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Wrist and Hand Anatomy

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Wrist and Hand Anatomy WristWrist andand HandHand AnatomyAnatomy BoneBone AnatomyAnatomy •• ScapoidScapoid •• LunateLunate •• TriquetriumTriquetrium •• PisiformPisiform •• TrapeziodTrapeziod •• TrapeziumTrapezium •• CapitateCapitate •• HamateHamate WristWrist ArticulationsArticulations •• RadiocarpalRadiocarpal JointJoint – Proximal portion – Distal portion – Most surface contact found ArticulationsArticulations •• MidcarpalMidcarpal JointJoint – Articulation between proximal and distal row of carpals – Not an uninterupted joint – Distal Row • 2 degrees of freedom • Moves as a fixed unit LigamentLigament SupportSupport •• VolarVolar CarpalCarpal LigamentsLigaments – Volar Radiocarpal Ligament • Three bands – Volar Ulnocarpal Ligament – Scapholunate Interosseous Ligament – Lunotriquetral Ligament LigamentLigament SupportSupport •• DorsalDorsal CarpalCarpal LigamentsLigaments – Dorsal Radiocarpal Ligament – Dorsal Intercarpal Ligament – Radial Collateral Ligament – Ulnar Collateral Ligament TriangularTriangular FibrcartilageFibrcartilage ComplexComplex •• CompositionComposition •• RoleRole HandHand CarpometacarpalCarpometacarpal (CMC)(CMC) JointsJoints ofof 22--55 •• CompositionComposition •• CarpalCarpal ArchArch CarpometacarpalCarpometacarpal (CMC)(CMC) JointsJoints ofof 22--55 •• CompositionComposition •• CarpalCarpal ArchArch •• LigamentLigament SupportSupport – Transverse Carpal Ligament – Dorsal and Palmar CMC Ligaments – Dorsal and Palmar Metacarpal Ligaments – Metacarpal Interosseous Ligaments CarpometacarpalCarpometacarpal (CMC)(CMC) JointsJoints ofof 22--55 • Composition • Carpal Arch • Ligament Support – Transverse Carpal Ligament – Dorsal and Palmar CMC Ligaments – Dorsal and Palmar Metacarpal Ligaments – Metacarpal Interosseous Ligaments • Movement of CMC Joints MetacarpophalangealMetacarpophalangeal (MCP)(MCP) JointsJoints ofof 22--55 FingersFingers •• LigamentLigament SupportSupport – Capsule – Volar Plate – Collateral Ligaments – Motions InterphalangealInterphalangeal JointsJoints ofof 22--55 FingersFingers •• HingeHinge JointsJoints •• MotionsMotions ThumbThumb CMCCMC ofof ThumbThumb •• SaddleSaddle JointJoint •• LigamentLigament SupportSupport – Capsule – Intermetacarpal Ligament MCPMCP ofof ThumbThumb •• LigamentLigament SupportSupport •• IPIP JointJoint ofof ThumbThumb ExtrinsicExtrinsic HandHand MusclesMuscles ExtensorExtensor IndicisIndicis • O – Dorsal surface lower ½ body of ulna – Interosseus membrane • I – Ulnar side of index finger’s EDC tendon • N – Radial (posterior interosseus) • F – MCP and IP Ext of 2nd digit ExtensorExtensor PollicisPollicis LongusLongus • O – Posterior 1/3 ulna – Interosseus membrane • I – Posterior surface of base of thumb distal phalanx • N – Radial (posterior interosseus) • F – CMC, MCP and IP Ext of 1st digit ExtensorExtensor PollicisPollicis BrevisBrevis • O – Dorsal 2/3 of radius • I – Dorsal surface of base of proximal 1st phalanx • N – Radial (posterior interosseus) • F – CMC & MCP Ext of thumb – CMC ABD of thumb AbductorAbductor PollicisPollicis LongusLongus • O – Posterior distal 2/3 of ulna – Posterior middle 1/3 of radius – Interosseus membrane • I – Radial side of base of 1st metacarpal • N – Radial (posterior interosseus) • F – CMC ABD & Ext of thumb FlexorFlexor PollicisPollicis LongusLongus • O – Anterior middle ½ of radius – Interosseus membrane • I – Palmar surface of base of distal 1st phalanx • N – Median (anterior interosseus) • F – IP Flexion of thumb ExtensorExtensor DigitiDigiti MinimiMinimi •• OO – Lateral epicondyle of humerus •• II – Extensor expansion of 5th digit •• NN – Radial (posteior interosseus) •• FF – MCP and IP extension of 5th digit FlexorFlexor DigitorumDigitorum SuperficialisSuperficialis • O – Medial epicondyle of humerus – Coronoid process – Middle ½ anterior radius • I – Four tendons separating into two parts that insert into sides of bases of middle 2-5 phalanxes • N – Median • F – MCP flexion digits 2-5 – PIP flexion digits 2-5 FlexorFlexor DigitorumDigitorum ProfundusProfundus • O – Anteriomedial surface of ulna – Interosseus membrane • I – Four tendons inserting into distal phalanxes of digits 2-5 • N – Media 2-3 digits – Ulna 4-5 digits • F – DIP flexion of 2-5 digits IntrinsicIntrinsic HandHand MusclesMuscles ThenarThenar EminanceEminance AbductorAbductor PollicisPollicis BrevisBrevis • O – Scaphoid tuberosity – Trapezium ridge – Transverse carpal ligament • I – Lateral base f proximal 1st phalanx • N – Median • F – CMC & MCP ABD of thumb FlexorFlexor PollicisPollicis BrevisBrevis • O – Superficial head – trapezium – Deep head – trapezoid, capitate and palmar ligaments of distal carpal bones • I – Base of prximal 1st phalanx on radial side – Extensor expansion • N – Superficial – median – Deep – Ulnar • F – CMC & MCP Flexion of thumb OpponensOpponens PollicisPollicis •• OO – Trapezium – Transverse Carpal Ligament •• II – Radial side of 1st metacarpal shaft •• NN – Median •• FF – Opposition IntrinsicIntrinsic HandHand MusclesMuscles HypothenarHypothenar EminenceEminence AbductorAbductor DigitiDigiti MinimiMinimi •• OO – Pisiform •• II – Ulnar side base of 5th proximal phalanx •• NN – Ulnar •• FF – MCP ABD of 5th digit OpponenOpponen DigitiDigiti MinimiMinimi • O – Hook of hamate – Transverse carpal ligament • I – Ulnar border of entire 5th metacarpal bone • N – Ulnar • F – MCP flexion & rotation of 5th digit FlexorFlexor DigitiDigiti MinimiMinimi •• OO – Hamate bone – Transverse carpal ligament •• II – Ulnar side of proximal 5th phalanx •• NN – Ulnar •• FF – MCP Flexion of 5th digit OtherOther IntrinsicIntrinsic HandHand MusclesMuscles AdductorAdductor PollicisPollicis • O – Oblique Head • Capitate bone • Bases of 2-3 metacarpals – Transverse Head • Proximal 2/3 of palmar surface of 3rd metacarpal • I – Ulnar side of base of 1st proximal phalanx • N – Ulnar • F – CMC ADD of thumb PalmarPalmar InterosseiInterossei • O – 1st – ulnar side base of 1st metacarpal bone – 2nd – ulnar side of 2nd MC bone – 3rd – radial side of 4th MC bone – 4th – radia side of 5th MC bone • I – Extensor expansion of 2,4 and 5th digits • N – Ulnar • F – ADD of 1st, 2nd, 4th and 5th digits toward midline of hand DorsalDorsal InterosseiInterossei • O – 1st lateral head – ulnar side of 1st metacarpal bone – 1st medial head – radial side of 2nd metacarpal bone – 2nd, 3rd, 4th space between metacarpal bones • I – 1st – radial side 2nd proximal phalanx – 2nd – radial side of 3rd – 3rd – ilnar side of 3rd – 4th – ulnar side of 4th • N – Ulnar • F – ABD of 2nd, 3rd, and 5th finger from midline LumbricalesLumbricales • O – Tendons of FDP • I – Extensor expansion on dorsal aspect of each digits radial side • N – 1 and 2 – median – 3 and 4 – ulnar • F – MCP flexion 2-5 digits – DIP & PIP ext 2-5 digits PalmarisPalmaris BrevisBrevis •• OO – Flexor retinaculum •• II – Palmar surface skin on ulnar side of hand •• NN – Ulnar •• FF – Wrinkles skin of hand on ulnar side BiomechanicsBiomechanics ofof HandHand BiomechanicsBiomechanics ofof FingerFinger FlexionFlexion •• GlidingGliding mechanismsmechanisms – Retinaculae – Ligaments – Bursa – Digital tendon sheaths •• AnnularAnnular PulleysPulleys – A1-A5 •• CruciateCruciate LigamentsLigaments – C1-C3 •• FunctionFunction ofof PulleysPulleys BiomechanicsBiomechanics ofof FingerFinger ExtensionExtension •• ExtensorExtensor HoodHood – EDC tendons – DI and PI tendons – Lumbricales – Central tendon – Oblique Retinacular Ligaments – Sagittal Bands •• EffectsEffects onon MCPMCP jointsjoints •• EffectsEffects onon IPIP JointsJoints.
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