KIN 191B – Advanced Assessment of Upper
Extremity Injuries
Wrist, Hand and Finger Anatomy
Anatomy
Bony anatomy
Articulations and ligamentous support
Muscular anatomy
Neurovascular anatomy
Carpal tunnel
Bony Anatomy
Bony Anatomy
Distal radius and ulna
Carpal bones
Metacarpals
Phalanges Proximal, middle and distal
Bony Anatomy
Distal Radius and Ulna
Distal radius broadens Ulnar notch articulates with ulnar head (distal
radioulnar joint) Radial styloid process (thumb side)
Distal ulna terminates at ulnar head Ulnar head has circular appearance Ulnar styloid process (little finger side)
Carpal Bones
Total of eight bones – 2 rows of 4 Irregular shapes and surfaces
Proximal row Articulate with distal radius (radiocarpal joint)
Distal row Articulate with proximal aspect of metacarpals
Carpal Bones
Proximal row (lateral to medial) Scaphoid Lunate Triquetrum Pisiform
“Some Lovers Try Positions”
Distal row (lateral to medial) Trapezium Trapezoid Capitate Hamate
hook
“That They Can’t Handle”
Metacarpals
Numbered 1 through 5 (lateral to medial)
Represent most of length of hand – all have base, shaft and head from proximal to distal
Proximal aspects articulate with distal row of carpals – carpometacarpal joints
Distal aspects articulate with proximal aspect of proximal phalanges of fingers
Phalanges
Each phalange has base, shaft and head from proximal to distal
All fingers (2nd through 4th digits) have proximal, middle and distal phalanges
Thumb (1st digit) has only proximal and distal phalanges
Bony Anatomy
Articulations and Ligamentous Support
Articulations
Distal radioulnar joint Radiocarpal joint Intercarpal joints Carpometacarpal joints Metacarpophalangeal joints Interphalangeal joints (proximal and distal) Retinaculum and palmar aponeurosis
Distal Radioulnar Joint
Head of ulna articulating with ulnar notch on distal radius
Contributes to forearm pronation and supination ROM (with proximal radioulnar joint)
Radiocarpal Joint
Comprised of 2 articulations Laterally – distal radius with scaphoid and
lunate bones Medially – triangular fibrocartilaginous disc
(TFCC) with lunate and triquetrum
Allows for flexion/extension and radial/ulnar deviation movements
Radiocarpal Joint
Radiocarpal Joint
Radial collateral ligament Radial styloid process to scaphoid and trapezium Limits ulnar deviation, terminal wrist flexion and
extension
Ulnar collateral ligament Ulnar styloid process to triquetrum and pisiform Limits radial deviation, terminal wrist flexion and
extension
Radiocarpal Joint
Palmar (volar) radiocarpal ligament Most important stabilizer of wrist Anterior distal radius to capitate, triquetrum and
scaphoid Collectively limits wrist hyperextension
Dorsal radiocarpal ligament Only major stabilizer on dorsal wrist Posterior distal radius to lunate and triquetrum Limits wrist hyperflexion
Radiocarpal Joint
Intercarpal Joints
Individual ligaments connecting adjacent carpal bones (named as such) within proximal and distal rows
Contribute to significant stability of bones
Subtle gliding motions allowed between adjacent bones, but no collective gross movements allowed
Carpometacarpal Joints
First 3 metacarpals articulate with single carpal bone each 1 – trapezium 2 – trapezoid 3 – capitate
4th and 5th metacarpals articulate with same bone - hamate
Carpometacarpal Joints
1st and 5th carpometacarpal joints allow for flexion/extension and abduction/adduction movements 1st also has accessory rotation to
accommodate opposition/reposition
2nd through 4th carpometacarpal joints allow only flexion/extension movements
Metacarpophalangeal (MP) Joints
Articulations between convex metacarpal heads and corresponding concave base of proximal phalanges
Allow for flexion/extension and abduction/adduction movements 2nd through 5th digits have more
abduction/adduction ROM when extended
Hand Articulations
Metacarpophalangeal (MP) Joints
MP joint ligamentous support Varus/valgus forces resisted by radial (lateral) and
ulnar (medial) collateral ligaments – tighter in flexion than extension
Palmar (volar) aspect reinforced by thick, fibrocartilaginous palmar (volar) ligament
Dorsal aspect reinforced by extensor tendinous structure and deep transverse metacarpal ligament – limits abduction/adduction
Interphalangeal (IP) Joints
IP joint only at thumb due to only 2 phalanges Proximal interphalangeal (PIP) joints between
proximal and middle phalanges of 2nd through 5th digits
Distal interphalangeal (DIP) joints between middle and distal phalanges of 2nd through 5th digits
Varus/valgus forces resisted by radial (lateral) and ulnar (medial) collateral ligaments
Interphalangeal Joints
Flexor Retinaculum orTransverse Carpal Ligament
Palmar Aponeurosis
Muscular Anatomy
Muscular Anatomy
Extrinsic muscles acting on wrist, hand and fingers
Intrinsic muscles acting on wrist, hand and fingers
Extrinsic Muscles
Abductor pollicis longus Extensor pollicis brevis Extensor carpi radialis
longus Extensor carpi radialis
brevis Extensor carpi ulnaris Extensor digitorum
(communis) Extensor indicis
Extensor digiti minimi Flexor carpi radialis Flexor carpi ulnaris Flexor digitorum
superficialis Flexor digitorum
profundus Flexor pollici longus Palmaris longus
Extrinsic Muscles
Origin, insertion, innervation and action of each addressed with elbow presentation
Refer to 4 groups of 3 for review of extensor muscles (no brachioradialis, supinator or anconeus)
Refer to hand placement/layers for review of flexor muscles (no pronators)
Intrinsic Muscles
Abductor digiti minimi Abductor pollicis
brevis Adductor pollicis Flexor digiti minimi Flexor pollicis brevis
Opponens pollicis Opponens digiti
minimi Lumbricales Palmar interossei Dorsal interossei
Hand Eminences
Thenar eminence – thumb Abductor pollicis
brevis Flexor pollicis brevis Opponens pollicis Tendon of flexor
pollicis longus
Hypothenar eminence – little finger Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi
Abductor Digiti Minimi
O: flexor carpi ulnaris tendon, pisiform
I: ulnar side of base of 5th proximal phalanx
N: ulnar A: abduction of 5th
finger
Abductor Pollicis Brevis
O: flexor retinaculum, trapezium, scaphoid
I: radial side of base of 1st proximal phalanx
N: median A: abduction of 1st
CMC and MP joints, opposition
Adductor Pollicis
O: capitate, 2nd and 3rd metacarpal bases
I: ulnar side of base of 1st proximal phalanx
N: ulnar A: adduction of 1st
CMC and MP joints, opposition
Flexor Digiti Minimi
O: hook of hamate I: ulnar side of 5th
proximal phalanx N: ulnar A: 5th MP joint flexion,
opposition
Flexor Pollicis Brevis
O: flexor retinaculum, trapezoid, captitate
I: radial side of base of 1st proximal phalanx
N: median, ulnar A: flexion of 1st CMC
and MP joints, opposition
Opponens Pollicis
O: flexor retinaculum, trapezium
I: 1st metacarpal shaft N: median A: thumb opposition
Opponens Digiti Minimi
O: flexor retinaculum, hook of hamate
I: ulnar side of shaft of 5th metacarpal
N: ulnar A: opposition of 5th
finger
Lumbricales
O: 1 & 2 - radial surface of flexor profundus tendons, 3 – adjacent sides of flexor profundus tendons of 3rd and 4th fingers, 4 – adjacent sides of flexor profundus tendons of 4th and 5th fingers
I: radial border of extensor tendons of respective fingers
N: 1 & 2 – median, 3 & 4 – ulnar A: flexion of MP joints, extension of PIP/DIP
joints
Lumbricales
Palmar Interossei
O: 1 – ulnar border of 2nd metacarpal, 2 – radial border of 4th metacarpal, 3 – radial border of 5th metacarpal
I: 1 – ulnar side of 2nd proximal phalanx, 2 – radial side of 4th proximal phalanx, 3 – radial side of 5th proximal phalanx
N: ulnar A: adduction of 2nd , 4th and 5th fingers (middle
finger is reference point)
Palmar Interossei
Dorsal Interossei
O: 1 – radial border of 2nd metacarpal, 2 – radial border of 3rd metacarpal, 3 – ulnar border of 3rd metacarpal, 4 – ulnar border of 4th metacarpal
I: 1 – radial side of 2nd proximal phalanx, 2 – radial side of 3rd proximal phalanx, 3 – ulnar side of 3rd proximal phalanx, 4 – ulnar side of 4th proximal phalanx
N: ulnar A: abduction of 2nd through 4th fingers (middle
finger is reference point)
Dorsal Interossei
Neurovascular Anatomy
Neurological Anatomy
Peripheral nerves Median Ulnar Radial
Nerve root level (brachial plexus) distribution Dermatomes Myotomes
Sensory Maps
Vascular Anatomy
Radial artery
Ulnar artery
Superficial and deep arch vessels in hand
Capillary refill
Vascular Supply
Radial artery lateral (thumb side) Common pulse point
Ulnar artery medial (little finger side)
Hand Vascular Supply
Carpal Tunnel
Carpal Tunnel
Floor – proximal row of carpal bones Roof – transverse carpal ligament Contents (10 structures)
Median nerve Flexor pollicis longus tendon 4 tendons of flexor digitorum superficialis 4 tendons of flexor digitorum profundus
Carpal Tunnel
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