This document provides an overview of the carpals and phalanges bones in the hand. It discusses the characteristic features, muscular attachments, ossification, and clinical aspects of the carpals (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate) and phalanges. Methods for differentiating right and left carpals are presented. Common injuries and conditions like scaphoid fractures, Kienbock's disease, mallet finger, and Jersey finger are described. MCQs are provided to test understanding. Radiographic images demonstrate examples like the "spilt tea cup" sign of lunate dislocation.

1. Carpal & Phalanges
Presenter: Rahul Sharma

2. Objectives
• Introduction
• Carpal bone
• Characteristic features
• Muscular attachment
• Ossification
• Phalanges
• Characteristic features
• Muscular attachment
• Ossification
• Clinical aspect
• Clinical vignette

3. Skeleton of hand:
•Carpals
•Metacarpal
•Phalanges

4. She look to pretty try to catch her

8. Scaphoid (G. skaphé, skiff, boat)

9. Differentiating Right from Left
1. Your thumb should be in concave capitate facet, and your forefinger on
the convex radial facet
2. Scaphoid ridge must be toward you
3. Scaphoid prong is now on same side of scaphoid as that to which bone
belongs

10. Scaphoid Fractures

11. Lunate (L. luna, moon)

12. Differentiating Right from Left
1. Place flattest edge of bone against the table top
2. Scaphoid facet is down and triquetral facet is up
3. Concave capitate facet should be toward you
4. triquetral facet is now on the same side of the lunate as that
to which the bone belongs

13. Lunate Dislocation
(lateral view)The ‘spilt tea cup’ sign can be seen (in red) as lunate is rotated and
displaced volarly with respect to the radial articular surface. Scapolunate angle (D) is
abnormal (normal range 30–60°), and the hamate and lunate overlap.

14. Kienbock’s disease

15. Kienbock’s disease

16. Triquetrum (A Pyramidal Bone)

17. Differentiating Right from Left
1. Put your thumb into concave facet for hamate ,facet is facing you,
place your index finger onto facet for pisiform
2. Facet for lunate should now be facing you if you are holding bone in
same hand as that to which bone belongs
3. If irregular ridge is facing you, you are holding it in wrong hand

18. Pisiform (L. pisum, pea)

19. Trapezium (G. trapeze, table)

20. Differentiating Right from Left*
Dorsum of this bone is the flattest surface, place this down
against the table
1. Palmar ridge should now be facing away from the table &
metacarpal 2 facet should be facing toward you
2. look at the palmar ridge – the groove for the tendon of the
flexor carpi radialis muscle is lying either left or right of

21. Trapezoid: a wedge-shaped bone

22. Differentiating Right from Left
1. Place bone into a “boot position” with flat non-articular
dorsal surface on tabletop and the “V-shaped” trapezoid
groove toward you
2. Toe end of boot now points toward same side of body as
that which the bone belongs

23. Capitate
(L. caput, head)

24. Differentiating Right from Left
Place metacarpal 3 facet on tabletop – the rounded head (facet
for scaphoid) should now be away from the Table
•Place capitate line toward you
(a) Head leans toward the same side as that which bone belongs
(b) Capitate line travels upwards toward same side as that which bone
belongs

25. Hamate (L. hamulus, a little hook)

26. Differentiating Right from Left
1. place flat, roughened, non-articular surface on the tabletop,
hook of hamate should now be pointing away from the table
2. Place the L-shaped capitate facet toward you
3. Hook of hamate is now on same side of the bone as that to
which the bone belongs

27. Radiocarpal articulation

29. Carpal Tunnel

31. Ossification
• Cartilagenous at birth then start to ossify
• Each carpal bone ossified from 1 centre
• 1st – Capitate , last - pisiform

32. Medico legal Importance
• Ossifications of 8 carpals have a definite
relation with age and can be considered as a
good indicator for age assessment and skeletal
maturation in pediatric age groups.
• Carpals are the most important bones in
determining skeletal age

33. Phalanges

34. Parts of phalanx

35. Characteristic features

36. Ossification

39. Muscle Attachment

40. MUSCLE NAME ORIGIN INSERTION
Flexor pollicis brevis Tubercles of scaphoid and
trapezium
lateral side of proximal
phalanx of the thumb.
Abductor pollicis brevis Tubercle of trapezium base of proximal phalanx of
the thumb
Oppenens pollicis Tubercle of trapezium, and
associated flexor
retinaculum
lateral margin of the 1st
metacarpal of the thumb

41. Adductor pollicis muscles.

42. Name Origin Insertion
Opponens Digiti Minimi Hook of hamate & flexor
retinaculum
Medial margin of metacarpal
V
Abductor Digiti Minimi pisiform and tendon of
flexor carpi ulnaris
Base of proximal phalanx of
little finger
Flexor Digiti Minimi Brevis hook of hamate base of proximal phalanx of
little finger

45. Mallet finger

46. Jersey finger

47. Fracture of proximal phalanx

48. Fracture of distal phalanx

49. Buddy strapping

50. MCQs
Q.1) Which carpal bone is not appear on x ray of
below 8 year old children?
A) Hamate
B) Pisiform
C) Capitate
D) Triquetrum
Ans. B

51. MCQs
A 16 year old girl jump from a 4ft wall, she hit her wrist in
extended position while landing, now her radial side palmar
projection of wrist swollen and having pain during brushing teeth
and in wrist flexion. Which of the most likely muscle tendon injured
at radial site of wrist .
a) Flexor carpi radialis
b) Abductor digiti mini
c) Flexor pollicis brevis
d) Oppenens pollicis
Flexor carpi radialis

52. Clinical vignette
1. A 25 year old young man who fell from a height of 12
feet onto an extended, outstretched right hand. Plain
radiographs demonstrated classical signs as shown in
given images .
Q Name the classic sign which is seen in
radiograph?
Ans Spilt tea cup

53. Clinical vignette
2. A 15 years male patient came in orthopedics OPD with
a chief complain that he was not able to bent his
middle finger it remains straight , it happens sudden
when he was playing with his friends & trying to hold
collar of his friend’s T- shirt then sudden click sound
produced & from then he was not able to bend his
finger? What will be the clinical condition?
• Ans. Jersey finger

54. 3. Identify age of individual according to given
image
Ans More than 2 year
less than 8 year

55. REFERENCES
• Gray's Anatomy_ The Anatomical Basis of
Clinical Practice, 41e
• Thime Atlas of Anatomy
• Human Osteology and Skeletal Radiology_ An
Atlas and Guide by Carrie Allen