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Session 3: The Upper Extremity: The Elbow, Forearm,
Wrist, And Hand
COURSE: Introduction to Exercise Science Level I (Kinesiology)
Presentation Created byKen Baldwin, M.Ed
Copyright © EFS Inc. All Rights Reserved.
Objectives1. Name, locate, & describe the structures of
the elbow, forearm, wrist, and hand area2. Analyze the fundamental movements with
respect to joint & muscle actions3. Describe common injuries to elbow, forearm,
wrist, and hand area
THE ELBOW JOINT
• The Joints and muscles of elbow joint meant to serve the hand
• WHY? 15 Muscles that cross elbow complex act at shoulder or wrist
• Wrist and Shoulder linked by elbow• Example, eating, writing, and driving
THE ELBOW JOINT Structure
• Distal humerus - Trochlea- Capitulum– Coronoid fossa/
process– Olecranon fossa/
process• Radial head• Radial notch of ulna
Fig 6.1
THE ELBOW JOINT Structure• All 3 joints enveloped
in a capsule, lined by synovial membrane
• Strengthen by Radial & Ulnar collateral ligaments
• Annular ligament encircles the radial head & bind it to ulna
Fig 6.2Fig 6.3
THE ELBOW JOINT Structure
4 joints of Elbow• Humeroulnar
– Hinge joint • Humeroradial
– Gliding joint• Proximal/Distal
Radioulnar– Pivot joint
Fig 6.1
THE HUMEROULNAR JOINT• Hinge Joint- Articulation between –
Humerus & Ulna• Trochlea notch- slides into Trochlear
Groove• Medial (Ulnar) Collateral Ligaments= Lateral
stability- Valgus Stress• In Flexion- Coronoid process hits coronoid
fossa• Extension- Olecranon process hits
olecranon fossa
THE HUMERORADIAL JOINT
• Gliding Joint- Articulation between – Humerus & Radius
• Articulation- Radial head spins on Capitulum & Radial Notch on Ulna
• Annular Ligament- covers radial head, keeps head in place
• Lateral (Radial) Collateral Ligaments cover annular ligament and radial providing strength against Varus Stress
THE ELBOW – CARRYING ANGLE
• The carrying angle is made from the Long Axis of Humerus and Long Axis of forearm forming
• Angle for men 10 to 15°• Angle for women 20 to 25°• Application to fitness – Bicep Curls-Straight bar• Flexion- trochlear groove, Forearm in Flexion will
be centered, medial/lateral position
Elbow Joint Movements
• Flexion• Extension• Supination• Pronation
THE ELBOW JOINT Movements
Fig 6.4a
THE RADIOULNAR JOINTS Movements
Fig 6.4b
THE RADIOULNAR JOINTS Structure
Proximal:• Pivot joint• Radius articulates with
radial notch of ulnaDistal:• Pivot joint• Ulna Articulates with
ulnar notch of radius & articular disk-triangular
Fig 6.1
THE PROXIMAL RADIOULNAR JOINT
• Pivot joint• Radius articulates with radial notch of
ulna• ROTATION-Head of radius articulates
w/ capitulum of humerus
THE DISTAL RADIOULNAR JOINT
• Distal Radioulnar Joint-Pivot Joint• Articulation-Ulnar Notch on radius articulates
with end of Ulna• Articular Disk at end of Joint- a reinforcer• Strengthened by
– Volar radioulnar– Dorsal radioulnar
THE RADIOULNAR JOINT Interosseous Membrane
• Interosseous Membrane- Collaginous Sheet
• Reinforces proximal/distal radioulnar joints
• Provides stability and binds radius and ulna
• Under Tension, transmits forces• Movements- Supination and Pronation
Supination and Pronation
• Axis of Motion- Longitudinal axis-from radial/ulnar head
• In Supination- Radius and Ulna parallel (outward rotation, like humerus)
• In Pronation- Radius crosses over Ulna (inward rotation, like humerus)
• Ulna does not move much during either motion
• Range of Motion (150°) at 90° of flexion
MUSLCES OF ELBOW AND RADIOULNAR JOINTS
Location:• Anterior proximal (Elbow): Biceps brachii,
Brachialis, Brachioradialis, Pronator teres• Anterior distal (near wrist): Pronator
quadratus• Posterior: Triceps brachii, Anconeus,
Supinator
Biceps Brachii
Function: • Flexes and supinates
the forearm• Contracts more with
resistance Fig 6.5
Brachialis
Function: • Flexion of the elbow• Considered the “work
horse” of elbow flexor muscles Fig 6.7
BrachioradialisFunction: • Contributes to elbow
flexion• Mid-position-neutral grip
Pronator TeresFunction:• Pronates the forearm,
assists in elbow flexion
Fig 6.8
Pronator Quadratus
Function: • Pronation of the
forearm• Stronger of the two
pronator mucles Fig 6.9
Triceps BrachiiFunction: • Powerful extensor of
elbow
SupinatorFunction: • Supination of the
forearm
Fig 6.10
Anconeus
Function: • Working with the
triceps, extends the forearm
• Provides stability to posterior elbow joint
Fig 6.11
MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM
Flexion
1. Biceps is most active in supination, bicep curl2. Brachioradialis most active in midposition or
in supination3. Brachialis is a flexor under all conditions4. Pronator teres, a moderate flexor, most
active in a position of pronation
MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM
Extension • Triceps & anconeusPronation• Pronator teres & Pronator quadratusSupination• Biceps; Long more active with greater muscle
length (extension), while short head more active with shorter muscle length (flexion)
• Supinator-primary for supination
THE WRIST AND HAND
Mobility due to generous supply of joints
• Radiocarpal joint• Articulation between
two rows of carpal bones
• Carpometacarpal joint
Fig 6.12
Structure of the Wrist (Radiocarpal) Joint
• Condyloid joint• Radius & radioulnar
disk and 3 carpal bones
• 4 ligaments– Volar radiocarpal– Dorsal radiocarpal– Ulnar collateral– Radial collateral
Fig 6.14
Proximal/Distal Carpal bones
• Proximal = Scaphoid, Lunate, Triquetrum & pisiform
• Distal = Trapezium, Trapezoid, Capitate, & Hamate
• Proximal and distal carpal bones form the mid-carpal joint which is a Gliding Joint
Movements of the Hand at the Wrist Joint
Fig 6.16
Circumduction: fingertips describe a circle, hand describe a cone
Structure and Movements of the Midcarpal
• Proximal row of 4 carpal bones articulates with four carpal bones of distal row
• Permit only a slight gliding motion• However, the gliding add up to a modified
(hinge/condyloid?) joint• Anterior surface of carpal bone are slightly
concave form side to side, referred to as the Carpal Tunnel
Structure of the Carpometacarpal and Intermetacarpal Joints
• For all fingers (metacarpophalange al joints are modified condyloid joints, except thumb
• Thumb is known as carpometacarpal joint, or saddle joint
Fig 6.13
Movements of the Carpometacarpal Joint of the Thumb
Fig 6.19
AbductionHyperadduction
Extension
Flexion Hyperflexion Opposition
MUSCLES OF THE WRIST
• Flexors: Flexor carpi radialis, Flexor carpi ulnaris, Palmaris longus
• Extensors: Extensor carpi radialis brevis, Extensor carpi radialis longus, Extensor carpi ulnaris
• Adductors: Extensor carpi ulnaris, Flexor carpi ulnaris
• Abductors: Flexor carpi radialis, Extensor carpi radialis longus
Flexor Carpi radialisFunction: • Flexes wrist• Radial deviationFlexor Carpi UlnarisFunction: • Flexes wrist• Ulnar deviationPalmaris longusFunction: • Weakly flexes wrist
Fig 6.21
Extensor carpi radialisFunction: • Extends wrist• Radial deviationExtensor carpi ulnarisFunction: • Extends wrist• Ulnar deviation
Fig 6.23a
Extensor digitorumFunction: • Extends fingers & wristExtensor digiti minimiFunction: • Extends little finger &
wristFig 6.23b
Flexor digitorum superficialFunction: • flexes fingers & wrist
Fig 6.24a
Flexor digitorum profundus
Function: • Flexes fingers & wristFlexor pollicis longusFunction: • Flexes thumb
Fig 6.24b
Extensor pollicis longusFunction: • Extends thumbExtensor indicisFunction: • Extends index fingerAbductor pollicis longusFunction: • Abducts thumbExtensor pollicis brevisFunction: • Extends thumb
Fig 6.25
MUSCULAR ANALYSIS OF FUNDAMENTAL MOVEMENTS OF WRIST, FINGERS, & THUMB
Wrist• Flexion• Extension • Radial deviation
(Abduction)• Ulnar Deviation
(adduction)
Fingers • Flexion• Extension• Abduction• Adduction • Opposition
MUSCULAR ANALYSIS OF FUNDAMENTAL MOVEMENTS OF WRIST, FINGERS, & THUMB
Thumb Metacarpal• Flexion• Extension• Abduction• Adduction• Opposition
Thumb Phalanges • Flexion• Extension
COOPERATIVE ACTIONS OF WRIST AND DIGITS
• Long finger muscles do not have sufficient length to permit full ROM in joints of fingers & wrist at the same time
Example: make a tight fist, now flex wrist, fingers loosen their grip
Length of Long Finger Muscles Relative to Range of Motion in Wrist & Fingers
Examples of Using Hands for Grasping
• Power grip involves flexion of all fingers
Cylindrical Spherical Hook
Fig 6.30c Fig 6.30f Fig 6.30g
Examples of Using Hands for Grasping
• Precision involves thumb & two finger, depending on shape & size of object
Fig 6.30a Fig 6.30b
COMMON INJURIES OF THE FOREARM, ELBOW, WRIST, AND FINGERS
These areas may be presented for each injury • Fractures of the forearm- falling on
outstretched hand, usually both ulna & radius fracture
• Elbow dislocation-falling on outstretched hand with elbow extended or hyperextended, most common is backward displacement of ulna & radius in relation to humerus, Very serious: blood vessels & nerves
Medial Elbow Injuries
• Most common is to medial epicondyle fractures in minors, epiphyses not yet closed, pitching or serving
• Medial Collateral ligament tears-baseball pitchers, minors and adults
Sprained or Strained Wrist • Falling on palm of hand with wrist
hyperextended, usually a sprain of ligaments, May be a strain to tendons
Carpal Tunnel Syndrome • Overuse, repetitive stress injury• Long hours working with small hand tools and
keyboards• Median nerve & blood vessel compression at
they pass through carpal arch & transverse carpal ligament
• Pain, numbing of fingers
Epicondylitis• Lateral epicondylitis – “tennis elbow”• Medial epicondylitis – ‘Little league elbow”• Repetitive stress injury• Microtraumas or tears in muscle & soft tissue
at proximal attachments• Pain on activity• Rest, Ice, anti-inflammatory drugs, & possibly
cortisone injection