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KIN 191B – Advanced Assessment of Upper Extremity Injuries Wrist, Hand and Finger Anatomy
Anatomy <ul><li>Bony anatomy </li></ul><ul><li>Articulations and ligamentous support </li></ul><ul><li>Muscular anatomy </...
Bony Anatomy
Bony Anatomy <ul><li>Distal radius and ulna </li></ul><ul><li>Carpal bones </li></ul><ul><li>Metacarpals </li></ul><ul><li...
Bony Anatomy
Distal Radius and Ulna <ul><li>Distal radius broadens </li></ul><ul><ul><li>Ulnar notch articulates with ulnar head (dista...
Carpal Bones <ul><li>Total of eight bones – 2 rows of 4 </li></ul><ul><ul><li>Irregular shapes and surfaces </li></ul></ul...
Carpal Bones <ul><li>Proximal row (lateral to medial) </li></ul><ul><ul><li>Scaphoid </li></ul></ul><ul><ul><li>Lunate </l...
Metacarpals <ul><li>Numbered 1 through 5 (lateral to medial) </li></ul><ul><li>Represent most of length of hand – all have...
Phalanges <ul><li>Each phalange has base, shaft and head from proximal to distal </li></ul><ul><li>All fingers (2 nd  thro...
Bony Anatomy
Articulations and Ligamentous Support
Articulations <ul><li>Distal radioulnar joint </li></ul><ul><li>Radiocarpal joint </li></ul><ul><li>Intercarpal joints </l...
Distal Radioulnar Joint <ul><li>Head of ulna articulating with ulnar notch on distal radius </li></ul><ul><li>Contributes ...
Radiocarpal Joint <ul><li>Comprised of 2 articulations </li></ul><ul><ul><li>Laterally – distal radius with scaphoid and l...
Radiocarpal Joint
Radiocarpal Joint <ul><li>Radial collateral ligament </li></ul><ul><ul><li>Radial styloid process to scaphoid and trapeziu...
Radiocarpal Joint <ul><li>Palmar (volar) radiocarpal ligament </li></ul><ul><ul><li>Most important stabilizer of wrist </l...
Radiocarpal Joint
Intercarpal Joints <ul><li>Individual ligaments connecting adjacent carpal bones (named as such) within proximal and dista...
Carpometacarpal Joints <ul><li>First 3 metacarpals articulate with single carpal bone each </li></ul><ul><ul><li>1 – trape...
Carpometacarpal Joints <ul><li>1 st  and 5 th  carpometacarpal joints allow for flexion/extension and abduction/adduction ...
Metacarpophalangeal (MP) Joints <ul><li>Articulations between convex metacarpal heads and corresponding concave base of pr...
Hand Articulations
Metacarpophalangeal (MP) Joints <ul><li>MP joint ligamentous support </li></ul><ul><ul><li>Varus/valgus forces resisted by...
Interphalangeal (IP) Joints <ul><li>IP joint only at thumb due to only 2 phalanges </li></ul><ul><li>Proximal interphalang...
Interphalangeal Joints
Flexor Retinaculum or Transverse Carpal Ligament
Palmar Aponeurosis
Muscular Anatomy
Muscular Anatomy <ul><li>Extrinsic muscles acting on wrist, hand and fingers </li></ul><ul><li>Intrinsic muscles acting on...
Extrinsic Muscles <ul><li>Abductor pollicis longus </li></ul><ul><li>Extensor pollicis brevis  </li></ul><ul><li>Extensor ...
Extrinsic Muscles <ul><li>Origin, insertion, innervation and action of each addressed with elbow presentation </li></ul><u...
Intrinsic Muscles <ul><li>Abductor digiti minimi </li></ul><ul><li>Abductor pollicis brevis </li></ul><ul><li>Adductor pol...
Hand Eminences <ul><li>Thenar eminence – thumb </li></ul><ul><ul><li>Abductor pollicis brevis </li></ul></ul><ul><ul><li>F...
Abductor Digiti Minimi <ul><li>O: flexor carpi ulnaris tendon, pisiform </li></ul><ul><li>I: ulnar side of base of 5 th  p...
Abductor Pollicis Brevis <ul><li>O: flexor retinaculum, trapezium, scaphoid </li></ul><ul><li>I: radial side of base of 1 ...
Adductor Pollicis <ul><li>O: capitate, 2 nd  and 3 rd  metacarpal bases </li></ul><ul><li>I: ulnar side of base of 1 st  p...
Flexor Digiti Minimi <ul><li>O: hook of hamate </li></ul><ul><li>I: ulnar side of 5 th  proximal phalanx </li></ul><ul><li...
Flexor Pollicis Brevis <ul><li>O: flexor retinaculum, trapezoid, captitate </li></ul><ul><li>I: radial side of base of 1 s...
Opponens Pollicis <ul><li>O: flexor retinaculum, trapezium </li></ul><ul><li>I: 1 st  metacarpal shaft </li></ul><ul><li>N...
Opponens Digiti Minimi <ul><li>O: flexor retinaculum, hook of hamate </li></ul><ul><li>I: ulnar side of shaft of 5 th  met...
Lumbricales <ul><li>O: 1 & 2 - radial surface of flexor profundus tendons, 3 – adjacent sides of flexor profundus tendons ...
Lumbricales
Palmar Interossei <ul><li>O: 1 – ulnar border of 2 nd  metacarpal, 2 – radial border of 4 th  metacarpal, 3 – radial borde...
Palmar Interossei
Dorsal Interossei <ul><li>O: 1 – radial border of 2 nd  metacarpal, 2 – radial border of 3 rd  metacarpal, 3 – ulnar borde...
Dorsal Interossei
Neurovascular Anatomy
Neurological Anatomy <ul><li>Peripheral nerves </li></ul><ul><ul><li>Median </li></ul></ul><ul><ul><li>Ulnar </li></ul></u...
Sensory Maps
Vascular Anatomy <ul><li>Radial artery </li></ul><ul><li>Ulnar artery </li></ul><ul><li>Superficial and deep arch vessels ...
Vascular Supply <ul><li>Radial artery lateral (thumb side) </li></ul><ul><ul><li>Common pulse point </li></ul></ul><ul><li...
Hand Vascular Supply
Carpal Tunnel
Carpal Tunnel <ul><li>Floor – proximal row of carpal bones </li></ul><ul><li>Roof – transverse carpal ligament </li></ul><...
Carpal Tunnel
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Kin 191 B – Wrist, Hand And Finger Anatomy

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Kin 191 B – Wrist, Hand And Finger Anatomy

  1. 1. KIN 191B – Advanced Assessment of Upper Extremity Injuries Wrist, Hand and Finger Anatomy
  2. 2. Anatomy <ul><li>Bony anatomy </li></ul><ul><li>Articulations and ligamentous support </li></ul><ul><li>Muscular anatomy </li></ul><ul><li>Neurovascular anatomy </li></ul><ul><li>Carpal tunnel </li></ul>
  3. 3. Bony Anatomy
  4. 4. Bony Anatomy <ul><li>Distal radius and ulna </li></ul><ul><li>Carpal bones </li></ul><ul><li>Metacarpals </li></ul><ul><li>Phalanges </li></ul><ul><ul><li>Proximal, middle and distal </li></ul></ul>
  5. 5. Bony Anatomy
  6. 6. Distal Radius and Ulna <ul><li>Distal radius broadens </li></ul><ul><ul><li>Ulnar notch articulates with ulnar head (distal radioulnar joint) </li></ul></ul><ul><ul><li>Radial styloid process (thumb side) </li></ul></ul><ul><li>Distal ulna terminates at ulnar head </li></ul><ul><ul><li>Ulnar head has circular appearance </li></ul></ul><ul><ul><li>Ulnar styloid process (little finger side) </li></ul></ul>
  7. 7. Carpal Bones <ul><li>Total of eight bones – 2 rows of 4 </li></ul><ul><ul><li>Irregular shapes and surfaces </li></ul></ul><ul><li>Proximal row </li></ul><ul><ul><li>Articulate with distal radius (radiocarpal joint) </li></ul></ul><ul><li>Distal row </li></ul><ul><ul><li>Articulate with proximal aspect of metacarpals </li></ul></ul>
  8. 8. Carpal Bones <ul><li>Proximal row (lateral to medial) </li></ul><ul><ul><li>Scaphoid </li></ul></ul><ul><ul><li>Lunate </li></ul></ul><ul><ul><li>Triquetrum </li></ul></ul><ul><ul><li>Pisiform </li></ul></ul><ul><ul><li>“ Some Lovers Try Positions” </li></ul></ul><ul><li>Distal row (lateral to medial) </li></ul><ul><ul><li>Trapezium </li></ul></ul><ul><ul><li>Trapezoid </li></ul></ul><ul><ul><li>Capitate </li></ul></ul><ul><ul><li>Hamate </li></ul></ul><ul><ul><ul><li>hook </li></ul></ul></ul><ul><ul><li>“ That They Can’t Handle” </li></ul></ul>
  9. 9. Metacarpals <ul><li>Numbered 1 through 5 (lateral to medial) </li></ul><ul><li>Represent most of length of hand – all have base, shaft and head from proximal to distal </li></ul><ul><li>Proximal aspects articulate with distal row of carpals – carpometacarpal joints </li></ul><ul><li>Distal aspects articulate with proximal aspect of proximal phalanges of fingers </li></ul>
  10. 10. Phalanges <ul><li>Each phalange has base, shaft and head from proximal to distal </li></ul><ul><li>All fingers (2 nd through 4 th digits) have proximal, middle and distal phalanges </li></ul><ul><li>Thumb (1 st digit) has only proximal and distal phalanges </li></ul>
  11. 11. Bony Anatomy
  12. 12. Articulations and Ligamentous Support
  13. 13. Articulations <ul><li>Distal radioulnar joint </li></ul><ul><li>Radiocarpal joint </li></ul><ul><li>Intercarpal joints </li></ul><ul><li>Carpometacarpal joints </li></ul><ul><li>Metacarpophalangeal joints </li></ul><ul><li>Interphalangeal joints (proximal and distal) </li></ul><ul><li>Retinaculum and palmar aponeurosis </li></ul>
  14. 14. Distal Radioulnar Joint <ul><li>Head of ulna articulating with ulnar notch on distal radius </li></ul><ul><li>Contributes to forearm pronation and supination ROM (with proximal radioulnar joint) </li></ul>
  15. 15. Radiocarpal Joint <ul><li>Comprised of 2 articulations </li></ul><ul><ul><li>Laterally – distal radius with scaphoid and lunate bones </li></ul></ul><ul><ul><li>Medially – triangular fibrocartilaginous disc (TFCC) with lunate and triquetrum </li></ul></ul><ul><li>Allows for flexion/extension and radial/ulnar deviation movements </li></ul>
  16. 16. Radiocarpal Joint
  17. 17. Radiocarpal Joint <ul><li>Radial collateral ligament </li></ul><ul><ul><li>Radial styloid process to scaphoid and trapezium </li></ul></ul><ul><ul><li>Limits ulnar deviation, terminal wrist flexion and extension </li></ul></ul><ul><li>Ulnar collateral ligament </li></ul><ul><ul><li>Ulnar styloid process to triquetrum and pisiform </li></ul></ul><ul><ul><li>Limits radial deviation, terminal wrist flexion and extension </li></ul></ul>
  18. 18. Radiocarpal Joint <ul><li>Palmar (volar) radiocarpal ligament </li></ul><ul><ul><li>Most important stabilizer of wrist </li></ul></ul><ul><ul><li>Anterior distal radius to capitate, triquetrum and scaphoid </li></ul></ul><ul><ul><li>Collectively limits wrist hyperextension </li></ul></ul><ul><li>Dorsal radiocarpal ligament </li></ul><ul><ul><li>Only major stabilizer on dorsal wrist </li></ul></ul><ul><ul><li>Posterior distal radius to lunate and triquetrum </li></ul></ul><ul><ul><li>Limits wrist hyperflexion </li></ul></ul>
  19. 19. Radiocarpal Joint
  20. 20. Intercarpal Joints <ul><li>Individual ligaments connecting adjacent carpal bones (named as such) within proximal and distal rows </li></ul><ul><li>Contribute to significant stability of bones </li></ul><ul><li>Subtle gliding motions allowed between adjacent bones, but no collective gross movements allowed </li></ul>
  21. 21. Carpometacarpal Joints <ul><li>First 3 metacarpals articulate with single carpal bone each </li></ul><ul><ul><li>1 – trapezium </li></ul></ul><ul><ul><li>2 – trapezoid </li></ul></ul><ul><ul><li>3 – capitate </li></ul></ul><ul><li>4 th and 5 th metacarpals articulate with same bone - hamate </li></ul>
  22. 22. Carpometacarpal Joints <ul><li>1 st and 5 th carpometacarpal joints allow for flexion/extension and abduction/adduction movements </li></ul><ul><ul><li>1 st also has accessory rotation to accommodate opposition/reposition </li></ul></ul><ul><li>2 nd through 4 th carpometacarpal joints allow only flexion/extension movements </li></ul>
  23. 23. Metacarpophalangeal (MP) Joints <ul><li>Articulations between convex metacarpal heads and corresponding concave base of proximal phalanges </li></ul><ul><li>Allow for flexion/extension and abduction/adduction movements </li></ul><ul><ul><li>2 nd through 5 th digits have more abduction/adduction ROM when extended </li></ul></ul>
  24. 24. Hand Articulations
  25. 25. Metacarpophalangeal (MP) Joints <ul><li>MP joint ligamentous support </li></ul><ul><ul><li>Varus/valgus forces resisted by radial (lateral) and ulnar (medial) collateral ligaments – tighter in flexion than extension </li></ul></ul><ul><ul><li>Palmar (volar) aspect reinforced by thick, fibrocartilaginous palmar (volar) ligament </li></ul></ul><ul><ul><li>Dorsal aspect reinforced by extensor tendinous structure and deep transverse metacarpal ligament – limits abduction/adduction </li></ul></ul>
  26. 26. Interphalangeal (IP) Joints <ul><li>IP joint only at thumb due to only 2 phalanges </li></ul><ul><li>Proximal interphalangeal (PIP) joints between proximal and middle phalanges of 2 nd through 5 th digits </li></ul><ul><li>Distal interphalangeal (DIP) joints between middle and distal phalanges of 2 nd through 5 th digits </li></ul><ul><li>Varus/valgus forces resisted by radial (lateral) and ulnar (medial) collateral ligaments </li></ul>
  27. 27. Interphalangeal Joints
  28. 28. Flexor Retinaculum or Transverse Carpal Ligament
  29. 29. Palmar Aponeurosis
  30. 30. Muscular Anatomy
  31. 31. Muscular Anatomy <ul><li>Extrinsic muscles acting on wrist, hand and fingers </li></ul><ul><li>Intrinsic muscles acting on wrist, hand and fingers </li></ul>
  32. 32. Extrinsic Muscles <ul><li>Abductor pollicis longus </li></ul><ul><li>Extensor pollicis brevis </li></ul><ul><li>Extensor carpi radialis longus </li></ul><ul><li>Extensor carpi radialis brevis </li></ul><ul><li>Extensor carpi ulnaris </li></ul><ul><li>Extensor digitorum (communis) </li></ul><ul><li>Extensor indicis </li></ul><ul><li>Extensor digiti minimi </li></ul><ul><li>Flexor carpi radialis </li></ul><ul><li>Flexor carpi ulnaris </li></ul><ul><li>Flexor digitorum superficialis </li></ul><ul><li>Flexor digitorum profundus </li></ul><ul><li>Flexor pollici longus </li></ul><ul><li>Palmaris longus </li></ul>
  33. 33. Extrinsic Muscles <ul><li>Origin, insertion, innervation and action of each addressed with elbow presentation </li></ul><ul><li>Refer to 4 groups of 3 for review of extensor muscles (no brachioradialis, supinator or anconeus) </li></ul><ul><li>Refer to hand placement/layers for review of flexor muscles (no pronators) </li></ul>
  34. 34. Intrinsic Muscles <ul><li>Abductor digiti minimi </li></ul><ul><li>Abductor pollicis brevis </li></ul><ul><li>Adductor pollicis </li></ul><ul><li>Flexor digiti minimi </li></ul><ul><li>Flexor pollicis brevis </li></ul><ul><li>Opponens pollicis </li></ul><ul><li>Opponens digiti minimi </li></ul><ul><li>Lumbricales </li></ul><ul><li>Palmar interossei </li></ul><ul><li>Dorsal interossei </li></ul>
  35. 35. Hand Eminences <ul><li>Thenar eminence – thumb </li></ul><ul><ul><li>Abductor pollicis brevis </li></ul></ul><ul><ul><li>Flexor pollicis brevis </li></ul></ul><ul><ul><li>Opponens pollicis </li></ul></ul><ul><ul><li>Tendon of flexor pollicis longus </li></ul></ul><ul><li>Hypothenar eminence – little finger </li></ul><ul><ul><li>Abductor digiti minimi </li></ul></ul><ul><ul><li>Flexor digiti minimi </li></ul></ul><ul><ul><li>Opponens digiti minimi </li></ul></ul>
  36. 36. Abductor Digiti Minimi <ul><li>O: flexor carpi ulnaris tendon, pisiform </li></ul><ul><li>I: ulnar side of base of 5 th proximal phalanx </li></ul><ul><li>N: ulnar </li></ul><ul><li>A: abduction of 5 th finger </li></ul>
  37. 37. Abductor Pollicis Brevis <ul><li>O: flexor retinaculum, trapezium, scaphoid </li></ul><ul><li>I: radial side of base of 1 st proximal phalanx </li></ul><ul><li>N: median </li></ul><ul><li>A: abduction of 1 st CMC and MP joints, opposition </li></ul>
  38. 38. Adductor Pollicis <ul><li>O: capitate, 2 nd and 3 rd metacarpal bases </li></ul><ul><li>I: ulnar side of base of 1 st proximal phalanx </li></ul><ul><li>N: ulnar </li></ul><ul><li>A: adduction of 1 st CMC and MP joints, opposition </li></ul>
  39. 39. Flexor Digiti Minimi <ul><li>O: hook of hamate </li></ul><ul><li>I: ulnar side of 5 th proximal phalanx </li></ul><ul><li>N: ulnar </li></ul><ul><li>A: 5 th MP joint flexion, opposition </li></ul>
  40. 40. Flexor Pollicis Brevis <ul><li>O: flexor retinaculum, trapezoid, captitate </li></ul><ul><li>I: radial side of base of 1 st proximal phalanx </li></ul><ul><li>N: median, ulnar </li></ul><ul><li>A: flexion of 1 st CMC and MP joints, opposition </li></ul>
  41. 41. Opponens Pollicis <ul><li>O: flexor retinaculum, trapezium </li></ul><ul><li>I: 1 st metacarpal shaft </li></ul><ul><li>N: median </li></ul><ul><li>A: thumb opposition </li></ul>
  42. 42. Opponens Digiti Minimi <ul><li>O: flexor retinaculum, hook of hamate </li></ul><ul><li>I: ulnar side of shaft of 5 th metacarpal </li></ul><ul><li>N: ulnar </li></ul><ul><li>A: opposition of 5 th finger </li></ul>
  43. 43. Lumbricales <ul><li>O: 1 & 2 - radial surface of flexor profundus tendons, 3 – adjacent sides of flexor profundus tendons of 3 rd and 4 th fingers, 4 – adjacent sides of flexor profundus tendons of 4 th and 5 th fingers </li></ul><ul><li>I: radial border of extensor tendons of respective fingers </li></ul><ul><li>N: 1 & 2 – median, 3 & 4 – ulnar </li></ul><ul><li>A: flexion of MP joints, extension of PIP/DIP joints </li></ul>
  44. 44. Lumbricales
  45. 45. Palmar Interossei <ul><li>O: 1 – ulnar border of 2 nd metacarpal, 2 – radial border of 4 th metacarpal, 3 – radial border of 5 th metacarpal </li></ul><ul><li>I: 1 – ulnar side of 2 nd proximal phalanx, 2 – radial side of 4 th proximal phalanx, 3 – radial side of 5 th proximal phalanx </li></ul><ul><li>N: ulnar </li></ul><ul><li>A: adduction of 2 nd , 4 th and 5 th fingers (middle finger is reference point) </li></ul>
  46. 46. Palmar Interossei
  47. 47. Dorsal Interossei <ul><li>O: 1 – radial border of 2 nd metacarpal, 2 – radial border of 3 rd metacarpal, 3 – ulnar border of 3 rd metacarpal, 4 – ulnar border of 4 th metacarpal </li></ul><ul><li>I: 1 – radial side of 2 nd proximal phalanx, 2 – radial side of 3 rd proximal phalanx, 3 – ulnar side of 3 rd proximal phalanx, 4 – ulnar side of 4 th proximal phalanx </li></ul><ul><li>N: ulnar </li></ul><ul><li>A: abduction of 2 nd through 4 th fingers (middle finger is reference point) </li></ul>
  48. 48. Dorsal Interossei
  49. 49. Neurovascular Anatomy
  50. 50. Neurological Anatomy <ul><li>Peripheral nerves </li></ul><ul><ul><li>Median </li></ul></ul><ul><ul><li>Ulnar </li></ul></ul><ul><ul><li>Radial </li></ul></ul><ul><li>Nerve root level (brachial plexus) distribution </li></ul><ul><ul><li>Dermatomes </li></ul></ul><ul><ul><li>Myotomes </li></ul></ul>
  51. 51. Sensory Maps
  52. 52. Vascular Anatomy <ul><li>Radial artery </li></ul><ul><li>Ulnar artery </li></ul><ul><li>Superficial and deep arch vessels in hand </li></ul><ul><li>Capillary refill </li></ul>
  53. 53. Vascular Supply <ul><li>Radial artery lateral (thumb side) </li></ul><ul><ul><li>Common pulse point </li></ul></ul><ul><li>Ulnar artery medial (little finger side) </li></ul>
  54. 54. Hand Vascular Supply
  55. 55. Carpal Tunnel
  56. 56. Carpal Tunnel <ul><li>Floor – proximal row of carpal bones </li></ul><ul><li>Roof – transverse carpal ligament </li></ul><ul><li>Contents (10 structures) </li></ul><ul><ul><li>Median nerve </li></ul></ul><ul><ul><li>Flexor pollicis longus tendon </li></ul></ul><ul><ul><li>4 tendons of flexor digitorum superficialis </li></ul></ul><ul><ul><li>4 tendons of flexor digitorum profundus </li></ul></ul>
  57. 57. Carpal Tunnel

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