Chapter 7Wrist & Hand Joints

Hand

Distal

Middle

BaseMetacarpals

Hamate

Capitate

TrapezoidPisiform

TriquetrumLunate

Scaphoid

ProximalPhalanges

Head

Shaft

Carpals Trapezum

Label

Joints

• Radioulnar (Pivot)– Supination and

pronation

• Radiocarpal (Condylodial)– Primarily articulates with

scaphoid, lunate, and triquetrum

– Movement and Range of Motion

• Flexion: 80°-90°• Extension: 70°-90°• Abduction: 15°-25°• Adduction: 25°-40°

Joints

• Intercarpal (Arthrodial)

• Intermetacarpal (Arthrodial)

• Metacarpophalangeal (Condylodial)– Movement and ROM

• Flexion: 90°• Extension: 0-40°

– Metacarpophalangeal of the thumb:

• 40º to 90º from full extension

Joints• Carpometacarpal of

the thumb: (seller)– Movement and ROM

• Flexion: 15º to 45º• Extension: 0º to

20º • Abduction: 50º to

70º• Opposition:

– movement of thumb across palmer aspect to oppose any or all of the phalanges

• Reposition: – movement of

thumb back to anatomical position

• Proximal Interphalangeal (ginglymus)– ROM:

• Flexion: 90º to 120º from full extension

• Distal Interphalangeal (ginglymus)– ROM:

• Flexion: 80º to 90º from full extension

Cutaneous Distribution

• Wrist Flexors– Flexor Carpi Radialis– Palmaris Longus– Flexor Carpi Ulnaris– Flexor Digitorum

Superficialis – Flexor Digitorum

Profundus– Flexor Pollicis Longus

Muscles

Label

Muscles

• Wrist Extensors– Extensor Carpi Radialis

Longus– Extensor Carpi Ulnaris– Extensor Carpi Radialis

Brevis– Extensor Digitorum– Extensor Indicis– Extensor Digiti Minimi– Abductor Pollicis Longus – Extensor Pollicis Brevis– Extensor Pollicis Longus

Not Shown?

Label

MusclesFlexor Carpi Radialis • Strengthening

• Stretching

MusclesPalmaris Longus • Strengthening

• Stretching

MusclesFlexor Carpi Ulnaris • Strengthening

• Stretching

MusclesExtensor Carpi Ulnaris • Strengthening

• Stretching

MusclesExtensor Carpi

Radialis Brevis

• Strengthening

• Stretching

MusclesExtensor Carpi

Radialis Longus

• Strengthening

• Stretching

Muscles

Flexor Digitorum Superficialis

• Strengthening

• Stretching

MusclesFlexor Digitorum

Profundus• Strengthening

• Stretching

MusclesExtensor Indicis • Strengthening

• Stretching

MusclesExtensor Digiti Minimi • Strengthening

• Stretching

MusclesExtensor Pollicus

Longus

• Strengthening

• Stretching

Muscles

Extensor Pollicus Brevis

• Strengthening

• Stretching

MusclesAbductor Pollicus

Longus• Strengthening

• Stretching

Thenar Muscles

Opponens Pollicis

Thenar Muscles

Abductor Pollicis Brevis

Thenar Muscles

Flexor Pollicis Brevis

Intermediate Muscles

Adductor Pollicis

Intermediate Muscles

Palmar Interossei

Drawn illustration

Intermediate Muscles

Dorsal Interossei

Drawn illustration

Intermediate Muscles

Lumbricals

Hypothenar Muscles

Opponens Digiti Minimi

Hypothenar Muscles

Abductor Digiti Minimi

Hypothenar Muscles

Flexor Digiti Minimi Brevis

Injuries of the Wrist

• Scaphoid Fracture • Carpel Tunnel• Claw Hand• Ape Hand

Carpal Tunnel Syndrome

1. Anatomya. Boundsb. Muscles/Tendonsc. Nerved. Other

Carpel Tunnel Syndrome

• Common Causes:– Pregnancy– Rheumatoid Arthritis – Diabetes– Wrist Trauma– Occupational (typing)

• Symptoms

• Tests:

Carpel Tunnel Syndrome

TINEL’S SIGN

STRIKE THE PATIENT’S WRIST AS SHOWN. A TINGLING SENSATION RADIATING DOWN THE WRIST TO THE HAND IN THE DISTIBUTION OF THE MEDIAN NERVE IS A POSITIVE SIGN.

Tinel’s Sign

Phalen Test

Thumb Abduction Test

PHALEN TEST

HAVE THE PATIENT HOLD THEIR WRISTS AS SHOWN FOR ONE MINUTE. NUMBNESS AND PARAESTHESIA IN THE DISTRIBUTION OF THE MEDIAN NERVE IS A POSITIVE TEST.

THUMB ABDUCTION TEST

TESTS THE STRENGTH OF THE ABDUCTOR POLLICIS BREVIS WHICH IS INERVATED BY THE MEDIAN NERVE.

HAVE THE PATIENT PLACE THEIR PALM UP WITH THEIR THUMB PERPENDICULAR TO IT.

APPLY DOWNWARD PRESSURE ON THE THUMB. WEAKNESS IS ASSOCIATED WITH CARPAL TUNNEL SYNDROME.

JAMA 2000;283:3110-3117MOSBY’S GUIDE TO THE PHYSICAL EXAMINATION 5TH ED.

Claw Hand

1. Description: Hyperextension at the MCP joint, and flexion at the IP joint

2. Etiology?

Ape Hand

1. Description: atrophy of the thenar eminence 2. What nerves and muscles are involved and how?