Wrist and Hand

Dr. Muthoka Mativo

Objectives

 Osteology of hand
 Joints: Classification, movements
 Muscles
 Applied anatomy
Osteology

 Wrist is a joint complex consisting of radio-carpal

joint and many relationships between the carpal
bones
 Review of carpals
Proximal row = Pisiform, Triquetrum, Lunate, and
Scaphoid*

Distal row = Hamate, Capitate, Trapezoid, and Trapezium

*Scaphoid has a notoriously poor blood supply and
recovers poorly following injury
Bones
 29 bones including:
• distal aspect of the radius and ulna
• 8 carpal (bulk of the hand)
• 14 phalanges (the fingers)
• 5 metacarpals
• total: 2+8+14+5=29
Bones

 Radius and Ulna

• the radius is more massive distally than the ulna
• the ulna is more massive proximally than the
radius

• Remember, forearm pronation and supination are

the result of the radius rotating about the ulna and
carrying with it the hand
Bones
 Carpal Bones
• 8 total
• 2 rows of 4
• Proximal row:
• pisiform, triquetrum, lunate, scaphoid
• Distal row:
• hamate, capitate, trapezoid, trapezium
Bones

 Metacarpals
•5
 Phalanges
• 3 per finger
• 2 per thumb
Osteology
Osteology
Osteology
Scaphoid
Joints
 Wrist Joint
• Classified as a Condyloid Joint

• allows for flexion, extension, radial and ulnar deviation

• Remember, radius=thumb side

• The motion of the wrist is due to the articulation of the radius and
proximal carpal bones (or Radiocarpal joint).

• There is an articular disk between the distal aspect of the ulna and
triquetrum
Movements of the wrist and
hand
 Wrist (remember start from anatomical position)
• Flexion
• (or palmar flexion): anterior deviation from
anatomical position.
• Extension: dorsal flexion
• Abduction
• (or radial deviation or radial flexion)
• Adduction
• (or ulnar deviation or ulnar flexion)
Muscles causing wrist actions
 Wrist flexors
• flexor carpi radialis
• flexor carpi ulnaris
• palmaris longus These muscles do not
cause finger
 Wrist extensors movements
• extensor carpi radialis longus
• extensor carpi radialis brevis
• extensor carpi ulnaris
Definition of Finger Movements
 Reference is imaginary line through the middle
of long (3rd) finger
 Adduction of 2-5 = towards that point
 Abduction = away –1, 4, and 5
 Thumb
• Flexion
• Extension
• ABD
• ADD
• Rotation
• Opposition = flexion with adduction and rotation
Finger Movements
Intrinsic Muscles
 Thenar Eminence - median
 Hypothernar Eminence - ulnar
 Intermediate – ulnar and some median
 There are NO muscles in the hand
innervated by the Radial nerve
Palmar Aponeurosis
Thenar Eminence
 Flexor Pollicus Brevis
 Abductor Pollicus Brevis
 Opponens Pollicus
Hypothenar Eminence
 Abductor Digiti Minimi
 Flexor Digiti Minimi
 Opponens Diditi Minimi
Intermediate
 Adductor Pollicus
 Lumbricales
 Volar (Palmar) Interossei
 Dorsal Interossei
Adductor Pollicus
Lumbricales
Lumbricales
Dorsal Interossei
1st Dorsal Interosseous
Volar (Palmar) Interrossei
Blood Supply
 Ulnar aa
• Superficial Palmar Arch
• Common Palmar aa
• Proper palmar digital aa
 Radial aa
• Deep Palmar Arch
• Dorsal digital aa
• Princeps Pollicus
• Radialis Indicis
Superficial Palmar Arch
Superficial Palmar Arch
Superficial Palmar Arch
Deep Palmar Arch
Deep Palmar Arch-Dorsal View
Deep Palmar Arch
Applied anatomy
 Median nerve: Carpal tunnel syndrome
 Scaphoid fractures: avascular necrosis
 HAVE A BLESSED DAY

Quote of the day

“Unless the Lord watches over a city, the watchmen
stay awake in vain…”