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Wrist & first carpometacarpal joint
Wrist joint
• Radiocarpal joint
• Bi-axial
• Type
• Synovial
• Variety
• Ellipsoid
Ellipsoid joints
• Characters
• Elliptical convex surface of one
bone articulates with
• Elliptical concave surface of
another
• Permit movements in two axes
• Combination of movements cause
circumduction
• e.g. wrist and atlanto-occipital
joints
Bones participating
• Above
• Inferior surface of lower end of radius
• Articular disc of inferior radio-ulnar joint
• Below
• Scaphoid, Lunate & Triquetral (L to M)
Articular surfaces
• Proximal articular surface
• Elliptical socket
• Distal articular surface of radius &
• Articular disc of distal radio-ulnar joint
• Distal articular surface
• Proximal surfaces of
• Scaphoid, Lunate & Triquetral
Ligaments
• Capsule
• Palmar ligaments
• Palmar radio carpal ligament
• Palmar ulno carpal ligament
• Dorsal radio carpal ligament
• Collateral ligaments
• Radial collateral
• Ulnar Collateral
Ligaments - Capsule
• Fibrous covering of the joint
• Attachment
• Proximally
• Articular margins of radius and ulna
• Distally
• Articular margins of proximal row of carpal
bones
• Synovial membrane
• Lines the internal surface of capsule
Palmar ligaments
• Palmar radio-carpal ligament
• Proximally
• Ant. margin of lower part of radius
• Distally
• Ant. Surface of scaphoid, lunate,
triquetral & capitate
• Palmar ulno-carpal ligament
• Proximally
• Ant. Margin of articular disc & styloid
process of ulna
• Distally
• Lunate & triquetral
Dorsal radio-carpal ligament
• Proximally
• Posterior margin of lower end of
radius
• Distally
• Dorsal surface of scaphoid, lunate &
triquetral bones
Collateral ligaments
• Radial collateral ligament
• From styloid process of radius
• To scaphoid & Trapezium
• Ulnar collateral ligament
• From styloid process of ulna
• To Triquetral & Pisiform
Relations - Anterior
• Superficial
• Flexor carpi radialis, Palmaris longus,
Flexor carpi ulnaris
• Deep
• Radial artery, Median nerve, Tendons of
Flexor digitorum superficialis, Ulnar
vessels & nerve
• Deepest
• Flexor pollicis longus, Anterior
interosseous vessels & nerve, Flexor
digitorum profundus
Relations - Posterior
• Extensor retinaculum
• 6 compartments for
• Lateral to medial
1. Abductor pollicis longus & Extensor pollicis
brevis
2. Extensor carpi radialis longus & brevis
3. Extensor pollicis longus
4. Extersor digitorum, Extensor indicis with
Posterior interosseous nerve & anterior
interosseous artery
5. Extensor digiti minimi
6. Extensor carpi ulnaris
• Anterior and posterior carpal arches
Relations – Medial & Lateral
• Medial
• Posterior cutaneous branch of ulnar nerve
• Lateral
• Radial artery
Arterial supply
• Palmar & dorsal carpal arches
Nerve supply
• Anterior and posterior
interosseous nerves
Movement of wrist joint
• Flexion
• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris longus
• Flexor digitorum superficialis
• Flexor digitorum profundus
• Flexor policis longus
• Extension
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor carpi ulnaris
• Extensor digitorum
• Extensor indicis
• Extensor pollicis longus
• Extensor digiti minimi
• Adduction
• Flexor carpi ulnaris
• Extensor carpi ulnaris
• Abduction
• Abductor pollicis longus
• Extensor pollicis longus
• Extensor pollicis brevis
• Flexor carpi radialis
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
Carpometacarpal Joint of the Thumb
• First carpometacarpal
• Multiaxial joint
• Synovial joint
• Saddle variety
Saddle (sellar) joints
• Articular surfaces are reciprocally
saddle haped
• i.e. concavo-convex
• Allows a wide range of movement
• e.g. first carpo-metacarpal, sterno-
clavicular, incudo-malleolar joints
• Minimal osseous stability
• Rely on static ligaments
Articular surfaces
• Proximally
• Distal surface of Trapezium
• Distally
• Proximal surface of base of 1st
metacarpal
Ligaments
• Capsule
• Lateral ligament
• Anterior ligament
• Posterior ligament
Capsule
• Loosely arranged
• Attachment
• Proximally
• Trapezium
• Distally
• Base of first metacarpal bone
• Synovial membrane
• Lined inner surface of capsule
Lateral ligament
• Proximally
• Lateral surface of trapezium
• Distally
• Lateral side of base of 1st metacarpal
Anterior ligament
• Obliquely placed
• Proximally
• Palmar surface of trapezium
• Distally
• Ulnar side of base of 1st metacarpal
Posterior ligament
• Obliquely placed
• Proximally
• Dorsal surface of trapezium
• Dorsally
• Ulnar side of base of 1st metacarpal
Relations
• Posteromedial side
• Radial artery
• Medial side
• First dorsal interosseous muscle
Blood supply
• Radial artery
Nerve supply
• Median nerve
Anatomical position of the thumb
• At a right angle with palm and with
other fingers
Thumb - Movements
• Flexion
• Extension
• Abduction
• Adduction
• Opposition
Muscles producing movements
• Flexion
• Flexor pollicis brevis
• Opponens pollicis
• Extension
• Extensor pollicis longus and brevis
• Abduction
• Abductor pollicis longus and extensor pollicis brevis
• Adduction
• Adductor pollicis
• Opposition
• Opponens pollicis
Wrist & I carpometacarpal.pptx

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Wrist & I carpometacarpal.pptx

  • 1. Wrist & first carpometacarpal joint
  • 2. Wrist joint • Radiocarpal joint • Bi-axial • Type • Synovial • Variety • Ellipsoid
  • 3. Ellipsoid joints • Characters • Elliptical convex surface of one bone articulates with • Elliptical concave surface of another • Permit movements in two axes • Combination of movements cause circumduction • e.g. wrist and atlanto-occipital joints
  • 4. Bones participating • Above • Inferior surface of lower end of radius • Articular disc of inferior radio-ulnar joint • Below • Scaphoid, Lunate & Triquetral (L to M)
  • 5. Articular surfaces • Proximal articular surface • Elliptical socket • Distal articular surface of radius & • Articular disc of distal radio-ulnar joint • Distal articular surface • Proximal surfaces of • Scaphoid, Lunate & Triquetral
  • 6. Ligaments • Capsule • Palmar ligaments • Palmar radio carpal ligament • Palmar ulno carpal ligament • Dorsal radio carpal ligament • Collateral ligaments • Radial collateral • Ulnar Collateral
  • 7. Ligaments - Capsule • Fibrous covering of the joint • Attachment • Proximally • Articular margins of radius and ulna • Distally • Articular margins of proximal row of carpal bones • Synovial membrane • Lines the internal surface of capsule
  • 8. Palmar ligaments • Palmar radio-carpal ligament • Proximally • Ant. margin of lower part of radius • Distally • Ant. Surface of scaphoid, lunate, triquetral & capitate • Palmar ulno-carpal ligament • Proximally • Ant. Margin of articular disc & styloid process of ulna • Distally • Lunate & triquetral
  • 9. Dorsal radio-carpal ligament • Proximally • Posterior margin of lower end of radius • Distally • Dorsal surface of scaphoid, lunate & triquetral bones
  • 10. Collateral ligaments • Radial collateral ligament • From styloid process of radius • To scaphoid & Trapezium • Ulnar collateral ligament • From styloid process of ulna • To Triquetral & Pisiform
  • 11. Relations - Anterior • Superficial • Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris • Deep • Radial artery, Median nerve, Tendons of Flexor digitorum superficialis, Ulnar vessels & nerve • Deepest • Flexor pollicis longus, Anterior interosseous vessels & nerve, Flexor digitorum profundus
  • 12. Relations - Posterior • Extensor retinaculum • 6 compartments for • Lateral to medial 1. Abductor pollicis longus & Extensor pollicis brevis 2. Extensor carpi radialis longus & brevis 3. Extensor pollicis longus 4. Extersor digitorum, Extensor indicis with Posterior interosseous nerve & anterior interosseous artery 5. Extensor digiti minimi 6. Extensor carpi ulnaris • Anterior and posterior carpal arches
  • 13. Relations – Medial & Lateral • Medial • Posterior cutaneous branch of ulnar nerve • Lateral • Radial artery
  • 14. Arterial supply • Palmar & dorsal carpal arches
  • 15. Nerve supply • Anterior and posterior interosseous nerves
  • 16. Movement of wrist joint • Flexion • Flexor carpi radialis • Flexor carpi ulnaris • Palmaris longus • Flexor digitorum superficialis • Flexor digitorum profundus • Flexor policis longus • Extension • Extensor carpi radialis longus • Extensor carpi radialis brevis • Extensor carpi ulnaris • Extensor digitorum • Extensor indicis • Extensor pollicis longus • Extensor digiti minimi • Adduction • Flexor carpi ulnaris • Extensor carpi ulnaris • Abduction • Abductor pollicis longus • Extensor pollicis longus • Extensor pollicis brevis • Flexor carpi radialis • Extensor carpi radialis longus • Extensor carpi radialis brevis
  • 17. Carpometacarpal Joint of the Thumb • First carpometacarpal • Multiaxial joint • Synovial joint • Saddle variety
  • 18. Saddle (sellar) joints • Articular surfaces are reciprocally saddle haped • i.e. concavo-convex • Allows a wide range of movement • e.g. first carpo-metacarpal, sterno- clavicular, incudo-malleolar joints • Minimal osseous stability • Rely on static ligaments
  • 19. Articular surfaces • Proximally • Distal surface of Trapezium • Distally • Proximal surface of base of 1st metacarpal
  • 20. Ligaments • Capsule • Lateral ligament • Anterior ligament • Posterior ligament
  • 21. Capsule • Loosely arranged • Attachment • Proximally • Trapezium • Distally • Base of first metacarpal bone • Synovial membrane • Lined inner surface of capsule
  • 22. Lateral ligament • Proximally • Lateral surface of trapezium • Distally • Lateral side of base of 1st metacarpal
  • 23. Anterior ligament • Obliquely placed • Proximally • Palmar surface of trapezium • Distally • Ulnar side of base of 1st metacarpal
  • 24. Posterior ligament • Obliquely placed • Proximally • Dorsal surface of trapezium • Dorsally • Ulnar side of base of 1st metacarpal
  • 25. Relations • Posteromedial side • Radial artery • Medial side • First dorsal interosseous muscle
  • 28. Anatomical position of the thumb • At a right angle with palm and with other fingers
  • 29. Thumb - Movements • Flexion • Extension • Abduction • Adduction • Opposition
  • 30. Muscles producing movements • Flexion • Flexor pollicis brevis • Opponens pollicis • Extension • Extensor pollicis longus and brevis • Abduction • Abductor pollicis longus and extensor pollicis brevis • Adduction • Adductor pollicis • Opposition • Opponens pollicis