Elbow Wrist and Hand The aim of this lesson is introduce learners to the anatomy of the elbow, wrist and hand

classify and describe the articulations of the elbow, wrist and hand Learning Objectives By the end of this session learners will be able to; classify and describe the articulations of the elbow, wrist and hand name the movements available at the elbow, wrist and hand joint identify the common bony prominences that aid palpation on a human subject identify and palpate the muscles of the elbow, wrist and hand on a human subject

THE ELBOW JOINT The elbow joint is made up of the humerus, radius and ulna. It is a synovial hinge joint that allows for flexion and extension of the elbow The humerus and ulnar articulate to form the humeroulnar joint. The humerus and radius articulate to form the humeroradial joint.

THE ELBOW JOINT (cont) Inferior to the true elbow joint, the proximal radius articulates with the ulna to form the radioulnar joint This is a synovial pivot joint and allows pronation and supination of the forearm

medial and lateral epicondyles of the humerus olecranon process Palpation of bony prominences medial and lateral epicondyles of the humerus olecranon process radial and ulna styloid process scaphoid (one of the carpal bones)

Bony prominences of elbow and radioulnar joint

Ligaments of the elbow joint The elbow joint is contained in a synovial capsule that provides stability. Additional stability is provided by ligaments; Annular ligament – stabilises radius against ulna during pronation and supination Ulnar collateral ligament –stabilises the humerus to the ulna

Ligaments of the elbow joint The radiocollateral ligament runs from the lateral epicondyle of the humerus to the proximal radius It stabilises the humerus and radius at the elbow joint Together, these ligaments helpt to prevent unwanted sideways movement of the elbow.

Movement of the elbow and radioulnar joint

THE WRIST JOINT The wrist is a synovial condyloid joint The true wrist joint is formed by the radius and carpal bones of the hand There are 8 carpal bones in two rows of 4. It is the proximal carpal bones that articulate with the distal radius to form the wrist joint The radius and ulna also articulate at their distal ends Scaphoid

Movements of the wrist The wrist also allows for limited circumduction Radial deviation is also known as abduction of the wrist Ulnar deviation is also known as adduction of the wrist

THE HAND The hand has many similarities to the structure of the foot Carpometacarpal joints – formed between carpals and metacarpals Metacarpophalangeal joints – formed between metacarpals and phalanges Phalanges (14) – each finger has 3 phalanges (the thumb has 2)

Movements of the hand

maintaining the elbow in a flexed position Assessment of the Elbow, Wrist and Hand Observation maintaining the elbow in a flexed position maintaining the wrist in a flexed position positioning of the thumbs and fingers condition and shape of the knuckles

Elbow flexion extension supination pronation Wrist flexion extension Range of Movement (ROM) Elbow flexion extension supination pronation Wrist flexion extension abduction adduction Hand finger flexion finger extension abduction adduction

Palpation All of the soft tissues related to the elbow, wrist and hand need to be palpated to identify areas of pain inflammation and muscular tonicity.

Special Tests Phalen’s Test

Functional Tests picking up items putting down items typing