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.