1. Forearm, Wrist and Hand

2. Functions of the Forearm, Wrist, and Hand
Enables the hand to grip and hold objects
Wrist
Provides stability for hand movements
Hand
Perception (hot, cold, sharp…)
Fine motor movements
Manipulation
Grasp
Support or transfer of force
Nonverbal communication (sign language)

3. Nerves of the Forearm, Wrist, and Hand
Radial Nerve
Innervates the triceps brachii and provides sensation to dorsal side of thumb, index, middle, and half of ring finger
Ulnar Nerve
Palmar side of the little finger and half of the ring finger
Median Nerve
Palmar side of thumb, index , and half of ring finger

5. Bones of the Forearm, Wrist and Hand
2 from the forearm-radius and ulna
8 carpals
5 metacarpals
14 phalanges
Total: =29

6. Forearm Anatomy Bones Radius and Ulna Radioulnar Joint
Formed by radius and ulna
Joint Actions
Pronation and Supination
In supination the radius and ulna are parallel
During pronation the radius crosses over the ulna
Find and grip objects in different positions (vertical, horizontal and at an angle) and observe how the position of the forearm changes to allow the hand to grip

7. X-Ray

8. Pronators Supinators Biceps Brachii Supinator Brachioradialis
Muscles of the Forearm
Pronators
Pronator Teres
Pronator Quadratus
Brachioradialis
Supinators
Biceps Brachii
Supinator
Brachioradialis

9. Pronator Teres Superficial Anterior Muscle
O: Medial Epicondyle of Humerus
I: Medial and Lateral Surface of Radius
A: Pronation of Radioulnar Joint
Integrated Function: Assists in deceleration of supination of radioulnar joint
Assists in dynamic stabilization of radioulnar joint

11. Pronator Quadratus Deep Anterior Muscle O: Distal anterior ulna
I: Distal anterior radius
A: Forearm Pronation
Integrated Function: Assists in deceleration of supination of radioulnar joint

12. Supinator Deep Posterior Muscle O: Lateral Epicondyle of Humerus
I: Wraps around proximal radius
A: Supination of Radioulnar Joint
Integrated Function: Assists in deceleration of pronation of radioulnar joint
Assists in dynamic stabilization of radioulnar joint

14. Wrist Anatomy Bones Distal radius and ulna and carpals
Radiocarpal Joint
Formed by distal radius and proximal row of carpal bones
Ulna makes NO contact with carpals
Joint Actions
Flexion, extension, abduction, adduction and circumduction
Carpal Bones
Flat bones aligned in two rows of 4 (8 total)
Proximal and Distal Row

15. Carpal Bones Beginning with the radial side Proximal Row
Scaphoid-most commonly fractured
Lunate-most commonly dislocated
Triquetrum-triangular
Pisiform
Distal Row
Trapezium-aligns with 1st metacarpal
Trapezoid-aligns with 2nd metacarpal
Capitate-aligns with 3rd metacarpal
Hamate-aligns with 4th and 5th metacarpal

17. X-Ray

18. Carpals
On the dorsal side, locate the third metacarpal bone . A depression can be found on the proximal end of the third metacarpal bone. This is the location of the Capitate bone. Flex the wrist and you may feel the Capitate bone.
The Scaphoid bone is found below the anatomical snuff box (when snuff was popular, this compartment was used to hold tobacco for snorting)

19. Hand Anatomy Metacarpals Phalanges Numbered 1-5
Thumb =1 and pinky = 5
Actions: Flexion, extension,
abduction, adduction, and
circumduction
Phalanges
Proximal, intermediate and distal
abduction, adduction, and thumb
opposition

20. Muscles Causing Wrist Actions
Superficial Wrist flexors
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris
Superficial Wrist extensors
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris
These muscles do not cause finger movements

21. Attachments Wrist Flexors
All originate from the medial epicondyle of the humerus
Insertions: Anterior aspect of the wrist and hand
Wrist Extensors
All originate from the lateral epicondyle of the humerus
Insertions: Posterior aspect of wrist and hand

22. Flexor Carpi Radialis O: Medial Epicondyle of Humerus
I: Bases of 2nd and 3rd metacarpals
A: Flexion and Abduction of wrist (radial deviation)

23. Palmaris Longus Absent in 15 - 20% of Population
O: Medial Epicondyle of Humerus
I: Palmar Aponeurosis
A: Wrist flexion
Q: How do you test for this muscle and why is it important?

24. Palmaris Longus Tested: With wrist slightly flexed
Oppose thumb and little finger
Importance:
Used in tendon transfers (autografts)

25. Flexor Carpi Ulnaris O:Medial Epicondyle of Humerus
I: Pisiform (carpal bone proximal row)
A: Flexion and Adduction of Wrist (ulnar deviation)

26. Wrist Flexor Palpation Video

28. Integrated Function of Wrist Flexors
Assists in deceleration of wrist extensors
Assists in dynamic stabilization of the wrist and hand
Flexor Carpi Radialis and Flexor Carpi Ulnaris
Assists in deceleration of wrist abduction
Flexor Digitorum Superficialis
Assists in deceleration of finger extension

29. Extensor Carpi Radialis Longus
O: Lateral Epicondyle of Humerus
I: Base of 2nd metacarpal
A: Extension of wrist
Abduction of wrist
(radial deviation)

30. Extensor Carpi Radialis Brevis
O: Lateral Epicondyle of Humerus
I: Base of 3rd metacarpal on dorsal surface
A: Extension of wrist
Abduction of Wrist

31. Extensor Carpi Ulnaris
O: Lateral Epicondyle of Humerus
I: Base of 5th metacarpal on dorsal surface
A: Extension of Wrist
Adduction of Wrist (ulnar deviation)

33. Integrated Function of Wrist Extensors
Assists in deceleration of wrist flexion
Assists in dynamic stabilization of the wrist and hand
Extensor Carpi Radialis Brevis and Longus
Assists in deceleration of wrist adduction
Extensor Carpi Ulnaris
Assists in deceleration of wrist abduction

34. Phalange Muscles These muscles assist in wrist actions Finger flexors
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Thumb flexor
Flexor Pollicis Longus
Finger extensors
Extensor Digitorum
Extensor Indicis
Extensor Digiti Minimi
Thumb extensor
Extensor Pollicis Longus
Extensor Pollicis Brevis
These muscles assist in
wrist actions

36. Carpal Tunnel Syndrome
Impingement or compression of the median nerve
Occurs from chronic swelling of the wrist flexor tendons
The median nerve, which innervates the first three fingers and the thumb, can become impaired from pressure in the carpal tunnel in the wrist

37. Carpal Tunnel Syndrome
Causes
Awkward hand postures
Long hours of repetitive typing
Repeated use of hand tools
Smoking-it may reduce blood flow to median nerve
Wrist injuries
Development of a cyst or tumor in the carpal tunnel
Common in assembly line workers, nail technicians, data entry personnel, musicians

38. Carpal Tunnel Syndrome
Signs and Symptoms
Pain, numbness, or tingling in the first three fingers and the thumb
Increased pain with increased use of your hand, such as typing
Night pain
Weak grip and tendency to drop objects

39. Carpal Tunnel Syndrome
Tests
Tinel’s Sign: Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand
Phalen’s Test: Pushing the back of your hands together for 60 seconds compresses the carpal tunnel and may cause pain

40. Carpal Tunnel Syndrome
Treatments
Ergonomic aids: Split keyboards, keyboard trays, typing pads, cushioned mouse pads and wrist braces, may be used to improve wrist posture during typing
Take frequent breaks when typing and always stop if there is tingling or pain
Avoid sleeping on wrists
NSAID’s
Physical or Occupational Therapy
Carpal tunnel release surgery

41. Carpal Tunnel Syndrome
Exercises
Contraindicated
Heavy resistance training
Excessive wrist flexion and extension
What to do:
Focus on flexibility!

42. Carpal Tunnel Syndrome
Stretch the following muscle groups
Elbow Flexors
Wrist Flexors
Finger Flexors
Extension exercises are key to recovery! It will help hold the carpal tunnel open
Strengthen the following muscle groups
Elbow Extensors
Wrist Extensors
Finger Extensors
Finger Abductors