Wrist and Hand CREATED BY BRIANA OCHOA ELIZABETH

Wrist and Hand CREATED BY: BRIANA OCHOA ELIZABETH RICH DAVID SNYDER

Surface Anatomy Ulnar Styloid Process Pisiform Ulnar Pulse Radial Pulse

Surface Anatomy Distal Wrist Crease Tendon of Flexor Carpi Ulnaris Radial Artery Tendon of Flexor Carpi Radialis Tendon of Palmaris Longus

Surface Anatomy Hypothenar Eminence Thenar Eminence

Surface Anatomy • • Anatomical Snuff Box Tendons of: • Extensor Digitorum • Extensor Pollicis Longus (EPL) • Abductor Pollicis Longus (APL)

Median Nerve

Bones Head Ulnar Notch Radius Styloid Process

Bones • Fingers numbered 1 -5 • Thumb side is always #1

Carpals

Carpals �Some Lovers Try Positions That They Can’t Handle

Joints

Bones of Wrist and Hand

Articular Capsule �Synovial Membrane Produces synovial fluid for lubrication and shock absorption �Fibrous Layer Enclose synovial sheaths (outer membrane) May contain ligaments

Membrane and Cartilage Articular Cartilage

Ligaments �Common Flexor Sheath Through carpal canal to cover flexor tendons of digits �Palmar Aponeurosis Insertion of palmaris longus Common Flexor Sheath

Ligaments �Extensor Retinaculum Connects lateral margin of radius to medial margin of ulna �Flexor Retinaculum Crosses over carpal bones Extensor Retinaculum

Wrist Movement � Actions � Extension � Adduction aka Ulnar Extensor carpi ulnaris Extensor carpi radialis brevis Extensor carpi radialis longus � Assist in Extension Extensor digitorum Extensor indicis � Flexion Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Flexor digitorum superficialis Flexor digitorum profundus Deviation Extensor carpi ulnaris Flexor carpi ulnaris � Abduction Deviation aka Radial Deviation Extensor carpi radialis brevis Extensor carpi radialis longus Flexor carpi radialis � Pronation Pronator quadratus

Extrinsic Extensor Muscles Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris muscle

Extrinsic Muscles: Anatomical Snuff Box Extensor pollicis longus Extensor indicis Abductor pollicis longus Extensor pollicis longus brevis

Extrinsic Flexor Muscles

Extrinsic Muscles of the 1 st Digit �Extensors Extensor pollicis longus Extensor pollicis brevis �Abductors Abductor pollicis longus �Flexors Flexor pollicis longus

Extrinsic Pollicis Muscles �Abduction, Extension, and Flexion

Movements of the Pollicis at the MCP and CMC Joints

Movements of the Pollicis at the CMC Joint � Abduction Abductor pollicis longus Abductor pollicis brevis � Adduction Adductor pollicis: transverse and oblique heads

Thumb Movement �Extension Extensor pollicis longus Extensor pollicis brevis �Flexion Flexor pollicis brevis

Thumb Movement �Opposition Opponens pollicis �Reposition Abductor pollicis

Compartments and Spaces-Intrinsic Muscles

Thenar Compartment Flexor pollicis brevis Abductor pollicis brevis Opponens pollicis

Hypothenar Compartment Opponens digiti minimi Flexor digiti minimi Abductor digiti minimi

Compartments and Spaces of Hand �Adductor Compartment �Central Compartment Adductor pollicis palp Contents: long flexor tendons, digital nerves, su

Thenar and Midpalmer Spaces � Thenar Space 1 st lumbrical muscle Flexor digitorum profundus tendon of digit 2 � Midpalmer Space Lumbricals 2 -4 Flexor digitorum profundus tendons of digits 3 -5 � Actions of Lumbrical Muscles: Flex MCP joints Extend IP joints (PIP & DIP)

Interosseous Compartment �Dorsal Interossei Arise from 4 medial metacarpal bones Action: Abduction Mnemonic: DAB Dorsal: Abduction �Palmer Interossei Arise from metacarpal bones 2, 4, 5 Action: Adduction Mnemonic: PAD Palm ar: Adduction

Movement of Medial Digits at the MCP Joints �Extension Extensor digitorum Extensor indicis Extensor digiti minimi �Flexion Flexor digitorum superficialis Flexor digitorum profundus Flexor digiti minimi Lumbricals

Medial Digit Movement �Abduction Abductor digiti minimi Dorsal interossei (digits 2 -4) �Adduction Palmer interossei (digits 2, 4, 5) �Opposition Opponens digiti minimi

Digital Movement Opponens digiti minimi Flexor digiti minimi Abductor digiti minimi

Digital Movement-Abduction and Adduction �Dorsal Interossei (4) Arise from 4 medial metacarpal bones Action: Abduction Mnemonic: DAB Dorsal: Abduction �Palmer Interossei (3) Arise from metacarpal bones 2, 4, 5 Action: Adduction Mnemonic: PAD Palm ar: Adduction

Digital Movement at PIP and DIP Joints Flexion D 1 IP: Flexor pollicis longus D 2 -5 PIP: Flexor digitorum superficialis DIP: Flexor digitorum profundus Extension D 1: Extensor pollicis longus D 2 -D 4 PIP: Lumbricals, Interossei and Extensor digitorum D 2: Extensor indicis D 3: Dorsal interosseus D 5 PIP – Palmar interosseus and Extensor digiti minimi DIP - Palmar interosseus and Extensor digiti minimi