Anatomy of wrist joint by Dr Bipul Borthakur

1. DR BIPUL BORTHAKUR
PROFESSOR & HOD
DEPT OF ORTHOPAEDICS,
SMCH

2. LEARNING OBJECTIVES
ARTICULAR SURFACES
LIGAMENTS
MOVEMENTS
BLOOD SUPPLY
NERVE SUPPLY
MECHANISM OF INJURY
RADIOLOGICAL EVALUATION
APPLIED ANATOMY
SCAPHOID FRACTURE
LUNATE FRACTURE
PERILUNATE DISLOCATION
OTHERS

3. WRIST JOINT
• Wrist joint is a synovial joint of ellipsoid type.
• Also called radio carpal joint
• Carpal fracture accounts for 18% all wrist fracture
• Carpal fracture associated with 7% of distal radius
fracture

4. Normal anatomic relationship
Radial inclination: ranges from 13
to 30 %
Radial length: ranges from 8 to 18
mm
Palmar tilt: ranges from 0 to 28
degree

5. ARTICULAR SURFACES
WRIST JOINT IS FORMED BY:
DISTALLY:
•The proximal row of the carpel
bone(except pisiform)
PROXIMALLY:
•The distal end of radius and
articular disc
CARPAL BONES:
•Proximal row: scaphoid, lunate,
triquetrum and pisiform (lateral
to medial)
•Distal row: trapezium, trapezoid,
capitate and hamate (lateral to
medial)

6. SURFACE MARKINGS OF WRIST JOINT
•The position of wrist joint can
be indicated by drawing a curve
line, with its convexity upward ,
between the styloid process of
radius and ulna
•The summit of convexity is
about 1 cm , above the centre
of straight line joining the two
processes

7. LIGAMENTS
• There are four ligaments in the wrist joint:
• Palmar radiocarpal: it is found on the palmar( anterior)
surface of hand. It provides stability of joint. Besides it
ensure that the hand follows the forearm during pronation
• Dorsal radiocarpal: it is found on posterior surfaces of hand .
It also provides joint stability

8. Ulnar collateral:
•Runs from the ulnar styloid proces to the triquetrum and
pisiform. It prevent excessive lateral joint displacement
Radial collateral:
•Runs from radial styloid process to the scaphoid and
trapezium. It also prevent excessive lateral displacement

9. Movements of the wrist joint
All the movements are performed by the musles of forearm
i. Flexion:
 Produced by flexor carpi ulnaris , flexor carpi radialis,
and flexor digitorium superficialis
ii. Extension:
 Produced by extensor carpi radialis longus and brevis
and extensor carpi ulnaris
iii. Adduction:
 Extensor carpi ulnaris and flexor carpi ulnaris
iv. abduction:
 Produced by the abductor pollicis longus flexor carpi
radialis and extensor carpi radialis longus and brevis

11. Blood supply of wrist joint
•The wrist received blood from branches of
the deep and superficial palmar arches, which
are derived from the ulnar and radial arteries

12. Nerve supply of wrist joint
Wrist is innervated by:
i. Anterior interosseous branch:
 Branch of median nerve
ii. Posterior interosseus branch:
 Branch of radial nerve
iii. Deep & dorsal branches:
 Branch of ulnar nerve

13. MECHANISM OF INJURY
• The most common mechanism of carpal
bones injury in hand is fall onto
outstretched, due to axial compressive force
with the wrist in hyperextension
• The volar ligaments are placed under tension
with compression and shear forces applied
dorsally ,especially when the wrist is
extended beyond the physiological limits
• Excessive ulnar deviation and intercarpal
supination result in a predictable pattern of
perilunate injury
• Direct injuries like crush injuries

14. CLINICAL EVALUATION
• The clinical evaluation of individual carpal
bones are variable , but in general most
consistent sign of carpel injury are well
localized tenderness
• Gross deformity may be present , ranging from
displacement of carpus to prominance of
individual carpal bones

15. RADIOLOGICAL EVALUATION
• Radiography:
– Posteroanterior, oblique and lateral x rays are each taken
with the wrist in the neutral position. Gilula lines (3 smooth
radiographic arc) are distorted in ligamentous instability
• Arthrography &arthroscopy:
– Can assist in the diagnosis of carpal ligament injuries.
• Computed tomography (CT):
– Helps in evaluating carpel fractures, malunion , nonunion
and bone loss
• Magnetic resonance imaging(MRI):
– It is sensitive to occult fractures and osteonecrosis of bones
and soft tissue injury and ligament injury

16. SOME SPECIFIC RADIOLOGICAL VIEWS
WRIST INJURY
•Scaphoid view:
It is anteroposterior x-ray with wrist supinated 30
degree and ulnar deviation
•Pronated oblique view:
To look for schaphoid fracture
•Clenched fist AP view:
To look for widening of scapholunate interval
•Maximal ulnar & radial deviation:
To look for carpal instability

17. APPLIED ANATOMY
Ossification of carpal bones

18. ANATOMICAL SNUFF BOX

19. BLOOD SUPPLY OF SCAPHOID
•The scaphoid is at
particular risk of avascular
necrosis after fracture
because of its retrograde
blood supply

20. CLINICAL CONDITION AFFECTING WRIST JOINT
Fracture of distal radius Fracture of carpel bone
Adults:
•Colles fracture
•Smith fracture
•Barton’fracture
•Radial styloid fracture
Children
•Fracture of distal radial
epiphysis
•Fracture of distal radial
metaphysis
•scaphoid fracture
•Lunate fracture
•Perilunate dislocation
•Dorsal chip fracture

21. SUMMARY
• Wrist joint is also known as radio carpal joint which
is a synovial joint of ellipsoid type
• Colles fracture is the fracture of distal end of radius
in a skeletally mature person produced by a fall on
outstreched hand
• The most common mechanism of carpal bones injury
in hand is fall onto outstretched, due to axial
compressive force with the wrist in hyperextension
• Scaphoid fracture is the commonest injury of carpus
• Carpal tunnel syndrome is due to compression of
median nerve causing numbness and tingling or
weakness in hand

22. THANK YOU