1. 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

2. 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.

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

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

5. 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

6. 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

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

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

9. 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

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

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

12. 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

13. 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.

14. 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

15. 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

16. 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.

17. 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.

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

19. 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.

20. 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

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

22. 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 .

23. 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.

24. 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.

25. 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

26. 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

27. 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.

28. 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

29. 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

30. 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

31. 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

32. 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.

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

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

35. 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

36. 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.

37. 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.

38. 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.

39. 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.

40. 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.