HAND AND WRIST JOINT

1. HAND AND WRIST JOINT
By: RAJNISH KUMAR
CIMS Bilaspur

2. DORSUM OF HAND
 RAJNISH KUMAR

3. Extensor Retinaculum
 Attachment.
Laterally: Lower part of anterior border of radius
.
Medially: Triquetral and Pisiform bone

4. Structure passing deep to extensor
retinaculum

5.  1st Compartment
. Abducter Pollices Longus
. Extenser Pollices Brevis
 2nd Compartment
. Extensor carpi radialis longus
. Extensor carpi radialis Brevis
 3rd Compartment
. Extensor Pollices Longus
 4th Compartment
. Extensor digitorum
. Extensor indicis
. Posterior introsseous Nerve
Anterior interossous artery

6.  5th Compartment
. Extensor digiti mini
 6th Compartment
Extensor carpi ulnaris

7. Synovial Sheath of Extensor tendon
 All tendon has its own synovial Sheath except extensor digitorum and
extensor indices has common sheath
 They begIn just above the retinaculum down to the insertion
 Except that of Extensor Digitorum, Extendor Indices and extensor digiti
minimi which end in the middle of the dorsam of hand.

8. PALM OF HAND

9. Palmar Aponeurosis

10.  Palmer Aponeurosis: is triangular thickening of the deep fascia that covers
the centre part of the palm.
 The medial and lateral borders of palmer aponeurosis are continuous with
thin deep fascia covering the hypothenar and thenar muscles
 FUNCTION:The palmer aponeurosis is to give firm attachment to the
overlying skin and so improve the grip and to protect the underlying structure

11. FLEXOR RETINACULUM AND CARPEL TUNNEL
 Flexor Retinaculum Attachment:
 Medially to the Pisiform and hook of hamate
 Laterally split into to be attached to the tubercle of Scaphoid and to the
margines of the groove on the trapezium
 Lateral split divides the carpel Tunnel into two compartments – a smaller
lateral and larger medial.

12. Structure passing in front of flexor Retinaculum
 Ulnar nerve
 Ulnar artery
 Palmer cutaneous branch of ulnar nerve
 Tendon of Palmaris Longus
 Palmer cutaneous branch of median nerve

13. Structure passing deep to the flexor Retinaculum
(CARPEL TUNNEL)
 Tendon of flexor carpi radialis and it’s synovial Sheath
 Tendon of flexor digitorum superficialis
 Tendon of flexor digitorum profundus
 Tendon of flexor Pollices Longus
 Median nerve
 Synovial sheath of Tendon of flexor Pollices Longus
 Common flexor sheath
 CARPEL TUNNAL SYNDROME
Carpal tunnel syndrome (CTS) is a medical condition due to compression of
the median nerve as it travels through the wrist at the carpal tunnel.

14.  Signs and symptoms
. People with CTS experience numbness, tingling, or burning
sensations in the thumb and fingers, in particular the index
and middle fingers and radial half of the ring finger, because
these receive their sensory and motor function (muscle
control) from the median nerve.

15. WRIST JOINT

16. WRIST JOINT
 Type: Synovial joint
 Subtype: Elipsoidal variety
 Wrist complex: Radiocarpel Joint
Mid CARPEL Joint
ARTICULATING SURFACES
Above: Distal end of radius
Below: Scaphoid,Lunate, Triquetral bone.

17. LIGAMENTS
 Palmar radiocarpal:It is found on the palmar (anterior) side of the hand. It
passes from the radius to both rows of carpal bones. Its function, apart from
increasing stability, is to ensure that the hand follows the forearm during
supination.
 Dorsal radiocarpal : It is found on the dorsum (posterior) side of the
hand. It passes from the radius to both rows of carpal bones. It
contributes to the stability of the wrist, but also ensures that the hand
follows the forearm during pronation.
 Ulnar collateral :Runs from the ulnar styloid process to the triquetrum
and pisiform. Works in union with the other collateral ligament to
prevent excessive lateral joint displacement.
 Radial collateral :Runs from the radial styloid process to the scaphoid
and trapezium. Works in union with the other collateral ligament to
prevent excessive lateral joint displacement.

19. Relations
 Anteriorly: Tendon of
. Flexor digitorum superficialis
Flexor digitorum profundus
Flexor Pollices Longus
Flexor carpi radialis
Flexor carpi ulnaris
. Medical and ulnar nerve
 Laterally:Radial artery

20.  Posteriorly: Tendon of
. Abductor Pollices Longus
. Extensor Pollices Brevis
Extensor carpi radialis Longus
. Extensor carpi radialis Bravis
. Extensor Pollices Longus
Extensor Indices
Extensor Digitorum
Extensor Digiti Minimi
Extensor Carpi Ulnaris

21. Blood and Nerve Supply
 Blood supply: Anterior and posterior carpel arches formed by
branches of radial and ulnar artery.
 Nerve supply: anterior and posterior introsseous Nerves

22. MOVEMENTS

23.  Flexion: Mainly at mid carpel joint
Range 0 to 60 degree
Muscles involved in flexion:
Flexor Carpi Radialis
. Flexor carpi ulnaris
Palmaris Longus
Assisted by: Flexor digitorum superficialis
. Flexor digitorum Profundus
. Flexor Pollices Longus

24.  EXTENSION: Mainly at wrist joint
Range 0 to 50 degree
Muscles Involved in extension:
Extensor carpi Radialis Longus
Extensor Carpi Radialis Bravis
Extensor Carpi Ulnaris
Assisted by: Extensor Indices
Extensor digitorum
. Extensor Digiti Minimi
. Extensor Pollices Longus

25.  ABDUCTION: At mid carpel joint
Range 0 to 15 degree
Muscles involved in Abduction:
Flexor Carpi Radialis
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Bravis
Assisted by: Abductor Pollices Longus
Extensor Pollices Longus
Extensor Pollices Brevis

26.  Adduction: Mainly at wrist joint
Range 0 to 50 degree
Muscles involved in Adduction:
Flexor Carpi Ulnaris
Extersor Carpi Ulnaris
Circumduction: Combination of flexor, Adduction, Extension,and Abduction

29. Clinical Anatomy

30. THANK YOU