Wrist and Hand Anatomy

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1 Wrist and Hand Anatomy

2 Bone Anatomy Scapoid Lunate Triquetrium Pisiform Trapeziod Trapezium Capitate Hamate

3 Wrist Articulations Radiocarpal Joint Proximal portion Distal portion Most surface contact found

4 Articulations Midcarpal Joint Articulation between proximal and distal row of carpals Not an uninterupted joint Distal Row 2 degrees of freedom Moves as a fixed unit

5 Ligament Support Volar Carpal Ligaments Volar Radiocarpal Ligament Three bands Volar Ulnocarpal Ligament Scapholunate Interosseous Ligament Lunotriquetral Ligament

6 Ligament Support Dorsal Carpal Ligaments Dorsal Radiocarpal Ligament Dorsal Intercarpal Ligament Radial Collateral Ligament Ulnar Collateral Ligament

7 Triangular Fibrcartilage Complex Composition Role

8 Hand

9 Carpometacarpal (CMC) Joints of 2-52 Composition Carpal Arch

10 Carpometacarpal (CMC) Joints of 2-52 Composition Carpal Arch Ligament Support Transverse Carpal Ligament Dorsal and Palmar CMC Ligaments Dorsal and Palmar Metacarpal Ligaments Metacarpal Interosseous Ligaments

11 Carpometacarpal (CMC) Joints of 2-52 Composition Carpal Arch Ligament Support Transverse Carpal Ligament Dorsal and Palmar CMC Ligaments Dorsal and Palmar Metacarpal Ligaments Metacarpal Interosseous Ligaments Movement of CMC Joints

12 Metacarpophalangeal (MCP) Joints Ligament Support Capsule Volar Plate Collateral Ligaments Motions of Fingers

13 Interphalangeal Joints of Fingers Hinge Joints Motions

14 Thumb

15 CMC of Thumb Saddle Joint Ligament Support Capsule Intermetacarpal Ligament

16 MCP of Thumb Ligament Support IP Joint of Thumb

17 Extrinsic Hand Muscles

18

19 Extensor Indicis O I N F Dorsal surface lower ½ body of ulna Interosseus membrane Ulnar side of index finger s EDC tendon Radial (posterior interosseus) MCP and IP Ext of 2 nd digit

20 Extensor Pollicis Longus O I N F Posterior 1/3 ulna Interosseus membrane Posterior surface of base of thumb distal phalanx Radial (posterior interosseus) CMC, MCP and IP Ext of 1 st digit

21 Extensor Pollicis Brevis O I N F Dorsal 2/3 of radius Dorsal surface of base of proximal 1 st phalanx Radial (posterior interosseus) CMC & MCP Ext of thumb CMC ABD of thumb

22 Abductor Pollicis Longus O I N F Posterior distal 2/3 of ulna Posterior middle 1/3 of radius Interosseus membrane Radial side of base of 1 st metacarpal Radial (posterior interosseus) CMC ABD & Ext of thumb

23 Flexor Pollicis Longus O I N F Anterior middle ½ of radius Interosseus membrane Palmar surface of base of distal 1 st phalanx Median (anterior interosseus) IP Flexion of thumb

24 Extensor Digiti Minimi O I N F Lateral epicondyle of humerus Extensor expansion of 5 th digit Radial (posteior( interosseus) MCP and IP extension of 5 th digit

25 Flexor Digitorum Superficialis O I Medial epicondyle of humerus Coronoid process Middle ½ anterior radius Four tendons separating into two parts that insert into sides of bases of middle 2-52 phalanxes N Median F MCP flexion digits 2-52 PIP flexion digits 2-52

26 Flexor Digitorum Profundus O I N F Anteriomedial surface of ulna Interosseus membrane Four tendons inserting into distal phalanxes of digits 2-52 Media digits Ulna digits DIP flexion of digits

27 Intrinsic Hand Muscles Thenar Eminance

28 Abductor Pollicis Brevis O I N F Scaphoid tuberosity Trapezium ridge Transverse carpal ligament Lateral base f proximal 1 st phalanx Median CMC & MCP ABD of thumb

29 Flexor Pollicis Brevis O I N F Superficial head trapezium Deep head trapezoid, capitate and palmar ligaments of distal carpal bones Base of prximal 1 st phalanx on radial side Extensor expansion Superficial median Deep Ulnar CMC & MCP Flexion of thumb

30 Opponens Pollicis O I Trapezium Transverse Carpal Ligament Radial side of 1 st metacarpal shaft N Median F Opposition

31 Intrinsic Hand Muscles Hypothenar Eminence

32 Abductor Digiti Minimi O I N F Pisiform Ulnar side base of 5 th proximal phalanx Ulnar MCP ABD of 5 th digit

33 Opponen Digiti Minimi O I N Hook of hamate Transverse carpal ligament Ulnar border of entire 5 th metacarpal bone Ulnar F MCP flexion & rotation of 5 th digit

34 Flexor Digiti Minimi O I Hamate bone Transverse carpal ligament Ulnar side of proximal 5 th phalanx N Ulnar F MCP Flexion of 5 th digit

35 Other Intrinsic Hand Muscles

36 Adductor Pollicis O I Oblique Head Capitate bone Bases of metacarpals Transverse Head Proximal 2/3 of palmar surface of 3 rd metacarpal Ulnar side of base of 1 st proximal phalanx N Ulnar F CMC ADD of thumb

37 Palmar Interossei O I 1 st ulnar side base of 1 st metacarpal bone 2 nd ulnar side of 2 nd MC bone 3 rd radial side of 4 th MC bone 4 th radia side of 5 th MC bone Extensor expansion of 2,4 and 5 th digits N Ulnar F ADD of 1 st, 2 nd, 4 th and 5 th digits toward midline of hand

38 O I Dorsal Interossei 1 st lateral head ulnar side of 1 st metacarpal bone 1 st medial head radial side of 2 nd metacarpal bone 2 nd, 3 rd, 4 th space between metacarpal bones 1 st radial side 2 nd proximal phalanx 2 nd radial side of 3 rd 3 rd ilnar side of 3 rd 4 th ulnar side of 4 th N Ulnar F ABD of 2 nd, 3 rd, and 5 th finger from midline

39 Lumbricales O I N F Tendons of FDP Extensor expansion on dorsal aspect of each digits radial side 1 and 2 median 3 and 4 ulnar MCP flexion digits DIP & PIP ext digits

40 Palmaris Brevis O Flexor retinaculum I Palmar surface skin on ulnar side of hand N Ulnar F Wrinkles skin of hand on ulnar side

41 Biomechanics of Hand

42 Biomechanics of Finger Flexion Gliding mechanisms Retinaculae Ligaments Bursa Digital tendon sheaths Annular Pulleys A1-A5 A5 Cruciate Ligaments C1-C3 C3 Function of Pulleys

43 Biomechanics of Finger Extension Extensor Hood EDC tendons DI and PI tendons Lumbricales Central tendon Oblique Retinacular Ligaments Sagittal Bands Effects on MCP joints Effects on IP Joints

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