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This ppt explain about the bony structure that made up our hand and also extrinsic and intrinsic hand muscles that move our wrist and hand joint.

This ppt explain about the bony structure that made up our hand and also extrinsic and intrinsic hand muscles that move our wrist and hand joint.

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  • 1. COLLEGE OF ALLIED HEALTH AND SCIENCES ANATOMY MUSKULOSKELETAL UPPER LIMB (PART 5) Carpals, Metacarpals and Phalanges By : HERMIZAN BIN HALIHANAFIAH
  • 2.  
  • 3. HAND
    • Introduction
    • Gross motor skills and fine motor skills.
    • 5 Digits / fingers
      • Thumb – pollex
      • Index finger – digitus indicis
      • Middle finger – digitus tertius
      • Ring finger – digitus annulus
      • Little finger – digitus minimi
  • 4. Hand
    • Hand composed by a bony framework :
    • 8 carpals bones
    • 5 metacarpals
    • 14 phalanges
  • 5.  
  • 6. Carpal Bones
    • The names reflect on their shape
    • Divide in two rows; proximal and distal row
    • Proximal row:
      • From lateral to medial
      • Scaphoid, lunate, triquetrum and pisiform
    • Distal row
      • From lateral to medial
      • Trapezium, trapezoid, capitate and hamate
  • 7.  
  • 8. 8 bones of Carpals
    • A – Scaphoid (boatlike)
    • B – Lunate (moon-shaped)
    • C – Triquatrum (three-cornered)
    • D – Pisiform (pea-shaped)
    • E – Trapezium (four sided figure)
    • F – Trapezoid
    • G – Capitate (head-shaped)
    • H – Hamate (hooked)
    Try this pneumonic!!: S he L ook T oo P retty, T ry T o C atch H er
  • 9.  
  • 10.
    • Capitate
    • Largest carpal bone
    • Rounded projection
    • Head articulate with lunate bone
    • Lunate
    • Large hook-projection on its anterior surface
  • 11.
    • Scaphoid
    • 70 % fractures involve the scaphoid
    • Fall on outstretched hand – force is transmitted from the capitate through the scaphoid to the radius
  • 12. Carpal Tunnel
    • Concave space formed by the pisiform and hamate (on the ulnar side), and the scaphoid and trapezium ( on the radial side) plus the flexor retinaculum (deep fascia)
    • Long flexor tendons of the digits and thumb (flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus) and the median nerve pass through the carpel tunnel
    • Narrowing of the carpel tunnel may give rise to a condition called carpal tunnel syndrome .
  • 13. Anatomy of Carpal Tunnel
  • 14. Carpal Turnel Syndrome
  • 15. Flexor Retinaculum
    • The flexor retinaculum ( transverse carpal ligament , or anterior annular ligament ) is a strong, fibrous band, which arches over the carpus.
    • Converting the deep groove on the front of the carpal bones into a tunnel, the carpal tunnel
    • Flexor tendons of the digits and the median nerve pass.
  • 16. Flexor Retinaculum
  • 17. Extensor Retinaculum
    • The extensor retinaculum ( dorsal carpal ligament ) is an anatomical term for the fascia that holds the tendons of the extensor muscles in place.
    • It is located on the back of the forearm, just proximal to the hand.
  • 18. Extensor Retinaculum
  • 19. Joints of the Carpal Bones
    • Intercarpal /midcarpal joint
      • Articulation between carpals bone.
      • Planar joint
      • Biaxial movement – gliding movement( back – forth , side – side)
  • 20. Metacarpals
    • Divide into:
      • Proximal base
      • Intermediate shaft
      • Distal head
  • 21.
    • It consists of five cylindrical bones which are numbered from the radial (lateral ) to the ulnar (medial) side.
    • First metacarpal bone
    • Second metacarpal bone
    • Third metacarpal bone
    • Fourth metacarpal bone
    • Fifth metacarpal bone
    Metacarpals
  • 22. Metacarpals Proximal base Intermediate Shaft Distal Head
  • 23. Joints of the Metacarpals
    • Carpometacarpal joints
      • Proximal based of metacarpals articulate with distal row of carpal bones.
      • 1 st metacarpal articulate with trapezium bones
      • The second metacarpal articulates primarily with the trapezoid and secondarily with the trapezium and capitate.
      • The third metacarpal articulates primarily with the capitate,
      • The fourth metacarpal articulates with the capitate and hamate.
      • The fifth metacarpal articulates with the hamate.
  • 24.
    • Carpometacarpal
      • The 1 st CMC (between trapezium and 1 st metacarpal) is a saddle joint
      • Also known as a trapeziometacarpal joint (TMC)
      • Produce triaxial diarthrosis
      • The rest CMC – condyloid joint
      • Produce biaxial diarthrosis
    Joints of the Metacarpals
  • 25.
    • Metacarpophalangeal joint
      • Distal head of metacarpals articulate with proximal phalanges.
      • Condyloid joint
      • Produce biaxial diarthrosis ; flexion – extension / abduction - adduction
    Joints of the Metacarpals
  • 26. Phalanges
    • 14 bones
    • Numbered 1-5 same with metacarpals
    • Each phalanx consist:
      • Proximal base
      • Intermediate shaft
      • Distal head
    • 2 phalanges in thumb, 3 the other fingers.
  • 27.
    • Phalanges can divide into:
      • Proximal phalanx
      • Middle phalanx
      • Distal phalanx
    • Except thumb; only proximal and distal part.
    Phalanges
  • 28. Joint of the Phalanges
    • Interphalangeal joint
      • Joint between phalanges
      • Proximal and distal IP except thumb
      • Hinge joint
      • Permits monoaxial diarthrosis ; flexion and extension
  • 29.  
  • 30. Movement of Hand and Digits
    • ulnar and radial deviation at RC
    • Wrist flexion and extension at RC
    • Flexion and extension digit at MCP
    • Abduction and adduction digits at MCP
    • Abduction and adduction thumb at 1 st CMC
    • Opposition and reposition thumb at 1 st CMC
    • Flexion and extension digits at IP
  • 31. Wrist Movement
  • 32. Thumb Movement Thumb opposition Thumb adduction Thumb abduction
  • 33. Adduction / abduction digits at MCP
  • 34. Thumb extension / flexion at MCP / CMC
  • 35. Flexion Digit at PIP / DIP
  • 36. Extrinsic Hand Muscles
  • 37. Muscles of the Forearm Move the Wrist, Hand, Thumb and Fingers
    • Group of muscles that act on the digits are known as extrinsic hand muscles because originate outside the hand and insert within it.
    • There is 2 groups of forearm muscles:
      • Anterior compartment (flexor muscles)
      • Posterior compartment (extensor muscles)
  • 38. Extrinsic Hand Muscles
  • 39. Anterior compartment of Forearm Muscles
    • Muscle of the forearm originate on the humerus
    • Insert on the carpals, metarcarpals, and phalanges
    • Act as flexor
    • Divide into superficial or deep muscles.
  • 40. Posterior compartment of Forearm Muscles
    • Muscle of the forearm originate on the humerus
    • Insert on the carpals, metarcarpals, and phalanges
    • Act as extensor
    • Divide into superficial or deep muscles.
  • 41. Forearm Muscles
    • Superficial anterior compartment muscles
    • Deep anterior compartment muscles
    • Superficial posterior compartment muscles
    • Deep posterior compartment muscles
  • 42. Superficial Anterior Compartment Muscles
    • Arrange in following order from lateral to medial:
      • Flexor carpi radialis
      • Palmaris longus
      • Flexor carpi ulnaris
      • Flexor digitorum superficialis – deep to the other 3 muscles and is a largest superficial muscle in the forearm.
  • 43.  
  • 44. From lateral – medial : Flexor Carpi Radialis, Palmaris Longus, Flexor Carpi Ulnaris, Flexor Digitorum Superficialis
  • 45. Deep Anterior Compartment Muscles
    • Arrange in following order from lateral to medial:
      • Flexor pollicis longus
      • Flexor digitorum profundus
  • 46. Deep Flexor Muscles: From lateral to Medial : Flexor Pollicis Longus, Flexor Digitorum Profundus (deep to flexor digitorum superficialis)
  • 47. Superficial Posterior Compartment Muscles
    • Arrange in following order from lateral to medial:
      • Extensor carpi radialis longus
      • Extensor carpi radialis brevis
      • Extensor digitorum
      • Extensor digiti minimi
      • Extensor carpi ulnaris
  • 48. From lateral – medial : extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
  • 49. Deep Posterior Compartment Muscles
    • Arrange in following order from lateral to medial:
      • Abductor pollicis longus
      • Extensor pollicis brevis
      • Extensor pollicis longus
      • Extensor indicis
  • 50. From lateral to medial : abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis.
  • 51. Flexor Carpi Radialis
    • Origin – medial epicodyle of humerus
    • Insertion –base of Second and third metacarpals
    • Action
      • Flexion and abduction hand (radial deviation) at wrist joint
    • Nerve innervations – median nerve
  • 52. Palmaris longus
    • Origin – medial epicondyle of humerus
    • Insertion – flexor retinaculum and palmar aponeurosis (deep fascia in center of palm)
    • Action
      • Weakly flexes hand at wrist joint
    • Nerve innervations – median nerve
  • 53. Flexor Carpi Ulnaris
    • Origin – medial epicondyle of humerus, proximal posterior of ulna
    • Insertion – pisiform, hamate, and base of fifth metacarpal.
    • Action – flexion and adduction hand (ulnar deviation) at wrist joint.
    • Nerve innervations – ulnar nerve
  • 54. Flexor digitorum superficialis
    • Origin – medial epicondyle of humerus, coronoid process of ulna, ridge along lateral margin of anterior surface of radius.
    • Insertion – middle phalanx of each fingers (2 nd – 5 th digits)
    • Action
      • Flexion the proximal interphalangeal joints of 2 nd through 5 th digits
      • Assist flexion metacarpophalangeal
      • Assist wrist flexion
    • Nerve innervations – Medial nerve
  • 55. Flexor digitorum superficialis
  • 56. Flexor Pollicis Longus
    • Origin – anterior surface of radius and interosseous membrane, medial epicondyle of humerus
    • Insertion – base of distal phalanx of thumb
    • Action – flexes distal phalanx of thumb at interphalangeal joint.
    • Nerve innervations – Median nerve
  • 57. Flexor Digitorum Profundus
    • Origin - anterior medial surface of proximal body of ulna
    • Insertion – base of distal phalanx of each finger (2 nd – 5 th )
    • Action
      • Flexion distal interphalangeal joint of 2 nd – 5 th digits
      • Assist flexion proximal interphalangeal and MCP
      • Assist wrist flexion
    • Nerve innervations – index and middle (median nerve), ring and digiti minimi (ulnar nerve)
  • 58. Flexor Digitorum Profundus
  • 59. Flexor Digitorum Profundus (FDP) & Superficialis (FDS)
    • Flexor digitorum superficialis (FDS) insert into middle phalanx.
    • Flexor digitorum profundus (FDP) runs deep to the FDS until the level of the MP joint where FDS bifurcates.
    • FDP inserts at the base of the distal phalanx and acts primarily to flex the DIP joint as well as all other joints flexed by FDS.
  • 60. Extensor Carpi Radialis Longus
    • Origin – lateral supracondylar ridge of humerus
    • Insertion – dorsal surface of base second metacarpal
    • Action – extend and abduct hand at wrist joint
    • Nerve innervations – Radial nerve
  • 61. Extensor Carpi Radialis Brevis
    • Origin – lateral epicondyle of humerus
    • Insertion – dorsal surface of base third metacarpal
    • Action - Extend and adduct hand at wrist joint
    • Nerve innervations – Radial nerve
  • 62. Extensor digitorum
    • Origin – lateral epicondyle of humerus
    • Insertion – dorsum of distal and middle phalanges of each fingers (2 nd - 5 th digits).
    • Action
      • Extends proximal of each finger at metacarpophalangeal joint
      • Extends distal and middle phalanges of each fingers at interphalangeal joint.
      • Assists in Extends hand at wrist joint
    • Nerve innervation – Radial nerve
  • 63. Extensor digitorum
  • 64. Extensor digiti minimi
    • Origin – lateral epicondyle of humerus
    • Insertion – tendon of extensor digitorum on fifth phalanx.
    • Action
      • Extends proximal phalanx of little finger at metacarpophalangeal
      • Extend the interphalangeal of little finger.
    • Nerve supply – Radial nerve
  • 65. Extensor Carpi Ulnaris
    • Origin – lateral epicondyle of humerus and posterior border of ulna
    • Insertion –base of fifth metacarpal
    • Action – extends and adducts hand at wrist joint.
    • Nerve innervations – Radial nerve
  • 66. Abductor Pollicis Longus
    • Origin – posterior surface of middle of radius and ulna and interosseous membrane
    • Insertion – base of first metacarpals
    • Action
      • Abducts and extends thumb at carpometacarpal joint
      • Abducts hands at wrist joint
    • Nerve innervations – Radial nerve
  • 67. Extensor pollicis brevis
    • Origin – posterior surface of middle of radius and interosseous membrane.
    • Insertion – base of proximal phalanx of thumb
    • Action
      • Extends proximal phalanx of thumb at metacarpophalangeal joint
      • Extends1 st metacarpal of thumb at carpometacarpal joint
      • Assists in radial deviation at wrist joint
    • Nerve innervations – Radial nerve
  • 68. Extensor pollicis brevis
  • 69. Extensor Pollicis Longus
    • Origin – posterior surface of middle of ulna and interosseous membrane
    • Insertion – base of distal phalanx of thumb
    • Action
      • extend distal phalanx of the thumb at interphalangeal joint
      • Assist in extension of thumb at metacarpophalangeal and carpometacarpal joint.
      • Assist radial deviation and extension hand at wrist joint.
    • Nerve innervations - Radial nerve
  • 70. Extensor pollicis longus
  • 71. Extensor Indicis
    • Origin – posterior surface of ulna, interosseous membrane
    • Insertion – tendon of entensor digitorum of index finger
    • Action – extend distal and middle phalanx at IP joint, extend proximal phalanx at MCP
    • Deep radial nerve
  • 72. Surface anatomy of hand The tendons that are palpated with thumb abducted and extended form an anatomic snuff-box
  • 73. Surface anatomy of hand
    • Flexor Tendons:
      • Flexor carpi radialis, flexor carpi ulnaris, and palmaris longus primarily flex the wrist
  • 74. InTrinSic HanD MuscLes
  • 75. Intrinsic Hand Muscles
    • Has a origins and insertions within the hand
    • Produce weak but intricate and precise movements of the digits (Fine motor skills)
  • 76. Intrinsic Hand Muscles
    • The intrinsic muscle of the hand divided into 3 groups:
      • Thenar muscles
      • Hypothenar muscles
      • Intermediate muscles
  • 77. Thenar Muscles
    • Thenar (lateral aspect of palm)
      • Abductor pollicis brevis
      • Opponens pollicis
      • Flexor pollicis brevis
      • Adductor pollicis
    • Move the thumb (pollex)
    • This 4 muscles form the thenar eminence, lateral rounded contour on the palm. (ball of the thumb)
  • 78.  
  • 79. Abductor Pollicis Brevis
    • Origin
      • Flexor retinaculum
      • Scaphoid
      • Trapezium
    • Insertion
      • Lateral side of proximal phalanx of thumb
    • Action
      • Abduct of thumb at CMC joint.
    • Median Nerve
  • 80. Opponens Pollicis
    • Origin
      • Flexor retinaculum
      • Trapezium
    • Insertion
      • Lateral side of 1 st metacarpal (thumb)
    • Action
      • Opposition thumb at CMC joint.
    • Median nerve
  • 81. Flexor Pollicis Brevis
    • Origin
      • Flexor retinaculum
      • Trapezoid
      • Trapezium
      • Capitate
    • Insertion
      • Lateral side of proximal phalanx of thumb.
    • Action
      • Flexion thumb at CMC and MCP joint.
    • Median and ulnar nerves
  • 82. Adductor Pollicis
    • Origin
      • Oblique head – Capitate and 2 nd and 3 rd metacarpals
      • Transverse head – 3 rd metacarpal
    • Insertion
      • Medial side of proximal phalanx of thumb
    • Action – adduct thumb at CMC and MCP
    • Ulnar Nerve
  • 83. Hypothenar Muscles
    • Medial aspect of palm
      • Abductor digiti minimi
      • Flexor digiti minimi brevis
      • Opponens digiti minimi
    • Move the digiti minimi
    • This 3 muscles form the hypothenar muscles (medial rounded contour in the palm) – ball of the little finger
  • 84.  
  • 85. Abductor digiti minimi
    • Origin
      • Tendon flexor carpi ulnaris
      • Pisiform
    • Insertion
      • Medial side of proximal phalanx of little fingers.
    • Action
      • Abduction little finger at MCP
      • Assist flexion little finger at MCP
    • Ulnar nerve
  • 86. Flexor digiti minimi brevis
    • Origin
      • Flexor retinaculum
      • Hamate
    • Insertion
      • Medial side of proximal phalanx of little fingers
    • Action – flexion little finger at MCP, assist opposition little finger at CMC
    • Ulnar nerve
  • 87. Opponens Digiti Minimi
    • Origin
      • Flexor retinaculum
      • Hamate
    • Insertion
      • Medial side of entire length fifth metacarpals (little finger)
    • Action
      • Opposition little finger at CMC
    • Ulnar nerve
  • 88. Intermediate Muscle
    • Midpalmar / intermediate (11 muscles)
      • Lumbricals
      • Palmar interossei
      • Dorsal interossei
    • Acts on all the digits
    • Important muscles for movements in skilled activities (playing piano , writing, typing, precision handling etc)
  • 89. Lumbricals
    • Consists of 4 muscles
    • Origin
      • Lateral and adjacent side of tendons of flexor digitorum profundus of each fingers (2 nd – 5 th )
    • Insertion
      • Lateral side of tendon of extensor digitorum on proximal phalanges of each fingers (2 nd – 5 th )
    • Action
      • Flexion each finger at MCP and extend each finger at IP
    • Median and ulnar nerve
  • 90. Lumbricals Flexor Digitorum Profundus 1 st lumbricals Insertion to tendon of Extensor digitorum 4 th lumbricals
  • 91.  
  • 92.  
  • 93.  
  • 94. Palmar interossei
    • 4 muscles
    • Origin
      • Sides of shafts of metacarpals of all digits (except the middle one)
    • Insertion
      • Side of bases of proximal phalanges of all digits (except the middle finger)
    • Action
      • Adduction each finger at MCP assists in Flexion each finger at MCP
    • Ulnar nerves
  • 95.  
  • 96. Dorsal Interossei
    • 4 muscles
    • Origin
      • Adjacent side of metacarpals
    • Insertion
      • Proximal phalanx of each finger
    • Action
      • Abduction Finger 2-4 at MCP
      • Assist Flexion Finger 2-4 at MCP and extension at IP at the same finger
    • Ulnar nerve
  • 97.  
  • 98. Carpal Tunnel
    • Concave space located at the palmar surface of the wrist.
    • Formed by medially by pisiform and hamate and laterally by scaphoid and trapezium.
    • Cover by flexor retinaculum on the roof side.
  • 99. Carpal Tunnel
    • 10 structures passed through this passageway.
    • 4 flexor digitorum superficialis
    • 4 flexor digitorum profundus
    • 1 flexor pollicis longus
    • Median nerve
  • 100.  
  • 101.
    • Thank You
    • For Your Unbelievable
    • Attention!!!