1. Wrist and Hand

2. Wrist
Wrist is a joint complex consisting of radio-carpal joint and many relationships between the carpal bones
Review of carpals
Proximal row = Pisiform, Triquetrum, Lunate, and Scaphoid*
Distal row = Hamate, Capitate, Trapezoid, and Trapezium
*Scaphoid has a notoriously poor blood supply and recovers poorly following injury

3. Osteology

4. Osteology

5. Osteology

6. Scaphoid

7. Cross Section at Wrist

8. Wrist All carpal bones articulate via gliding or plane joints
A more or less joint exists between proximal row and distal row of bones called mid-carpal – truly is a series of gliding joints
Scaphoid, Lunate and Triquetrum with Trapezium, Trapezoid, Capitate and Hamate
Pisiform is not involved

9. Wrist True Wrist = Radio-Carpal Distal radius with proximal carpals
“Ulnar-Carpal” = interposed disc
Distal radius with proximal carpals
Condyloid joint – 2 degrees of freedom
Major Ligaments
Palmar radio-carpal, palmar ulnocarpal, dorsal radio-carpal, dorsal ulno-carpal, radial and ulnar collateral

10. Radio-Carpal

11. Ligaments

12. Ligaments

13. Interactive Wrist

14. Wrist Mid-Carpal Proximal row of carpals with distal row
A series of gliding joints – 3 DOF
MAJOR Ligaments – Capsule plus
Pisohamate, pisometacarpal, capitotriquetral, palmar and dorsal carpometacarpal

15. Ligaments

16. Interactive Wrist

17. Wrist Movements Flexion/Extension – about 70-80 degrees of ROM
Radiocarpal v. Mid Carpal
Flexion is initiated in mid carpal joint and 60% occurs there
Extension is also initiated at mid carpal but most occurs in radio-carpal. Need 35 degrees for good function – at least 10 for any significant function.
Abduction/Adduction – about 15 to 20 degrees
Intercarpal – proximal row slides over distal row

18. Movements

19. Movements

20. Movements

21. Carpo-Metacarpal Joints
2-5
Hamate with 4 and 5
Capitate with 3
Trapezoid with 2
Gliding joints with limited range – mostly passive
Palmar and Dorsal carpometacarpal ligaments

22. C-M Joints

23. C-M Joints

24. C- M Thumb Trapezium with 1st met Saddle
Adds rotary component – very mobile
Capsule support

25. C-M Thumb

26. Interactive Hand

27. Metacarpal – Phalangeal Joints
Ellipsoid
2 DOF
Passive rotation
Collateral Ligaments
Deep Transverse Metacarpal Ligaments
Palmar Ligaments (Plates)

28. Ligaments

29. Ligaments

30. Interactive Hand

31. Interphalangeal Joints
Hinge
Collateral Ligaments
Palmar Ligaments (Plates)

32. Ligaments

33. Interactive Hand

34. Definition of Finger Movements
Reference is imaginary line through the middle of long (3rd) finger
Adduction of 2-5 = towards that point
Abduction = away –1, 4, and 5
Thumb
Flexion
Extension
ABD
ADD
Rotation
Opposition = flexion with adduction and rotation

35. Finger Movements

36. Finger Movements

37. Flexor Tendons Tenosynovium (AKA Fibro-Osseous Tunnels)
Anular Pulleys AKA Vaginal Ligaments
Anular and Cruciform
Relationship to Palmar Plates

38. Vinculum Longa and Breve

39. Tunnels

40. Tunnels

41. Interactive Hand

42. Dorsal Hood

43. Dorsal Hood

44. Dorsal Hood Mechanism Insertion of Long Extensor Tendons
Ext. Dig. Communis
Ext. Indicis Proprius
Ext. Digiti Minimi
Extensor Expansion – MP Joints
Central Band – Middle Phalanx
Lateral Band –Distal Phalanx
Relationship to Intrinsic Muscles

45. Dorsal Hood

46. Dorsal Hood

47. Interactive Hand

48. Intrinsic Muscles Thenar Eminence - median
Hypothernar Eminence - ulnar
Intermediate – ulnar and some median
There are NO muscles in the hand innervated by the Radial nerve

49. Palmar Aponeurosis

50. Thenar Eminence Flexor Pollicus Brevis Abductor Pollicus Brevis
Opponens Pollicus

51. Thenar Muscles

52. Hypothenar Eminence Abductor Digiti Minimi Flexor Digiti Minimi
Opponens Diditi Minimi

53. Intermediate Adductor Pollicus Lumbricales Volar (Palmar) Interossei
Dorsal Interossei

54. Adductor Pollicus

55. Lumbricales

56. Lumbricales

57. Dorsal Interossei

58. 1st Dorsal Interosseous

59. Volar (Palmar) Interrossei

60. Digit Movement

61. Digit Movement Cont.

62. Blood Supply Ulnar aa Radial aa Superficial Palmar Arch
Common Palmar aa
Proper palmar digital aa
Radial aa
Deep Palmar Arch
Dorsal digital aa
Princeps Pollicus
Radialis Indicis

63. Superficial Palmar Arch

64. Superficial Palmar Arch

65. Superficial Palmar Arch

66. Deep Palmar Arch

67. Deep Palmar Arch-Dorsal View

68. Deep Palmar Arch

69. Digital Supply

70. Median Cutaneous

71. Ulnar Cutaneous

72. Radial Cutaneous (Hand)

73. Common Nerve Injuries
Median
Symptoms
Ulnar