1. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Chapter 6: The Upper Extremity: The Elbow, Forearm, Wrist, And Hand, (Pt. 2) KINESIOLOGY Scientific Basis of Human Motion, 11 th edition Hamilton, Weimar & Luttgens Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University Revised by Hamilton & WeimarKINESIOLOGY Scientific Basis of Human Motion, 11 th edition Hamilton, Weimar & Luttgens Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University Revised by Hamilton & Weimar

2. © 2008 McGraw-Hill Higher Education. All Rights Reserved. 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.

3. © 2008 McGraw-Hill Higher Education. All Rights Reserved. MUSCLES OF THE FINGERS 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.

4. © 2008 McGraw-Hill Higher Education. All Rights Reserved. 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.

5. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Flexor Carpi radialis Function:  Flexes wrist  Radial deviation Flexor Carpi Ulnaris Function:  Flexes wrist  Ulnar deviation Palmaris longus Function:  Weakly flexes wrist Fig 6.21 Muscles of the Wrist

6. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Extensor carpi radialis Function:  Extends wrist  Radial deviation Extensor carpi ulnaris Function:  Extends wrist  Ulnar deviation Fig 6.23a Muscles of the Wrist and Hand Extensor carpi radialis (longus) (brevis) Extensor carpi ulnaris

7. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Extensor digitorum Extenso r digiti minimi Extensor digitorum Function:  Extends fingers & wrist. Extensor digiti minimi Function:  Extends little finger & wrist. Fig 6.23b Muscles of the Wrist and Hand

8. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Flexor digitorum superficialis Function:  Flexes fingers & wrist. Fig 6.24a Muscles of the Wrist and Hand

9. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Flexor digitorum profundus Function:  Flexes fingers & wrist. Flexor pollicis longus Function:  Flexes thumb. Fig 6.24b Muscles of the Wrist and Hand

10. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Extensor pollicis longus Function:  Extends thumb Extensor indicis Function:  Extends index finger Abductor pollicis longus Function:  Abducts thumb Extensor pollicis brevis Function:  Extends thumb Fig 6.25 Muscles of the Wrist and Hand

11. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Abductor pollicis brevis Function:  Abducts thumb. Flexor pollicis brevis Function:  Flexes thumb. Opponens pollicis Function:  Opposition of thumb. Fig 6.26 Muscles of the Wrist and Hand

12. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Abductor digit minimi Function:  Abducts little finger. Flexor digiti minimi Function:  Flexes little finger. Opponens digiti minimi Function:  Opposition of little finger. Fig 6.26 Muscles of the Wrist and Hand

13. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Abductor pollicis Function:  Abducts thumb. Opponens pollicis Function:  Opposition of thumb. Opponens digiti minimi Function:  Opposition of little finger. Fig 6.27 Muscles of the Wrist and Hand

14. © 2008 McGraw-Hill Higher Education. All Rights Reserved. MUSCULAR ANALYSIS OF FUNDAMENTAL MOVEMENTS OF WRIST, FINGERS, & THUMB Wrist  Flexion  Extension & Hyperextension  Radial deviation (Abduction)  Ulnar Deviation (adduction) Fingers  Flexion  Extension  Abduction  Adduction  Opposition

15. © 2008 McGraw-Hill Higher Education. All Rights Reserved. MUSCULAR ANALYSIS OF FUNDAMENTAL MOVEMENTS OF WRIST, FINGERS, & THUMB Thumb Metacarpal  Flexion  Extension  Abduction  Adduction  Opposition Thumb Phalanges  Flexion  Extension

16. © 2008 McGraw-Hill Higher Education. All Rights Reserved. COOPERATIVE ACTIONS OF WRIST AND DIGITS  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. Length of Long Finger Muscles Relative to Range of Motion in Wrist & Fingers

17. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Examples of Using Hands for Grasping  Power grip involves flexion of all fingers Fig 6.30 CylindricalSphericalHook

18. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Examples of Using Hands for Grasping  Precision involves thumb & two finger, depending on shape & size of object Fig 6.30 Fig 6.30b

19. © 2008 McGraw-Hill Higher Education. All Rights Reserved. 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.

20. © 2008 McGraw-Hill Higher Education. All Rights Reserved. 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.

21. © 2008 McGraw-Hill Higher Education. All Rights Reserved. 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.

22. © 2008 McGraw-Hill Higher Education. All Rights Reserved. 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.

23. © 2008 McGraw-Hill Higher Education. All Rights Reserved. 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.

24. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Epicondylitis Lateral epicondylitis – “tennis elbow” Medial epicondylitis – ‘Little league elbow”  Both are repetitive stress injuries.  Microtraumas or tears in muscle & soft tissue at proximal attachments.  Indication is pain on activity.  Rest, ice, anti-inflammatory drugs, bracing often used as treatment.

25. © 2008 McGraw-Hill Higher Education. All Rights Reserved. Chapter 6: The Upper Extremity: The Elbow, Forearm, Wrist, And Hand, (Pt. 2)