Chapter 7 Wrist & Hand Joints

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

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°

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

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

Cutaneous Distribution

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

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

Muscles Flexor Carpi Radialis Strengthening Stretching

Muscles Palmaris Longus Strengthening Stretching

Muscles Flexor Carpi Ulnaris Strengthening Stretching

Muscles Extensor Carpi Ulnaris Strengthening Stretching

Muscles Strengthening Stretching Extensor Carpi Radialis Brevis

Muscles Strengthening Stretching Extensor Carpi Radialis Longus

Muscles Strengthening Stretching Flexor Digitorum Superficialis

Muscles Flexor Digitorum Profundus Strengthening Stretching

Muscles Extensor Indicis Strengthening Stretching

Muscles Extensor Digiti Minimi Strengthening Stretching

Muscles Strengthening Stretching Extensor Pollicus Longus

Muscles Strengthening Stretching Extensor Pollicus Brevis

Muscles Abductor Pollicus Longus Strengthening Stretching

Thenar Muscles Opponens Pollicis

Thenar Muscles Abductor Pollicis Brevis

Thenar Muscles Flexor Pollicis Brevis

Intermediate Muscles Adductor Pollicis

Intermediate Muscles Palmar Interossei Drawn illustration

Intermediate Muscles Dorsal Interossei Drawn illustration

Intermediate Muscles Lumbricals

Hypothenar Muscles Opponens Digiti Minimi

Hypothenar Muscles Abductor Digiti Minimi

Hypothenar Muscles Flexor Digiti Minimi Brevis

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

Carpal Tunnel Syndrome Anatomy Bounds Muscles/Tendons Nerve Other

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

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;283:3110-3117 MOSBY’S GUIDE TO THE PHYSICAL EXAMINATION 5TH ED. Thumb Abduction Test

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

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