Chapter 6:Part 1 The Upper Extremity: The Elbow, Forearm, Wrist, And Hand KINESIOLOGY Scientific Basis of Human Motion, 12th edition Hamilton, Weimar & Luttgens Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University Revised by Hamilton & Weimar Copyright © 2012 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill/Irwin

Objectives 1. Name, locate, & describe the structure & ligamentous reinforcements of the elbow, forearm, wrist, and hand joints. 2. Name & demonstrate the movements possible in these joints. 3. Name & locate muscles & muscle groups, and name their primary actions. 4. Analyze the fundamental movements with respect to joint & muscle actions. 5. Describe common athletic injuries.

THE ELBOW JOINT Structure Fig 6.1 Actually 3 joints: Humeroulnar Hinge joint Humeroradial Gliding joint Proximal Radioulnar Pivot joint

THE ELBOW JOINT Structure Fig 6.1 Distal humerus -trochlea & capitulum. Ulna - semilunar notch: Coronoid process Olecranon process Radial head Radial notch of ulna

THE ELBOW JOINT Structure Fig 6.2 & 6.3 THE ELBOW JOINT Structure All 3 joints enveloped in a capsule, lined by synovial membrane. Strengthened by radial & ulnar collateral ligaments. Annular ligament encircles the radial head & binds it to ulna. Fig 6.4a Movements of the elbow joint

THE RADIOULNAR JOINTS Structure Fig 6.1 Proximal: previously described. Distal: Pivot joint Radius articulates with head of ulna. Strengthened by: Volar radioulnar ligament Dorsal radioulnar ligament The radiolunar joints--movements

MUSclES OF ELBOW AND RADIOULNAR JOINTS Location: Anterior (Elbow): Biceps brachii, brachialis, brachioradialis, pronator teres Anterior (wrist): Pronator quadratus Posterior: Triceps brachii, anconeus, supinator

Biceps Brachii Function: Function: Flexes and supinates the forearm. Flexion at the elbow. Fig 6.7 Fig 6.5

Brachioradialis Pronator Teres Pronator Quadratus Fig 6.8 Brachioradialis Function: Contributes to elbow flexion. Pronator Teres Pronates the forearm, assists in elbow flexion. Pronator Quadratus Pronation of the forearm. Fig 6.9

Triceps Brachii & Supinator Fig 6.10 Triceps Brachii Function: Powerful extensor of elbow. Supinator Supination of the forearm.

Anconeus Function: Working with the triceps, extends the forearm. Fig 6.11 Function: Working with the triceps, extends the forearm.

MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM pronation supination Flexion Biceps brachii, brachioradialis, brachialis Brachialis active in all conditions. Biceps brachii most active with supination, least with pronation. Fig 6.6

MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM Extension Triceps & anconeus, against gravity. Pronation Pronator teres & pronator quadratus. Supination Supinator & biceps; Long head more active with greater muscle length, while short head more active with shorter muscle length.

THE WRIST AND HAND Great mobility due to generous supply of joints: Radiocarpal (wrist) joint. Articulation between two rows of carpal bones. Carpometacarpal joints. Fig 6.12 Trapezoid Trapezium Hamate Capitate Lunate Triquetral Scaphoid

Structure of the Wrist (Radiocarpal) Joint Fig 6.14 Condyloid joint 4 ligaments Volar radiocarpal Dorsal radiocarpal Ulnar collateral Radial collateral Circumduction: fingertips describe a circle, hand describes a cone. Fig 6.16 Movements of the hand at the wrist

Structure and Movements of the Midcarpal and Intercarpal Joints Proximal row of 4 carpal bones articulate with four carpal bones of distal row. Permits only a slight gliding motion. However, the gliding adds up to a modified hinge type of movement. Anterior surface of carpal bones are slightly concave, referred to as the carpal tunnel.

Structure of the Carpometacarpal and Intermetacarpal Joints Fig 6.13 The thumb is a prime example of a saddle joint. Joints between bases of metacarpal bones are irregular. All are enclosed in capsules.

Movements of the Carpometacarpal Joint of the Thumb Fig 6.19 Abduction Hyperadduction Extension Flexion Hyperflexion Opposition

Movements of Carpometacarpal & Intermetacarpal Joints of Fingers Because of short ligaments in this region, motion in these joint is almost nonexistent. Limited to slight gliding. 5th carpometacarpal joint is slightly more mobile.

Structure of Metacarpophalangeal Joints Fig 6.17 Joints at bases of four fingers, uniting proximal phalanges with metacarpals. Condyloid joints Encased in capsules Protected by collateral ligaments. Also a dorsal ligament. Fig 6.20 Movements of Metacarpophalangeal Joint of the Fingers

Movements of Metacarpophalangeal Joints of the Thumb Flexion: volar surface of the thumb approaches base of thumb. Extension: return movement from flexion.

The Interphalangeal Joints Joints between adjacent phalanges of any of the five digits. All are hinge joints, permit only flexion & extension. Hyperextension is slight, if present at all. Each enclosed in a capsule. Strengthen by collateral ligaments and in front by a volar ligament .

MUSCLES OF THE WRIST Location: (table 6.1) Anterior: Flexor carpi radialis, flexor carpi ulnaris, palmaris longus. Posterior: Extensor carpi radialis brevis, extensor carpi radialis longus, extensor carpi ulnaris. Location: (table 6.1) From forearm: Extensor digiti minimi, extensor digitorum, extensor indicis, flexor digitorum profundus, flexor digitorum superficialis. Intrinsic to Hand: Abductor digiti minimi, flexors digiti minimi brevis, interossei dorsales manus, interossei palmaris, lumbricales manus, opponens digiti minimi.

MUSCLES OF THE THUMB Location: (table 6.1) From forearm: Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, flexor pollicis longus. Intrinsic to hand: Abductor pollicis brevis, adductor pollicis, flexor pollicis brevis, opponens pollicis.

Muscles of the wrist and hand Extensor carpi radialis (longus) (brevis) Extensor carpi ulnaris Fig 6.23a Fig 6.21 Flexor Carpi radialis Function: Flexes wrist Radial deviation Flexor Carpi Ulnaris Ulnar deviation Palmaris longus Weakly flexes wrist Extensor carpi radialis Function: Extends wrist Radial deviation Extensor carpi ulnaris Ulnar deviation

Muscles of the wrist and hand Extensor digitorum Extensor digiti minimi Fig 6.23b Flexor digitorum superficialis Function: Flexes fingers & wrist. Extensor digitorum Function: Extends fingers & wrist. Extensor digiti minimi Extends little finger & wrist. Fig 6.24a

Muscles of the wrist and hand Fig 6.24b Extensor pollicis longus Function: Extends thumb Extensor indicis Extends index finger Abductor pollicis longus Abducts thumb Extensor pollicis brevis Fig 6.25 Flexor digitorum profundus Function: Flexes fingers & wrist. Flexor pollicis longus Flexes thumb.

Muscles of the wrist and hand Abductor pollicis brevis Function: Abducts thumb. Flexor pollicis brevis Flexes thumb. Opponens pollicis Opposition of thumb. Fig 6.26

Muscles of the wrist and hand Abductor pollicis brevis Function: Abducts thumb. Flexor pollicis brevis Flexes thumb. Opponens pollicis Opposition of thumb. Fig 6.26 Abductor digit minimi Function: Abducts little finger. Flexor digiti minimi Flexes little finger. Opponens digiti minimi Opposition of little finger. Fig 6.26

Muscular analysis of the fundamental movements of the wrist, thumb, and hand Flexion Extension & Hyperextension Radial deviation (Abduction) Ulnar Deviation (adduction) Fingers Flexion Extension Abduction Adduction Opposition

Thumb Metacarpal Thumb Phalanges Flexion Flexion Extension Extension Muscular analysis of the fundamental movements of the wrist, thumb, and hand Thumb Metacarpal Flexion Extension Abduction Adduction Opposition Thumb Phalanges Flexion Extension

Cooperative action of wrist and digits Length of Long Finger Muscles Relative to Range of Motion in Wrist & Fingers Long finger muscles do not have sufficient length to permit full ROM in joints of fingers & wrist at the same time. Example: make a tight fist, now flex wrist, fingers loosen their grip.

Examples of Using Hands for Grasping Power grip involves flexion of all fingers Fig 6.30 Cylindrical Spherical Hook

Examples of Using Hands for Grasping Precision involves thumb & two fingers, depending on shape & size of object Fig 6.30

COMMON INJURIES OF THE FOREARM, ELBOW, WRIST, AND FINGERS Fractures of the ForeArm Result of direct blow or falling on outstretched hand. Usually both ulna & radius fracture. In the young usually a greenstick type. Immobilization of the elbow is important to reduce movement at fracture site. 35

Elbow Dislocation and Fracture Results from falling on outstretched hand with elbow extended or hyperextended. Most common is backward displacement of ulna & radius in relation to humerus. Dislocation is frequently accompanied by fracture. Most common is to medial epicondyle. Very serious - likely to involve blood vessels & nerves.

Sprained or Strained Wrist From falling on palm of hand with wrist hyperextended. Usually a sprain of ligaments. May be a strain to tendons. May be pain, weakness, limited ROM.

Carpal Tunnel Syndrome This is an overuse, repetitive stress injury. Long hours working with small hand tools and keyboards. Nerve & blood vessel compression as they pass through carpal arch & transverse carpal ligament. Indicators are pain, numbing of fingers.

Avulsion Fracture External force applied to tendon pulls off a piece of bone. Often from rapid pronation/supination or high energy flexion of fingers. Probability for occurrence greatest during growth and maturation.

Epicondylitis Lateral epicondylitis – “tennis elbow” Medial epicondylitis – ‘Little League elbow” Both are repetitive stress injuries. Micro-traumas or tears in muscle & soft tissue at proximal attachments. Indication is pain on activity. Rest, ice, anti-inflammatory drugs, bracing often used as treatment.