1. 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

2. 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

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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

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

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

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

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

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

31. 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

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

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

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

35. 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

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

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

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

39. 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

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

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

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

43. 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

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

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

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

47. 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

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

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

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

51. 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

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

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

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

55. 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

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

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

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

59. 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

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

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

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

63. 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

64. 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