Anatomy Unit 8: Wrist

Lippert CH 12, Moore CH 3 (149-150, 241-262, 276-282), Clarkson CH 5

The Wrist Lecture:

1. Recognize the joints and primary ligaments that comprise the wrist joint.
● Wrist is complex and helps us maintain our hand position, it provides control and stability. Ulna
is not considered part of the wrist. No rotation at the wrist (that occurs at elbow)
● Made up of two joints:
− Radiocarpal joint: distal end of radius, radioulnar disk, scaphoid, lunate, and triquetrum
Biaxial, condyloid joint
Wrist flexion and wrist extension (sagittal plane around frontal axis), wrist abduction or
radial deviation (hard) and wrist adduction or ulnar deviation (frontal plane around
sagittal axis), circumduction (combo of all 4 of these movements)
End feel for these is firm except radial deviation which is hard
− Midcarpal joint: located between the two rows of carpal bones
Intercarpal joints: located between the carpal bones in each individual row.
Both joints are irregular, nonaxial plane joints. Allow for gliding motions which
contribute to motion of the wrist
● Radius bony landmarks: Head is proximal
− Styloid process: tip at bottom of radius. Brachioradialis attaches here
● Ulna bony landmarks: Head is distal
− Styloid process: tip at bottom of ulna
● Medial epicondyle- distal medial side of humerus. Attachment for common flexor tendon
● Lateral epicondyle- distal lateral side of humerus. Attachment for common extensor tendon
● Lateral supracondylar ridge- proximal to lateral epicondyle. Attachment for extensor carpi
radialis longus
● Carpal bones:
− Thumb side of proximal row:
Scaphoid with tubercle
Lunate
Triquetrum with Pisiform on top
− Distal row:
Trapezium with tubercle
Trapezoid
Capitate
Hamate bone and Hook of Hamate: projection on anterior surface of hamate, providing
attachment for the transverse carpal ligament
● 4 ligaments of the radiocarpal joint that provide support of the wrist:
− Radial collateral ligament: attaches to styloid process of radius and scaphoid and
trapezium bones. Provides lateral support
 − Ulnar collateral ligament: attaches to styloid process of ulna and to pisiform and
triquetrum. Provide medial support
− Palmar radiocarpal ligament: thick, tough. Becomes taut in extension, limiting wrist
extension. Broad band that attaches from anterior surface of distal radius and ulna to
the anterior surface of the proximal carpal bones and to the capitate bone. More apt to
being stretched or sprained.
− Dorsal radiocarpal ligament: attaches form posterior surface of distal radius to same
surface of scaphoid, lunate, and triquetrum. Becomes taut in flexion, limiting the
amount of flexion allowed at wrist. Not as strong as palmar radiocarpal ligament
− Joint capsule: encloses radiocarpal joint. Reinforced by radial and ulnar collateral
ligaments and by the palmar and dorsal radiocarpal ligaments.
− Articular disk: located on distal end of ulna and articulates triquetrum and lunate. Shock
absorber and filler between distal ulna and carpal bones (triquetrum and lunate). Fills
the gap created because the ulna and its styloid process do not extend as far distally as
the radius and its styloid process
− Palmar aponeurosis: thick, triangular fascia located superficially in the palm of the hand.
Covers the tendons of the extrinsic muscles and provides some protection to the
structures in the palm. It is the distal attachment of the palmaris longus.
● Tendons:
− Common Flexor Tendon: single tendon that originates on medial epicondyle of humerus.
Gives rise to many muscles that are prime movers for flexion.
− Common Extensor Tendon: originates on lateral epicondyle. Gives rise to many muscles
that are prime movers for either wrist or finger extension.
● Wrist flexion: both flexor carpi ulnaris and flexor carpi radialis at same time
Also palmaris longus does wrist flexion. They all originate from medial epicondyle of humerus
● Radial deviation: flexor carpi ulnaris and extensor carpi ulnaris at same time
● Muscles that move the wrist come from above the wrist, crosses the wrist, to below the wrist
● Anterior muscles: flexion
● Flexor Carpi Ulnaris
● Flexor Carpi Radialis
● Palmaris Longus: absent in about 18% of the population
● Radial deviation/wrist abduction: flexor carpi radialis and extensor carpi radialis brevis and
longus
● Ulnar deviation/wrist adduction: flexor carpi ulnaris and extensor carpi ulnaris
● Posterior muscles: extension
● Extensor carpi radialis longus: ECRL
● Extensor carpi radialis brevis
● Extensor carpi ulnaris
● Pronator Quadratus: distal 4th of radius and distal 4th of ulna
● Know anatomical relationships between the muscles and bones
● Summary of Muscle Action:
Action Muscles (Prime Movers

Flexion Flexor Carpi radialis, flexor carpi ulnaris

Extension Extensor carpi radialis longus and brevis, extensor

carpi ulnaris

Radial Deviation Flexor carpi radialis, Extensor carpi radialis longus

Ulnar Deviation Flexor Carpi ulnaris, Extensor Carpi Ulnaris

● Summary of Innervation of Muscles of Wrist:

Muscle Nerve Spinal Segment

Extensor Carpi Radialis Longus Radial C6, C7

Extensor Carpi Radialis Brevis Radial C6. C7

Extensor Carpi Ulnaris Radial C6, C7, C8

Flexor Carpi Radialis Median C6, C7

Palmaris Longus Median C6, C7

Flexor Carpi Ulnaris ulnar C8, T1

● Segmental Innervation of Wrist Joint:

C6 C7 C8 T1

Extensor Carpi X X
Radialis Longus

Extensor Carpi X X
Radialis Brevis

Extensor Carpi X X X
Ulnaris

Palmaris Longus X X

Flexor Carpi X X
Radialis

Flexor Carpi X X
Ulnaris
● Identify wrist positions, actions, and muscle groups for: putting on mascara, shaving face,
opening a jar, brushing teeth, doing hair
● Difficulty putting in contacts: what muscles involved, other ADLs/IADLs might have difficulty
with, what nerve or spinal segment could be involved?
● Common wrist pathologies:
● Colles Fracture- break/transverse fracture in distal radius at the level of the metaphysis and is a
common injury in the elderly. Includes a posterior displacement of distal fragment.
● Smith’s fracture- distal fragment is displaced anteriorly (reverse Colles) and is caused by a fall on
the back on the hand. “Greenstick” fracture is an incomplete fracture of the radius and it is
more proximal than a Colles fracture. More common in children.
● Scaphoid fracture- associated with damage to the blood vessel which can lead to avascular
necrosis or death of bone tissue
● Ganglion cyst- benign, fluid-filled cyst commonly seen as a bump on dorsal surface of wrist.
● Wrist sprains- common when falling on outstretched hand. Hyperextended when it hits the
ground.