10-1 Kinesiology for Manual Therapies Chapter 10 The Wrist and Hand Joints McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-2 Learning Outcomes o 10-1 Define key terms. o 10-2 Locate on a human skeleton selected bony structures of the arm, forearm, wrist, hand, and fingers. o 10-3 Label selected bony landmarks of the wrist and hand on the skeletal chart. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-3 Learning Outcomes (cont.)  10-4 Name the bones of the hand.  10-5 Draw and identify the muscles involved in the hand and wrist on a skeletal chart.  10-6 Palpate the bony structures and the muscles of the forearm, hand, and wrist on a partner. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-4 Learning Outcomes (cont.)  10-7 Explore the origins and insertions of the muscles of the forearm, hand, and wrist on a partner.  10-8 Demonstrate with a partner all the active and passive movements of the hand and wrist joints. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-5 Learning Outcomes (cont.)  10-9 Organize and list the muscles that produce the primary movements of the wrist, hand, and fingers.  List the antagonists and synergists of the muscles of the wrist and hand. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-6 Learning Outcomes (cont.)  Determine the names of the muscles and nerve that travel through the carpal tunnel.  Practice flexibility and strengthening exercises for each muscle group. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-7 Introduction  This chapter reviews the bones, joints, and movements involved in gross motor activities; discusses nerves involved.  Each prime mover is discussed in detail.  Intrinsic muscles are briefly reviewed. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-8 Bones  The wrist and hand contain 29 bones including the radius and ulna.  There are eight carpal bones in two rows of four to form the wrist: the scaphoid, lunate, triquetrum, and pisiform form the proximal row, and the trapezium, trapezoid, capitate, and hamate form the distal row. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-9 Bones (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-10 Bones (cont.)  There are five metacarpal bones that join the wrist and provide a joint for the phalanxes.  There are 14 phalanxes, 3 for each phalange and 2 for the thumb. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-11 Bones (cont.)  The medial and lateral epicondyles of the humerus are common origin sites for the flexors and extensors of the hand and wrist. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-12 Joints  The wrist joint is classified as a condyloid-type joint which enables movement in two planes, allowing flexion, extension, abduction, and adduction. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-13 Joints (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-14 Joints (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-15 Joints (cont.)  Each finger has three joints. The metacarpophalangeal (MCP) joint is a condyloid joint (knuckle).  The next joint is the proximal interphalangeal (PIP) joint and is a ginglymus joint McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-16 Joints (cont.)  At the end of the finger is the distal interphalangeal (DIP) joint that is a ginglymus joint also.  The carpometacarpal (CMC) joint of the thumb is a saddle-type joint that allows opposition which is unique to humans. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-17 Joints (cont.) Finger Joints and Ligaments McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-18 Movements McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-19 Movements (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-20 Movements (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-21 Movements (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-22 Muscles  Three wrist flexors are flexor carpi radialis, flexor carpi ulnaris, and palmaris longus flex the wrist.  The wrist extensors are extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-23 Muscles (cont.)  Nine muscles function the phalanges. The flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus.  The extensor digitorum, extensor indicis, and extensor digiti minimi are finger extensors. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-24 Muscles (cont.)  The extensor pollicis longus and extensor pollicis brevis extend the thumb.  The abductor pollicis longus abducts the thumb. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-25 Muscles (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-26 Muscles (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-27 Muscles (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-28 Nerves  The muscles of the wrist and hand are all innervated from the radial, median, and ulnar nerves of the brachial plexus.  Review the OIAI charts for individual muscle innervations. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-29 Nerves (cont.)  The carpal tunnel houses the median nerve on the palmar side of the hand, above the flexor tendons and just beneath the flexor retinaculum.  The flexor retinaculum spans from the hook of the hamate to the tubercle of the trapezium. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-30 Nerves (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-31 Nerves (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-32 Nerves (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-33 Individual Muscles of the Wrist and Hand-Flexors Palmaris longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-34 Individual Muscles of the Wrist and Hand-Flexors (cont.) Palmaris longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-35 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor carpi radialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-36 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor carpi radialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-37 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor carpi ulnaris McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-38 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor carpi ulnaris McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-39 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor digitorum superficialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-40 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor digitorum superficialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-41 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor digitorum profundus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-42 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor digitorum profundus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-43 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor pollicis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-44 Individual Muscles of the Wrist and Hand-Flexors (cont.) Flexor pollicis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-45 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor carpi ulnaris McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-46 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor carpi ulnaris McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-47 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor carpi radialis brevis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-48 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor carpi radialis brevis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-49 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor carpi radialis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-50 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor carpi radialis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-51 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor digitorum McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-52 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor digitorum McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-53 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor indicis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-54 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor indicis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-55 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor digiti minimi McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-56 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor digiti minimi McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-57 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor pollicis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-58 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor pollicis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-59 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor pollicis brevis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-60 Individual Muscles of the Wrist and Hand-Extensors (cont.) Extensor pollicis brevis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-61 Individual Muscles of the Wrist and Hand-Extensors (cont.) Abductor pollicis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-62 Individual Muscles of the Wrist and Hand-Extensors (cont.) Abductor pollicis longus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-63 Intrinsic Muscles of the Hand McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-64 Chapter Summary The bones, joints, movements, muscles, and nerves of the hand and wrist joints are explored in this chapter. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-65 Chapter Summary (cont.)  Individual muscles of the hand and wrist are reviewed in depth with regard to palpation, origin, insertion, action, and innervation.  Each muscle includes information with clinical notes, muscle specifics, clinical flexibility and strengthening. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-66 Chapter Review  The Chapter Review is divided into true and false, short answers, and multiple choice questions.  The questions are designed for the students to test their knowledge.  Worksheets are at the end of the text as an aid for learning. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10-67 Explore and Practice  Students should utilize the questions and charts at the end of the chapter to help focus on the content of the chapter. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved