Radio-carpal joint

- Shruti Shah.

Anatomy
The radiocarpal joint is formed by the radius and radioulnar disc triangularfibrocartilage complex [TFCC] proximally and by scaphoid, lunate, and triquetrum distally.

The proximal radiocarpal joint surface has a single continuous biconcave curvature that is long and shallow side to side (frontal plane) and shorter and sharper anteroposteriorly (sagittal plane).

 The proximal joint surface is composed of : 1. The lateral radial facet that articulates with the scaphoid 2. The medial radial facet that articulates with the lunate. 3. The TFCC that articulates predominantly with the triquetrum although it also has some contact with the lunate in the neutral wrist. The proximal carpal row is the distal surface of the radiocarpal joint.

 The proximal carpal row and ligaments together appear to present a single biconvex joint surface that, unlike a rigid segment, can change shape somewhat to accommodate to the demands of space between the forearm and hand.

TFCC
The TFCC consists of the radioulnar disc, a connective tissue wedge, and thevarious fibrous attachments. The disc is a fibrocartilaginous continuation of thearticular cartilage of the distal radius.
The disc is connected medially via two dense fibrous connective tissue laminae.

 The upper lamina attaches to the ulnar head and ulnar styloid; the lowerlamina has connections to the sheath of the extensor carpi ulnaris and to the triquetrum, hamate, and the base of the fifth metacarpal via fibres from the ulnar collateral ligament.

Ligaments
The ligaments of the wrist complex are devided into extrinsic and intrinsic ligaments. The extrinsic ligaments are those that connect the carpals to the radius or ulnar proximally or to the metacarpals distally The intrinsic ligaments are those that interconnect the carpals themselves and are also known as intercarpal or interosseous ligaments

 Volar Carpal Ligaments: The composite ligament known as the volar radiocarpal ligament has been described most commonly as having three distinct bands: 1. Radioscaphoid 2. Radiotriquetral 3. Radiocapitate The composite ulnocarpal ligament arises from the TFCC and has been described as having bands attaching to the lunate which is called ulnolunate and to the capitate either directly called Ulnocapitate or indirectly via ulnotriquetral and capitotriquetral ligaments.

 Dorsal carpal ligaments : The ligament as a whole converges on the triquetrum from the distal radius, with possible attachments along the way to the lunate and lunotriquetral interosseous ligament. Other ligament is dorsal intercarpal ligament that courses horizontally from the triquetrum to the lunate, scaphoid, and trapezium. The two dorsal ligaments together form a horizontal V that contributes to radiocarpal stability.

Muscles
Six muscles have tendons crossing the volar aspect of the wrist and, therefore, are capable of creating a wrist flexion movement. These are as follows : 1. Palmaris Longus (PL) 2. Flexor Carpi Radialis (FCR) 3. Flexor Carpi Ulnaris (FCU) 4. Flexor Digitorum Superficialis (FDS) 5. Flexor Digitorum Profundus (FDP) 6. Flexor Pollicis Longus (FPL)

 The first three of these muscles are primary wrist muscles. The last three areflexors of the digits with secondary actions at the wrist. All pass under theproximal flexor retinaculum of the wrist, except the palmaris longus andflexor carpi ulnaris. The tendons of nine muscles cross the dorsum of the wrist complex. Three of the nine muscles are primary wrist muscles, whereas the other six are finger and thumb muscles that may act secondarily on the wrist.

These muscles areas follows : Extensor Carpi Radialis Longus (ECRL) Exensor Carpi Radialis Brevis (ECRB) Extensor Carpi Ulnaris (ECU) Extensor Digitorum Communis (EDC) Extensor Indicis Proprius (EIP) Extensor Digiti Minimi (EDM) Extensor Pollicis Longus (EPL) Extensor Pollicis Brevis (EPB) Abductor Pollicis Longus (APL)
The tendons of all nine muscles pass under the extensor retinaculum.

Movements of wrist complex

Flexion / Extension of the Wrist: 1. The motion begins with wrist in full flexion. 2. Active extension is initiated at the distal carpal row and the attached metacarpals by the wrist extensor muscles attached to those bones. 3. The distal carpals (capitate, hamate, trapezium, and trapezoid) glide on the relatively fixed proximal bones (scaphoid, lunate, and triquetrum)

4. Although the surface configurations of the midcarpal joint are complex, the distal carpal row effectively glides in the same directions motion of the hand. 5. When the wrist complex reaches neutral, the ligaments spanning the capitate and scaphoid draw the capitate and scaphoid together into a close-packed position. 6. Continued extensor force now moves the combined unit of the distal carpal row and the scaphoid on the relatively fixed lunate and triquetrum.

7. At approximately 45 of hyperextension of the wrist complex, the scapholunate interosseous ligament brings the scaphoid and lunate into close-packed position. 8. This unites all the carpals and causes them to function as a single unit. 9. Wrist complex extension is completed as the proximal articular surface of the carpals move as a solid unit on the radius and radioulnar disc. 10. All ligaments become taut as full extension is reached and the entire wrist complex is close-packed. Wrist motion from full extension to full flexion occurs in reverse sequence.

Thank you