2. ARACELI G. DIZON, MD, DPPS
Department of Human Anatomy:
Gross Anatomy
3. OBJECTIVES
Identify the wrist & the hands.
Identify the bones, muscles of the wrist & hands.
Identify the joints & ligaments of the wrist &
hands.
Identify the blood supply, innervation & actions
of the wrist & hands.
Discuss conditions associated with the wrist &
hands.
4. WRIST
Wrist is a joint complex consisting of radio-
carpal joint & many relationships between the
carpal bones.
A. k. a. the CARPAL BONES
2 ROWS OF WRIST/CARPAL BONES
1. Proximal row – (PTLS) Pisiform,
Triquetrum, Lunate & Scaphoid
2. Distal row - (CHT2) Hamate, Capitate,
Trapezoid & Trapezium
Scaphoid has a notoriously poor blood supply
& recovers poorly following injury.
9. Mnemonic
for
Learning
Carpals
She Likes To Play
Lunate
In the moonlight
Triquetrum
The third T Bone
Pisiform
Pea-shaped
Try To Catch Her
Trapezium:
“It’s by the thumb”
Trapezoid
“Is by its side”
Capitate
Hamate
A hambone
With a hook
Scaphoid
A boat
Click R Button for Slideshow
WRIST BONES
15. All carpal bones articulate via GLIDING or
PLANE JOINTS.
A more or less joint exists between proximal row
& distal row of bones called mid-carpal – a
series of gliding joints.
BONES INVOLVED: Scaphoid, Lunate and
Triquetrum with Trapezium, Trapezoid, Capitate
& Hamate
Pisiform is not involved.
WRIST
17. RADIOCARPAL JOINT
Also referred as the WRIST
JOINT.
It is a condyloid synovial joint
of the distal upper limb.
Connects & serves as a
transition point between the
forearm & the hand.
A condyloid joint is a modified
ball & socket joint that allows
for flexion, extension,
abduction, & adduction
movements.
18. ULNAR-CARPAL/CARPOULNAR
JOINT
It serves as part of forearm
rotation as well as part of the
carpal movements.
The joint is comprised of the
distal radio-ulnar articulation,
triangular fibrocartilage complex,
Lunate, Triquetrum, Hamate, &
Pisiform, & the intra &
extracapsular ligamentous & soft
tissue constraints.
19. INTERCARPAL JOINTS
Intercarpal joints are all
classified as synovial plane
joints.
The articular surfaces are
functionally considered as
nearly flat & lined with
fibrocartilage.
The joints are enclosed by the
thin fibrous capsules whose
internal surfaces are lined by
the synovial membranes.
20. ARTICULATIONS & RANGE OF
MOTION (ROM)
Distal Radioulnar joint
Supination & Pronation
– 80-90o
Ulna moves posteriorly
& laterally with
pronation.
23. SOFT TISSUE OF THE WRIST
LIGAMENTS
- Covered by a fibrous capsule
Radial & Ulnar Collateral
ligaments
- Limit the ulnar & radial
deviation
- Collectively limits flexion &
extension
- Intercarpal &
Carpometacarpal
24. ULNAR COLLATERAL LIGAMENT
Is a rounded cord.
Attached above to the
end of the STYLOID
PROCESS of the Ulna,
& dividing below into
two.
One of which is
attached to the medial
side of the Triquetrum
& Pisiform.
27. TRANSVERSE CARPAL
LIGAMENT
A. k. a. the Flexor
Retinaculum.
A strong, fibrous band,
converting the deep groove
on the front of the carpal
bones into a tunnel, the
Carpal tunnel, through which
the Flexor tendons of the
digits & the Median nerve
pass.
28. COLLATERAL LIGAMENTS
Found on either side of
each finger & thumb
joint.
The function of the
collateral ligaments is
to prevent abnormal
sideways bending of
each joint.
29. VOLAR PLATE
This ligament connects
the proximal phalanx to
the middle phalanx on
the palm side of the
joint.
The ligament tightens as
the joint is straightened
& keeps the PIP joint
from bending back too
far (hyperextending).
30. PALMAR RADIOCARPAL
LIGAMENT
Broad membranous band,
attached above to the
anterior margin of the lower
end of the Radius, to its
Styloid process, & to the
front of the lower end of the
Ulna.
Its fibers pass downward to
be inserted into the volar
surfaces of the Scaphoid,
Lunate, & some being
continued to the Capitate.
31. DORSAL RADIOCARPAL
LIGAMENT
Less thick & strong than
the Palmar ligament.
The ligament begins on
the Radius.
Its fibers are directed
downward & medially, &
are fixed, below, to the
dorsal surfaces of the
Scaphoid & Lunate.
35. TRIANGULAR FIBROCARTILAGE
COMPLEX (TFCC)
It is a cartilage structure
located on the small finger side
of the wrist that, cushions &
supports the small carpal
bones in the wrist.
The TFCC keeps the forearm
bones (Radius & Ulna) stable
when the hand grasps or the
forearm rotates.
An injury or tear to the TFCC
can cause chronic wrist pain.
36. MUSCLE OF THE WRIST
EXTENSOR MUSCLES
Extensor Retinaculum
8 Extensor muscles
Muscles innervated by
Radial nerve.
FLEXOR MUSCLES
Flexor retinaculum (a.k.a.
Transverse Carpal
Ligament)
Two compartments
Superficial – 4
Deep – 3
Innervated by Median &
Ulnar nerve.
38. FLEXOR TENDONS
The muscles that flex the
wrist are on the palmar
side.
A group of muscles that
begins at the Medial
epicondyle of the
Humerus at the elbow.
39. FLEXOR DIGITI MINIMI BREVIS
Origin:
Hook of Hamate & Flexor
Retinaculum
Insertion:
Medial side of base of proximal
phalanx of Little Finger
Action:
Flexes proximal phalanx of the
Little (5th) finger
Innervation:
Ulnar nerve
40. FLEXOR POLLICIS BREVIS
Origin:
Flexor retinaculum &
tubercles of Scaphoid &
Trapezium
Insertion:
Lateral side of base of
proximal phalanx of
thumb
Action:
Flexes thumb
41. FLEXOR POLLICIS BREVIS
Innervation:
Superficial head – lateral
terminal branch of the
Median nerve.
1. Deep part - deep branch
of the Ulnar nerve (C8
&T1).
2. Recurrent branch of
Median nerve (C8 & T1) .
46. FLEXOR POLLICIS LONGUS
Origin:
Anterior surface of Radius &
adjacent Interosseous membrane
Insertion:
Base of distal phalanx of thumb
Action:
Flexes phalanges of 1st digit
(thumb)
Innervation:
Anterior Interosseous nerve
from Median nerve (C8 & T1)
47. THE 2 MUSCLES OF PRONATION
Two muscles work
together to turn the
Radius over the Ulna &
put the hand in a prone
position.
1. Pronator teres
2. Pronator quadratus
48. ABDUCTOR DIGITI MINIMI
Origin:
Pisiform
Insertion:
Medial side of base of
proximal phalanx of Little
finger.
Action:
Abducts Little finger .
Innervation:
Ulnar nerve (C8 & T1)
49. ABDUCTOR POLLICIS BREVIS
Origin:
Scaphoid & Trapezium
Insertion:
Lateral side of base of
proximal phalanx of
thumb
Action:
Abducts thumb
Innervation:
Median nerve (C8 & T1)
50. ABDUCTOR POLLICIS LONGUS
Origin:
Posterior surfaces of the Ulna
Insertion:
Base of 1st Metacarpal
Action:
Abducts thumb
Innervation:
Radial nerve
51. ADDUCTION & ABDUCTION
ADDUCTION Movement
towards the midline of
the body.
ABDUCTION
Movement away from
the midline of the
body.
52. ADDUCTOR POLLICIS
Origin:
2nd & 3rd Metacarpals &
Capitate
Insertion:
Medial side of base of
proximal phalanx of thumb
Action:
Adducts thumb
Innervation:
Ulnar nerve
53. WRIST EXTENSORS & FLEXORS
The Extensors of the
wrist are on the dorsal
side of the forearm.
A majority of the wrist
extensors begin at the
Lateral epicondyle
Majority of the wrist
Flexors are on the
anterior side of the
forearm begin at the
Medial epicondyle.
55. OPPONENS DIGITI MINIMI
Origin:
Hook of Hamate & Flexor
retinaculum
Insertion:
Medial border of 5th metacarpal
Action:
Brings little finger (5th digit)
into opposition with thumb.
Innervation:
Deep branch of Ulnar nerve
(C8 and T1)
56. OPPONENS POLLICIS
Origin:
Flexor retinaculum & tubercles
of Scaphoid & Trapezium
Insertion:
Lateral side of 1st Metacarpal
Action:
Draws 1st Metacarpal laterally
to oppose thumb toward center
of palm.
Innervation:
Recurrent branch of Median
nerve (C8 & T1)
57. THENAR
EMINENCE
Body of muscle on
the palm of the
human hand just
beneath the thumb.
Abductor pollicis
brevis, Flexor
pollicis brevis &
Opponens pollicis
58. HYPOTHENAR
EMINENCE
Body of muscle on the
palm of the human
hand just beneath the
5th phalange.
Abductor digiti
minimi, Flexor digiti
minimi & Opponens
digiti minimi
60. LUMBRICALS
Origin:
Radial side of the 2nd most
radial tendon of the Flexor
digitorum profundus.
Insertion:
Extensor expansion near
the metacarpophalangeal
joint.
61. LUMBRICALS
Action:
Flex the metacarpophalangeal
joints, & extend the
interphalangeal joints.
Innervation:
Lumbricals 1-2: Median nerve
(C8-T1)
Lumbricals 3-4: Ulnar nerve
(C8-T1)
62. INTEROSSEI MUSCLES
They are intrinsic muscles of the hand located between
the metacarpals.
They consist of the following:
1. Palmar/Volar interossei (four or three)
2. Dorsal interossei(four)
Action:
Finger adduction & abduction.
Innervation:
Deep ulnar branch of the ulnar nerve.
73. MOVEMENTS OF THE WRIST
Flexion/Extension – about 70 °- 80° of ROM
Radiocarpal vs. Mid Carpal
Flexion is initiated in mid carpal joint & 60% occurs
in this location.
Extension is also initiated at mid carpal but most
occurs in radio-carpal. Need 35° for good function –
at least 10 for any significant function.
Abduction/Adduction – about 15° - 20°
Intercarpal – proximal row slides over distal row
84. ULNAR ARTERY
Gives off Common
Interosseous artery
(trunk) near its origin.
Runs through
antebrachium with Ulnar
nerve.
Enters wrist & hand to
form Superficial Palmar
arch.
86. ULNAR ARTERY
Common Interosseous
artery gives off
Anterior & Posterior
Interosseous arteries:
Run on either side
of the Interosseous
membrane in the
Antebrachium.
89. WRIST & HAND DEFORMITIES
Wrist, hand & finger deformities include:
SWAN-NECK DEFORMITY
BOUTONNIERE DEFORMITY
DUPUYTREN’S CONTRACTURE
These deformities may be caused by an injury or may
result from another disorder (Rheumatoid arthritis
Gouty arthritis).
Doctors base the diagnosis of hand & finger deformities
on an examination.
90. SWAN-NECK DEFORMITY
Hyperextension of the proximal
interphalangeal (PIP) joint.
Flexion of the distal
interphalangeal (DIP) joint.
Flexion of the
metacarpophalangeal (MCP)
joint.
The usual cause of the deformity
is weakness or tearing of a
ligament on the palm side of the
middle joint of the finger.
91. SWAN-NECK DEFORMITY
It can also be due to it is tearing of the
tendon that flexes the middle joint.
In other cases, injury of the tendon
that straightens the end joint is the
cause.
Can be seen in patients with
Rheumatoid arthritis (RA).
RA is an autoimmune disorder, where
joints become inflamed, leading to
pain & deformity of the joints.
Ruptured finger tendon can also a
cause of this deformity.
92. BOUTONNIERE DEFORMITY
It may develop either in the
acute setting (secondary to
trauma) or progressively
(secondary to arthritis).
It is generally caused by a
forceful blow to the top
(dorsal) side of a bent
(flexed) middle joint of a
finger.
93. BOUTONNIERE DEFORMITY
The patient’s finger exhibits
the following:
- Pathologic flexion at the
proximal interphalangeal
(PIP) joint.
- Hyperextension at the
distal interphalangeal
(DIP) joint.
Extremely rare in pediatric
age group.
94. BOUTONNIERE DEFORMITY
A severe cut to the top of the finger can cause the
tendon to be severed from the bone.
In some severe cases, the bone may come out through
the cut.
In rare cases it may be Congenital.
Genetic conditions such as Ehlers-Danlos syndrome
can cause a Boutonniere deformity.
96. DUPUYTREN’S CONTRACTURE
A condition that causes nodules,
or knots, to build up underneath
the skin of the fingers & palms.
It can cause the fingers to
become stuck in place
(Contracture).
It is also said to be familial.
cause: Unknown
It may be linked to Cigarette
smoking, Alcoholism, DM,
Nutritional deficiencies, or
Anticonvulsant drugs.
97. DUPUYTREN’S CONTRACTURE
Most commonly affects the
ring & little fingers.
It causes the proximal &
middle joints, which are
those closest to the palm,
to become bent & difficult
to straighten.
Treatment varies
depending on the severity
of the nodules
98. WRIST & HAND DEFORMITIES
Deformities can sometimes be treated by
splinting or exercises, but if the deformity has
lasted for weeks or months, these treatments
may be ineffective because scarring has
developed.
When splinting or exercises are not helpful,
surgery may be needed.
99. WRIST & HAND INFECTIONS
Human & animal bites can cause an infection of the
hands.
Some other infections are:
FELON & PARONYCHIA
HERPETIC WHITLOW
HAND ABSCESS
INFECTION OF THE TENDON SHEATH
Hand & finger infections can cause constant, intense,
throbbing pain.
100. WRIST & HAND INFECTIONS
Doctors base the diagnosis of hand & finger
infections on the history, an examination &
sometimes x-rays.
These infections are treated with antibiotics
taken by mouth or by vein & sometimes surgery.
101. FELON FINGER
A bacterial infection in the pad of
the fingertip.
It causes pain, swelling &
erythema.
If not treated immediately, a pus-
filled sac (ABSCESS) can form.
Early-stage infections can
usually be treated with
antibiotics.
Once an abscess forms, the felon
usually needs surgically drained.
102. PARONYCHIA
Inflammation of the skin
around the fingernail.
It when the skin around the
nail gets irritated or injured.
Microorganisms get into the
skin & cause an infection.
It can be bacteria or a fungus.
Often, the skin is injured
because of biting, chewing, or
picking at the nails.
103. NERVE COMPRESSION
SYNDROMES OF THE WRIST &
HAND
Carpal tunnel syndrome
Cubital tunnel syndrome
Radial tunnel syndrome
104. CARPAL TUNNEL SYNDROME
(CTS)
A common symptom is
numbness or tingling in the
thumb & first three fingers.
The compression of the
Median nerve, the nerve that
passes through your wrist.
Treatments for CTS are
generally successful, but
early diagnosis is important.
108. TREATMENT OF CARPAL TUNNEL
SYNDROME
NONSURGICAL TREATMENTS
1. Wrist splinting.
A splint that holds the wrist still
while sleeping can help relieve
nighttime symptoms of tingling &
numbness.
2. Nonsteroidal anti-inflammatory
drugs (NSAIDs).
3. Corticosteroids
109. PREVENTION OF CARPAL
TUNNEL SYNDROME
Adjusting the daily routine to reduce stress on
your hands & wrists in the following ways:
1. Minimize repetitive hand movements.
2. Alternate between activities or tasks to reduce
the strain on your hands & wrists.
3. Keep wrists straight or in a neutral position.
111. CUBITAL TUNNEL SYNDROME
It is a condition that involves
pressure or stretching of the
ULNAR NERVE (a. k. a. the
“funny bone” nerve)
ULNAR NEUROPATHY.
It can cause numbness or
tingling in the ring & small
fingers, pain in the forearm,
&/or weakness in the hand.
The Ulnar nerve runs in a
groove on the inner side of the
elbow.
112. RADIAL TUNNEL SYNDROME
It is caused by increased
pressure on the Radial
nerve as it travels from the
upper arm (the brachial
plexus) to the hand & wrist.
The Radial nerve becomes
irritated &/or inflamed from
friction caused by
compression by muscles of
the Forearm.
113. RADIAL TUNNEL SYNDROME
Signs & symptoms
- Pain that worsens when rotating
the wrist.
- Outer elbow tenderness.
- Decreased ability to grip.
- Loss of strength in the forearm,
wrist, & hand.
- Difficulty extending wrist.
- Tingling & numbness may be
present, but pain will be the most
noticeable of the symptoms.
114. RADIAL TUNNEL SYNDROME
The pain, numbness,
and/or paresthesia,
especially in the middle
finger, index finger,
thumb, back of the
hand, &/or arm.
Wrist drop & finger
drop may also be
present.
115. TREATMENT OF RADIAL TUNNEL
SYNDROME
Anti-inflammatory medications,
IBUPROFEN (NSAIDs)
Steroid injections to relieve
inflammation & pressure on the
radial nerve, if necessary.
Wearing a wrist &/or elbow splint
to reduce movement & irritation on
the Radial nerve (this is
particularly common at night,
while you're sleeping).
117. NERVE COMPRESSION
SYNDROMES OF WRIST & HAND
In these disorders, something, usually bone or
CT, presses on a nerve, causing abnormalities of
sensation, movement, or both.
Symptoms of nerve compression syndromes
include tingling sensation, pain, loss of
sensation, weakness, or a combination.
118. NERVE COMPRESSION SYNDROMES
OF THE HAND & WRIST
The diagnosis of nerve compression syndromes
is suggested by the examination & can be
confirmed by Electromyography & Nerve
conduction studies.
In these syndromes, surgery may be necessary
to relieve pressure on the nerve if symptoms are
severe despite noninvasive treatments or if there
is persistent loss of sensation or weakness.
119. REFERENCES
Gray, H. (2020). Gray’s Anatomy. Medina University
Press International.
Snell, R. S. (2012). Clinical Anatomy By Regions.
Lippincott Williams & Wilkins.
