation by Posterior Cord
Radial Nerve (largest branch)
Course: Through arm, around humerus, around lateral epicondyle, then divides
Innervates: all posterior muscles of arm and forearm
Triceps brachii, anconeus, supinator, brachioradialis
Divides in forearm:
Superficial = skin of arm and dorsolateral surface of hand
Deep = extensor muscles of forearm (eg E. carpi radialis L + B)
Damage to Radial Nerve = wristdrop
Inability to extend the hand, st inability to fully extend forearm

51. Innervation by Posterior Cord (continued)
Axillary Nerve (runs w/ humeral circumflex a.)
Innervates:
Deltoid and Teres minor (motor inn)
Capsule of shoulder, skin of shoulder (sensory inn)
Subscapular Nerve {branches of C5 + C6 rami}
Innervates: Subscapularis, Teres major
Thoracodorsal Nerve (runs w/thoracodorsal a+v)
Innervates: Latissimus dorsi

52. Innervation by Lateral Cord
Musculocutaneous
Course: branches to arm, distal to elbow becomes cutaneous for lateral forearm skin
Innervates
Biceps brachii, brachialis, coracobrachialis (motor inn)
Skin distal to elbow (sensory)
Suprascapular (runs w/suprascapular a+v) {C5, C6}
Innervates: Supraspinatus, Infraspinatus

53. Innervation by both Lateral and Medial Cords
Median
Course: middle of brachial plexus, does not branch in arm, distal to elbow provides many branches to most forearm flexors, passes through carpal tunnel to hand to lateral palmar intrinsics
Innervates: most muscles of anterior forearm (motor inn)
(eg) most flexors, some intrinsics (thumb)
Innervates: skin of lateral 2/3 hand on palm side, dorsum of fingers 2+3 (sensory inn)
Nerve Damage = “Ape” Hand
Inability to Oppose Thumb

54. Innervation by Medial Cord
Ulnar
Course: runs along medial side of arm, behind medial epicondyle, superficial to carpal tunnel into hand, branches to supply intrinsics and skin
Innervates:
FCU and part of FDP, most intrinsics (motor inn)
Skin of medial 2/3 of hand A+P (sensory inn)
Nerve Damage: Clawhand
Inability to extend fingers at interphalangeal joints, results in permanent flexion = claw

56. Cutaneous Innervation to the Hand

57. Ulnar Nerve Median Nerve Brachial Artery Musculocutaneous Nerve
UlnarArtery
Where’s Radial Nerve?
Radial Artery
Median Nerve
Ulnar Nerve

59. Thank you…