Wrist joint Bones of Wrist dorsal Trapezoid Capitate
Wrist joint
Bones of Wrist (dorsal) Trapezoid ﺷﺒﻪ ﻣﻨﺤﺮﻑ Capitate ﺻﻮﺭﺓ ﺭﺃﺲ Hamate ﺣﺎﻣﻲ Trapezium ﻣﻌﻴﻦ ﻣﻨﺤﺮﻑ Scaphoid ﺯﻭﺭﻗﻲ Pisiform ﺣﻤﺼﻲ Triquetral ﻣﺜﻠﺜﻲ Lunate ﻫﻼﻟﻲ Distal end of ulna Distal end of radius
Wrist joint Articular surfaces Lunate bone Scaphoid bone Distal end of the radius Ellipsoid synovial joint (biaxial). Triquetral bone Articular disc So the ulna does not share
v. Ligaments 1 - Radial collateral (Lateral) ligament: from the tip of the styloid process of the radius to the scaphoid. 2 - Ulnar collateral (Medial) ligament: from the tip of the styloid process of the ulna to the triquetral 3 - Palmar radiocarpal ligament: - From the anterior margin of the lower end of the radius to the front of the carpal bones. 4 - Dorsal radiocarpal ligament: - From the posterior margin of the lower end of the radius to the back of the carpal bones. 5 - Palmar ulnocarpal ligament: - From the anterior margin of the inter-articular disc and styloid process of the ulna to the front of the carpal bones.
Anterior Flexor muscles are named: • Pronator teres m. • Flex. carpi radialis m. • Palmaris longus m. • Flex. digitorum superficialis m. • Flex. carpi ulnaris m. • Flex. pollicis longus m. • Flex. digitorum profundus m. • Pronator quadratus m.
Pronator teres Palmaris Longus Flexor Carpi Radialis Flexor digitorum superficialis Flexor Carpi Ulnaris
Flex. pollicis longus Pronator quadratus Flexor Digitorum Profundus
Posterior compartment • • • Brachioradilis m. Ext. carpi radialis longus m. Ext. carpi radialis brevis m. Extensor digitorum m. Extensor digiti minimi m. Ext. carpi ulnaris m. Anconeus Ext. pollicis longus/brevis m. Abd pollicis longus m. Extensor indicis m. supinator m.
(Superficial groups) Anconeus m. extensor digitorum Extensor carpi ulnaris extensor digiti minimi Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis
Deep groups Supinator abductor pollicis longus extensor pollicis brevis extensor pollicis longus extensor indicis
v Movements 1 - Flexion: - Flexors carpi radialis (2 nd, 3 rd metacarpal), flexors carpi ulnaris (Pisiform bone (main insertion), Hook of hamate and 5 th metacarpal bone) and palmaris bogus (apex of palmar aponeurosis). - Flexors digitorum superficialis (middle phalanges) and profundus (distal phalanges of the medial four fingers. 2 - Extension: - Extensors carpi radialis longus (2 nd metacarpal), and brevis (3 rd metacarpal), . - Extensor carpi ulnaris (5 th metacarpal), . - Extensor digitorum, extensor gigiti minimi, and extensor indicis (extensor expansion). 3 - Abduction: - Flexor carpi radialis & Extensors carpi radialis longus and brevis. 4 - Adduction: - Flexor carpi ulnaris & Extensor carpi ulnaris
Flexor retinaculum & Anterior relations Medial Lateral
Palmar cutaneous branch of ulnar nerve Superficial part of Flexor retinaculum Canal of Guyon Palmaris Longus tendon Palmar cutaneous branch of median nerve ulnar artery Structures passing superficial to Flexor retinaculum
flex. digitorum superficialis Structures passing deep to Flexor retinaculum Common flexor sheath Palmer carpal branch of ulnar A Median nerve Palmer carpal branch of radial A Flexor Digitorum Profundus Flexor pollicus longus enclosed by synovial sheath Flexor Carpi Radialis enclosed by synovial sheath
CARPAL TUNNEL • Carpal Tunnel: is a tunnel formed between the carpal bone concavity and flexor retinaculum. • Contains: long tendons and Median nerve § Carpal tunnel syndrome § Compression of Median nerve in the tunnel § Causes - Inflammation of tendons swelling - Arthritis fibrosis of the ligament - Pregnancy edema § Symptoms - Numbness, tingling, burning and pain of the palmar aspect of the lateral three and half fingers and their nail beds. - Wasting of thenar muscles except adductor pollicis and weakness of thumb movement ( Difficult to perform fine movement as buttoning the clothes) - Night time symptoms is very common • NB; Lateral 2/3 of the palm of the hand is escaped because the palmar cutaneous branch of the median nerve passes superficial.
** Structures passing deep to the extensor retinaculum 1 - The 1 st compartment: tendons of abductor pollicis longus and extensor pollicis brevis. 2 - The 2 nd compartment: tendons of extensors carpi radialis longus and brevis. 3 - The 3 rd compartment; tendon of extensor pollicis longus. 4 - The 4 th compartment: a- Tendons of extensor digitorum and extensor indicis. b- Posterior intorosseous nerve. c- Anterior interosseous artery. 5 - The 5 th compartment: tendon of extensor digiti minimi. 6 - The 6 th compartment: tendon of extensor carpi ulnaris.
Posterior 6 th 5 th 4 th Lateral 3 rd 2 nd e ia ad R l rv e N ia ad R l ry te Ar li a ph Ce e c. V 1 st Ulna Extensor retinaculum & Post. , Lat. Relations Dorsal tubercle Radius Styloid process in
v Carpometacarpal joint of the thumb ** Types: saddle synovial joint. ** Articular parts: trapezium and base of the 1 st metacarpal bone. ** Movements at the thumb 1 - Flexion by flexor pollicis longus and brevis (median nerve). 2 - Extension by extensor pollicis longus and brevis (radial nerve). 3 - Abduction by abductor pollicis longus and brevis (radial nerve). 4 - Adduction by adductor pollicis (ulnar nerve). 5 - Opposition by opponens pollicis (median nerve).
Movement of the thumb Position of rest Extension of thumb Flexion of thumb
Movement of the thumb Abduction Adduction opposition
Bones of the hand
Joints of the hand 1) Intercarpal Joints; synovial joints between the carpal bones. - They allow slight sliding movements between the bones. 2 - Carpometacarpal Joints: synovial Joints between the distal row of carpal bones and the bases of the metacarpal bones. - They allow a slight amount of gliding movements. 3 - Metacarpophalangeal Joints, These are ellipsoid synovial joints. - Movements 1 - Flexion by the flexor digitorum superficialis and profundus. 2 - Extension by extensor digitorum, indicis and digiti minimi. 3 - Abduction by palmar interossei. 4 - Adduction by dorsal interossei. 4 - Interphalangeal Joints: hinge (uniaxial) synovial joints between the phalanges. - They allow flexion and extension movements.
Th ank Qu you est ion s I/Azzam - 2004
- Slides: 24