Kinesiology of The Wrist and Hand. Cuneyt Mirzanli Istanbul Gelisim University
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1 Kinesiology of The Wrist and Hand Cuneyt Mirzanli Istanbul Gelisim University
2 Bones The wrist and hand contain 29 bones including the radius and ulna. There are eight carpal bones in two rows of four to form the wrist: the scaphoid, lunate, triquetrum, and pisiform form the proximal row, and the trapezium, trapezoid, capitate, and hamate form the distal row. 2
3 3
4 Bones There are five metacarpal bones that join the wrist and provide a joint for the phalanxes. There are 14 phalanxes, 3 for each phalange and 2 for the thumb. 4
5 5
6 Bones The medial and lateral epicondyles of the humerus are common origin sites for the flexors and extensors of the hand and wrist. 6
7 Joints The wrist joint is classified as a condyloid-type joint, which enables movement in two planes, allowing flexion, extension, abduction and adduction. 7
8 8
9 Joints 9
10 Joints Each finger has three joints. The metacarpophalangeal (MCP) joint is a condyloid joint (knuckle). The next joint is the proximal interphalangeal (PIP) joint and is a ginglymus joint. 10
11 Joints At the end of the finger is the distal interphalangeal (DIP) joint that is a ginglymus joint also. The carpometacarpal (CMC) joint of the thumb is a saddle-type joint that allows opposition which is unique to humans. 11
12 Joints Finger Joints and Ligaments 12
13 13
14 14
15 Movements 15
16 Movements 16
17 Movements 17
18 Muscles Three wrist flexors are flexor carpi radialis, flexor carpi ulnaris and palmaris longus flex the wrist. The wrist extensors are extensor carpi radialis longus, extensor carpi radialis brevis and extensor carpi ulnaris. 18
19 Muscles Nine muscles function the phalanges. The flexor digitorum superficialis, flexor digitorum profundus and flexor pollicis longus are finger flexors. The extensor digitorum, extensor indicis and extensor digiti minimi are finger extensors. 19
20 Muscles The extensor pollicis longus and extensor pollicis brevis extend the thumb. The abductor pollicis longus abducts the thumb. 20
21 Muscles 21
22 Muscles 22
23 Muscles 23
24 Nerves The muscles of the wrist and hand are all innervated from the radial, median and ulnar nerves of the brachial plexus. 24
25 Nerves The carpal tunnel houses the median nerve on the palmar side of the hand, above the flexor tendons and just beneath the flexor retinaculum. 25
26 26
27 Individual Muscles of the Wrist and Hand- Flexors Palmaris longus 27
28 Individual Muscles of the Wrist and Hand- Flexors (cont.) Palmaris longus 28
29 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor carpi radialis 29
30 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor carpi radialis 30
31 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor carpi ulnaris 31
32 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor carpi ulnaris 32
33 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor digitorum superficialis 33
34 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor digitorum superficialis 34
35 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor digitorum profundus 35
36 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor digitorum profundus 36
37 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor pollicis longus 37
38 Individual Muscles of the Wrist and Hand- Flexors (cont.) Flexor pollicis longus 38
39 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor carpi ulnaris 39
40 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor carpi ulnaris 40
41 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor carpi radialis brevis 41
42 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor carpi radialis brevis 42
43 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor carpi radialis longus 43
44 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor carpi radialis longus 44
45 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor digitorum 45
46 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor digitorum 46
47 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor indicis 47
48 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor indicis 48
49 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor digiti minimi 49
50 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor digiti minimi 50
51 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor pollicis longus 51
52 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor pollicis longus 52
53 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor pollicis brevis 53
54 Individual Muscles of the Wrist and Hand- Extensors (cont.) Extensor pollicis brevis 54
55 Individual Muscles of the Wrist and Hand- Extensors (cont.) Abductor pollicis longus 55
56 Individual Muscles of the Wrist and Hand- Extensors (cont.) Abductor pollicis longus 56
57 Intrinsic Muscles of the Hand Muscles acting on the hand can be divided into two groups: extrinsic and intrinsic muscles. The extrinsic muscles are located in the anterior and posterior compartments of the forearm. They control crude movements and produce a forceful grip. The intrinsic muscles of the hand are located within the hand itself. They are responsible for the fine motor functions of the hand.
58 Intrinsic Muscles of the Hand 58
59 Thenar Intrinsic Muscles Opponens Pollicis Abductor Pollicis Brevis Flexor Pollicis Brevis
60 Hypothenar Intrinsic Muscles Opponens Digiti Minimi Abductor Digiti Minimi Flexor Digiti Minimi Brevis
61 Lumbricals There are four lumbricals in the hand, each associated with a finger. They are very crucial to finger movement, linking the extensor tendons to the flexor tendons. They flex the MCP joint, and extend the interphalangeal (IP) joints of each finger.
62
63 Interossei The interossei muscles are located between the metacarpals. They can be divided into two groups: the dorsal and palmar interossei. They abduct and adduct the fingers.
64
65 Wrist and Hand Injuries Fractures of the Wrist and Hand Scaphoid Fracture - fracture of scaphoid which you call palpate in anatomical snuffbox. Occurs with fall on hand in extension. 65
66 Scaphoid bone palpation It can be palpated in the anatomical snuff box. 66
67 Colles s fracture- fracture of the Radius just above the wrist. A result of a fall with wrist extended. 67
68 Tendon Injuries Mallet Finger- hitting something with the tip of a finger and causing the extensor tendon to tear. 68
69 Jersey Finger- grabbing something and tearing the flexor tendon. (so called because it often occurs in athletes who have grasped the sporting jersey of an opponent.)
70
71 Boutonniere deformity - Extensor tendon injury affecting two joints of the finger. It is an injury to the central tendon on top of the finger. Finger cannot be extended from the PIP joint. 71
72 Dislocations/Subluxations Dislocations occur in the fingers and wrist bones. Point tenderness and swelling, possible deformity. 72
73
74
75 Hand Functions-Hand Grips Power grip is when an object needs to be held forcefully and then moved by more proximal muscles. Precision Grip is when an object is manipulated with fingers. 75
76 Power grip is when an object needs to be held forcefully and then moved by more proximal muscles. 76
77 Precision grip is when an object is manipulated with fingers. 77
78
79 79
80 Power grips: Cylindrical grip: Fingers flexed around an object, thumb on one side fingers on other side. 80
81 Spherical grip: fingers and thumb are together around an object. Like grabbing a spherical object. 81
82 Hook grip: involves the second through fifth fingers flexed around an object in a hook like manner. Thumb is extended and not involved. Only possible grip for someone with no thumb or median nerve ability. 82
83 Precision Grips: Pinch Grip: the thumb and one finger gripping. 83
84 Three jaw chuck: holding a pencil, three fingers and thumb. Holding an object with an opposed thumb and the index and middle fingers where the interphalangeal joints are slightly flexed. 84
85 Lumbrical grip or plate grip: the MCP and PIP joint flexed and the DIP extended. The thumb opposed and this grip is used to hold something horizontal like a plate. 85
86 86
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