1. Wrist and Hand

2. Wrist
Wrist is a joint complex consisting of radio-carpal joint and many relationships between the carpal bone
Review of carpals
Proximal row = Pisiform, Triquetrum, Lunate, and Scaphoid*
Distal row = Hamate, Capitate, Trapezoid, and Trapezium
*Scaphoid has a notoriously poor blood supply and recovers poorly following injury

3. Osteology

4. Osteology

5. Osteology

6. Scaphoid

7. Cross Section at Wrist

8. Wrist All carpal bones articulate via gliding or plane joints
A more or less joint exists between proximal row and distal row of bones called mid-carpal – truly is a series of gliding joints
Scaphoid, Lunate and Triquetrum with Trapezium, Trapezoid, Capitate and Hamate
Pisiform is not involved

9. Wrist True Wrist = Radio-Carpal Distal radius with proximal carpals
“Ulnar-Carpal” = interposed disc
Distal radius with proximal carpals
Condyloid joint – 2 degrees of freedom
Major Ligaments
Palmar radio-carpal, palmar ulnocarpal, dorsal radio-carpal, dorsal ulno-carpal, radial and ulnar collateral

10. Ligaments

11. Ligaments

12. Wrist Mid-Carpal Proximal row of carpals with distal row
A series of gliding joints – 3 DOF
MAJOR Ligaments – Capsule plus
Pisohamate, pisometacarpal, capitotriquetral, palmar and dorsal carpometacarpal

13. Ligaments

14. Wrist Movements Flexion/Extension – about 70-80 degrees of ROM
Radiocarpal v. Mid Carpal
Flexion is initiated in mid carpal joint and 60% occurs there
Extension is also initiated at mid carpal but most occurs in radio-carpal. Need 35 degrees for good function – at least 10 for any significant function.
Abduction/Adduction – about 15 to 20 degrees
Intercarpal – proximal row slides over distal row

15. Movements

16. Movements

17. Movements

18. Carpo-Metacarpal Joints
2-5
Hamate with 4 and 5
Capitate with 3
Trapezoid with 2
Gliding joints with limited range – mostly passive
Palmar and Dorsal carpometacarpal ligaments

19. C-M Joints

20. C-M Joints

21. C- M Thumb Trapezium with 1st met Saddle
Adds rotary component – very mobile
Capsule support

22. C-M Thumb

23. Metacarpal – Phalangeal Joints
Ellipsoid
2 DOF
Passive rotation
Collateral Ligaments
Deep Transverse Metacarpal Ligaments
Palmar Ligaments (Plates)

24. Ligaments

25. Ligaments

26. Interphalangeal Joints
Hinge
Collateral Ligaments
Palmar Ligaments (Plates)

27. Ligaments

28. Definition of Finger Movements
Reference is imaginary line through the middle of long (3rd) finger
Adduction of 2-5 = towards that point
Abduction = away –1, 4, and 5
Thumb
Flexion
Extension
ABD
ADD
Rotation
Opposition = flexion with adduction and rotation

29. Finger Movements

30. Finger Movements

31. Flexor Tendons Tenosynovium (AKA Fibro-Osseous Tunnels)
Anular Pulleys AKA Vaginal Ligaments
Anular and Cruciform
Relationship to Palmar Plates

32. Vinculum Longa and Breve

33. Tunnels

34. Tunnels

35. Dorsal Hood Mechanism Insertion of Long Extensor Tendons
Ext. Dig. Communis
Ext. Indicis Proprius
Ext. Digiti Minimi
Extensor Expansion – MP Joints
Central Band – Middle Phalanx
Lateral Band –Distal Phalanx
Relationship to Intrinsic Muscles

36. Dorsal Hood

37. Dorsal Hood

38. Dorsal Hood

39. Dorsal Hood

40. Intrinsic Muscles Thenar Eminence - median
Hypothernar Eminence - ulnar
Intermediate – ulnar and some median
There are NO muscles in the hand innervated by the Radial nerve

41. Palmar Aponeurosis

42. Thenar Eminence Flexor Pollicus Brevis Abductor Pollicus Brevis
Opponens Pollicus

43. Thenar Muscles

44. Hypothenar Eminence Abductor Digiti Minimi Flexor Digiti Minimi
Opponens Diditi Minimi

45. Intermediate Adductor Pollicus Lumbricales Volar (Palmar) Interossei
Dorsal Interossei

46. Adductor Pollicus

47. Lumbricales

48. Lumbricales

49. Volar (Palmar) Interrossei

50. Dorsal Interossei

51. 1st Dorsal Interosseous

52. Digit Movement

53. Digit Movement Cont.

54. Blood Supply Ulnar aa Radial aa Superficial Palmar Arch
Common Palmar aa
Proper palmar digital aa
Radial aa
Deep Palmar Arch
Dorsal digital aa
Princeps Pollicus
Radialis Indicis

55. Superficial Palmar Arch

56. Superficial Palmar Arch

57. Superficial Palmar Arch

58. Deep Palmar Arch

59. Deep Palmar Arch

60. Deep Palmar Arch

61. Digital Supply

62. Median Cutaneous

63. Ulnar Cutaneous

64. Radial Cutaneous (Hand)

65. Common Nerve Injuries
Median
Symptoms
Ulnar