Wrist and Hand Anatomy - Weebly

Wrist and Hand Anatomy - Weebly

Wrist and Hand Anatomy Bone Anatomy

Scapoid Lunate Triquetrium Pisiform Trapeziod Trapezium Capitate Hamate Hand and Wrist Anatomy

14 phalanges 2 sesamoid bones (thumb) 5 metacarpals 8 carpal bones Distal Radius Forms small ulnar notch to accept the ulnar head Radial styloid process Distal Ulna Ulnar styloid process arises from medial surface

Ulnar head Articulations Distal Radioulnar Formed by ulnar head and ulnar notch Allows 1 degree freedom of movement Pronation/supination Radius glides around the ulna Radiocarpal joint

Reinforced by ligamentous thickening Formed by distal radius articulating with scaphoid, lunate and triangular fibrocartilage disk(TFCC) Ellipsoid joint (2 degrees freedom) Flexion/extension Radial/ulnar deviation Intercarpal Joints Palmar/dorsal/interosseous ligaments between each carpal Very little gliding

Midcarpal Joints Proximal/distal carpal row separated by a single joint cavity with small fibrous projections connecting the rows Limited mobility in flex/ext, radial/ulnar deviation Carpometacarpal Joint (CMC) MC1/trapezium MC2/trapezoid MC3/capitate

MC4and 5/hamate (forms 1 articulation) 1st CMC (thumb) Saddle joint 2 degrees of freedom(3) Flexion/extension Abduction/adduction Accessory rotation Allows for opposition

2-4 CMC Plane/synovial joint 1 degree freedom Flexion/extension 5th CMC 2 degree freedom Flexion/extension Abduction/adduction Metacarpophalangeal Joint (MCP)

Two degrees freedom of movement Flexion/extension Abduction/adduction Thumb can abduct at any point/fingers only when extended Collateral ligaments Varus/valgus force When fingers are in flexion they tighten and limit abduction/adduction Interphalangeal Joint

One degree freedom of movement Flexion/extension Collateral ligaments Ligament Support Volar Carpal Ligaments Volar Radiocarpal Ligament Three bands

Volar Ulnocarpal Ligament Scapholunate Interosseous Ligament Lunotriquetral Ligament Ligament Support Dorsal Carpal Ligaments Dorsal Radiocarpal Ligament Dorsal Intercarpal

Ligament Radial Collateral Ligament Ulnar Collateral Ligament Carpal Tunnel Fibro-osseous structure Floor is proximal carpal bones Roof is transverse carpal ligament

Tunnel contains 10 structures Median n., flexor pollicis longus tendon, 4 slips of flexor digitorium superficialis, 4 flexor digitorium profundus Compression results in paresthesia 2-4 fingers and decrease grip Hand Wrist flexors (median n.) Superficial

Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor digitorium superficialis Pronator teres

Deep Flexor digitorium profundus Flexor pollicis longus Pronator quadratus Palmar (intrinsic) Thenar

Abductor pollicis brevis Flexor pollicis brevis Opponens Pollicis Tendon FPL Adductor pollicis Hypothenar Abductor digiti minimi

Opponens digiti minimi Flexor digiti minimi brevis Central Tendons FDS/FDP Superficialis (PIP) Profundus (DIP) Lumbricales Radial side profundus tendon(extensor hood) Flex MP/ext PIP/DIP

Palmar aponeurosis Interossei 4 palmar/4 dorsal Extrinsic Hand Muscles Extensor Indicis O Dorsal surface lower body of ulna

Interosseus membrane I Ulnar side of index fingers EDC tendon N Radial (posterior interosseus) F MCP and IP Ext of 2nd digit

Extensor Pollicis Longus O Posterior 1/3 ulna Interosseus membrane I Posterior surface of base of thumb distal phalanx N

Radial (posterior interosseus) F CMC, MCP and IP Ext of 1st digit Extensor Pollicis Brevis O Dorsal 2/3 of radius I

Dorsal surface of base of proximal 1st phalanx N Radial (posterior interosseus) F CMC & MCP Ext of thumb CMC ABD of thumb Abductor Pollicis Longus

O Posterior distal 2/3 of ulna Posterior middle 1/3 of radius Interosseus membrane I Radial side of base of 1st metacarpal N Radial (posterior interosseus)

F CMC ABD & Ext of thumb Flexor Pollicis Longus O Anterior middle of radius Interosseus membrane I Palmar surface of base of

distal 1st phalanx N Median (anterior interosseus) F IP Flexion of thumb Extensor Digiti Minimi O Lateral epicondyle of

humerus I Extensor expansion of 5th digit N Radial (posteior interosseus) F

MCP and IP extension of 5th digit Flexor Digitorum Superficialis O I Medial epicondyle of humerus Coronoid process

Middle anterior radius Four tendons separating into two parts that insert into sides of bases of middle 2-5 phalanxes N Median F

MCP flexion digits 2-5 PIP flexion digits 2-5 Flexor Digitorum Profundus O Anteriomedial surface of ulna Interosseus membrane I Four tendons inserting into

distal phalanxes of digits 2-5 N Media 2-3 digits Ulna 4-5 digits F DIP flexion of 2-5 digits Intrinsic Hand Muscles Thenar Eminance

Abductor Pollicis Brevis O Scaphoid tuberosity Trapezium ridge Transverse carpal ligament I Lateral base f proximal 1st phalanx

N Median F CMC & MCP ABD of thumb Flexor Pollicis Brevis O I

Superficial head trapezium Deep head trapezoid, capitate and palmar ligaments of distal carpal bones Base of prximal 1st phalanx on radial side Extensor expansion N

Superficial median Deep Ulnar F CMC & MCP Flexion of thumb Opponens Pollicis O Trapezium Transverse Carpal

Ligament I Radial side of 1st metacarpal shaft N Median F Opposition

Intrinsic Hand Muscles Hypothenar Eminence Abductor Digiti Minimi O Pisiform I Ulnar side base of 5th proximal phalanx

N Ulnar F MCP ABD of 5th digit Opponen Digiti Minimi O Hook of hamate Transverse carpal ligament

I Ulnar border of entire 5th metacarpal bone N Ulnar F MCP flexion & rotation of 5th digit

Flexor Digiti Minimi O Hamate bone Transverse carpal ligament I Ulnar side of proximal 5th phalanx

N Ulnar F MCP Flexion of 5th digit Other Intrinsic Hand Muscles Adductor Pollicis O Oblique Head

Capitate bone Bases of 2-3 metacarpals Transverse Head Proximal 2/3 of palmar surface of 3rd metacarpal I Ulnar side of base of 1st proximal phalanx

N Ulnar F CMC ADD of thumb Palmar Interossei O I

1st ulnar side base of 1st metacarpal bone 2nd ulnar side of 2nd MC bone 3rd radial side of 4th MC bone 4th radia side of 5th MC bone Extensor expansion of 2,4 and 5th digits N Ulnar

F ADD of 1st, 2nd, 4th and 5th digits toward midline of hand O I Dorsal Interossei

1st lateral head ulnar side of 1st metacarpal bone 1st medial head radial side of 2nd metacarpal bone 2nd, 3rd, 4th space between metacarpal bones 1st radial side 2nd proximal phalanx 2nd radial side of 3rd 3rd ilnar side of 3rd

4th ulnar side of 4th N Ulnar F ABD of 2nd, 3rd, and 5th finger from midline

Lumbricales O Tendons of FDP I Extensor expansion on dorsal aspect of each digits radial side N 1 and 2 median

3 and 4 ulnar F MCP flexion 2-5 digits DIP & PIP ext 2-5 digits Palmaris Brevis O Flexor retinaculum I

Palmar surface skin on ulnar side of hand N Ulnar F Wrinkles skin of hand on ulnar side Cords Give off Branches!! (in axilla)

Lateral Musculocutaneous Median Medial Posterior Axillary Ulnar Radial

(thoracodorsal) (subscapular) PUT IT ALL TOGETHER... pg 416 Innervation by Posterior Cord Radial Nerve (largest branch) Course: Through arm, around humerus, around lateral epicondyle, then divides

Innervates: all posterior muscles of arm and forearm Triceps brachii, anconeus, supinator, brachioradialis Divides in forearm: Superficial = skin of arm and dorsolateral surface of hand Deep = extensor muscles of forearm (eg E. carpi radialis L + B) Damage to Radial Nerve = wristdrop Inability to extend the hand, st inability to fully extend forearm

Innervation by Posterior Cord (continued) Axillary Nerve (runs w/ humeral circumflex a.) Innervates: Deltoid and Teres minor (motor inn) Capsule of shoulder, skin of shoulder (sensory inn) Subscapular Nerve {branches of C5 + C6 rami} Innervates: Subscapularis, Teres major Thoracodorsal Nerve (runs w/thoracodorsal a+v) Innervates: Latissimus dorsi

Innervation by Lateral Cord Musculocutaneous Course: branches to arm, distal to elbow becomes cutaneous for lateral forearm skin Innervates Biceps brachii, brachialis, coracobrachialis (motor inn) Skin distal to elbow (sensory) Suprascapular (runs w/suprascapular a+v) {C5, C6} Innervates: Supraspinatus, Infraspinatus

Innervation by both Lateral and Medial Cords Median Course: middle of brachial plexus, does not branch in arm, distal to elbow provides many branches to most forearm flexors, passes through carpal tunnel to hand to lateral palmar intrinsics Innervates: most muscles of anterior forearm (motor inn) (eg) most flexors, some intrinsics (thumb)

Innervates: skin of lateral 2/3 hand on palm side, dorsum of fingers 2+3 (sensory inn) Nerve Damage = Ape Hand Inability to Oppose Thumb Innervation by Medial Cord Ulnar Course: runs along medial side of arm, behind medial epicondyle, superficial to carpal tunnel into hand, branches to supply intrinsics and skin

Innervates: FCU and part of FDP, most intrinsics (motor inn) Skin of medial 2/3 of hand A+P (sensory inn) Nerve Damage: Clawhand Inability to extend fingers at interphalangeal joints, results in permanent flexion = claw Cutaneous Innervation to the Hand

Median Nerve Ulnar Nerve Brachial Artery Musculocutaneous Nerve UlnarArtery Wheres Radial Nerve? Radial Artery

Median Nerve Ulnar Nerve Thank you

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