WRIST JOINT, CARPAL BONEs AND HAND by Shapi.pdf

ANATOMY
• GROSS ANATOMY
• UPPER LIMB
• WRIST JOINT AND HAND
• Dr. Chongo Shapi (BSc. HB, MBChB)
• Medical Doctor
17/11/22 Dr. Chongo Shapi, BSc. HB,MBChB. 1

INTRODUCTION
• Power grip
• Hook grip
• Precision handling grip
• pinching

FASCIA OF THE HAND

Fascial compartment of the hand

Applied anatomy
• Dupuytren
Contracture of
Palmar Fascia
• Hand infection

ELABORATES

ELABORATES CONT’

INTRODUCTION
• The wrist/hand region consists of 29 bones and
multiple joints - which lends to high mobility.
• Wrist:
– As a joint, it is the articulation between the forearm
and hand.
– Sometimes, the wrist is discussed as a region, which
would include the carpal bones.
• Hand
– The bones distal to the wrist joint.
– As a region, the wrist is part of the hand.

BONES
• 29 bones including:
– (2 from the forearm, 27 from the hand)
– distal aspect of the radius and ulna
– 8 carpal (bulk of the hand)
– 14 phalanges (the fingers)
– 5 metacarpals
– total: 2+8+14+5=29

BONES CONT’

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

Bones of the Wrist (Which hand? what
view?)

JOINTS
• Wrist Joint
– Classified as a Condyloid Joint
• Allows for flexion, extension, radial and ulnar deviation
• Remember, radius=thumb side
– The motion of the wrist is due to the articulation of the
radius and proximal carpal bones (or Radiocarpal joint).
– There is an articular disk between the distal aspect of the
ulna and triquetrum

JOINTS CONT
•Proximal and distal interphalangeal joints
–Fingers:
•Classified as ginglymus joints
•Allows for flexion and extension
–Thumb:
•consists of three joints, the first two are classified
as ginglymus joints
–metacarpophalangeal: g.j.
–interphalangeal: g.j.
–carpometacarpal: trapezium and metacarpal; saddle jt.

JOINTS AND ARTICULATING
BONES

LIGAMENTS OF THE WRIST JOINT
• Palmar radiocarpal ligaments
• Dorsal radiocarpal ligaments
• Ulnar collateral ligament
• Radial collateral ligament

ELABORATION

PALMAR RADIOCARPAL LIGAMENT
• Broad membranous band,
attached above to the
anterior margin of the lower
end of the radius, to its
styloid process, and 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, and some being
continued to the capitate.

DOSAL RADIOCARPAL LIGAMENT
• less thick and strong
than the palmer
ligament
• The ligament begins on
the radius
• its fibers are directed
downward and
medially, and are fixed,
below, to the dorsal
surfaces of the scaphoid
and lunate

ULNAR COLLATERAL LIGAMENT
• is a rounded cord.
• Attached above to the
end of the styloid
process of the ulna, and
dividing below into two
• One of which is
attached to the medial
side of the triquetrium
and pisiform

RADIAL COLLATERAL CARPAL
LIGAMENT
• The radial collateral
carpal ligament
• Attaches to the styloid
process of the radius
and the radial side of
the scaphoid bone.

TRANSVERSE CARPAL LIGAMENT
• AKA 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 and the median
nerve pass.

MUSCLES MOVING WRIST JOINT
• Flexion of the wrist is produced by the FCR and FCU, with
assistance from the flexors of the fingers and thumb, the
palmaris longus and the APL.
• Extension of the wrist is produced by the ECRL, ECRB, and
ECU, with assistance from the extensors of the fingers
and thumb.
• Abduction of the wrist is produced by the APL, FCR, ECRL,
and ECRB; it is limited to approximately 15Â° because of
the projecting radial styloid process.
• Adduction of the wrist is produced by simultaneous
contraction of the ECU and FCU.

ELABORATE

BLOOD SUPPLY AND INNERVATION
o Blood Supply of the Wrist Joint
• The arteries supplying the wrist joint are
branches of the dorsal and palmar carpal arches
o Innervation of the Wrist Joint
• The nerves to the wrist joint are derived from the
anterior interosseous branch of the median
nerve, the posterior interosseous branch of the
radial nerve, and the dorsal and deep branches of
the ulnar nerve

MUSCLES OF THE HAND
• The intrinsic muscles of the hand are located in five
compartments
• Thenar muscles in the thenar compartment: abductor pollicis
brevis, flexor pollicis brevis, and opponens pollicis.
• Adductor pollicis in the adductor compartment.
• Hypothenar muscles in the hypothenar compartment:
abductor digiti minimi, flexor digiti minimi brevis, and
opponens digiti minimi.
• Short muscles of the hand, the lumbricals, are in the central
compartment with the long flexor tendons.
• The interossei lie in separate interosseous compartments
between the metacarpals.

Hypothenar eminence
• Is the body of muscle
on the palm of the
human hand just
beneath the 5th
phalange
• Abductor digiti minimi
& Flexor digiti minimi
Opponens digiti minimi
• “OAF”

Thenar eminence
• Is the body of muscle
on the palm of the
human hand just
beneath the thumb.
• Abductor pollicis, Flexor
pollicis brevis,
Opponens pollicis,
Adductor pollicis
• “OA2F”

DEEP MUSCLES OF THE THENAR AND
HYPOTHENAR

Flexor Muscles/ Tendons
• The muscles that flex your
wrist are on the palmer
side.
• They share the flexors of
the forearm:
1. Flexor carpi radialis
2. Flexor digitorum
superficialis/ profundus
3. Flexor carpi ulnaris
4. Palmaris longus
5. Flexor digiti minimi brevis
6. Flexor pollicis brevis/ longus

THE TWO MUSCLES OF
PRONATION
• Two muscles work
together to turn the
radius over the ulna and
put the hand in a prone
position
• Pronator teres and
pronator quadratus

ABDUCTION AT THE HAND
• Abduction really only
occurs at the thumb
and little fingers
• Abductor digiti minimi
• Abductor pollicis brevis/
longus

ADDUCTION AT THE HAND
• Movement towards the
midline of the body
• Adductor pollicis

WRIST EXTENSORS
• The extensors of the
wrist are on the Dorsal
side of the forearm
• Extensor carpi radialis
brevis/ longus
• Extensor carpi ulnaris
• Extensor digiti minimi
• Extensor digitorum
• Extensor indicis
• Extensor brevis/ longus

SUPPINATION MUSCLES
• There are two muscles
that return you to the
anatomical position by
uncrossing the radius
and ulna
1. Biceps brachii
2. supinator

OPPOSITION
• The ability to touch
your thumb and pinky
1. Opponens digiti minimi
2. Opponens pollicis

WHAT IS A JOINT?
Joint – A point where bones
articulate

JOINT SHAPES
• Condyloid: Egg-shape
articular surface + oval
concavity
– side-to-side, back+forth
movement
– (eg)
metacarpophalangeal
(knuckle)

JOINT SHAPES CONT’
• Saddle: Articular
surface both concave +
convex
– side-to-side, back-forth
movement
– (eg) carpometacarpal jt
of thumb

HINGE JOINT
• In between the
Phalanges are Hinge
Joints
• They move in flexion
and extension

LIGAMENT/TENDON
• A Ligament attaches a
bone to bone
• An Injury to a Ligament
is called a Sprain
• A Tendon Attaches a
muscle to a bone
• An injury to a tendon or
Muscle is a strain

ELABORATE

COLLATERAL LIGAMENTS
• Collateral ligaments,
are found on either side
of each finger and
thumb joint.
• The function of the
collateral ligaments is to
prevent abnormal
sideways bending of
each joint.

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 and keeps
the PIP joint from
bending back too far
(hyperextending).

BLOOD SUPPLY

• The Three
Nerves of
the wrist
and hand

INNERVATION
The nerves to the wrist joint are derived from
• The anterior interosseous branch of the
median nerve,
• The posterior interosseous branch of the
radial nerve, and
• The dorsal and deep branches of the ulnar
nerve
• Ulnar Canal Syndrome (Guyon Tunnel Syndrome)
• Handlebar Neuropathy
• Radial Nerve Injury and the Hand

WRIST AND HAND INJURIES
• Fractures of the
Wrist and Hand
– Finger Fractures
• Scaphoid Fracture-
fracture of scaphoid
which you can
palpate in anatomical
snuffbox. Occurs
with fall on hand in
extension.

Wrist and Hand Injuries
Wrist Fractures
• Colles’s fracture- fracture of
the radius just above the wrist.
A result of a fall with wrist
extended.

TENDON INJURIES
• Mallet Finger- hitting
something with the
tip of a finger and
causing the extensor
tendon to tear.
• Jersey Finger-
grabbing something
and tearing the
flexor tendon

TENDON INJURIES
•Boutonniere deformity-
extensor tendon injury
affecting
two joints of the finger. It is
an injury to the central
tendon
on top of the finger.
–It may appear as a “jammed
finger” that cannot be
extended from the PIP joint.
–Treatment should be in an
extended position so the
tendon can heal

DISLOCATIONS/SUBLUXATIONS
•Dislocations occur in
the fingers and wrist
bones.
•Point tenderness and
swelling, possible
deformity.
•Physician
intervention
may be
necessary.

CLINICAL CORRELATE OF THE CARPAL
BONES AND THE WRIST JOINT
•FRACTURE OF THE DISTAL END OF RADIUS
•FRACTURE OF THE SCAPHOID
•ANTERIOR DISLOCATION OF THE LUNATE
Anterior dislocation of the lunate is an uncommon
but serious injury that usually results from a fall on
the dorsiflexed wrist. The lunate is pushed out of its
place in the floor of the carpal tunnel toward the
palmar surface of the wrist. The displaced lunate may
compress the median nerve and lead to carpal tunnel
syndrome. Because of its poor blood supply,
avascular necrosis of the lunate may occur.

COLLES FRACTURE
(Fracture of the distal end of radius)

FRACTURE OF THE SCAPHOID

FRACTURE OF THE HAMATE
• Fracture of the hamate may result in non-union
of the fractured bony parts because of the
traction produced by the attached muscles.
• Because the ulnar nerve is close to the hook of
the hamate, the nerve may be injured by this
fracture, causing decreased grip strength of the
hand.
• The ulnar artery may also be damaged when the
hamate is fractured.

Hand Injuries/Conditions
• Osteoarthritis
– Heberden’s nodes
– Bouchard’s nodes

Central Slip Extensor Tendon Injury
• Tender at dorsal aspect of
the PIP joint (middle
phalanx)
• Inability to actively extend
the
PIP joint
• Splint in full extension for 6
weeks
• Refer: Avulsion fracture
involving more than 30
percent of the joint or
inability to achieve full
passive extension

Boutonniere Deformity
• Can occur acutely, but
more often after several
weeks
• Extensor
tendon/Central slip
ruptures at PIP
• Lateral bands slip volar
and flex PIP, DIP extends

Extensor tendon injury-Mallet finger
• Tear or stretch of
extensor tendon prior
to insertion on distal
phalanx
• Exam: Soft tissue
swelling, lack of full
extension of DIPJ

Mallet finger
• X-ray may show lack of full extension with or without
a fracture of proximal aspect of distal phalanx
• Strict immobilization in full extension 6-8 weeks
• Consider surgery for fx > 30% of articular surface

Flexor tendon injury-Jersey finger
• Inability to actively flex
distal phalanx
• Ring finger most
commonly affected
– Protrudes further than
other fingers on grasping
• Forced extension of
actively flexed DIP joint
• Examples
– Football player grabs a
player's jersey on tackle
– Lifting latch on car door

Jersey Finger
• Avulsion of Flexor Digitorum Profundus (FDP)
as DIP is forcibly extended
• Can be seen with a laceration of the volar
aspect of the phalanx
• Tendon may retract to the PIP or as far as the
palm
• Surgical referral

Collateral Ligament Injury
• Maximal tenderness at involved collateral
ligament
• Test stability of joint while the finger is in 30
degrees of flexion and the MCP joint is flexed.
• Stable joint: buddy tape for two to four weeks.
Do not leave fifth digit exposed if ring finger is
taped.

THANK YOU!

WRIST JOINT, CARPAL BONEs AND HAND by Shapi.pdf

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