Wrist and Hand

Wrist is the most complex joints of the body due to the numerous joints combined to create one.

Wrist and Hand Anatomy

Carpal bones- Create a Mnemonic for them. S-L-T-P-T-T-C-H

Wrist and Hand Anatomy

Two rows of bones starting on the thumb side.

Scaphoid, lunate, triquetrum, pisiform

Palpate the Scaphoid

You would palpate the scaphoid in the anatomical snuff box.

Wrist and Hand Anatomy

Second row of carpals bones, is more proximal

Trapezium, trapezoid, capitate, Hamate.

Wrist and Hand Anatomy

Medial and Lateral epicondyle are where many of the wrist and hand muscles originate.

Wrist and Hand Anatomy

Styloid process- projection at distal end of radius and ulna where the collateral ligaments attach.

Wrist and Hand Joints

Radiocarpal Joint- distal end of the radius and scaphoid, lunate, and triquetrum. There is a radioulnar disk in between the radius and other bones. It is a condyloid joint.

Wrist and Hand Joints

Midcarpal joint- between the two rows of carpal bones. Plane joints that allow gliding motion, but assist with wrist motions.

Wrist and Hand Joints

Carpometacarpal joint- between the distal row of carpal bones and proximal end of the metacarpal bones. Provide more stability than mobility.

Ligaments of hand

Palmar radiocarpal ligament-broad band attaches anterior surface of distal radius and ulna to anterior surface of the proximal carpal bones and the capitate. Limits wrist extension. So repeated falls in extension would injur it.

Wrist and Hand Injuries

Fractures of the Wrist and Hand Finger Fractures

Boxer’s Fracture- fracture of 5th metacarpal. Hitting something with fisted hand.

Wrist and Hand Injuries

Fractures of the Wrist and Hand Finger Fractures

Scaphoid Fracture- fracture of scaphoid which you call palpate in anatomical snuffbox. Occurs with fall on hand in extension.

Wrist and Hand Injuries

Wrist Fractures Colles’s fracture- fracture of

the radius just above the wrist. A result of a fall with wrist extended.

Tendon Injuries

Mallet Finger- hitting something with the tip of a finger and causing the extensor tendon to tear.

Jersey Finger- grabbing something and tearing the flexor tendon.

Tendon Injuries

Boutonniere deformity-

extensor tendon injury affecting

two joints of the finger. It is

an injury to the central tendon

on top of the finger. It may appear as a “jammed finger” that cannot

be extended from the PIP joint. Treatment should be in an extended position so

the tendon can heal.

Dislocations/Subluxations

Dislocations occur in the fingers and wrist bones.

Point tenderness and swelling, possible deformity.

Physician

intervention

may be

necessary.

Wrist and Hand Muscles

Extensor Carpi Ulnaris- superficial muscle that arises from the common extensor tendon on the lateral epicondyle. It runs the medial side of the posterior arm and attaches to the fifth metcarpal. What does it do?

Wrist and Hand Muscles

Flexor carpi radialis- superficial muscle running from the medial epicondyle diagonaly across the anterior forearm to attach to lateral base of second and third metacarpal. What is the motions?

Wrist and Hand Muscles

Palmaris Longus- superficial muscle running down the anterior surface of the forearm from common flexor attachment of medial epicondyle to the midline of the palmar fascia.

Missing in 21%

of people. Flexor

Wrist and Hand Muscles

Flexor Digitorum superficialis- deep to the wrist flexors and palmaris longus muscle. Starts at the common flexor tendon of medial epicondyle and coranoid process, inserts to the sides of digits 2-5.

Wrist and Hand Muscles

Abductor pollicis brevis- proximal attachment is the scaphoid, trapezium and inserts to the base of the proximal phalange of the thumb.

Hand Grips

GraspsPower grip is when an object needs to be held

forcefully and then moved by more proximal muscles.

Precision Grip is when an object is manipulated with fingers

Hand Grips

Power gripsCylindrical grip is fingers flexed around an

object. Thumb on one side fingers on other, like gripping a hammer or racquet.

Spherical grip is fingers and thumb are together around an

object. Like grabbing an apple or doorknob.

Hand Grips

Power GripHook grip involves the second through fifth

fingers flexed around an object in a hooklike manner. Thumb is extended and not involved at all. Only possible grip for

someone with no thumb or median nerve ability.

Hand Grips

Precision Grips- Pad to pad

Pinch grip is the thumb and one finger gripping Three jaw chuck is holding a pencil, three fingers

and thumb.

Hand Grips

Precision GripsTip to Tip grip

Pincer grip is tip of thumb against tip of a finger, like to pick up a coin. Difficult with long fingernails

Hand Grips

Precision GripsLumbrical grip or plate grip has the MCP and

PIP joint flexed and the DIP extended. The thumb opposes and this grip is used to hold something horizontal like a plate. Lumbricals is used they flex the MCP joint.

Wrist Strengthening

Flexion Extension Ulnar Deviation Radial Deviation Pronation Supination