ESAT 3600 Fundamentals of Athletic Training Wrist and Hand ESAT 3600 Fundamentals of Athletic Training

Wrist Anatomy Distal end of radius (and ulna) and the carpal bones Proximal row Scaphoid, lunate, triquetrum, pisiform Distal row Trapezium, trapezoid, capitate, hamate

Wrist Joints Radiocarpal Midcarpal

Wrist Weak bony arrangement Strong ligamentous and muscle stability

Wrist Ligaments Palmer radiocarpal ligaments Radial collateral ligament Palmer ulnocarpal ligament Palmer intercarpal ligament Transverse carpal ligament

Wrist Ligaments Ulnar collateral ligament Dorsal radiocarpal ligament Dorsal intercarpal ligament

Tensing Pattern of Ligaments During RD UD

Movements of the Wrist Flexion Extension Radial deviation Ulnar deviation

Arthrokinematics of Wrist Flexion and Extension

Arthrokinematics of RD/UD

Wrist Muscles

Wrist Extensors Primary movers Secondary movers Extensor carpi radialis longus and brevis Extensor carpi ulnaris Secondary movers Extensor digitorum communis Extensor digiti minimi Extensor pollicis longus

Wrist Flexors Primary movers Secondary movers Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Secondary movers Flexor digitorum profundus Flexor digitorum superficialis Flexor pollics longus

Radial and Ulnar Deviation

Carpal Instability

Carpal Tunnel Bounded by 8 carpal bones and flexor retinaculum Contents of tunnel 9 finger flexor tendons MEDIAN NERVE

Carpal Tunnel Syndrome Entrapment of median nerve in the tunnel Signs and symptoms Pain Numbness Tingling Thenar muscle atrophy Affect on strength and dexterity

Precipitating Factors of CTS Misaligned fractures Rheumatoid and osteoarthritis Thickening and swelling of synovial sheath Inflammation

Hand

Structure of Hand 5 metacarpals Thumb 4 fingers Ligaments Radial collateral Ulnar collateral Carpometacarpals intermetacarpals

Joints of the Hand CMC MCP PIP DIP

Finger movements Extension Flexion Adduction Abduction Circumduction

CMC of Thumb

Orientation of Thumb Rotated 90 degrees

Thumb Movements Extension Flexion Adduction Abduction Opposition

Arthrokinematics of the 1st CMC Joint

Arthrokinematics of the MCP and IP Joints

Cooperative Actions of Wrist and Fingers Prehension Power grip Cylindrical Spherical Hook Precision grip Power pinch Precision pinch

Muscles of the Wrist Palmaris Longus O: common flexor tendon from medial epicondyle of humerus I: flexor retinaculum and palmar aponeurosis A: flexes hand at the wrist

Muscles of the Wrist Flexor carpi radialis O: common flexor tendon from medial epicondyle of humerus I: anterior surfaces of bases of 2nd and 3rd metacarpals A: flexes and radially deviates the hand at the wrist

Muscles of the Wrist Flexor carpi ulnaris O: by 2 heads from medial epicondyle of humerus and medial border of olecranon process of ulna I: palmer surface of pisiform and hamate and base of 5th metacarpal A: flexes and ulnarly deviates the hand at the wrist

Muscles of the Wrist Flexor digitorum superficialis O: humero-ulnar head – medial epicondyle of the humerus by the common flexor tendon, ulnar collateral ligament of elbow and coronoid process of ulna; radial – oblique line of radius extending from radial tuberosity to the insertion of the pronator teres I: 4 tendons, 1 to each finger, divide fro the passage of the tendons of flexor digitorum profundus then insert as 2 slips on sides of the shaft of the middle phalanx A: flexes the phalanx of each finger on the proximal phalanx. Flexes the proximal phalanx at the hand, flexes the hand at the wrist

Muscles of the Wrist Flexor pollicis longus O: anterior surface of middle ½ of radius. Adjacent interosseous membrane and slip from the coronoid process of the ulna or medial epicondyle of humerus I: palmar surface of the base of the distal phalanx of the thumb A: flexes the interphalangeal joint of the thumb. Flexes the metacarpophalangeal and carpometacarpal joints

Muscles of the Wrist Flexor digitorum profundus O: upper ¾ of anterior and medial surfaces of the ulna, interosseous membrane and deep fascia of the forearm I: 4 tendons, 1 to each finger, to palmer surface of base of distal phalanx, after passing through tendon of flexor digitorum superficialis A: flexes the distal phalanges of the 4 fingers. Assists in flexing metacarpophalangeal, carpometacarpal and wrist joints

Muscles of the Wrist Extensor carpi radialis longus O: lower 1/3 of lateral supracondylar ridge, and a few fibers from lateral epicondyle I: posterior surface of base of 2nd metacarpal A: extends and radially deviates hand at the wrist

Muscles of the Wrist Extensor digitorum O: common extensor tendon from lateral epicondyle of humerus I: by 4 tendons, 1 to each finger, each dividing into 3 slips, middle one attaches to dorsal surface of middle phalanx, the other 2 unit to attach to the dorsal surface of base of distal phalanx A: extends phalanx at the interphalangeal joints, continued action extends the metacarpophalangeal and carpometacarpal articulations. Assists in wrist extension

Muscles of the Wrist Extensor digiti minimi O: common tendon of extensor digitorum I: tendon of the extensor digitorum at the proximal phalanx of the little finger and into the dorsal expansion of the finger extensor tendons A: extends the proximal phalanx of the little finger at the metacarpophalangeal joint, assists extension at the wrist. Extends middle and distal phalanges especially when the proximal phalanx is held in flexion

Muscles of the Wrist Extensor carpi radialis brevis O: common extensor tendon from lateral epicondyle I: posterior surface of base of 3rd metacarpal A: extension and radial deviation of the hand at the wrist

Muscles of the Wrist Extensor carpi ulnaris O: by 2 heads from lateral epicondyle of humerus and middle 1/3 of posterior ridge of ulna I: posterior surface of base of 5th metacarpal A: extends and ulnarly deviates the hand at the wrist

Muscles of the Wrist Extensor indicis O: dorsal surface of distal half of ulna I: index finger extensor digitorum tendon A: extension of all phalanges of index finger. Assists in wrist extension

Extensor Pollicis Longus O: Posterior surface of the middle 1/3 of ulna an interosseous membrane I: Posterior surface of base of distal phalanx of thumb A: Extends distal phalanx of thumb. Continued action, extends proximal phalanx and metacarpal, and adducts 1st metacarpal

Extensor Pollicis Brevis O: Posterior surface of distal end of body of ulna near the middle and adjacent interosseous membrane I: Posterior surface of the base of proximal phalanx of thumb A: Extends proximal phalanx of thumb. Continued action extends and assists abduction of 1st metacarpal

Abductor Pollicis Longus O: Small facet of the ulnar side of radius near its middle. On the lateral side of the dorsal surface of body of ulna just below insertion of anconeus and interosseous membrane I: Radial surface of base of 1st metacarpal A: Abducts and assists in extension of carpometacarpal joint of thumb

Opponens Digiti Minimi O: Hook of hamate bone and flexor retinaculum I: Entire length of ulnar boarder of 5th metacarpal A: Flexes and slight lateral rotation of 5th metacarpal. Helps to cup palm of the hand.

Abductor Digiti Minimi O: Pisiform bone and from tendon of flexor carpi ulnaris I: 2 slips; into ulnar side of base of proximal phalanx of little finger; into ulnar border of extensor expansion of finger A: Abducts little finger and assists in flexing its proximal phalanx at the metacarpophalangeal joint

Flexor Digiti Minimi Brevis O: Hook of hamate and flexor retinaculum I: Ulnar side of base of proximal phalanx of 5th finger A: Flexes 5th digit at the metacarpophalangeal joint

Flexor Pollicis Brevis O: Superficial head – Distal border of flexor retinaculum and tubercle of trapezium bone. Deep head – Trapezoid and capitate bones I: Radial side of the base of proximal phalanx of tumb A: Flexes proximal phalanx of thumb. Continued action, flexes 1st metacarpal and rotates it medially

Abductor Pollicis Brevis O: Flexor retinaculum and tubercle of the scaphoid and trapezium I: Radial side of the base of the proximal phalanx of the thumb A: Abduction and medial rotation of proximal phalanx and the metacarpal of the thumb

Adductor Pollicis O: Oblique head – capitate bone, bases of 2nd and 3rd metacarpals. Transverse head – Distal 2/3 of the palmar surface of the 3rd metacarpal bone I: 2 heads converge to insert on the ulnar side of the base of proximal phalanx of thumb A: adduction of thumb at the carpometacarpal joint. Adduction and assists in flexion of thumb at the MCP joint

Opponens Pollicis O: Flexor retinaculum and tubercle of trapezium bone I: Radial side of entire length of 1st metacarpal bone A: Flexes and abducts the first metacarpal with slight medial rotation

Lumbricals O: Tendons of flexor digitorum profundus in center of palm I: Around the radial side of the metacarpal bone and into extensor expansion A: Principle extensors of interphalangeal joints. Weak flexor of the metacarpophalangeal joints