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Hand and Wrist Bony Anatomy Distal Radius and Ulna 8 Carpal Bones 5 Metacarpals 14 Phalanges Bony Anatomy

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Hand and Wrist Bony Anatomy Distal Radius and Ulna 8 Carpal Bones 5 Metacarpals 14 Phalanges Bony Anatomy Hand and Wrist Bony Anatomy distal radius and ulna 8 carpal bones 5 metacarpals 14 phalanges Bony Anatomy Distal radius- broadens to form a small ulnar notch on its medial surface Radial styloid process- projects off the anterolateral border Bony Anatomy Ulnar head- more circular, with the ulnar styloid process arising from the medial surface Carpal Bones Aligned in two rows: Proximal row Distal row Proximal Row (lateral to medial) scaphoid- articulates proximally with the radius and has a prominent tubercle lunate- articulates proximally with the radius and is broader anteriorly than posteriorly triquetrum- articulates proximally with the articular disc of the distal radioulnar joint pisiform- lies on the palmar surface of the triquetrum Distal Row (lateral to medial) trapezium-4 sided trapezoid- wedge shaped capitate- rounded head hamate- wedge shaped and has a hooked process, the hook of the hamate Metacarpal Bones numbered I-V body and two ends proximal ends or bases distal ends or heads Metacarpal Bones bases of the metacarpals concave to articulate with the carpal bones heads of the metacarpals convex to articulate with the proximal phalanges Metacarpal Bones 1st metacarpal (thumb): thickest and shortest two sesamoid bones over the distal ends 3rd metacarpal: distinguished by a styloid process on the lateral side of its base Phalanges each digit has 3 phalanges, except the thumb (2) BASE (proximally) BODY (center) HEAD (distally) Distal Radioulnar Joint formed by the ulnar head and the ulnar notch of the radius allows 1° of freedom of movement: pronation/supination Radiocarpal Joint Formed by the distal end of radius articulating with the scaphoid & lunate and the triangular disk articulating with the lunate & triquetrum Provides 2° of freedom of movement: flexion/extension Ligaments of Radiocarpal Joint Radial collateral ligament (RCL) origin- styloid process insertion- scaphoid & trapezium limits ulnar deviation Ligaments of Radiocarpal Joint Ulnar collateral ligament (UCL) origin- ulnar styloid process insertion- triquetrum dorsally & pisiform palmarly limits radial deviation Ligaments of Radiocarpal Joint Palmar (volar) radiocarpal ligament most important ligament for controlling motion and wrist stability origin- anterior surface of distal radius insertion- courses obliquely and medially to split into the radiocapitate ligament, the radiotriquetrum ligament, and the radioscaphoid ligament. Ligaments of Radiocarpal Joint Dorsal radiocarpal ligament origin- posterior surface of the distal radius & styloid process insertion- lunate & triquetrum limits wrist flexion Intercarpal Joints Interconnecting the carpal bones by small palmar, dorsal, and interosseous ligaments. very little gliding occurs between the bones Midcarpal Joints The proximal and distal carpal rows are separated by a single joint cavity with small fibrous projections connecting the rows. This structure allows limited movements… flexion/extension radial/ulnar deviation and glide Carpometacarpal Joints The first three metacarpals articulate with a single carpal: MC I- with the trapezium MC II- with the trapezoid MC III- with the capitate 4th and 5th articulate with the hamate to form one of the carpometacarpal (CMC) joints Ligaments of Carpometacarpal Joint Bones are united by anterior carpometacarpal and metacarpal ligaments as well as by the posterior and interosseous ligaments. Transverse Carpal Ligament encloses the median nerve, FPL, FDP, and FDS on the palmer surface of the hand. Metacarpophalangeal & Interphalangeal Joints Metacarpophalangeal articulations are condyloid joints with movement in two planes flexion/extension & adduction/abduction Interphalangeal articulations are hinge joints with flexion/extension only Ligaments of the MCP & IP Joints Each fibrous capsule is strengthened by … Two collateral ligaments pass distally from the heads of the MCP and phalanges to the bases of the phalanges limits amount of abduction/adduction Ligaments of MCP & IP Joints Palmar ligament (plate) Reinforces the palmar aspect of the MCP joints Dorsally, the MCP joints are reinforced by the extensor hood and the transverse metacarpal ligament. Limit abduction/adduction and reinforce the palmar ligaments MUSCLES OF THE HAND Pronator Teres Proximal Attachment:Medial epicondyle of humerus & coronoid process of ulna Distal Attachment: Middle of lateral surface of radius Innervation: Median nerve (C6-C7) Main Action: Pronates & flexes forearm (at elbow) Flexor Carpi Radialis Proximal Attachment: Medial epicondyle of humerus Distal Attachment:Base of 2nd metacarpal bone Innervation:Median nerve (C6-C7) Main Action:Flexes & abducts hand (at wrist) Palmaris Longus Proximal Attachment: Medial epicondyle of humerus Distal Attachment: Distal half of flexor retinaculum & palmar aponeurosis Innervation:Median nerve (C7-C8) Main Action:Flexes hand (at wrist) & tightens palmar aponeurosis Flexor Carpis Ulnaris Proximal Attachment: Humeral head: medial epicondyle of humerus Ulnar head: olecranon & posterior border of ulna Distal Attachment:Pisiform bone, hook of hamate bone, & 5th metacarpal bone Innervation:Ulnar nerve (C7-C8) Main Action:Flexes & adducts hand (at wrist) Flexor Digitorum Superficialis Proximal Attachment: Humeroulnar head: med. epicondyle of humerus, ulnar collateral lig. & coronoid process of ulna Radial Head: superior 1/2 of ant. border of radius Distal Attachment: Bodies of middle phalanges of medial four digits Innervation: Median nerve (C7, C8,& T1) Continued Flexor Digitorum Superficialis Main Action:Flexes middle phalanges at proximal interphalangeal joints of medial 4 digits;acting more strongly, it also flexes proximal phalanges at metacarpo- phalangeal joints & hand Flexor Digitorum Profundus Proximal Attachment: Proximal 3/4 of medial & anterior surfaces of ulna & interosseous membrane Distal Attachment: Bases of distal phalanges of medial four digits Innervation: Medial part: Ulnar nerve (C8 & T1) Lateral part: Median nerve (C8 & T1) Con’t Flexor Digitorum Profundus Main Action: Flexes distal phalanges at distal interphalangeal joints of medial four digits; assists with flexion of hand Flexor Pollicus Longus Proximal Attachment: Ant. Surface of radius & adjacent interosseus membrane Distal Attachment: Base of distal phalanx of thumb Innervation:Anterior interosseus nerve from median (C8 & T1) Main Action:Flexes phalanges of 1st digit (thumb) MUSCLES OF THE THUMB Pronator Quadratus Proximal Attachment: Distal 4th of anterior surface of ulna Distal Attachment: Distal 4th of anterior surface of radius Innervation:Anterior interosseus nerve from median (C8 & T1) Main Action:Pronates forearm; deep fibers bind radius & ulna together Brachioradialis Proximal Attachment: Proximal 2/3 of lateral supracondylar ridge of humerus Distal Attachment:Lateral surface of distal end of radius Innervation:Radial nerve (C5, C6,and C7) Main Action: Flexes forearm Extensor Carpi Radialis Longus Proximal Attachment: lateral suprocondylar ridge of humerus Distal Attachment:Base of 2nd metacarpal Innervation:Radial nerve (C6 & C7) Main Action:Extend & abduct hand at wrist Extensor Carpi Radialis Brevis Proximal Attachment: lateral epicondyle of humerus Distal Attachment:Base of 3rd metacarpal Innervation:Deep branch of radial nerve (C7 & C8) Main Action:Extend & abduct hand at wrist Extensor Digitorum Proximal Attachment: lateral epicondyle of humerus Distal Attachment:Extensor expansion of medial 4 digits Innervation:Posterior interosseous nerve(C7& C8), the continuation of deep branch of radial nerve Main Action:Extends medial 4 digits at metacarpophalangeal joints; extends hand at wrist joint EXTENSOR DIGITORUM Extensor Digiti Minimi Proximal Attachment:lateral epicondyle of humerus Distal Attachment:Extensor expansion of 5th digit Innervation:Posterior interosseous nerve (C7& C8), the continuation of deep branch of radial nerve Main Action:Extends 5th digit at metacarpo-phalangeal & interphalangeal joints Extensor Carpi Ulnaris Proximal Attachment: lateral epicondyle of humerus and posterior border of ulna Distal Attachment:Base of 5th metacarpal Innervation:Posterior interosseous nerve(C7& C8), the continuation of deep branch of radial nerve Main Action:Extends and adducts hand at wrist joint Supinator Proximal Attachment: Lateral epicondyle of humerus, radial collateral & anular ligaments, supinator fossa, & crest of ulna Distal Attachment:Lateral, posterior, & anterior surfacesof proximal 1/3 of radius Innervation:Deep branch of radial nerve (C5 & C6) Main Action:Supinates forearm (rotates radius to turn palm anteriorly) Abductor Pollicus Longus Proximal Attachment: Posterior surfaces of ulna, radius, &interosseus membrane Distal Attachment:Base of 1st metacarpal Innervation:Posterior interosseous nerve (C7 & C8) the continuation of Deep branch of radial Main Action:Abducts thumb & extends it at carpometacarpal joint Extensor Pollicus Brevis Proximal Attachment: Posterior surface of radius & interosseous membrane Distal Attachment:Base of proximal phalanx of thumb Innervation:Posterior interosseous nerve (C7 & C8) the continuation of Deep branch of radial Main Action:Extends proximal phalanx of thumb at carpometacarpal joint Extensor Digitorum Longus Extensor Pollicus Longus Proximal Attachment: Posterior surface of middle 1/3 of ulna & interosseous membrane Distal Attachment:Base of distal phalanx of thumb Innervation:Posterior interosseous nerve (C7 & C8) the continuation of Deep branch of radial Main Action:Extends distal phalanx of thumb at metacarpophalangeal
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