WRIST & HANDWRIST & HANDPTA 106

Unit 3 presentation by:Lisa, Bobbi, Deanna, Chris

Surface AnatomySurface Anatomy

Surface Anatomy Surface Anatomy

Anatomical Snuff BoxAnatomical Snuff Box

Compartments & SpacesCompartments & Spaces

Wrist BonesWrist Bones

Wrist BonesWrist BonesSomeLoversTryPositionsThatTheyCan’tHandle

Hand BonesHand Bones

CartilageCartilageArticular Cartilage

Is smooth shiny material that covers the bones of the hand and wrist. It absorbs forces of impact and provides for low friction motion.

Articular CapsuleArticular CapsuleSynovial Membrane • Is the inner membrane of a

joint made up of loose connective tissue.

• Secretes synovial fluid which services to lubricate the joint and reduce the friction between bones in joints.

• Supplies nutrients to the joint

Fibrous Layer• Formed by dense irregular

connective tissue attached to the periosteum surface of joints.

• Allows for movement.• Provides stability

JointsJoints• Metacarpo-phalangeal Joint

JointsJointsProximal Interphalangeal Joint Distal Interphalangeal Joint

Types of JointsTypes of JointsHinge Joints- Convex surface of one bone fits into the concave surface of the adjoining boneExample: interphalangeal joints

Condyloid Joints- Convex oval-shape projection of one bone fits into the oval-shaped depression of another boneExample: MCPJ and radio-scapho-lunate joint

Types of JointsTypes of JointsSaddle Joints- articular surface of one bone is the saddle-shaped, and the articular surface of the other bone fits into the “saddle” as a sitting rider would sit.Example: CMCJ between the trapezium and the thumb

Planar Joints- Flat or slightly curved bones joined together that allow back and forth and side to side movements.Example: Intercarpal joints

LigamentsLigamentsPalmar AponeurosisIt gives firm attachment to the skin of the palm to improve the grip, and it protects the underlying tendons

Flexor RetinaculumIs a strong band that is attached on the radial side to the tubercle of the scaphoid ridge of the trapezium and on the ulnar side to the pisiform and hook of the hamate. Serves as the top sheath of the carpal tunnel for which the flexor tendons and median nerve pass through.

LigamentsLigamentsCommon Flexor SheathSurrounds the eight tendons of the superficial and deep flexors of the digits of the hand as they pass through the carpal canal.

Extensor RetinaculumConsists of a group of heavy connective fibers in the tissues of the wrist. It connects the lateral margin of the radius with the inside border of the ulna.

Motions of the WristMotions of the Wrist Flexion: 80-90 degrees

Extension: 75-85 degrees Radial deviation: 20 degrees Ulnar deviation: 35 degrees

Supination: 90 degrees Pronation: 90 degrees

Motions of the FingersMotions of the FingersAbduction: 20-25 degrees

MCPJ flexion: 85-105 degrees

MCPJ extension: 20-30 degrees

PIPJ flexion: 110-120 degrees, 0 degrees extension

DIPJ flexion: 80-90 degrees, 0 degrees extension

Range of Motion of the ThumbRange of Motion of the Thumb

Thumb: CMCJ flexion: 60-70 degreesFlexion at MCPJ: 85-105 degreesAbduction: 70-80 degreesOpposition- combined motion of abduction, flexion, and rotation of the thumb.

Posterior Muscles of Wrist and HandPosterior Muscles of Wrist and Hand

Anterior Muscles of Wrist and HandAnterior Muscles of Wrist and Hand

Nerve, Artery/ Veins of the Nerve, Artery/ Veins of the Hand and Wrist Debrief:Hand and Wrist Debrief:

The Sinistra The Sinistra Nervous FamilyNervous Family

Central Nervous SystemAka “The

Boss”

The “Under Boss”The “Under Boss”

Capo # 1Capo # 1• The median nerve:- Is responsible for the innervations of the following

soldiers.- 1. Flexor carpi radialis- 2 .Flexor digitorum superficialis- 3. Flexor digitorum profundus- 4. Flexor pollicis longus- 5. Palmaris longus- Gives humans the ability to oppose the thumb joint

Capo # 2Capo # 2

- Is responsible for the innervations of the following soldiers.-1. Flexor carpi radialis-2. Flexor digitorum profundus

Capo # 3Capo # 3• The Radial Nerve:- Is responsible for the

innervations of the following muscles

- 1. Extensor carpi radialis longus

- 2. Extensor carpi radialis brevis- 3. extensor digitorum- 4. extensor carpi ulnaris- 5. Abductor pollicis longus- 6. Extensor digiti minimi- 7. extensor pollicis brevis- 8. Extensor pollicis longus

Other known associates

Dorsal cutaneous branch Vaga and Palmer cutaneous branch

Winfield

Median Associate #1Median Associate #1• - The Palmer

cutaneous branch: • - splits off the median

nerve before crease of the wrist

Ulnar Associate #1Ulnar Associate #1

• The dorsal cutaneous branch:• Known for famous debilitating

wrist lock

There Will Be BloodThere Will Be Blood

• Arteries:• 1. Deep palmar arch• 2. Superficial palmar arch• 3. Common palmar digital arteries

The Five BurrowsThe Five Burrows

• The Radial artery supplies blood to:- 1. Flexor carpi radialis- 2. Extensor carpi radialis longus- 3. Extensor carpi radialis brevis - 4. Flexor pollicis longus The Ulnar artery supplies blood to:- 1. Flexor carpi radialis- 2. Flexor carpi ulnaris- 3. Extensor carpi ulnaris- 4. Flexor digitorum superficialis- 5. Flexor digitorum profundus- 6. Palmaris longus

Reccurent Interosseous ArteryReccurent Interosseous Artery

• -supplies:• -Extensor digitorum• -Extensor digiti minimi

Posterior Interosseous ArteryPosterior Interosseous Artery

• -supplies:• - Abductor pollicis longus• -Extensor pollicis brevis• -Extensor pollicis longus

Waste ManagementWaste Management

- 1. Cephalic vein- 2. Basillic vein- 3. Superficial dorsal

venous arch (network)- 4. Deep dorsal venous

arch (network)

Clinical Concerns Clinical Concerns Carpal tunnel Ganglion cyst

- The transverse carpal ligament in the wrist puts pressure on the medial

nerve- - possible cause: overuse, hormonal

-http://www.youtube.com/watch?v=SGyKQchSEJ4

- Is a fluid filled cyst that develops out of a joint.

- - possible cause: joint trauma-http://www.youtube.com/watch?v=mJ6oj3lkqm8

De Quervain’s TenosynovitisDe Quervain’s Tenosynovitis

• -irritation of the sheath around the tendon• - affects the tendons on the thumb side of the wrist• - possibly caused by repetitive actions, over use • - http://www.youtube.com/watch?v=q87zSRYHa1o

Spoiler AlertSpoiler Alert