Carpal bones

Labelled image showing the eight carpal bones

Latin os carpale
pl. ossa
carpi

The carpal bones are the eight small bones that make up the wrist (or carpus) that connects
the hand to the forearm. The term "carpus" is derived from the Latin carpus and
the Greek καρπός (karpós), meaning "wrist". In human anatomy, the main role of the wrist is
to facilitate effective positioning of the hand and powerful use of the extensors and flexors of
the forearm, and the mobility of individual carpal bones increase the freedom of movements
at the wrist.[1]
In tetrapods, the carpus is the sole cluster of bones in the wrist between
the radius and ulna and the metacarpus. The bones of the carpus do not belong to
individual fingers (or toes in quadrupeds), whereas those of the metacarpus do. The
corresponding part of the foot is the tarsus. The carpal bones allow the wrist to move and
rotate vertically.[1]

Structure
Bones
The eight carpal bones may be conceptually organized as either two transverse rows, or three
longitudinal columns.
When considered as paired rows, each row forms an arch which is convex proximally and
concave distally. On the palmar side, the carpus is concave and forms the carpal tunnel,
which is covered by the flexor retinaculum.[2] The proximal row (comprising scaphoid,
lunate, triquetrum and psiform) articulates with the surfaces of the radius and distal carpal
row, and thus constantly adapts to these mobile surfaces. Within the proximal row, each
carpal bone has slight independent mobility. For example, the scaphoid contributes to
midcarpal stability by articulating distally with the trapezium and the trapezoid. In contrast,
the distal row is more rigid as its transverse arch moves with the metacarpals.[3]
Biomechanically and clinically, the carpal bones are better conceptualized as three
longitudinal columns:[4]

1. Radial scaphoid column: scaphoid, trapezium, and trapezoid

2. Lunate column: lunate and capitate
3. Ulnar triquetral column: triquetrum and hamate
In this context the pisiform is regarded as a sesamoid bone embedded in the tendon of
the flexor carpi ulnaris.[4] The ulnar column leaves a gap between the ulna and the triquetrum,
and therefore, only the radial or scaphoid and central or capitate columns articulate with the
radius. The wrist is more stable in flexion than in extension more because of the strength of
various capsules and ligaments than the interlocking parts of the skeleton.[3]
Almost all carpals (except the pisiform) have six surfaces. Of these
the palmar or anterior and the dorsal or posterior surfaces are rough, for ligamentous
attachment; the dorsal surfaces being the broader, except in the lunate.
The superior or proximal, and inferior or distal surfaces are articular, the superior generally
convex, the inferior concave; the medial and lateral surfaces are also articular where they are
in contact with contiguous bones, otherwise they are rough and tuberculated.
The structure in all is similar: cancellous tissue enclosed in a layer of compact bone.

Carpal bones and their articulations. Carpal bones are shown in violet. Human left hand,
anterior (palmar) view.
Joints

What each carpal bone joints to[5]

Proximal/radial Lateral/medial Distal/metacarpal

Name
articulations articulations articulations

Proximal row

Scaphoid radius capitate, lunate trapezium, trapezoid

radius, articular scaphoid,

Lunate capitate, hamate (sometimes)
disk triquetral

Triquetru
articular disk lunate, pisiform hamate
m

Pisiform triquetral

Distal row

Trapezium scaphoid trapezoid first and second metacarpal

trapezium,
Trapezoid scaphoid second metacarpal
capitate

trapezoid, third, partly second

Capitate scaphoid, lunate
hamate and fourth metacarpal

Hamate triquetral, lunate capitate fourth and fifth

Trapezium (bone)
For other uses, see Trapezium (disambiguation).

The
left trapezium bone ("navicular" refers to scaphoid, "lesser multangular" refers to
trapezoid)
Left hand anterior view (palmar view). Trapezium shown in red.
Articulations 1st metacarpal distally
scaphoid proximally
trapezoid medially
2nd metacarpal medially
The trapezium bone (greater multangular bone) is a carpal bone in the hand. It forms
the radial border of the carpal tunnel.

Structure
The trapezium is distinguished by a deep groove on its anterior surface. It is situated at the
radial side of the carpus, between the scaphoid and the first metacarpal bone (the metacarpal
bone of the thumb). It is homologous with the first distal carpal of reptiles and amphibians.

Surfaces
The trapezium is an irregular-shaped carpal bone found within the hand. The trapezium is
found within the distal row of carpal bones, and is directly adjacent to the metacarpal bone of
the thumb. On its ulnar surface are found the trapezoid and scaphoid bones.[1]: 708

The superior surface is directed upward and medialward; medially it is smooth, and
articulates with the scaphoid; laterally it is rough and continuous with the lateral surface.

The inferior surface is oval, concave from side to side, convex from before backward, so as
to form a saddle-shaped surface for articulation with the base of the first metacarpal bone.
This saddle-shaped articulation is partially responsible for the thumb's opposable motion.

The dorsal surface is smooth.

The palmar surface is narrow and rough. At its upper part is a deep groove, running from
above obliquely downward and medialward; it transmits the tendon of the Flexor carpi
radialis, and is bounded laterally by an oblique ridge. This surface gives origin to
the Opponens pollicis and to the Abductor and Flexor pollicis brevis; it also affords
attachment to the transverse carpal ligament.

The lateral surface is broad and rough, for the attachment of ligaments.

The medial surface presents two facets; the upper, large and concave, articulates with
the trapezoid bone; the lower, small and oval, with the base of the second metacarpal.

Tubercle of trapezium
The tubercle of trapezium is a tubercle found on the anterior surface of the bone.[1]: 708 It is
where sometimes abductor pollicis brevis muscle attaches.

Function
The carpal bones function as a unit to provide a bony superstructure for the hand. The
trapezium is the most radial of the bones surrounding the carpal tunnel.[1]: 708 It is important in
thumb movement.[2]

Clinical relevance
The trapezium is susceptible to arthritis at the joint with the metacarpal bone of the thumb,
due to overuse.[2]

History
The etymology derives from the Greek trapezion which means "a little table",
from trapeza meaning "table", itself from (te)tra- "four" and pod- "foot". The bone was first
documented in 1840.[

Trapezoid bone
The left trapezoid bone.

Left hand anterior view (palmar view). Trapezoid bone shown in red

Articulations articulates with four bones:

scaphoid proximally
second metacarpal distally The trapezoid bone (lesser
trapezium bone laterally multangular bone) is a carpal
capitate medially bone in tetrapods, including humans.
It is the smallest bone in the distal row of carpal bones that give structure to the palm of the
hand. It may be known by its wedge-shaped form, the broad end of the wedge constituting
the dorsal, the narrow end the palmar surface; and by its having four articular facets touching
each other, and separated by sharp edges. It is homologous with the "second distal carpal" of
reptiles and amphibians.

Structure
The trapezoid is a four-sided carpal bone found within the hand. The trapezoid is found
within the distal row of carpal bones.
Surfaces
The superior surface, quadrilateral, smooth, and slightly concave, articulates with
the scaphoid.
The inferior surface articulates with the proximal end of the second metacarpal bone; it is
convex from side to side, concave from before backward and subdivided by an elevated ridge
into two unequal facets.
The dorsal and palmar surfaces are rough for the attachment of ligaments, the former being
the larger of the two.
The lateral surface, convex and smooth, articulates with the trapezium.
The medial surface is concave and smooth in front, for articulation with the capitate; rough
behind, for the attachment of an interosseous ligament.

Function
The carpal bones function as a unit to provide a bony superstructure for the hand.

Clinical Significance
Isolated fractures of the trapezoid are rare, representing 0.4% of the total, thus being the least
common of all carpal fractures. This is due to the bone being in a fairly protected position.
Distally, it forms a stable, relatively immobile joint with the second metacarpal, radially and
proximally it forms strong ligaments with the trapezium and the capitate ulnarly, scaphoid
respectively.
However, injury can occur through axial force applied to the second metacarpal base.
Subluxations, such as ones caused by delivering a blow, are not uncommon. Direct trauma to
the bone can also cause fracture.
Due to its rarity, standard treatment has not been established. A wide range of treatments are
possible, including rest, surgery and casting.

History
The etymology derives from the Greek trapezion which means "irregular quadrilateral,"
from tra- "four" and peza "foot" or "edge." Literally, "a little table" from trapeza meaning
"table" and -oeides "shaped."

Capitate bone

The left capitate bone.

Left: ulnar surface (little-finger-side surface).
Right: radial surface (thumb-side surface)
Left hand anterior view (palmar view). Capitate-bone shown in red.

The capitate bone is a bone in the human wrist found in the center of the carpal bone region,
located at the distal end of the radius and ulna bones. It articulates with the
third metacarpal bone (the middle finger) and forms the third carpometacarpal joint. The
capitate bone is the largest of the carpal bones in the human hand. It presents, above, a
rounded portion or head, which is received into the concavity formed by
the scaphoid and lunate bones; a constricted portion or neck; and below this, the body.[1] The
bone is also found in many other mammals, and is homologous with the "third distal carpal"
of reptiles and amphibians.

Structure
The capitate is the largest carpal bone found within the hand.[2] The capitate is found within
the distal row of carpal bones. The capitate lies directly adjacent to the metacarpal of the ring
finger on its distal surface, has the hamate on its ulnar surface and trapezoid on its radial
surface, and abuts the lunate and scaphoid proximally.

Surfaces
The proximal surface is round, smooth, and articulates with the lunate bone.[1]

The distal surface is divided by two ridges into three facets, for articulation with the second,
third, and fourth metacarpal bones, that for the third being the largest.[1]

The dorsal surface is broad and rough.[1]

The palmar surface is narrow, rounded, and rough, for the attachment of ligaments and a part
of the adductor pollicis muscle.[1]

The lateral surface articulates with the lesser multangular by a small facet at its anterior
inferior angle, behind which is a rough depression for the attachment of an interosseous
ligament. Above this is a deep, rough groove, forming part of the neck, and serving for the
attachment of ligaments; it is bounded superiorly by a smooth, convex surface, for
articulation with the scaphoid bone.

The medial surface articulates with the hamate bone by a smooth, concave, oblong facet,
which occupies its posterior and superior parts; it is rough in front, for the attachment of an
interosseous ligament.
Variation
The capitate bone variably articulates with the metacarpal of the index finger. However, its
normal articulation is with the middle finger.

Development
The ossification of capitate starts at 1 – 5 months.

Function
The carpal bones function as a unit to provide a bony superstructure for the hand. They allow
movements of the wrist from side to side (medial to lateral) as well as up and down (anterior
to posterior). H. A. Harris wrote in the British Medical Journal in 1944 that "the strength of
construction of the hand in a man is concentrated in the radius, thumb, and index and middle
fingers." Therefore, the capitate is larger to support the strength and stress that the middle
finger undergoes.

Clinical significance
A capitate fracture accounts for 1.3% of all wrist fractures. Isolated fractures of the capitate
comprise only 0.3% and are often non-displaced. This is since the capitate is at the centre of
the carpal region and is therefore quite well protected. Capitate fractures occur together with
fractures of another carpal bone, the scaphoid.

Various mechanisms for fractures of the capitate have been postulated. Adler et al. described
three mechanisms—the first is direct trauma to the dorsal surface of the bone, the second is
fall on the palm with the wrist in forced extension and the third is fall on the forcefully flexed
hand; the second being the most frequent and the third rarest.

In the case of an acute capitate fracture where there is x-ray evidence of excellent alignment
of the fracture fragments, the attending doctor will immobilise the wrist in a plaster or
lightweight wrist brace. Once the cast has been removed the patient begins physiotherapy to
regain the range of movement of the wrist joint and strength in the muscles involved.

If x-rays show that the capitate fracture fragments are out of alignment, surgery is indicated.
A surgeon can use small compression screws or K-wires to unite the two pieces of bone. The
headless compression screw has advantage over the K-wire as it provides compression across
the fracture site and allows early motion. It may be the case that the ligament between the
сapitate and the scaphoid bone is also injured; if so, this would be repaired at the same time.
Because the capitate has a poor blood supply there are sometimes complications with the
healing process. This may manifest itself as a diffuse ache in the wrist upon activity, and can
persist for many months. This is due to a breakdown of the capitate caused by the lack of
blood supply and healing (avascular necrosis). Nonunion has been reported as the most
common complication; 19.6% to 56% in isolated capitate fractures. Early diagnosis is key to
preventing this.

Etymology
The name of the bone derives from Latin: capitātus 'having a head', from Latin: capit- 'head'.

Hamate bone

The left hamate bone

Left hand anterior view (palmar view). Hamate bone shown in red.
The hamate bone (from Latin hamatus, "hooked"), or unciform bone (from Latin uncus,
"hook"), Latin os hamatum and occasionally abbreviated as just hamatum, is a bone in the
human wrist readily distinguishable by its wedge shape and a hook-like process ("hamulus")
projecting from its palmar surface.

Structure
The hamate is an irregularly shaped carpal bone found within the hand. The hamate is found
within the distal row of carpal bones, and abuts the metacarpals of the little finger and ring
finger.

Adjacent to the hamate on the ulnar side, and slightly above it, is the pisiform bone. Adjacent
on the radial side is the capitate, and proximal is the lunate bone.

Surfaces
The hamate bone has six surfaces:

 The superior, the apex of the wedge, is narrow, convex, smooth, and articulates
with the lunate.
 The inferior articulates with the fourth and fifth metacarpal bones, by concave
facets which are separated by a ridge.
 The dorsal is triangular and rough for ligamentous attachment.
 The palmar presents, at its lower and ulnar side, a curved, hook-like process,
the hamulus, directed forward and laterally.
 The medial articulates with the triangular bone by an oblong facet, cut obliquely
from above, downward and medialward.
 The lateral articulates with the capitate by its upper and posterior part, the
remaining portion being rough, for the attachment of ligaments.

Hook
Hamate bone of the left hand. Hamulus shown in red.
The hook of hamate (Latin: hamulus) is found at the proximal, ulnar side of the hamate bone.
The hook is a curved, hook-like process that projects 1–2 mm distally and radially.[5] The
ulnar nerve hooks around the hook of hamate as it crosses towards the medial side of hand.

The hook forms the ulnar border of the carpal tunnel, and the radial border for Guyon's canal.
Numerous structures attach to it, including ligaments from the pisiform, the transverse carpal
ligament, and the tendon of Flexor carpi ulnaris.

Its medial surface to the flexor digiti minimi brevis and opponens digiti minimi; its lateral
side is grooved for the passage of the flexor tendons into the palm of the hand.

Development
The ossification of the hamate starts between 1 and 12 months.[6] The hamate does not fully
ossify until about the 15th year of life.[5]
In animals
The bone is also found in many other mammals, and is homologous with the "fourth distal
carpal" of reptiles and amphibians.

Function
The carpal bones function as a unit to provide a bony superstructure for the hand.

Clinical significance
The hamate bone is the bone most commonly fractured when a golfer hits the ground hard
with a golf club on the downswing or a hockey player hits the ice with a slap shot. The
fracture is usually a hairline fracture, commonly missed on normal X-rays. Symptoms are
pain aggravated by gripping, tenderness over the hamate and symptoms of irritation of
the ulnar nerve. This is characterized by numbness and weakness of the fifth digit with partial
involvement of the fourth digit as well, the "ulnar 1½ fingers".
The hook of hamate is particularly prone to fracture-related complications such as non-union
due to its tenuous blood supply.[5]

It is also a common injury in baseball players. Several professional baseball players have had
the bone removed during the course of their careers.[7][8][9][10][11] This condition has been called
"Wilson's Wrist".

The calcification of the hamate bone is seen on X-rays during puberty and is sometimes used
in orthodontics to determine if an adolescent patient is suitable for orthognathic
intervention (i.e. before or at their growth spurt).[citation needed]

Etymology
The etymology derives from the Latin hamatus "hooked," from hamus which means "hook".

Phalanx bone

Phalanx bone
 Bones of the hand

Bones of the foot

Details

Articulations Metacarpophalangeal, metatarsophalangeal, interphalangeal

The phalanges /fəˈlændʒiːz/ (singular: phalanx /ˈfælæŋks/) are digital bones in

the hands and feet of most vertebrates. In primates, the thumbs and big toes have two
phalanges while the other digits have three phalanges. The phalanges are classed as long
bones.

Structure
The phalanges in a human hand

Toe bones or phalanges of the foot. Note the big toe has no middle phalanx.
People vary; sometimes the smallest toe also has none (not shown).[1]
Distal phalanges of the foot

Middle phalanges of the foot

Proximal phalanges of the foot

The phalanges are the bones that make up the fingers of the hand and the toes of the foot.
There are 56 phalanges in the human body, with fourteen on each hand and foot. Three
phalanges are present on each finger and toe, with the exception of the thumb and large toe,
which possess only two. The middle and far phalanges of the fourth and [citation needed] fifth toes
are often fused together (symphalangism).[1][2] The phalanges of the hand are commonly
known as the finger bones. The phalanges of the foot differ from the hand in that they are
often shorter and more compressed, especially in the proximal phalanges, those closest to the
torso.[3]
A phalanx is named according to whether it is proximal, middle, or distal and its associated
finger or toe. The proximal phalanges are those that are closest to the hand or foot. In the
hand, the prominent, knobby ends of the phalanges are known as knuckles. The proximal
phalanges join with the metacarpals of the hand or metatarsals of the foot at
the metacarpophalangeal joint or metatarsophalangeal joint. The intermediate phalanx is not
only intermediate in location, but usually also in size. The thumb and large toe do not possess
a middle phalanx. The distal phalanges are the bones at the tips of the fingers or toes. The
proximal, intermediate, and distal phalanges articulate with one another
through interphalangeal joints of hand and interphalangeal joints of the foot.[4]: 708–711 : 708–711
Bone anatomy
Each phalanx consists of a central part, called the body, and two extremities.[5]

 The body is flat on either side, concave on the palmar surface, and convex on the
dorsal surface.[6] Its sides are marked with rough areas giving attachment to
fibrous sheaths of flexor tendons. It tapers from above downwards.[7]
 The proximal extremities of the bones of the first row present oval, concave
articular surfaces, broader from side to side than from front to back. The proximal
extremity of each of the bones of the second and third rows presents a double
concavity separated by a median ridge.[7]
 The distal extremities are smaller than the proximal, and each ends in
two condyles (knuckles) separated by a shallow groove; the articular surface
extends farther on the palmar than on the dorsal surface, a condition best marked
in the bones of the first row.[7]
In the foot, the proximal phalanges have a body that is compressed from side to side, convex
above, and concave below. The base is concave, and the head presents a trochlear surface for
articulation with the second phalanx.[8] The middle are remarkably small and short, but rather
broader than the proximal. The distal phalanges, as compared with the distal phalanges of the
finger, are smaller and are flattened from above downward; each presents a broad base for
articulation with the corresponding bone of the second row, and an expanded distal extremity
for the support of the nail and end of the toe.[9]
Distal phalanx
In the hand, the distal phalanges are flat on their palmar surface, small, and with a roughened,
elevated surface of horseshoe form on the palmar surface, supporting the finger pulp.[10]: 6b. 3. The
Phalanges of the Hand
The flat, wide expansions found at the tips of the distal phalanges are called
apical tufts. They support the fingertip pads and nails.[11] The phalanx of the thumb has a
pronounced insertion for the flexor pollicis longus (asymmetric towards the radial side), an
ungual fossa, and a pair of unequal ungual spines (the ulnar being more prominent). This
asymmetry is necessary to ensure that the thumb pulp is always facing the pulps of the other
digits, an osteological configuration which provides the maximum contact surface with held
objects.[12]
In the foot, the distal phalanges are flat on their dorsal surface. It is largest proximally and
tapers to the distal end. The proximal part of the phalanx presents a broad base for
articulation with the middle phalanx, and an expanded distal extremity for the support of the
nail and end of the toe.[10]: 6b. 3. The Phalanges of the Foot The phalanx ends in a crescent-shaped rough
cap of bone epiphysis — the apical tuft (or ungual tuberosity/process) which covers a larger
portion of the phalanx on the volar side than on the dorsal side. Two lateral ungual spines
project proximally from the apical tuft. Near the base of the shaft are two lateral tubercles.
Between these a V-shaped ridge extending proximally serves for the insertion of the flexor
pollicis longus. Another ridge at the base serves for the insertion of the extensor aponeurosis.
[13]
The flexor insertion is sided by two fossae — the ungual fossa distally and the
proximopalmar fossa proximally.
Development
The number of phalanges in animals is often expressed as a "phalangeal formula" that
indicates the numbers of phalanges in digits, beginning from the innermost medial or
proximal. For example, humans have a 2-3-3-3-3 formula for the hand, meaning that the
thumb has two phalanges, whilst the other fingers each have three.
In the distal phalanges of the hand the centres for the bodies appear at the distal extremities of
the phalanges, instead of at the middle of the bodies, as in the other phalanges. Moreover, of
all the bones of the hand, the distal phalanges are the first to ossify.[10]: 6b. 3. The Phalanges of the Hand

Function

Thumb and index finger of right hand during pad-to-pad precision grasping in ulnar view.[12]
The distal phalanges of ungulates carry and shape nails and claws and these in primates are
referred to as the ungual phalanges.

History of phalanges
Etymology
The term phalanx or phalanges refers to an ancient Greek army formation in which soldiers
stand side by side, several rows deep, like an arrangement of fingers or toes.

In animals
Most land mammals including humans have a 2-3-3-3-3 formula in both the hands (or paws)
and feet. Primitive reptiles usually had the formula 2-3-4-4-5, and this pattern, with some
modification, remained in many later reptiles and in the mammal-like reptiles. The
phalangeal formula in the flippers of cetaceans (marine mammals) varies widely due to
hyperphalangy (the increase in number of phalanx bones in the digits). In humpback whales,
for example, the phalangeal formula is 0/2/7/7/3; in pilot whales the formula is 1/10/7/2/1.[14]
In vertebrates, proximal phalanges have a similar placement in the corresponding limbs, be
they paw, wing or fin. In many species, they are the longest and thickest phalanx ("finger"
bone). The middle phalanx also has a corresponding place in their limbs, whether they
be paw, wing, hoof or fin.
The distal phalanges are cone-shaped in most mammals, including most primates, but
relatively wide and flat in humans.
Primates

Morphological comparisons of pollical distal phalanges in African apes, extant humans and
selected hominins. Although with several morphological differences, all the features related
to refined manipulation in modern humans are already present in the late Miocene Orrorin.[12]
The morphology of the distal phalanges of human thumbs closely reflects an adaptation for a
refined precision grip with pad-to-pad contact. This has traditionally been associated with the
advent of stone tool-making. However, the intrinsic hand proportions of australopiths and the
resemblance between human hands and the short hands of Miocene apes, suggest that human
hand proportions are largely plesiomorphic (as found in ancestral species) — in contrast to
the derived elongated hand pattern and poorly developed thumb musculature of other
extant hominoids.[12]
In Neanderthals, the apical tufts were expanded and more robust than in modern and early
upper Paleolithic humans. A proposal that Neanderthal distal phalanges was an adaptation to
colder climate (than in Africa) is not supported by a recent comparison showing that
in hominins, cold-adapted populations possessed smaller apical tufts than do warm-adapted
populations. [15]
In non-human, living primates the apical tufts vary in size, but they are never larger than in
humans. Enlarged apical tufts, to the extent they actually reflect expanded digital pulps, may
have played a significant role in enhancing friction between the hand and held objects during
Neolithic toolmaking.[11]
Among non-human primates phylogenesis and style of locomotion appear to play a role in
apical tuft size. Suspensory primates and New World monkeys have the smallest apical tufts,
while terrestrial quadrupeds and Strepsirrhines have the largest.[15] A study of the fingertip
morphology of four small-bodied New World monkey species, indicated a correlation
between increasing small-branch foraging and reduced flexor and extensor tubercles in distal
phalanges and broadened distal parts of distal phalanges, coupled with expanded apical pads
and developed epidermal ridges. This suggests that widened distal phalanges were developed
in arboreal primates, rather than in quadrupedal terrestrial primates.[16]
Cetaceans
Whales exhibit hyperphalangy. Hyperphalangy is an increase in the number of phalanges
beyond the plesiomorphic mammal condition of three phalanges-per-digit.[17] Hyperphalangy
was present among extinct marine reptiles -- ichthyosaurs, plesiosaurs, and mosasaurs -- but
not other marine mammals, leaving whales as the only marine mammals to develop this
characteristic.[18] The evolutionary process continued over time, and a very derived form of
hyperphalangy, with six or more phalanges per digit, evolved convergently in rorqual
whales and oceanic dolphins, and was likely associated with another wave of signaling within
the interdigital tissues.[19]
Other mammals[edit]

Comparison of the phalanges of an orangutan, dog, pig, cow, tapir and horse
In ungulates (hoofed mammals) the forelimb is optimized for speed and endurance by a
combination of length of stride and rapid step; the proximal forelimb segments are short with
large muscles, while the distal segments are elongated with less musculature. In two of the
major groups of ungulates, odd-toed and even-toed ungulates, what remain of the "hands" —
the metacarpal and phalangeal bones — are elongated to the extent that they serve little use
beyond locomotion. The giraffe, the largest even-toed ungulate, has large terminal phalanges
and fused metacarpal bones able to absorb the stress from running.[20]
The sloth spends its life hanging upside-down from branches, and has highly specialized third
and fourth digits for the purpose. They have short and squat proximal phalanges with much
longer terminal phalanges. They have vestigial second and fifth metacarpals, and their palm
extends to the distal interphalangeal joints. The arboreal specialization of these terminal
phalanges makes it impossible for the sloth to walk on the ground where the animal has to
drag its body with its claws.
Metacarpal bones
The five metacarpal bones, numbered. Left hand, anterior (palmar) view.
Metacarpals shown in red. Left hand, anterior (palmar) view.
In human anatomy, the metacarpal bones or metacarpus form the intermediate part of
the skeletal hand located between the phalanges of the fingers and the carpal bones of
the wrist, which forms the connection to the forearm. The metacarpal bones are analogous to
the metatarsal bones in the foot.

Structure

Left hand shown with thumb on left.

The metacarpals form a transverse arch to which the rigid row of distal carpal bones are
fixed. The peripheral metacarpals (those of the thumb and little finger) form the sides of the
cup of the palmar gutter and as they are brought together they deepen this concavity. The
index metacarpal is the most firmly fixed, while the thumb metacarpal articulates with the
trapezium and acts independently from the others. The middle metacarpals are tightly united
to the carpus by intrinsic interlocking bone elements at their bases. The ring metacarpal is
somewhat more mobile while the fifth metacarpal is semi-independent.[1]
Each metacarpal bone consists of a body or shaft, and two extremities: the head at the distal
or digital end (near the fingers), and the base at the proximal or carpal end (close to the
wrist).
Body
The body (shaft) is prismoid in form, and curved, so as to be convex in the longitudinal
direction behind, concave in front. It presents three surfaces: medial, lateral, and dorsal.

 The medial and lateral surfaces are concave, for the attachment of the interosseus
muscles, and separated from one another by a prominent anterior ridge.
 The dorsal surface presents in its distal two-thirds a smooth, triangular, flattened
area which is covered in by the tendons of the extensor muscles. This surface is
bounded by two lines, which commence in small tubercles situated on either side
of the digital extremity, and, passing upward, converge and meet some distance
above the center of the bone and form a ridge which runs along the rest of the
dorsal surface to the carpal extremity. This ridge separates two sloping surfaces
for the attachment of the interossei dorsales.
 To the tubercles on the digital extremities are attached the collateral ligaments of
the metacarpophalangeal joints.[2]
Base
The base (basis) or carpal extremity is of a cuboidal form, and broader behind than in front: it
articulates with the carpal bones and with the adjoining metacarpal bones; its dorsal and volar
surfaces are rough, for the attachment of ligaments.[2]
Head
The head (caput) or digital extremity presents an oblong surface markedly convex from
before backward, less so transversely, and flattened from side to side; it articulates with
the proximal phalanx. It is broader, and extends farther upward, on the volar than on the
dorsal aspect, and is longer in the antero-posterior than in the transverse diameter. On either
side of the head is a tubercle for the attachment of the collateral ligament of
the metacarpophalangeal joint.
The dorsal surface, broad and flat, supports the tendons of the extensor muscles.
The volar surface is grooved in the middle line for the passage of the flexor tendons, and
marked on either side by an articular eminence continuous with the terminal articular surface.
[2]

Neck
The neck, or subcapital segment, is the transition zone between the body and the head.

Articulations
Besides the metacarpophalangeal joints, the metacarpal bones articulate by carpometacarpal
joints as follows:

1. the first with the trapezium;

2. the second with the trapezium, trapezoid, capitate and third metacarpal;
3. the third with the capitate and second and fourth metacarpals;
4. the fourth with the capitate, hamate, and third and fifth metacarpals;
5. and the fifth with the hamate and fourth metacarpal;

Carpometacarpal joints of the left hand. Thumb on left.

Carpometacarpal joints of the left hand. Thumb on left.

 

X-ray
Insertions
Extensor Carpi Radialis Longus/Brevis: Both insert on the base of metacarpal II; Assist with
wrist extension and radial flexion of the wrist
Extensor Carpi Ulnaris: Inserts on the base of metacarpal V; Extends and fixes wrist when
digits are being flexed; assists with ulnar flexion of wrist
Abductor Pollicis Longus: Inserts on the trapezium and base of metacarpal I; Abducts thumb
in frontal plane; extends thumb at carpometacarpal joint
Opponens Pollicis: Inserts on metacarpal I; flexes metacarpal I to oppose the thumb to the
fingertips
Opponens digiti minimi: Inserts on the medial surface of metacarpal V; Flexes metacarpal V
at carpometacarpal joint when little finger is moved into opposition with tip of thumb;
deepens palm of hand.[3]
Metacarpus (yellow). Insertions are shown in red. Left hand,
anterior (palmar) view.

Metacarpus (yellow). Insertions are shown in red. Left

hand, posterior (dorsal) view.
Clinical significance
Congenital disorders[edit]
The fourth and fifth metacarpal bones are commonly "blunted" or shortened,
in pseudohypoparathyroidism and pseudopseudohypoparathyroidism.
A blunted fourth metacarpal, with normal fifth metacarpal, can signify Turner syndrome.
Blunted metacarpals (particularly the fourth metacarpal) are a symptom of nevoid basal-cell
carcinoma syndrome.
Fracture
The neck of a metacarpal is a common location for a boxer's fracture, but all parts of the
metacarpal bone (including head, body and base) are susceptible to fracture. Several types of
treatment exist ranging from non-operative techniques, with or without immobilization, to
operative techniques using closed or open reduction and internal fixation (ORIF). Generally,
most fractures showing little or no displacement can be treated successfully without surgery.
[4]
Intraarticular fracture-dislocations of the metacarpal head or base may require surgical
fixation, as fragment displacement affecting the joint surface is rarely tolerated well. [4]

Other animals

The
principle of homology illustrated by the adaptive radiation of the metacarpal bones of
mammals. All conform to the basic pentadactyl pattern but are modified for different usages.
The third metacarpal is shaded throughout; the shoulder is crossed-hatched.

In four-legged animals, the metacarpals form part of the forefeet, and are frequently reduced
in number, appropriate to the number of toes. In digitigrade and unguligrade animals, the
metacarpals are greatly extended and strengthened, forming an additional segment to the
limb, a feature that typically enhances the animal's speed. In both birds and bats, the
metacarpals form part of the wing.

History
Etymology
The Greek physician Galen used to refer to the metacarpus as μετακάρπιον.[5][6] The Latin
form metacarpium [5][7][8][9] more truly resembles[5] its Ancient Greek predecessor μετακάρπιον
than metacarpus.[10][11] Meta– is Greek for beyond and carpal from Ancient
Greek καρπός (karpós, “wrist”). In anatomic Latin, adjectives like metacarpius,
[12]
metacarpicus,[13] metacarpiaeus,[14] metacarpeus,[15] metacarpianus[16] and metacarpalis[11]
can be found. The form metacarpius is more true[8][12] to the later Greek form μετακάρπιος.
[12]
Metacarpalis, as in ossa metacarpalia in the current official Latin
nomenclature, Terminologia Anatomica[11] is a compound consisting of Latin and Greek parts.
[13]
The usage of such hybrids in anatomic Latin is disapproved by some.
Pisiform bone

The left pisiform bone

Left hand anterior view (palmar view). Pisiform bone
shown in red.

The pisiform bone (/ˈpaɪsɪfɔːrm/ or /ˈpɪzɪfɔːrm/), also spelled pisiforme (from the
Latin pisifomis, pea-shaped), is a small knobbly, sesamoid bone that is found in the wrist. It
forms the ulnar border of the carpal tunnel.

Structure
The pisiform is a sesamoid bone, with no covering membrane of periosteum. It is the
last carpal bone to ossify. The pisiform bone is a small bone found in the proximal row of the
wrist (carpus). It is situated where the ulna joins the wrist, within the tendon of the flexor
carpi ulnaris muscle.[1]: 199, 205
It only has one side that acts as a joint, articulating with the triquetral bone. It is on a plane
anterior to the other carpal bones and is spheroidal in form.
The pisiform bone has four surfaces:

1. The dorsal surface is smooth and oval, and articulates with the triquetral: this
facet approaches the superior, but not the inferior border of the bone.
2. The palmar surface is rounded and rough, and gives attachment to
the transverse carpal ligament, the flexor carpi ulnaris and the abductor digiti
quinti.
3. The lateral surface is rough, and concave.
4. The medial surface' is rough and usually convex.

Etymology
The etymology derives from the Latin pīsum which means "pea" ultimately derived from the
Greek "pison" (pea)
Function
The pisiform bone is most recognizable as an unassuming palmar projection forming the heel
of your hand.[2]
The pisiform bone, along with the hamulus of the hamate, defines the medial boundary of
the carpal tunnel[2] because the pisiform body acts as one of the four attachments points of
the flexor retinaculum.[3] It also acts as an attachment site for tendons of the abductor digiti
minimi and for the flexor carpi ulnaris - the tendon in which it develops.[4][2] The pisiform is
the only carpal bone with insertions and attachments for the abductor digiti minimi and the
flexor carpi ulnaris.[2] It is suggested that due to the pisiform's surprisingly large range of
movement along its articulation surface with the triquetral bone (about 1 cm of movement is
allowed), contraction of the flexor carpi ulnaris is necessary for the pisiform to remain stable
enough for the abductor digiti minimi to function effectively.[5]
In clinical studies, the pisiform has been removed as treatment for osteoarthritis in the
pisotriquetral joint. While some studies came to the conclusion that the pisiform "contributes
to the stability of the ulnar column of the wrist",[6] others suggested that while excision
slightly impairs the range of motion of the wrist (especially wrist extension), the forces
generated within the wrist are not significantly impacted.[7] Subjects in the latter study did
report impaired function after excision when performing heavy lifting and weightbearing
activities, but this is suggested to be subjective considering that they did not have to change
occupation or their level of activity as a result of the excision.[7]

Development
Compared with other non-human primates, humans have a short pisiform bone. This dramatic
size difference is suggested to be the outcome of a lost growth plate in hominins some time
between Australopithecus afarensis, who has been shown to have an elongated and ape-like
pisiform, and Homo neanderthalensis, who is suggested to have a pisiform resembling the
modern human condition.
It is suggested that the first signs of human pisiform ossification, observed between the ages
of 7 and 12, corresponds to the period of secondary pisiform ossification in apes. This can
point to a couple different changes in development: either this growth plate loss in humans is
also accompanied by a developmental shift in the timing of pisiform formation, or it is the
primary center that fails to form in humans and as a result our pisiform is homologous to
the epiphysis of other mammalian pisiforms.[2]
Studies looking at the effect of Hox gene knockouts on the formation of the pisiform in mice
have suggested that the modification of Hoxa11 or Hoxd11 genes, or the downstream targets
they affect, could have acted as the mechanism for the reduction we see in the human
pisiform condition.[2]

Evolution
There are several hypotheses that seek to explain why we see pisiform reduction during the
course of hominin evolution. Some suggest that the reduction of the pisiform allowed for
ulnar deviation and that allowed for greater extension in the human wrist which increased our
capacity for throwing.[8] Scholars with this point of view would believe that these anatomical
changes would improve the action of clubbing in our hominin ancestors.
Others suggest that the pisiform's link with Hoxa11 and Hoxd11 could tie its developmental
history to that of the forearm, whose length is determined by Hox gene expression.[2] Within
the context of this hypothesis, because modern forearm proportions are not seen until Homo
erectus at 1.5 million years ago, it is possible that pisiform reduction would have also
occurred around this time.[2] Alternatively, the same group suggests that the reduction could
be a reflection of independent selection associated with the production and use of stone tools,
[2]
but changes in pisiform morphology have yet to be studied in relation to their effect on
wrist function.

Other animals
All other tetrapods have a pisiform, being the most common sesamoid.[9] In mammals and
non-human primates, the pisiform is an enlarged and elongated bone that articulates with the
distal ulna.[5] In some taxa, the pisiform even articulates with the hammate or radius.[5] In
these non-human taxa, the pisiform develops from two ossification centers that are divided by
a palmar epiphyseal plate.[5] Because in other mammals, the bone does not follow a
typical sesamoid development pattern and can be seen articulating with more than one bone,
the pisiform is not a true sesamoid bone.
Triquetral bone

The left triquetal bone

Left hand anterior view (palmar view). Triquetral bone shown in red.

Articulations articulates with three bones:

lunate laterally
pisiform in front
hamate distally
triangular articular disk which
separates it from the lower end of
the ulna.

The triquetral bone (/traɪˈkwɛtrəl, -ˈkwiː-/; also called triquetrum, pyramidal, three-
faced, and formerly cuneiform bone) is located in the wrist on the medial side of the
proximal row of the carpus between the lunate and pisiform bones. It is on the ulnar side of
the hand, but does not directly articulate with the ulna. Instead, it is connected to and
articulates with the ulna through the Triangular fibrocartilage disc[1] and ligament, which
forms part of the ulnocarpal joint capsule.[2] It connects with the pisiform, hamate,
and lunate bones. It is the 2nd most commonly fractured carpal bone.

Structure
The triquetral is one of the eight carpal bones of the hand. It is a three-faced bone found
within the proximal row of carpal bones. Situated beneath the pisiform, it is one of the carpal
bones that form the carpal arch, within which lies the carpal tunnel. [3]: 708
The triquetral bone may be distinguished by its pyramidal shape, and by an oval isolated facet
for articulation with the pisiform bone. It is situated at the upper and ulnar side of the carpus.
To facilitate its palpation in an exam, the hand must be radially deviated so that the
triquetrium moves out from under the ulnar styloid process. The triquetrum may be difficult
to find, since it also lies under the pisiform.
The triquetral bone has nutrient foramina for entering the nutrient vessels into the bone which
comes from branches of the radial, ulnar, and interosseous arteries.[4]

Ossification
The triquetral bone ossifies between 9 months and 50 months (4 years and 2 months).
Surfaces
The superior surface presents a medial, rough, non-articular portion, and a lateral convex
articular portion which articulates with the triangular articular disk of the wrist.
The inferior surface, directed lateralward, is concave, sinuously curved, and smooth for
articulation with the hamate. The dorsal surface is rough for the attachment of ligaments.
The volar surface presents, on its medial part, an oval facet, for articulation with the pisiform;
its lateral part is rough for ligamentous attachment.
The lateral surface, the base of the pyramid, is marked by a flat, quadrilateral facet, for
articulation with the lunate.
The medial surface, the summit of the pyramid, is pointed and roughened, for the attachment
of the ulnar collateral ligament of the wrist.
In animals
In reptiles and amphibians, the bone is instead referred to as the ulnare, since (at least in the
most primitive fossils) it articulates with the ulna.

Function
The carpal bones function as a unit to provide a bony superstructure for the hand.[3] : 708

Fracture
Triquetral fractures can occur due to forceful flexion of the wrist, causing an avulsion of
the dorsal aspect of the bone that is often hidden on anterior radiographs, but can be seen as a
tiny bone fragment on lateral views.

Etymology
The etymology derives from the Latin triquetrus which means "three-cornered." Therefore, it
is sometimes also called the triangular bone or os triangulare. However, os
triangulare may also refer to a nearby accessory bone.
Lunate bone

The left lunate bone

Left hand anterior view (palmar view). Lunate bone shown in red.

Articulations radius proximally

capitate and hamate distally
scaphoid laterally
triangular medially
triangular fibrocartilage[1]

The lunate bone (semilunar bone) is a carpal bone in the human hand. It is distinguished by
its deep concavity and crescentic outline. It is situated in the center of the proximal row
carpal bones, which lie between the ulna and radius and the hand. The lunate carpal bone is
situated between the lateral scaphoid bone and medial triquetral bone.

Structure
The lunate is a crescent-shaped carpal bone found within the hand. The lunate is found within
the proximal row of carpal bones. Proximally, it abuts the radius. Laterally, it articulates with
the scaphoid bone, medially with the triquetral bone, and distally with the capitate bone. The
lunate also articulates on its distal and medial surface with the hamate bone.[2]: 708 [3]
The lunate is stabilised by a medial ligament to the scaphoid bone and a lateral ligament to
the triquetral bone. Ligaments between the radius and carpal bone also stabilise the position
of the lunate, as does its position in the lunate fossa of the radius.[3]
Bone
The proximal surface of the lunate bone is smooth and convex, articulating with the radius.
The lateral surface is flat and narrow, with a crescentic facet for articulation with
the scaphoid bone. The medial surface possesses a smooth and quadrilateral facet for
articulation with the triquetral bone. The palmar surface is rough, as is the dorsal surface. The
dorsal surface is broad and rounded. The distal surface of the bone is deep and concave.[4]
Blood supply
The lunate receives its blood supply from dorsal and palmar branches.[3]
Variation
The lunate has a variable shape. About one-third of lunate bones do not possess a medial
facet, meaning they do not articulate with the hamate bone. Additionally, in about 20% of
people, blood supply may arise from palmar vessels alone.[3]
Ossification
The ossification of the lunate bone commences between 18 months and 4 years 3 months.[5]

Function
The carpal bones function as a unit to provide a bony superstructure for the hand.[2]: 708 As a
proximal carpal bone, the lunate is also involved in movement of the wrist.[3]

Clinical relevance

The lunate bone is the most frequently dislocated carpal

bone.

 Carpal coalition
 Kienbock's disease
 Teisen classification

Perilunar dislocation as seen on x-ray.

Etymology
The name of the lunate bone derives from the "crescent-shaped" (Latin: lunatus),
[6]
from Latin luna ("moon"), from the bone's resemblance to a crescent moon. In amphibians
and reptiles, the bone is instead referred to as the intermedium, because of its position
between the other two proximal carpals.
Scaphoid bone

The left scaphoid bone

Left hand anterior view (palmar view). Scaphoid bone shown in red.

Articulations articulates with five bones

radius proximally
trapezoid bone and trapezium
bone distally
capitate and lunate medially

The scaphoid bone is one of the carpal bones of the wrist. It is situated between
the hand and forearm on the thumb side of the wrist (also called the lateral or radial side). It
forms the radial border of the carpal tunnel. The scaphoid bone is the largest bone of the
proximal row of wrist bones, its long axis being from above downward, lateralward, and
forward. It is approximately the size and shape of a medium cashew.

Structure
The scaphoid is situated between the proximal and distal rows of carpal bones. It is located
on the radial side of the wrist, and articulates with the radius, lunate, trapezoid, trapezium,
and capitate.[1]: 176 Over 80% of the bone is covered in articular cartilage.[2]
Bone
The palmar surface of the scaphoid is concave, and forming a distal tubercle, giving
attachment to the transverse carpal ligament. The proximal surface is triangular, smooth and
convex.[2] The lateral surface is narrow and gives attachment to the radial collateral ligament.
The medial surface has two facets, a flattened semi-lunar facet articulating with the lunate
bone, and an inferior concave facet, articulating alongside the lunate with the head of the
capitate bone.[3]
The dorsal surface of the bone is narrow, with a groove running the length of the bone and
allowing ligaments to attach, and the surface facing the fingers (anatomically inferior) is
smooth and convex, also triangular, and divided into two parts by a slight ridge.[3]
Blood supply
It receives its blood supply primarily from lateral and distal branches of the radial artery, via
palmar and dorsal branches. These provide an "abundant" supply to middle and distal
portions of the bone, but neglect the proximal portion, which relies on retrograde flow.[1]:
189
The dorsal branch supplies the majority of the middle and distal portions, with the palmar
branch supplying only the distal third of the bone.[2]
Variation
The dorsal blood supply, particularly of the proximal portion, is highly variable.[1]:
189
Sometimes the fibers of the abductor pollicis brevis emerge from the tubercle.[3]
In animals
In reptiles, birds, and amphibians, the scaphoid is instead commonly referred to as
the radiale because of its articulation with the radius.

Function
The carpal bones function as a unit to provide a bony superstructure for the hand.[4]: 708 The
scaphoid is also involved in movement of the wrist.[1]: 6 It, along with the lunate, articulates
with the radius and ulna to form the major bones involved in movement of the wrist.[4] The
scaphoid serves as a link between the two rows of carpal bones. With wrist movement, the
scaphoid may flex from its position in the same plane as the forearm to perpendicular.[1]: 176–177

Clinical significance
Fracture[edit]
Main article: Scaphoid fracture

Scaphoid fracture before and after operation

Fractures of the scaphoid are the most common of the carpal bone injuries, because of its
connections with the two rows of carpal bones.[1]: 177
The scaphoid can be slow to heal because of the limited circulation to the bone. Fractures of
the scaphoid must be recognized and treated quickly, as prompt treatment by immobilization
or surgical fixation increases the likelihood of the bone healing in anatomic alignment, thus
avoiding mal-union or non-union.[5] Delays may compromise healing. Failure of the fracture
to heal ("non-union") will lead to post-traumatic osteoarthritis of the carpus.[1]: 189 One reason
for this is because of the "tenuous" blood supply to the proximal segment.[2] Even rapidly
immobilized fractures may require surgical treatment, including use of a headless
compression screw such as the Herbert screw to bind the two halves together.
Healing of the fracture with a non-anatomic deformity (frequently, a volar flexed
"humpback") can also lead to post-traumatic arthritis. Non-unions can result in loss of blood
supply to the proximal pole, which can result in avascular necrosis of the proximal segment.
Scaphoid fractures may be difficult to diagnose via plain x-ray. A repeat x-ray may be
required at a later date, as might cross-sectional imaging via MRI or CT scan.[5]
Other diseases
A condition called scapholunate instability can occur when the scapholunate
ligament (connecting the scaphoid to the lunate bone) and other surrounding ligaments are
disrupted. In this state, the distance between the scaphoid and lunate bones is increased.[1]: 180
One rare disease of the scaphoid is called Preiser's Disease.

Palpation
The scaphoid can be palpated at the base of the anatomical snuff box. It can also be palpated
in the volar (palmar) hand/wrist. Its position is the intersections of the long axes of the four
fingers while in a fist, or the base of the thenar eminence. When palpated in this position, the
bone will be felt to slide forward during radial deviation (wrist abduction) and flexion.
Clicking of the scaphoid or no anterior translation can indicate scapholunate instability.

Etymology
The word scaphoid (Greek: σκαφοειδές) is derived from the Greek skaphos, which means "a
boat", and the Greek eidos, which means "kind".[6] The name refers to the shape of the bone,
supposedly reminiscent of a boat. In older literature about human anatomy,[3] the scaphoid is
referred to as the navicular bone of the hand (this time from the Latin navis for boat); there is
also a bone in a similar position in the foot, which is called the navicular. The modern term
for the bone in the hand is scaphoid; in human anatomy the term navicular is reserved for the
bone in the foot.
Accessory bones

<<< Location of the accessory ossicles of the carpals

Occasionally accessory bones are found in the carpus, but of
more than 20 such described bones, only four (the central,
styloid, secondary trapezoid, and secondary pisiform bones) are considered to be proven
 Appearance of ossification centers of carpal bones[6][7]
Bone Average Variation[6] Variation[7]
Capitate 2.5 months 1–6 months 1–5 months
Hamate 4–5.5 months 1–7 months 1–12 months
Triquetru
2 years 5 months to 3 years 9 months to 4 years and 2 months
m
Lunate 5 years 2–5.5 years 18 months to 4 years and 3 months
Trapezium 6 years 4–8 years
Trapezoid 6 years 4–8 years
Scaphoid 6 years 4–7 years
Pisiform 12 years 8–12 years

accessory bones. Sometimes the scaphoid, triquetrum, and pisiform bones are divided into
two.

Development

Thecarpal bones are ossified endochondrally (from within the cartilage) and the ossific
centers appear only after birth. [5] The formation of these centers roughly follows a
chronological spiral pattern starting in the capitate and hamate during the first year of life.
The ulnar bones are then ossified before the radial bones, while the sesamoid pisiform arises
in the tendon of the flexor carpi ulnaris after more than ten years. [6] The commencement of
ossification for each bone occurs over period like other bones. This is useful in forensic age
estimation.

Function
Ligaments
 Four groups
of ligaments
in the region
of the wrist
(shown in
four different
colors.)

There are four groups of ligaments in the region of the wrist:[8]

1. The ligaments of the wrist proper which unite the ulna and radius with the
carpus: the ulnar and radial collateral ligaments; the palmar and dorsal
radiocarpal ligaments; and the palmar ulnocarpal ligament. (Shown in blue in
the figure.)
2. The ligaments of the intercarpal articulations which unite the carpal bones
with one another: the radiate carpal ligament; the dorsal, palmar,
and interosseous intercarpal ligaments; and the pisohamate ligament. (Shown
in red in the figure.)
3. The ligaments of the carpometacarpal articulations which unite the carpal
bones with the metacarpal bones: the pisometacarpal ligament and
the palmar and dorsal carpometacarpal ligaments. (Shown in green in the
figure.)
4. The ligaments of the intermetacarpal articulations which unite the metacarpal
bones: the dorsal, interosseous, and palmar metacarpal ligaments. (Shown in
yellow in the figure.)

Movements
Main article: Anatomical terms of motion § Special motions of the hands and feet
The hand is said to be in straight position when the third finger runs over the capitate bone
and is in a straight line with the forearm. This should not be confused with
the midposition of the hand which corresponds to an ulnar deviation of 12 degrees. From the
straight position two pairs of movements of the hand are possible: abduction (movement
towards the radius, so called radial deviation or abduction) of 15 degrees
and adduction (movement towards the ulna, so called ulnar deviation or adduction) of
40 degrees when the arm is in strict supination and slightly greater in
strict pronation. [9] Flexion (tilting towards the palm, so called palmar flexion)
and extension (tilting towards the back of the hand, so called dorsiflexion) is possible with a
total range of 170 degrees. [10]
Radial abduction/ulnar adduction

Left: Ulnar adduction

Right: Radial abduction

Left: Dorsiflexion
Right: Palmar flexion
During radial abduction the scaphoid is tilted towards the palmar side which allows the
trapezium and trapezoid to approach the radius. Because the trapezoid is rigidly attached to
the second metacarpal bone to which also the flexor carpi radialis and extensor carpi radialis
are attached, radial abduction effectively pulls this combined structure towards the radius.
During radial abduction the pisiform traverses the greatest path of all carpal bones. [9] Radial
abduction is produced by (in order of importance) extensor carpi radialis longus, abductor
pollicis longus, extensor pollicis longus, flexor carpi radialis, and flexor pollicis longus. [11]
Ulnar adduction causes a tilting or dorsal shifting of the proximal row of carpal bones.[9] It is
produced by extensor carpi ulnaris, flexor carpi ulnaris, extensor digitorum, and extensor
digiti minimi.[11]
Both radial abduction and ulnar adduction occurs around a dorsopalmar axis running through
the head of the capitate bone. [9]
Palmar flexion/dorsiflexion
During palmar flexion the proximal carpal bones are displaced towards the dorsal side and
towards the palmar side during dorsiflexion. While flexion and extension consist of
movements around a pair of transverse axes — passing through the lunate bone for the
proximal row and through the capitate bone for the distal row — palmar flexion occurs
mainly in the radiocarpal joint and dorsiflexion in the midcarpal joint. [10]
Dorsiflexion is produced by (in order of importance) extensor digitorum, extensor carpi
radialis longus, extensor carpi radialis brevis, extensor indicis, extensor pollicis longus,
and extensor digiti minimi. Palmar flexion is produced by (in order of importance) flexor
digitorum superficialis, flexor digitorum profundus, flexor carpi ulnaris, flexor pollicis
longus, flexor carpi radialis, and abductor pollicis longus. [11]
Combined movements[edit]
Combined with movements in both the elbow and shoulder joints, intermediate or combined
movements in the wrist approximate those of a ball-and-socket joint with some necessary
restrictions, such as maximum palmar flexion blocking abduction.[10]
Accessory movements
Anteroposterior gliding movements between adjacent carpal bones or along the midcarpal
joint can be achieved by stabilizing individual bones while moving another (i.e. gripping the
bone between the thumb and index finger).
Wrist

The car pal bones,

sometimes included in the definition of the wrist.
A human showing the wrist in the centre.
In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the
complex of eight bones forming the proximal skeletal segment of the hand;[1][2] (2) the wrist
joint or radiocarpal joint, the joint between the radius and the carpus[2] and; (3) the
anatomical region surrounding the carpus including the distal parts of the bones of the
forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of
joints between these bones, thus referred to as wrist joints.[3][4] This region also includes
the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and
the extensor retinaculum.
As a consequence of these various definitions, fractures to the carpal bones are referred to as
carpal fractures, while fractures such as distal radius fracture are often considered fractures to
the wrist.

Structure

Posterior and anterior aspects of right human wrist

Ligaments of wrist. Posterior and anterior views
The distal radioulnar joint is a pivot joint located between the bones of the forearm,
the radius and ulna. Formed by the head of the ulna and the ulnar notch of the radius, this
joint is separated from the radiocarpal joint by an articular disk lying between the radius and
the styloid process of the ulna. The capsule of the joint is lax and extends from the inferior
sacciform recess to the ulnar shaft. Together with the proximal radioulnar joint, the distal
radioulnar joint permits pronation and supination.[5]
The radiocarpal joint or wrist joint is an ellipsoid joint formed by the radius and the articular
disc proximally and the proximal row of carpal bones distally. The carpal bones on the ulnar
side only make intermittent contact with the proximal side — the triquetrum only makes
contact during ulnar abduction. The capsule, lax and un-branched, is thin on the dorsal side
and can contain synovial folds. The capsule is continuous with the midcarpal joint and
strengthened by numerous ligaments, including the palmar and dorsal radiocarpal ligaments,
and the ulnar and radial collateral ligaments. [6]
The parts forming the radiocarpal joint are the lower end of the radius and under surface of
the articular disk above; and the scaphoid, lunate, and triquetral bones below. The articular
surface of the radius and the undersurface of the articular disk form together with a
transversely elliptical concave surface, the receiving cavity. The superior articular surfaces of
the scaphoid, lunate, and triquetrum form a smooth convex surface, the condyle, which is
received into the concavity.[7]
Carpal bones of the hand:

 Proximal: A=Scaphoid, B=Lunate, C=Triquetrum, D=Pisiform

 Distal: E=Trapezium, F=Trapezoid, G=Capitate, H=Hamate
In the hand proper a total of 13 bones form part of the wrist: eight carpal bones—
scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, and hamate— and
five metacarpal bones—the first, second, third, fourth, and fifth metacarpal bones.[8]
The midcarpal joint is the S-shaped joint space separating the proximal and distal rows of
carpal bones. The intercarpal joints, between the bones of each row, are strengthened by
the radiate carpal and pisohamate ligaments and the palmar, interosseous, and dorsal
intercarpal ligaments. Some degree of mobility is possible between the bones of the proximal
row while the bones of the distal row are connected to each other and to the metacarpal bones
—at the carpometacarpal joints— by strong ligaments —
the pisometacarpal and palmar and dorsal carpometacarpal ligament— that makes a
functional entity of these bones. Additionally, the joints between the bases of the metacarpal
bones —the intermetacarpal articulations— are strengthened by dorsal, interosseous,
and palmar intermetacarpal ligaments.[6]
The earliest carpal bones to ossify are capitate bone and hamate bone in the first six months
of an infant life.[9]
Articulations
The radiocarpal, intercarpal, midcarpal, carpometacarpal, and intermetacarpal joints often
intercommunicate through a common synovial cavity. [10]
Articular Surfaces
It has two articular surfaces named, proximal and distal articular surfaces respectively. The
proximal articular surface is made up of the lower end of the radius and a triangular articular
disc of the inferior radio-ulnar joint. On the other hand, the distal articular surface is made up
of proximal surfaces of the scaphoid, triquetral and lunate bones.[11]

Micro-radiography of 8 weeks human embryo hand

Function
Movement
The extrinsic hand muscles are located in the forearm where their bellies form the proximal
fleshy roundness. When contracted, most of the tendons of these muscles are prevented from
standing up like taut bowstrings around the wrist by passing under the flexor retinaculum on
the palmar side and the extensor retinaculum on the dorsal side. On the palmar side the carpal
bones form the carpal tunnel,[12] through which some of the flexor tendons pass in tendon
sheaths that enable them to slide back and forth through the narrow passageway (see carpal
tunnel syndrome).[13]
Starting from the mid-position of the hand, the movements permitted in the wrist proper are
(muscles in order of importance):[14][15]0:04
Magnetic resonance imaging (MRI) of radial abduction (rightwards in image) and ulnar
adduction (leftwards in image).

 Marginal movements: radial deviation (abduction, movement towards the thumb)

and ulnar deviation (adduction, movement towards the little finger). These
 movements take place about a dorsopalmar axis (back to front) at the radiocarpal
and midcarpal joints passing through the capitate bone.
o Radial abduction (up to 20°):[16] extensor carpi radialis
longus, abductor pollicis longus, extensor pollicis longus, flexor carpi
radialis, flexor pollicis longus
o Ulnar adduction (up to 30°):[16] extensor carpi ulnaris, flexor carpi
ulnaris, extensor digitorum, extensor digiti minimi
 Movements in the plane of the hand: flexion (palmar flexion, tilting towards the
palm) and extension (dorsiflexion, tilting towards the back of the hand). These
movements take place through a transverse axis passing through the capitate bone.
Palmar flexion is the most powerful of these movements because the flexors,
especially the finger flexors, are considerably stronger than the extensors.
0:03
Magnetic resonance imaging (MRI) of wrist extension and return to neutral position.

 Extension (up to 60°):[16] extensor digitorum, extensor carpi radialis

longus, extensor carpi radialis brevis, extensor indicis, extensor pollicis
longus, extensor digiti minimi, extensor carpi ulnaris
 Palmar flexion (up to 70°):[16] flexor digitorum superficialis, flexor digitorum
profundus, flexor carpi ulnaris, flexor pollicis longus, flexor carpi
radialis, abductor pollicis longus
 Intermediate or combined movements
However, movements at the wrist can not be properly described without including
movements in the distal radioulnar joint in which the rotary actions
of supination and pronation occur and this joint is therefore normally regarded as part of the
wrist.[17]

Clinical significance

Projectional radiograph of a normal wrist (left image) and one with a dorsal tilt due to wrist
osteoarthritis (as well as osteoporosis). The angle of the distal surface of the lunate bone is
annotated. A dorsal tilt of 10 to 15 degrees is considered normal.[18]
Wrist pain has a number of causes, including carpal tunnel syndrome,[16] ganglion cyst,
[19]
tendinitis,[20] and osteoarthritis. Tests such as Phalen's test involve palmarflexion at the
wrist.
The hand may deviate at the wrist in some conditions, such as rheumatoid arthritis.
Ossification of the bones around the wrist is one indicator used in taking a bone age.
A wrist fracture usually means a fracture of the distal radius.

History
Etymology
The English word "wrist" is etymologically derived from the Proto-
Germanic word wristiz from which are derived modern German rist ("instep", "wrist") and
modern Swedish vrist ("instep", "ankle"). The base writh- and its variants are associated
with Old English words "wreath", "wrest", and "writhe". The wr- sound of this base seems
originally to have been symbolic of the action of twisting.

Radius (bone)
>>The radius (shown in red) is a bone in
the forearm.
The radius or radial bone is one of the two
large bones of the forearm, the other being the ulna.
It extends from the lateral side of the elbow to
the thumb side of the wrist and runs parallel to the
ulna. The ulna is usually slightly longer than the
radius, but the radius is thicker. Therefore the radius
is considered to be the larger of the two. It is a long
bone, prism-shaped and slightly curved
longitudinally.
The radius is part of two joints: the elbow and
the wrist. At the elbow, it joins with the capitulum of the humerus, and in a separate region,
with the ulna at the radial notch. At the wrist, the radius forms a joint with the ulna bone.
The corresponding bone in the lower leg is the fibula.

Structure

3D model.
Full Anterior View of Right Radius

Full Posterior View of Right Radius

Full Medial View of Right Radius

Full Lateral View of Right Radius
The long narrow medullary cavity is enclosed in a strong wall of compact bone. It is thickest
along the interosseous border and thinnest at the extremities, same over the cup-shaped
articular surface (fovea) of the head.
The trabeculae of the spongy tissue are somewhat arched at the upper end and pass upward
from the compact layer of the shaft to the fovea capituli (the humerus's cup-shaped
articulatory notch); they are crossed by others parallel to the surface of the fovea. The
arrangement at the lower end is somewhat similar. It is missing in radial aplasia.
The radius has a body and two extremities. The upper extremity of the radius consists of a
somewhat cylindrical head articulating with the ulna and the humerus, a neck, and a radial
tuberosity. The body of the radius is self-explanatory, and the lower extremity of the radius is
roughly quadrilateral in shape, with articular surfaces for the ulna, scaphoid and lunate bones.
The distal end of the radius forms two palpable points, radially the styloid
process and Lister's tubercle on the ulnar side. Along with the proximal and distal radioulnar
articulations, an interosseous membrane originates medially along the length of the body of
the radius to attach the radius to the ulna.[1]
 Anterior and Posterior view of Radius
bone - labelled.

Near the wrist

The distal end of the radius is large
and of quadrilateral form.
Joint surfaces
It is provided with two articular
surfaces – one below, for the carpus, and another at the medial side, for the ulna.

 The carpal articular surface is triangular, concave, smooth, and divided by a

slight antero-posterior ridge into two parts. Of these, the lateral, triangular,
articulates with the scaphoid bone; the medial, quadrilateral, with the lunate bone.
 The articular surface for the ulna is called the ulnar notch (sigmoid cavity) of the
radius; it is narrow, concave, smooth, and articulates with the head of the ulna.
These two articular surfaces are separated by a prominent ridge, to which the base of the
triangular articular disk is attached; this disk separates the wrist-joint from the distal
radioulnar articulation.
Other surfaces
This end of the bone has three non-articular surfaces – volar, dorsal, and lateral.

 The volar surface, rough and irregular, affords attachment to the volar radiocarpal
ligament.
 The dorsal surface is convex, affords attachment to the dorsal radiocarpal
ligament, and is marked by three grooves. Enumerated from the lateral side:
o The first groove is broad, but shallow, and subdivided into two by a
slight ridge: the lateral of these two, transmits the tendon of
the extensor carpi radialis longus muscle; the medial, the tendon of
the extensor carpi radialis brevis muscle.
o The second is deep but narrow, and bounded laterally by a sharply
defined ridge; it is directed obliquely from above downward and
lateralward, and transmits the tendon of the extensor pollicis longus
muscle.
o The third is broad, for the passage of the tendons of the extensor
indicis proprius and extensor digitorum communis.
 The lateral surface is prolonged obliquely downward into a strong, conical
projection, the styloid process, which gives attachment by its base to the tendon of
the brachioradialis, and by its apex to the radial collateral ligament of wrist joint.
 The lateral surface of this process is marked by a flat groove, for the tendons of
the abductor pollicis longus muscle and extensor pollicis brevis muscle.
Body
The body of the radius (or shaft of radius) is prismoid in form, narrower above than below,
and slightly curved, so as to be convex lateralward. It presents three borders and three
surfaces.
Borders
The volar border (margo volaris; anterior border; palmar;) extends from the lower part of
the tuberosity above to the anterior part of the base of the styloid process below, and
separates the volar from the lateral surface. Its upper third is prominent, and from its oblique
direction has received the name of the oblique line of the radius; it gives origin to the flexor
digitorum superficialis muscle (also flexor digitorum sublimis) and flexor pollicis longus
muscle; the surface above the line gives insertion to part of the supinator muscle. The middle
third of the volar border is indistinct and rounded. The lower fourth is prominent, and gives
insertion to the pronator quadratus muscle, and attachment to the dorsal carpal ligament; it
ends in a small tubercle, into which the tendon of the brachioradialis muscle is inserted.
The dorsal border (margo dorsalis; posterior border) begins above at the back of the neck,
and ends below at the posterior part of the base of the styloid process; it separates the
posterior from the lateral surface. is indistinct above and below, but well-marked in the
middle third of the bone.
The interosseous border (internal border; crista interossea; interosseous crest;) begins
above, at the back part of the tuberosity, and its upper part is rounded and indistinct; it
becomes sharp and prominent as it descends, and at its lower part divides into two ridges
which are continued to the anterior and posterior margins of the ulnar notch. To the posterior
of the two ridges the lower part of the interosseous membrane is attached, while the triangular
surface between the ridges gives insertion to part of the pronator quadratus muscle. This crest
separates the volar from the dorsal surface, and gives attachment to the interosseous
membrane. The connection between the two bones is actually a joint referred to as
a syndesmosis joint.

Surfaces
The volar surface (facies volaris; anterior surface) is concave in its upper three-fourths, and
gives origin to the flexor pollicis longus muscle; it is broad and flat in its lower fourth, and
affords insertion to the Pronator quadratus. A prominent ridge limits the insertion of the
Pronator quadratus below, and between this and the inferior border is a triangular rough
surface for the attachment of the volar radiocarpal ligament. At the junction of the upper and
middle thirds of the volar surface is the nutrient foramen, which is directed obliquely upward.
The dorsal surface (facies dorsalis; posterior surface) is convex, and smooth in the upper
third of its extent, and covered by the Supinator. Its middle third is broad, slightly concave,
and gives origin to the Abductor pollicis longus above, and the extensor pollicis brevis
muscle below. Its lower third is broad, convex, and covered by the tendons of the muscles
which subsequently run in the grooves on the lower end of the bone.
The lateral surface (facies lateralis; external surface) is convex throughout its entire extent
and is known as the convexity of the radius, curving outwards to be convex at the side. Its
upper third gives insertion to the supinator muscle. About its center is a rough ridge, for the
insertion of the pronator teres muscle.[2] Its lower part is narrow, and covered by the tendons
of the abductor pollicis longus muscle and extensor pollicis brevis muscle.
Near the elbow
The upper extremity of the radius (or proximal extremity) presents a head, neck, and
tuberosity.

 The radial head has a cylindrical form, and on its upper surface is a shallow cup
or fovea for articulation with the capitulum (or capitellum) of the humerus. The
circumference of the head is smooth; it is broad medially where it articulates with
the radial notch of the ulna, narrow in the rest of its extent, which is embraced by
the annular ligament. The deepest point in the fovea is not axi-symmetric with the
long axis of the radius, creating a cam effect during pronation and supination.
 The head is supported on a round, smooth, and constricted portion called the neck,
on the back of which is a slight ridge for the insertion of part of the supinator
muscle.
 Beneath the neck, on the medial side, is an eminence, the radial tuberosity; its
surface is divided into a posterior, rough portion, for the insertion of the tendon of
the biceps brachii muscle, and an anterior, smooth portion, on which a bursa is
interposed between the tendon and the bone.

Development
The radius is ossified from three centers: one for the body, and one for each extremity. That
for the body makes its appearance near the center of the bone, during the eighth week
of fetal life.
Ossification commences in the lower end between 9 and 26 months of age.[citation needed] The
ossification center for the upper end appears by the fifth year.
The upper epiphysis fuses with the body at the age of seventeen or eighteen years, the lower
about the age of twenty.
An additional center sometimes found in the radial tuberosity, appears about the fourteenth or
fifteenth year.

Function
Muscle attachments
The biceps muscle inserts on the radial tuberosity of the upper extremity of the bone. The
upper third of the body of the bone attaches to the supinator, the flexor digitorum
superficialis, and the flexor pollicis longus muscles. The middle third of the body attaches to
the extensor ossis metacarpi pollicis, extensor primi internodii pollicis, and the pronator
teres muscles. The lower quarter of the body attaches to the pronator quadratus muscle and
the tendon of the supinator longus.

Clinical significance
Radial aplasia refers to the congenital absence or shortness of the radius.
Fracture

A subtle radial head fracture with associated positive sail sign

Specific fracture types of the radius include:

 Proximal radius fracture. A fracture within the capsule of the elbow joint results
in the fat pad sign or "sail sign" which is a displacement of the fat pad at the
elbow.

Illustration showing radius shaft fracture

 Essex-Lopresti fracture – a fracture of the radial head with
concomitant dislocation of the distal radio-ulnar joint with disruption
of the interosseous membrane.[3]
 Radial shaft fracture
 Distal radius fracture
o Galeazzi fracture – a fracture of the radius with dislocation of
the distal radioulnar joint
o Colles' fracture – a distal fracture of the radius with dorsal (posterior)
displacement of the wrist and hand
o Smith's fracture – a distal fracture of the radius with volar (ventral)
displacement of the wrist and hand
o Barton's fracture – an intra-articular fracture of the distal radius with
dislocation of the radiocarpal joint.
History
The word radius is Latin for "ray". In the context of the radius bone, a ray can be thought of
rotating around an axis line extending diagonally[clarification needed] from center of capitulum to the
center of distal ulna. While the ulna is the major contributor to the elbow joint, the radius
primarily contributes to the wrist joint.[4]
The radius is named so because the radius (bone) acts like the radius (of a circle). It rotates
around the ulna and the far end (where it joins to the bones of the hand), known as the styloid
process of the radius, is[clarification needed] the distance from the ulna (center of the circle) to the
edge of the radius (the circle). The ulna acts as the center point to the circle because when the
arm is rotated the ulna does not move.

Animals
In four-legged animals, the radius is the main load-bearing bone of the lower forelimb. Its
structure is similar in most terrestrial tetrapods, but it may be fused with the ulna in
some mammals (such as horses) and reduced or modified in animals with flippers or vestigial
forelimbs.
Ulna
<<< An example of a human ulna, shown in red.
(in Standard anatomical position)
The ulna (pl. ulnae or ulnas[3]) is a long bone found
in the forearm that stretches from the elbow to the
smallest finger, and when in anatomical position, is
found on the medial side of the forearm. That is, the
ulna is on the same side of the forearm as the little
finger. It runs parallel to the radius, the other long
bone in the forearm. The ulna is usually slightly
longer than the radius, but the radius is thicker.
Therefore, the radius is considered to be the larger of
the two.

Structure
The ulna is a long bone found in the forearm that stretches from the elbow to the smallest
finger, and when in anatomical position, is found on the medial side of the forearm. It is
broader close to the elbow, and narrows as it approaches the wrist.
Close to the elbow, the ulna has a bony process, the olecranon process, a hook-like structure
that fits into the olecranon fossa of the humerus. This prevents hyperextension and forms
a hinge joint with the trochlea of the humerus. There is also a radial notch for the head of the
radius, and the ulnar tuberosity to which muscles attach.
Close to the wrist, the ulna has a styloid process.
Near the elbow
Near the elbow, the ulna has two curved processes, the olecranon and the coronoid process;
and two concave, articular cavities, the semilunar and radial notches. The olecranon is a
large, thick, curved eminence, situated at the upper and back part of the ulna. It is bent
forward at the summit so as to present a prominent lip which is received into the olecranon
fossa of the humerus in extension of the forearm. Its base is contracted where it joins the
body and the narrowest part of the upper end of the ulna. Its posterior surface, directed
backward, is triangular, smooth, subcutaneous, and covered by a bursa. Its superior surface is
of quadrilateral form, marked behind by a rough impression for the insertion of the triceps
brachii; and in front, near the margin, by a slight transverse groove for the attachment of part
of the posterior ligament of the elbow joint. Its anterior surface is smooth, concave, and forms
the upper part of the semilunar notch. Its borders present continuations of the groove on the
margin of the superior surface; they serve for the attachment of ligaments: the back part of
the ulnar collateral ligament medially, and the posterior ligament laterally. From the medial
border a part of the flexor carpi ulnaris arises; while to the lateral border the anconeus is
attached.
<<< Proximal extremity of left ulna. Lateral aspect.

The coronoid process is a triangular eminence projecting forward

from the upper and front part of the ulna. Its base is continuous
with the body of the bone, and of considerable strength. Its apex is
pointed, slightly curved upward, and in flexion of the forearm is
received into the coronoid fossa of the humerus. Its upper surface is
smooth, concave, and forms the lower part of the semilunar notch.
Its antero-inferior surface is concave, and marked by a rough
impression for the insertion of the brachialis. At the junction of this
surface with the front of the body is a rough eminence, the
tuberosity of the ulna, which gives insertion to a part of the
brachialis; to the lateral border of this tuberosity the oblique cord is
attached. Its lateral surface presents a narrow, oblong, articular
depression, the radial notch. Its medial surface, by its prominent,
free margin, serves for the attachment of part of the ulnar collateral
ligament. At the front part of this surface is a small rounded
eminence for the origin of one head of the flexor digitorum
superficialis; behind the eminence is a depression for part of the
origin of the flexor digitorum profundus; descending from the
eminence is a ridge which gives origin to one head of the pronator teres. Frequently,
the flexor pollicis longus arises from the lower part of the coronoid process by a rounded
bundle of muscular fibers.
The semilunar notch is a large depression, formed by the olecranon and the coronoid process,
and serving as articulation with the trochlea of the humerus. About the middle of either side
of this notch is an indentation, which contracts it somewhat, and indicates the junction of the
olecranon and the coronoid process. The notch is concave from above downward, and
divided into a medial and a lateral portion by a smooth ridge running from the summit of the
olecranon to the tip of the coronoid process. The medial portion is the larger, and is slightly
concave transversely; the lateral is convex above, slightly concave below.
The radial notch is a narrow, oblong, articular depression on the lateral side of the coronoid
process; it receives the circumferential articular surface of the head of the radius. It is
concave from before backward, and its prominent extremities serve for the attachment of the
annular ligament.
Body
The body of the ulna at its upper part is prismatic in form, and curved so as to be convex
behind and lateralward; its central part is straight; its lower part is rounded, smooth, and bent
a little lateralward. It tapers gradually from above downward, and has three borders and three
surfaces.

Borders

 The volar border (margo volaris; anterior border) begins above at the prominent
medial angle of the coronoid process, and ends below in front of the styloid
process. Its upper part, well-defined, and its middle portion, smooth and rounded,
give origin to the flexor digitorum profundus; its lower fourth serves for the origin
of the pronator quadratus. This border separates the volar from the medial surface.
 The dorsal border (margo dorsalis; posterior border) begins above at the apex of
the triangular subcutaneous surface at the back part of the olecranon, and ends
below at the back of the styloid process; it is well-marked in the upper three-
fourths, and gives attachment to an aponeurosis which affords a common origin to
the flexor carpi ulnaris, the extensor carpi ulnaris, and the flexor digitorum
profundus; its lower fourth is smooth and rounded. This border separates the
medial from the dorsal surface.
 The interosseous crest (crista interossea; external or interosseous border) begins
above by the union of two lines, which converge from the extremities of the radial
notch and enclose between them a triangular space for the origin of part of
the Supinator; it ends below at the head of the ulna. Its upper part is sharp, its
lower fourth smooth and rounded. This crest gives attachment to the interosseous
membrane, and separates the volar from the dorsal surface.
Surfaces

 The volar surface (facies volaris; anterior surface), much broader above than
below, is concave in its upper three-fourths, and gives origin to the flexor
digitorum profundus; its lower fourth, also concave, is covered by the pronator
quadratus. The lower fourth is separated from the remaining portion by a ridge,
directed obliquely downward and medialward, which marks the extent of origin of
the pronator quadratus. At the junction of the upper with the middle third of the
bone is the nutrient canal, directed obliquely upward.
 The dorsal surface (facies dorsalis; posterior surface) directed backward and
lateralward, is broad and concave above; convex and somewhat narrower in the
middle; narrow, smooth, and rounded below. On its upper part is an oblique ridge,
which runs from the dorsal end of the radial notch, downward to the dorsal
border; the triangular surface above this ridge receives the insertion of
the Anconæus, while the upper part of the ridge affords attachment to
the supinator. Below this the surface is subdivided by a longitudinal ridge,
sometimes called the perpendicular line, into two parts: the medial part is smooth,
and covered by the extensor carpi ulnaris; the lateral portion, wider and rougher,
 gives origin from above downward to the Supinator, the abductor pollicis longus,
the extensor pollicis longus, and the extensor indicis proprius.
 The medial surface (facies medialis; internal surface) is broad and concave
above, narrow and convex below. Its upper three-fourths give origin to the Flexor
digitorum profundus; its lower fourth is subcutaneous.
Near the wrist
The head of ulna presents an articular surface, part of which, of an oval or semilunar form, is
directed downward, and articulates with the upper surface of the triangular articular
disc which separates it from the wrist-joint; the remaining portion, directed lateralward, is
narrow, convex, and received into the ulnar notch of the radius.
Near the wrist, the ulnar, with two eminences; the lateral and larger is a rounded, articular
eminence, termed the head of the ulna; the medial, narrower and more projecting, is a non-
articular eminence, the styloid process.

 The head presents an articular surface, part of which, of an oval or semilunar

form, is directed downward, and articulates with the upper surface of the
triangular articular disk which separates it from the wrist-joint; the remaining
portion, directed lateralward, is narrow, convex, and received into the ulnar notch
of the radius.
 The styloid process projects from the medial and back part of the bone; it
descends a little lower than the head, and its rounded end affords attachment to
the ulnar collateral ligament of the wrist-joint.
The head is separated from the styloid process by a depression for the attachment of the apex
of the triangular articular disk, and behind, by a shallow groove for the tendon of the extensor
carpi ulnaris.

Vertical section through the articulations at the wrist,

showing the synovial cavities.
Bones of left forearm. Anterior
aspect.
 Ligaments of wrist. Anterior view Ligaments of wrist.
Posterior view.
Bones of left forearm. Posterior aspect.

Microanatomy
The ulna is a long bone. The long, narrow medullary cavity of the ulna is enclosed in a strong
wall of cortical tissue which is thickest along the interosseous border and dorsal surface. At
the extremities the compact layer thins. The compact layer is continued onto the back of the
olecranon as a plate of close spongy bone with lamellæ parallel. From the inner surface of
this plate and the compact layer below it trabeculæ arch forward toward the olecranon and
coronoid and cross other trabeculæ, passing backward over the medullary cavity from the
upper part of the shaft below the coronoid. Below the coronoid process there is a small area
of compact bone from which trabeculæ curve upward to end obliquely to the surface of the
semilunar notch which is coated with a thin layer of compact bone. The trabeculæ at the
lower end have a more longitudinal direction.[4]

Development
<<< The ulna is formed into bone from three centres, shown here.
The ulna is ossified from three centers: one each for the body, the
wrist end, and the elbow end, near the top of the olecranon.
Ossification begins near the middle of the body of the ulna, about
the eighth week of fetal life, and soon extends through the greater
part of the bone.
At birth, the ends are cartilaginous. About the fourth year or so, a
center appears in the middle of the head, and soon extends into
the ulnar styloid process. About the tenth year, a center appears in
the olecranon near its extremity, the chief part of this process being
formed by an upward extension of the body. The
upper epiphysis joins the body about the sixteenth, the lower about
the twentieth year.

Function
Joints
The ulna forms part of the wrist joint and elbow joints. Specifically, the ulna joins
(articulates) with:

 trochlea of the humerus, at the right side elbow as a hinge joint with
semilunar trochlear notch of the ulna.
  the radius, near the elbow as a pivot joint, this allows the radius to cross over the
ulna in pronation.
 the distal radius, where it fits into the ulnar notch.
 the radius along its length via the interosseous membrane that forms
a syndesmosis joint

Muscle attachments

Bones of left
forearm. Anterior aspect. The radius and ulna of the left forearm, posterior surface.

Muscle Direction Attachment

Triceps brachii posterior part of superior surface of Olecranon

Insertion
muscle process (via common tendon)

Anconeus muscle Insertion olecranon process (lateral aspect)

Brachialis muscle Insertion anterior surface of the coronoid process of the ulna

medial surface on middle portion of coronoid process

Pronator teres muscle Origin (also shares origin with medial epicondyle of the
humerus)
 Muscle Direction Attachment

Flexor carpi ulnaris olecranon process and posterior surface of ulna (also
Origin
muscle shares origin with medial epicondyle of the humerus)

Flexor digitorum coronoid process (also shares origin with medial

Origin
superficialis muscle epicondyle of the humerus and shaft of the radius)

Flexor digitorum anteromedial surface of ulna (also shares origin with

Origin
profundus muscle the interosseous membrane)

Pronator quadratus
Origin distal portion of anterior ulnar shaft
muscle

Extensor carpi ulnaris posterior border of ulna (also shares origin with lateral
Origin
muscle epicondyle of the humerus)

proximal ulna (also shares origin with lateral

Supinator muscle Origin
epicondyle of the humerus)

Abductor pollicis posterior surface of ulna (also shares origin with the
Origin
longus muscle posterior surface of the radius bone)

Extensor pollicis dorsal shaft of ulna (also shares origin with the dorsal
Origin
longus muscle shaft of the radius and the interosseous membrane)

Extensor indicis posterior surface of distal ulna (also shares origin with
Origin
muscle the interosseous membrane)

Clinical significance
Fractures
Further information: Bone fracture
Specific types of ulna fracture include:
  Monteggia fracture - a fracture of the proximal third of the ulna with the
dislocation of the head of the radius
 Hume fracture - a fracture of the olecranon with an
associated anterior dislocation of the radial head
Conservative management is possible for ulnar fractures when they are located in the distal
two-thirds, only involve the shaft, with no shortening, less than 10° angulation and less than
50% displacement.[5] In such cases, a cast should be applied that goes above the elbow.

Other animals
Quill knobs on the ulnae of fossil (top) and modern (bottom) birds.
In four-legged animals, the radius is the main load-
bearing bone of the lower forelimb, and the ulna is
important primarily for muscular attachment. In many
mammals, the ulna is partially or wholly fused with the
radius, and may therefore not exist as a separate bone.
However, even in extreme cases of fusion, such as
in horses, the olecranon process is still present, albeit as
a projection from the upper radius.[6]
In birds and other dinosaurs the ulna forms a surface of
attachment for the secondary feathers. These often leave osteological evidence in the form of
quill knobs, allowing for identification of feathers in fossils that otherwise lack
integumentary information.
Interphalangeal joints of the hand

Human hand bones

The DIP, PIP and MCP joints of the hand:
Distal InterPhalangeal
Proximal InterPhalangeal
MetaCarpoPhalangeal
The interphalangeal joints of the hand are the hinge joints between the phalanges of
the fingers that provide flexion towards the palm of the hand.
There are two sets in each finger (except in the thumb, which has only one joint):

 "proximal interphalangeal joints" (PIJ or PIP), those between the first (also called
proximal) and second (intermediate) phalanges
 "distal interphalangeal joints" (DIJ or DIP), those between the second
(intermediate) and third (distal) phalanges
Anatomically, the proximal and distal interphalangeal joints are very similar. There are some
minor differences in how the palmar plates are attached proximally and in the segmentation
of the flexor tendon sheath, but the major differences are the smaller dimension and reduced
mobility of the distal joint.[1]

Joint structure

>>Joints of the
hand, X-ray
Interphalangeal ligaments and phalanges. Right hand. Deep dissection. Posterior
(dorsal) view
The PIP joint exhibits great lateral stability. Its transverse diameter is greater than its antero-
posterior diameter and its thick collateral ligaments are tight in all positions during flexion,
contrary to those in the metacarpophalangeal joint.[1]
Further information: Collateral ligament of interphalangeal joints of hand
Dorsal structures
The capsule, extensor tendon, and skin are very thin and lax dorsally, allowing for both
phalanx bones to flex more than 100° until the base of the middle phalanx makes contact with
the condylar notch of the proximal phalanx.[1]
At the level of the PIP joint the extensor mechanism splits into three bands. The central slip
attaches to the dorsal tubercle of the middle phalanx near the PIP joint. The pair of lateral
bands, to which contribute the extensor tendons, continue past the PIP joint dorsally to the
joint axis. These three bands are united by a transverse retinacular ligament, which runs from
the palmar border of the lateral band to the flexor sheath at the level of the joint and which
prevents dorsal displacement of that lateral band. On the palmar side of the joint axis of
motion, lies the oblique retinacular ligament [of Landsmeer] which stretches from the flexor
sheath over the proximal phalanx to the terminal extensor tendon. In extension, the oblique
ligament prevents passive DIP flexion and PIP hyperextension as it tightens and pulls the
terminal extensor tendon proximally.[2]
Palmar structures
In contrast, on the palmar side, a thick ligament prevents hyperextension. The distal part of
the palmar ligament, called the palmar plate, is 2 to 3 millimetres (0.079 to 0.118 in) thick
and has a fibrocartilaginous structure. The presence of chondroitin and keratan sulfate in the
dorsal and palmar plates is important in resisting compression forces against the condyles of
the proximal phalanx. Together these structures protect the tendons passing in front and
behind the joint. These tendons can sustain traction forces thanks to their collagen fibers.[1]
Palmar ligament
The palmar ligament is thinner and more flexible in its central-proximal part. On both sides it
is reinforced by the so-called check rein ligaments. The accessory collateral ligaments (ACL)
originate at the proximal phalanx and are inserted distally at the base of the middle phalanx
below the collateral ligaments. The accessory ligament and the proximal margin of the palmar
plate are flexible and fold back upon themselves during flexion. The flexor tendon sheaths
are firmly attached to the proximal and middle phalanges by annular pulleys A2 and A4,
while the A3 pulley and the proximal fibres of the C1 ligament attach the sheaths to the
mobile volar ligament at the PIP joint. During flexion this arrangement produces a space at
the neck of the proximal phalanx which is filled by the folding palmar plate.[2]
The palmar plate is supported by a ligament on either side of the joint called the collateral
ligaments, which prevent deviation of the joint from side to side. The ligaments can partially
or fully tear and can avulse with a small fracture fragment when the finger is forced
backwards into hyperextension. This is called a "palmar plate, or volar plate injury".[3]
The palmar plate forms a semi-rigid floor and the collateral
ligaments the walls in a mobile box which moves together with
the distal part of the joint and provides stability to the joint
during its entire range of motion. Because the palmar plate
adheres to the flexor digitorum superficialis near the distal
attachment of the muscle, it also increases the moment of flexor
action. In the PIP joint, extension is more limited because of the
two so called check-rein ligaments, which attach the palmar
plate to the proximal phalanx.[2]

Metacarpophalangeal joint and joints of digit.

Palmar aspect. Palmar ligament labelled as volar ligament

Movements
The only movements permitted in the interphalangeal joints are flexion and extension.

 Flexion is more extensive, about 100°, in the PIP joints and slightly more
restricted, about 80°, in the DIP joints.
 Extension is limited by the volar and collateral ligaments.
The muscles generating these movements are:

Location Flexion Extension

the flexor digitorum profundus acting on mainly by

the proximal and distal joints, and the lumbricals and interossei, the
fingers
the flexor digitorum superficialis acting long extensors having little or no
on the proximal joints action upon these joints

thumb the flexor pollicis longus the extensor pollicis longus

The relative length of the digit varies during motion of the IP joints. The length of the palmar
aspect decreases during flexion while the dorsal aspect increases by about 24 mm. The useful
range of motion of the PIP joint is 30–70°, increasing from the index finger to the little
finger. During maximum flexion the base of the middle phalanx is firmly pressed into the
retrocondylar recess of the proximal phalanx, which provides maximum stability to the joint.
The stability of the PIP joint is dependent of the tendons passing around it.[2]

Clinical significance
Rheumatoid arthritis generally spares the distal interphalangeal joints.[4] Therefore, arthritis of
the distal interphalangeal joints strongly suggests the presence of osteoarthritis or psoriatic
arthritis.
Metacarpophalangeal joint

The DIP, PIP and MCP

joints of the hand: MetaCarpoPhalangeal joints,
and the interphalangeal joints of the hand:
Distal InterPhalangeal
Proximal InterPhalangeal
The palmar aspect of the hand showing
the epiphyses of the hand exploded. MCP joints in red.
The metacarpophalangeal joints (MCP) are situated between the metacarpal bones and the
proximal phalanges of the fingers.[1] These joints are of the condyloid kind, formed by the
reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal
ends of the proximal phalanges.[1] Being condyloid, they allow the movements of flexion,
extension, abduction, adduction and circumduction at the joint.[1]

Structure
Ligments

<<<Metacarpophalangeal articulation and articulations of digit. Palmar aspect.

Metacarpophalangeal articulation and articulations of digit. Ulnar aspect.
Dorsal surfaces
The dorsal surfaces of these joints are covered by the expansions of the Extensor tendons,
together with some loose areolar tissue which connects the deep surfaces of the tendons to the
bones.

Function
The movements which occur in these joints are flexion, extension, adduction, abduction,
and circumduction; the movements of abduction and adduction are very limited, and cannot
be performed while the fingers form a fist.[2]

Joints and ligaments of the arm

 Anterior sternoclavicular
Sternoclavicular  Posterior sternoclavicular
 Interclavicular
 Costoclavicular
 Syndesmoses: Coracoacromial
 Superior transverse scapular
Shoulde Acromioclavicular  Inferior transverse of scapula
r  Synovial: Acromioclavicular
 Coracoclavicular (trapezoid
 conoid)
 Capsule
 Coracohumeral
Glenohumeral  Glenohumeral (superior, middle, and inferior)
 Transverse humeral
 Glenoid labrum

Humeroradial  Radial collateral

Humeroulnar  Ulnar collateral

Elbow
Proximal  Anular
radioulnar  Oblique cord
 Quadrate

Forear Distal  Palmar radioulnar

m radioulnar  Dorsal radioulnar
 Interosseous membrane of forearm

Hand  Dorsal radiocarpal/Palmar radiocarpal

Wrist/radiocarpal  Dorsal ulnocarpal/Palmar ulnocarpal
 Ulnar collateral/Radial collateral
Intercarpal  Radiate carpal
  Dorsal intercarpal
 Palmar intercarpal
 Interosseous intercarpal
 Midcarpal
 Scapholunate
 Pisiform joint (Pisohamate
 Pisometacarpal)

 Dorsal carpometacarpal
Carpometacarpal  Palmar carpometacarpal
 thumb: Radial collateral
 Ulnar collateral

Intermetacarpal  Deep transverse metacarpal

 Superficial transverse metacarpal

Metacarpophalangeal  Collateral
 Palmar

Interphalangeal  Collateral
 Palmar

Other  Carpal tunnel

 Ulnar canal

The muscles of flexion and extension are as follows:

Location Flexion Extension

Flexor digitorum extensor digitorum

superficialis and profundus, lumbricals, communis, extensor indicis
fingers
and interossei, assisted in the case of the little proprius, and extensor digiti
finger by the flexor digiti minimi brevis minimi muscle

extensor pollicis
thumb flexor pollicis longus and brevis
longus and brevis

Clinical significance
Arthritis of the MCP is a distinguishing feature of rheumatoid arthritis, as opposed to
the distal interphalangeal joint in osteoarthritis.
Other animals[edit]
In many quadrupeds, particularly horses and other larger animals, the metacarpophalangeal
joint is referred to as the "fetlock". This term is translated literally as "foot-lock". In fact,
although the term fetlock does not specifically apply to other species' metacarpophalangeal
joints (for instance, humans), the "second" or "mid-finger" knuckle of the human hand does
anatomically correspond to the fetlock on larger quadrupeds. For lack of a better term, the
shortened name may seem more practical.
Carpometacarpal joint
<<<Ligaments of wrist. Posterior view.
The carpometacarpal (CMC) joints are five joints in
the wrist that articulate the distal row of carpal bones and the
proximal bases of the five metacarpal bones.
The CMC joint of the thumb or the first CMC joint, also known as
the trapeziometacarpal (TMC) joint, differs significantly from
the other four CMC joints and is therefore described separately.

Thumb

Bones of a human wrist. In this photo both the free

position and the saddle shape of the first CMC joint and
the proximal transverse palmar arch are clearly visible.
The carpometacarpal joint of the thumb (pollex), also
known as the first carpometacarpal joint, or the
trapeziometacarpal joint (TMC) because it connects
the trapezium to the first metacarpal bone, plays an irreplaceable role in the normal
functioning of the thumb. The most important joint connecting the wrist to the metacarpus,
osteoarthritis of the TMC is a severely disabling condition; up to twenty times more common
among elderly women than in average.[1]
Pronation-supination of the first metacarpal is especially important for the action of
opposition.[1] The movements of the first CMC are limited by the shape of the joint, by the
capsulo-ligamentous complex surrounding the joint, and by the balance among involved
muscles. If the first metacarpal fails to sit well 'on the saddle', for example because
of hypoplasia, the first CMC joint tends to be subluxated (i.e. slightly displaced) towards
the radius.[1]
The capsule is sufficiently slack to allow a wide range of movements and a distraction of
roughly 3 mm, while reinforcing ligaments and tendons give stability to the joint. It is slightly
thicker on its dorsal side than on the other.[1]
The first carpometacarpal joint is a frequent site of osteoarthritis in postmenopausal women.[2]
Ligaments
The description of the number and names of the ligaments of the first CMC varies
considerably in anatomical literature. Imaeda et al. 1993 describe three intracapsular and two
extracapsular ligaments to be most important in stabilizing the thumb:[1]
Anterior oblique ligament (AOL)
A strong, thick, and intracapsular ligament originating on the palmar tubercle of the
trapezium to be inserted on the palmar tubercle of the first metacarpal. It is taut in
 abduction, extension, and pronation, and has been reported to have an important
retaining function and to be elongated or absent in CMC joint arthritis.
Ulnar collateral ligament (UCL)
An extracapsular ligament, the UCL is located ulnarly to the AOL. It has its origin on
the flexor retinaculum and is inserted on the ulnopalmar tubercle of the first
metacarpal. It is taut in abduction, extension, and pronation, and often found
elongated in connection to CMC joint arthritis. The importance ascribed to the UCL
varies considerably among researchers.
First intermetacarpal ligament (IML)
Connecting the bases of the second and first metacarpals, this ligament inserts onto
the ulnopalmar tubercle of the first metacarpal where its fibers intermingle with those
of the UCL. It is taut in abduction, opposition, and supination. It has been reported to
be the most important restraining structure of the first CMC joint by several
researchers. Some consider it too weak to be able to stabilize the joint by itself, yet
accept that together with the UCL it represents an important restraining structure.
Posterior oblique ligament (POL)
An intracapsular ligament stretching from the dorsoulnar side of the trapezium to the
ulno-palmar tubercle of the first metacarpal. Not considered an important ligament to
the first CMC joint, it tightens during forced adduction and radial abduction.
Dorsoradial ligament (DRL)
Like the previous ligament, the DRL is not considered important to the first CMC. It
connects the dorsal sides of the trapezium and the first metacarpal.
Early, anatomically correct drawings of the ligaments of the first carpometacarpal joints were
produced by Weitbrecht 1742.[3]
Movements
In this articulation the movements permitted are flexion and extension in the plane of the
palm of the hand, abduction and adduction in a plane at right angles to the palm,
circumduction, and opposition.

>> It is by the movement of opposition that the tip of the thumb is brought into contact with
the volar surfaces of the slightly flexed fingers. This movement is effected through the
medium of a small sloping facet on the anterior lip of the saddle-shaped articular surface of
the greater multangular (trapezium). The flexor muscles pull the corresponding part of the
articular surface of the metacarpal bone on to this facet, and the movement of opposition is
then carried out by the adductors.

>> Flexion of this joint is produced by the flexor pollicis longus and brevis, assisted by
the opponens pollicis and the adductor pollicis.

>> Extension is effected mainly by the abductor pollicis longus, assisted by the extensores
pollicis longus and brevis.
>> Adduction is carried out by the adductor; abduction mainly by the abductor pollicis
longus and brevis, assisted by the extensors.
Range of motion for the first CMC is 53° of flexion/extension, 42° of abduction/adduction,
and 17° of rotation.[4]
Planes and axes of movements
The thumb's MP and CMC joints abduct and adduct in a plane perpendicular to the palm, a
movement also referred to as "palmar abduction." The same joints flex and extend in a plane
parallel to the palm, also referred to as "radial abduction," because the thumb moves toward
the hand's radial side. Abduction and adduction occur around an antero-posterior axis, while
flexion and extension occur around a lateral axis.[5]
For ease of orientation, the thumbnail can be considered as resting in the thumb's frontal
plane. Abduction and adduction of the first CMC (and MP) joint(s) occur in this plane;
flexion and extension of the first CMC, MP, and IP joints occur in a plane that is
perpendicular to the thumbnail. This remains true regardless of how the first metacarpal bone
is being rotated during opposition and reposition.[5]
Sexual dimorphism
Male and female thumb CMC joints are different in some aspects. In women, the trapezial
articular surface is significantly smaller than the metacarpal surface, and its shape also differs
from that of males. While most thumb CMC joints are more congruent in the radioulnar
direction than the dorsovolar, female CMC joints are less globally congruent than male joints.
[6]

Evolution
A primitive autonomisation of the first ray took place in dinosaurs, while a real
differentiation appeared in primitive primates approximately 70 million years ago. The shape
of the human TMC joint dates back about 5 million years ago. As a result of evolution, the
human thumb CMC joint has positioned itself at 80° of pronation, 40° of abduction, and 50°
of flexion in relation to an axis passing through the stable second and third CMC joints.[1]

Fingers

Section through the human wrist X-ray of a human hand

● The second metacarpal articulates primarily with the trapezoid and secondarily with
the trapezium and capitate.

● The third metacarpal articulates primarily with the capitate,

● The fourth metacarpal articulates with the capitate and hamate.

● The fifth metacarpal articulates with the hamate.

Among themselves, the four ulnar metacarpals also articulates with their neighbours at
the intermetacarpal articulations.[7]
Ligaments
These four CMC joints are supported by strong transverse and weaker longitudinal ligaments:
the dorsal carpometacarpal ligaments and the volar or palmar carpometacarpal ligaments.
The interosseous ligaments consist of short, thick fibers, and are limited to one part of the
carpometacarpal articulation; they connect the contiguous inferior angles of the capitate and
hamate with the adjacent surfaces of the third and fourth metacarpal bones.
Movements
The carpometacarpal joints of second through fifth digits are arthrodial. The movements
permitted in the second through fifth carpometacarpal joints most readily observable in the
(distal) heads of the metacarpal bones. The range of motions in these joints decrease from the
fifth to the second CMCs.
The second to fifth joints are synovial ellipsoidal joints with a nominal degree of
freedom (flexion/extension). The second and third joints are however almost essentially
immobile and can be considered to have zero degrees of freedom in practice, but capable of
anteroposterior gliding (translation) movements. The second and third CMC however also
capable of small degree of flexion-extension motion (11 degrees of flexion-extension motion
for the second, while 7 degrees for the third).[12] These two CMC provide the other three
CMCs with a fixed and stable axis. While the mobility of the fourth CMC joint thus is
perceptible, the first joint is a saddle joint with two degrees of freedom which except
flexion/extension also enable abduction/adduction and a limited amount of opposition.
Together the movements of the fourth and fifth CMCs facilitates for their fingers to oppose
the thumb.[8]
Function
The function of the finger carpometacarpal joints and their segments overall is to contribute
to the palmar arch system together with the thumb. The proximal transverse arch of the palm
is formed by the distal row of carpal bones. The concavity of this arch is augmented at the
level of the metacarpal heads by the flexibility of the first, fourth, and fifth metacarpal heads
around the fixed second and third metacarpal heads; a flexible structure called the distal
transverse arch. For each finger there is also a longitudinal arch. Together, these arches allow
the palm and the digits to conform optimally to objects as we grasp them (so-called palmar
cupping). Furthermore, as the amount of surface contact is maximized, stability is enhanced
and sensory feedback increases. The deep transverse metacarpal ligament stabilises the
mobile parts of the palmar arch system.
As the fingers are being flexed, palmar cupping is contributed to by muscles crossing the
carpometacarpal joints when they act on the mobile parts of the palmar arch system. The
oblique opponens digiti minimi muscle acts on the fifth carpometacarpal joint and is the only
muscle that act on the carpometacarpal joints alone. It is optimally positioned to flex and
rotate the fifth metacarpal bone about its long axis. Palmar arching is further increased when
[flexor carpi ulnaris] (which is attached to the pisiform) and intrinsic hand muscles attached
to the transverse carpal ligament acts on the arch system. The fixed second and third
carpometacarpal joints are crossed by the radial wrist muscles (flexor carpi radialis, extensor
carpi radialis longus, and extensor carpi radialis brevis). The stability of these two
carpometacarpal joints is a functional adaptation that enhances the efficiency of these
muscles at the midcarpal and radiocarpal joints.

Synovial membranes
The synovial membrane is a continuation of that of the intercarpal joints. Occasionally, the
joint between the hamate and the fourth and fifth metacarpal bones has a separate synovial
membrane.
The synovial membranes of the wrist and carpus are thus seen to be five in number:

 The first passes from the lower end of the ulnar to the ulnar notch of the radius, and
lines the upper surface of the articular disk.
 The second passes from the articular disk and the lower end of the radius above, to the
bones of the first row below.
 The third, the most extensive, passes between the contiguous margins of the two rows
of carpal bones, and sometimes, in the event of one of the interosseous ligaments
being absent, between the bones of the second row to the carpal extremities of the
second, third, fourth, and fifth metacarpal bones.
 The fourth extends from the margin of the greater multangular to the metacarpal bone
of the thumb.
 The fifth runs between the adjacent margins of the triangular and pisiform bones.
Occasionally the fourth and fifth carpometacarpal joints have a separate synovial membrane.

Clinical significance
Osteoarthritis of the carpometacarpal joints is a type of joint disease that results from
breakdown of joint cartilage and underlying bone.[13] When it affects the thumb it is
termed trapeziometacarpal osteoarthritis.
Carpometacarpal bossing is the presence of a small immovable protuberance over the joint.