Department of Health and Community Care Chisholm Institute Department of Health and Community Care Diploma of Remedial Massage HLT50307   Anatomy & Physiology Anatomy of the Wrist & Hand Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Wrist & Hand Introduction The wrist and hand contain some of the smallest bones and joints of the body. These are controlled by a myriad of muscles and tendons Our wrist and hand have so many moving parts due to the fine motor skills required – from threading a needle to plastic surgery! Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones of the Wrist and Hand Radius Ulna Carpal bones Metacarpals Phalanges Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Distal Radius Bone type: long Take note of the: Head Neck Radial tuberosity Dorsal (Lister’s) tubercle Radial styloid process Articulation with scaphoid and lunate Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Distal Ulna Bone type: Take note of the: Neck Ulnar styloid process Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones Bone type: Take note of the: 8 separate bones arranged around the Capitate Proximal row articulates with the radius Distal row articulates with bases of metacarpal bones Proximal carpal bones: - scaphoid, lunate, triquetral, pisiform Distal carpal bones: - trapezium, trapezoid, capitate, hamate Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones - Carpal bones - Scaphoid Proximal articular surface for articulation with the radius Medial surface for articulation with lunate Distal surface for articulation with capitate Lateral for articulation with trapezium & trapezoid Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones - Lunate Palmar surface larger than dorsal surface Distal articulation is a deep concavity for articulation with capitate Convex surface for articulation with radius Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones- Triquetral Lies in an angle between the lunate & hamate Distinguished by a circular articular surface for the pisiform Proximal part enters radiocarpal joint during ulnar deviation of the hand Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones - Pisiform Small, round sesamoid bone found in the tendon of FCU Anterior surface forms the medial part of the carpal tunnel Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones - Trapezium Most irregular bone of carpals Saddle shaped articular surface for base of 1st metacarpal Increases mobility of 1st CMC Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones - Trapezoid Small, irregular bone articulating with the 2nd metacarpal Articulates with 2nd MC, scaphoid, capitate & trapezium Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones - Capitate Largest, most central carpal bone Palmar aspect roughened by ligamentous attachments Distal surface mainly articulates with base of the 3rd metacarpal Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones – Carpal Bones - Hamate Wedge shaped with large palpable hook Hook forms part of the carpal tunnel Distal edge of base articulates with bases of 4th & 5th metacarpals Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones - Metacarpals Bone type: long Take note of the: 5 metacarpals corresponding to each digit 1st MC articulates with: trapezium 2nd MC articulates with: trapezium, trapezoid & capitate 3rd MC articulates with: capitate 4th & 5th MC articulates with: hamate MC 2-5 articulate with adjacent MC Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Bones - Phalanges Bone type: Take note of the: 14 phalanges in each hand: 2 for the thumb 3 for all other digits: proximal, middle & distal phalanx - Head of the distal phalanx is expanded to support the pulp pad of the digits Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints of the Wrist and Hand Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints – Distal Radio-Ulnar Joint type: Pivot type synovial joint Take note of the: Notch in radius at ulnar articulation Bones involved: Radius Ulna Movements: Supination Pronation Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints – Radio-carpal Joint type: Condyloid Synovial Take note of the: TFCC between ulna and triquetrum Bones involved: Radius Carpals - Scaphoid, Lunate Movements: Flexion/Extension Ulnar/Radial deviation Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints – Ulnocarpal Joint type: Disc synovial Take note of the: Triangular Fibro-Cartilaginous Cartilage (TFCC) Bones involved: Ulna Carpals – Triquetrum, Lunate Movements: Flexion/Extension Ulnar/Radial deviation Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints - Intercarpal Joint type: Plane synovial Take note of the: Accessory movements only Bones involved: Carpal bones Movements: Gliding Sliding Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints – Carpo-metacarpal Joint type: Plane synovial Take note of the: 1st CMC joint is saddle type Bones involved: Carpals Metacarpals Movements: Gliding Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints – Metacarpo-phalangeal Joint type: Condyloid synovial Take note of the: 1st digit circumduction Bones involved: Metacarpals Proximal phalanges Movements: Flexion/Extension Abduction/Adduction Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints - Interphalangeal Joint type: Uniaxial hinge joints Take note of the: Collateral ligaments Bones involved: Proximal, middle and distal phalanges Movements: Flexion Extension Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints - Main Ligaments Ulnar Collateral Radial Collateral Flexor retinaculum Anterior to the carpal bones Strong band for retention of long flexor tendons Supports median nerve Extensor retinaculum Prevents “bowstringing” by retaining extensor tendons in their position Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints - Ranges of movement Distal radioulnar joint pronation 85 – 90* supination 85 – 90* Radiocarpal joint (true wrist joint) flexion 80 - 90* extension 70 - 90* radial deviation 15* ulnar deviation 30 – 45* Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Joints - Ranges of movement Finger ROM (digits 2-5) flexion: MCP 85-90* PIP 100-115* DIP 80-90* extension: MCP 30-45* PIP 0* DIP 20* abduction: 20-30* adduction: 0* Thumb flexion: CMC 45-50* MCP 50-55* IP 85-90* extension: MCP 0* IP 0-5* abduction: 60-70* adduction: 30* Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Pronator Teres Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Pronator Quadrates Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles - Supinator Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Pronator teres 1H: medial epicondyle 1H: coronoid process Lateral radius Forearm pronation (& weak elbow flexion) Median nerve C6C7 Pronator quadratus Anteriorly, distal 1/3 of ulna Anteriorly, distal ¼ radius Initiates forearm pronation Median nerve C8T1 (anterior interosseous branch) Supinator Lateral epicondyle, radial collateral lig & supinator crest of ulna Posterior, lateral & anterior radius inferior to neck of radius Supination of the forearm Radial nerve C5C6 (posterior interosseous branch) Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Flexor Carpi Ulnaris Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Flexor Carpi Radialis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Palmaris Longus Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Flexor carpi ulnaris Medial epicondyle Pisiform, hook of hamate & base of 5th met Wrist flexion & ulnar deviation Ulnar nerve C7C8 Flexor carpi radialis Medial Epicondyle Base of 2nd and 3rd met Wrist flexion Median nerve C6C7 Palmaris longus Flexor retinaculum Weak wrist flexor Median nerve C8 Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Carpi Radialis Longus Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Carpi Radialis Brevis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Carpi Ulnaris Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Extensor carpi radialis longus Lateral supracondylar ridge Base of 2nd met Wrist extension Radial nerve C6C7 Extensor carpi radialis brevis Lateral epicondyle Base of 3rd met Posterior interosseous branch of radial nerve Extensor carpi ulnaris Base of 5th met Wrist extension & ulnar deviation Poserior interosseous branch of Radial nerve C6C7 Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Digitorum Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Digiti Minimi Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Indicis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Extensor digitorum Lateral Epicondyle Base of distal phalanx digits 2-5 Extension of MCP digits 2-5 Posterior interosseous branch of radial nerve C6C7 Extensor digiti minimi Lateral epicondyle Base of proximal phalanx of digit 5 MCP 5 extension Posterior interosseous branch of Radial nerve C6C7 Extensor indicis Distal ulna & interosseous membrane Proximal phalanx of index finger Assists extensor dogotorum Posterior interosseous branch of Radial nerve C7C8 Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Flexor Digitorum Superficialis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Flexor Digitorum Profundus Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Flexor Pollicis Longus Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Flexor digitorum superficialis Medial epicondyle, conronoid process and anterior radius Palmar surface base of middle phalanx` MCP and PIP flexion Median nerve C7C8T1 Flexor digitorum profundus Coronoid process of ulna Palmar surface distal phalanx DIP flexion Median nerve C7C8T1 & Ulnar nerve C8T1 Flexor pollicis longus Near radial tuberosity & interosseous membrane Distal phalanx of thumb IP flexion of thumb Median nerve C8T1 Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Flexor Pollicis Brevis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Pollicis Longus Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Extensor Pollicis Brevis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Flexor pollicis brevis Distal flexor retinaculum & tubercle of trapezium Base of proximal phalanx of thumb MCP and CMC flexion of the thumb Median nerve T1 (also Ulnar nerve T1) Extensor pollicis longus Middle 1/3 posterior ulna Distal phalanx of thumb Extends all joints of the thumb Radial nerve C7C8 Extensor pollicis brevis Posterior redius & interosseous membrane Base of proximal phalanx of the thumb Thumb CMC & MCP extension Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Abductor Pollicis Longus Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Abductor Pollicis Brevis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Opponens Pollicis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Abductor pollicis longus Middle 1/3 of ulna and radius Base of 1st metacarpal Mid position thumb abduction Radial nerve C7C8 Abductor pollicis brevis Tubercles of scaphoid and triquetrum Proximal phalanx of thumb CMC & MCP abduction of the thumb Median nerve T1 Opponens pollicis Flexor retinaculum & tubercle of trapezium Anterior surface of 1st metacarpal Thumb opposition Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Adductor Pollicis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Palmaris Brevis Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Abductor Digiti Minimi Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles about the wrist & hand Name Origin Insertion Action Innervation Adductor pollicis Tendon of FCR, bases of mets 2-4 and shaft of 3rd met Base of proximal phalanx of thumb Thumb adduction (precicion gripping) Ulnar nerve C8 Palmaris brevis Palmar aponeurosis in front of flexor retunaculum Skin of medial border of the hand Assists thumb with gripping Ulnar nerve T1 Abductor digiti minimi Pisiform & surrounding ligaments Proximal phalanx of digit 5 Digit 5 abduction Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Palmar Interossei Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles – Dorsal Interossei Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles - Lumbricals Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Muscles of the wrist & hand Name Origin Insertion Action Innervation Palmar interossei Shaft of met for the specific digit Base of proximal phalanx of that digit Adduct thumb, index, ring & little fingers Ulnar nerve T1 Dorsal interossei Sides of adjacent mets Proximal phalanx of that digit Abduct index, middle and ring fingers Lumbricals Adjacent sides of FDP tendons MCP flexion & IP extension Lat 2: Median nerve T1 Med 2: Ulnar nerve T1 Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12

Biomechanical application Compare the wrist and hand position in relation to handwriting postures and discuss differences between (L) and (R) handed scripts Discuss how the position of the wrist and hand position varies as a cricket bowler releases the ball Consider the movements that a javelin thrower’s wrist goes through as they move from the pre-release to release phase of throwing a javelin Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12