Wrist and Hand- Cumulative

Fully taken from Megan's study guide. The slide make me angry so I will only be looking at everyone's study guides <3

radiocarpal joint

radiocarpal joint

radius to scaphoid and lunate (synovial, ellipsoid)

2 df

-flexion/extension

-radial/ulnar deviation

midcarpal joint

proximal carpal row and distal carpal row (synovial, irregular plane )

2 df

-flexion/extension

-radial/ulnar deviation

Carpometacarpal joints of thumb

carpal bones and metacarpals (saddle joint)

2 df

-flexion/extension (radial abduction)

-palmar abduction/adduction

2ndary motion: opposition/reposition

What is opposition?

combination of thumb CMC abduction, flexion, and medial rotation

Saddle joints allow…

extensive motion: saggital, frontal, transverse

Carpometacarpal joints of index and long

complex saddle joint

very little/ no movement

carpometacarpal joints of ring

saddle joint

1 df

-flexion/extension

carpometacarpal joint of small

saddle joint

2 df

-flexion/extension

-opposition/reposition

metacarpophangeal (MCP) joint of thumb

ellipsoid/condyloid joint

2 df

-flexion/extension

-adduction/abduction

metacarpophalangeal (MCP) joint of 2-5

ellipsoid/condyloid joint

2 df

-flexion/extension

-adduction/abduction

abduction of fingers away from midline

adduction of fingers towards midline

hyperextension of MCP joints

extension beyond 0 degrees (neutral)

Proximal interphalangeal joints 2-5

hinge joint

1 df

-flexion/extension

Distal interphalngeal joint of 2-5 (DIP)

hinge joints

1 df: flex/ext

composite flexion/extension

flexion/extension at MCP, PIP, DIP of 2-5

wrist stability

1. bony configuration

2. Static stabilizers- ligaments

   1. extrinsic ligaments

   2. TFCC

   3. intrinsic ligaments

3. Dynamic Stabilizers- extrinsic finger muscles & wrist muscles

extrinsic ligaments

connects radius, ulna, and carpal bones

intrinsic ligaments

connect carpal bones

scapulo-lunate ligament

proximal carpal bones glide during flexion/extension & radial/ulnar deviation

this ligament is necessary for:

1. glide motion between scaphoid & lunate

2. facilitate wrist stability

prevents excessive extension

extrinsic ligaments on palmar aspect of wrist are tight

prevents excessive flexion

extrinsic ligaments on dorsal aspect of wrist are tight

thumb CMC joint ligaments

base of 1st metacarpal & distal end of trapezium

1. posterior oblique ligament

2. intermetacarpal ligament

3. anterior oblique ligament

   prevent excessive movement during grasp

radial & ulnar collateral ligaments

prevent excessive lateral

medial movement of MCP, PIP, DIP

taut in flexion

lax in extension

volar/palmar plates

stabilize during extension

prevents excessive hyperextension

fibrous capsule that thickens into fibrocartilage plates

taut in extension

taut in flexion

Triangular Fibrocartilage Complex (TFCC)

-occupies ulnocarpal space

-supports proximal carpal row

-transmits forces from hand/wrist to forearm

-binds distal ends of radius & ulna (DRUJ) to stabilize during pronation & supination

-allows radius & carpals to rotate around fixed ulna at DRUJ

deep transverse metacarpal ligament

prevents excessive abduction

Primary wrist extensors

extensor carpi radiales longus (ECRL)

extensor carpi radialis brevis (ECRB)

extensor carpi ulnaris (ECU)

Assist Wrist extensors

1. extensor digitorum (ED)

2. Extensor indicis (EI)

3. extensor digiti minimi (EDM)

Primary Wrist Flexors

flexor carpi radialis (FCR)

flexor carpi ulnaris (FCU)

palmaris longus

Assist wrist flexion

flexor pollicis longus (FPL)

flexor digitorum superficalis (FDS)

flexor digitorum profundus (FDP)

Primary wrist radial deviation

extensor carpi radialis longus (ECRL)

flexor carpi radialis (FCR)

Secondary wrist radial deviation

abductor pollicis longus (APL)

extensor pollicis brevis (EPB)

Primary wrist ulnar deviation

extensor carpi ulnaris (ECU)

flexor carpi ulnaris (FCU)

Extensor Carpi Radialis Longus (ECRL)

O: distal 1/3 of lateral supracondylar ridge of humerus

I: dorsal base of 2nd metacarpal

Extensor Carpi Radialis Brevis (ECRB)

O: common extensor tendon from lateral epicondyle

I: dorsal base of 3rd metacarpal

Extensor carpi ulnaris

O: common extensor tendon from lateral epicondyle

I: dorsal base of 5th metacarpal

Extensor Digitorum (ED)

O: common extensor tendon from lateral epicondyle

I: dorsal bases of middle and distal phalanges of 2-5

Extensor Indicis (EI)

O: back of distal shaft of ulna, interossesous membrane

I: tendons of extensor digitorum at 2nd metacarpal

Extensor Digiti Minimi (EDM)

O: lateral epicondyle of humerus

I: tendon of extensor digitorum at 5th metacarpal

Flexor Carpi Radialis

O: common flexor tendon from medial epicondyle of humerus

I: volar bases of 2&3 metacarpals

Flexor Carpi Ulnaris (FCU)

O: common flexor tendon from medial epicondyle of humerus -posterior, proximal 2/3 of ulna

I: pisiform, hook of hamate, volar base of 5th metacarpal

Palmaris Longus

O: common flexor tendon from medial epicondyle of humerus

I: transverse carpal ligament/flexor retinaculum, palmar aponeurosis

Flexor Pollicis Longus (FPL)

O: front of radius, interosseous membrane

I: volar base of distal phalanx of thumb

flexor digitorum superficialis (FDS)

O: common flexor tendon of medial epicondyle

-ulnar collateral ligament

-coronoid process

-interosseous membrane

-proximal shaft of radius

I: volar side of 205 middle phalanges

Flexor digitorum profundus (FDP)

O: anterior and medial surface of proximal ulna

I: volar base of 2-5 distal phalanges

Extensor Carpi Radialis Longus (ECRL)

O: lateral supracondylar ridge of humerus

I: dorsal base of 2nd metacarpal

Flexor carpi radialis (FCR)

O: common flexor tendon from medial epicondyle

I: volar bases of 2&3 metacarpals

Abductor Pollicis Longus (APL)

O: posterior, middle of ulna and radius, interossea membrane

I: radial base of 1st metacarpal

Extensor Pollicis Brevis (EPB)

O: posterior radius , interosseous membrane

I:dorsal base of proximal phalanx of thumb

Extensor Carpi Ulnaris (ECU)

O: common extensor tendon from lateral epicondyle

I: dorsal base of 5th metacarpal

Flexor Carpi Ulnaris

Humeral head: common flexor tendon of medial epicondyle

Ulnar head: posterior surface of proximal ulna

I: pisiform, hook of hamate, volar base of 5th metacarpal

extensor retinaculum

secure the extensor tendons to the wrist, a fibrous band that crosses over the extensor compartment, forms a pulley system

1st extensor compartment

extensor pollicis brevis (EPB)

abductor pollicis longus (APL)

2nd extensor compartment

extensor carpi radialis longus (ECRL)

extensor carpi radialis brevis (ECRB)

3rd extensor compartment

extensor pollicis longus (EPL)

4th extensor compartment

extensor digitorum communis

extensor indicis

5th extensor compartment

extensor digiti minimin (EDM)

6th extensor compartment

Extensor carpi ulnaris (ECR)

Anatomic Snuffbox Borders

radial: 1st compartment-APL, EPB

Ulnar: 3rd compartment- EPL

Floor: scaphoid & trapezium

Anatomic Snuffbox Contains

1. superficial sensory branch of radial nerve

   1. travels over extensor retinaculum and anatomical snuffbox

2. palmar carpal ligament

   1. stabilzes extrinsix muscles located volar

3. transverse carpal ligament/flexor retinaculum

   1. stabilizes tendons of extrinsic finger/thumb flexors in the carpal tunnel

carpal tunnel borders

roof: transverse carpal ligament (flexor retinaculum)

Floor: carpal bones : hook of hamate, pisoform, tubercule of trapezium, tubercule of scaphoid

contents of the carpal tunnel

1 median nerve

4 flexor digitorum superficialis (FDS) tendons

4 flexor digitorum profundus (FDP) tendons

1 flexor pollicis longus (FPL) tendon

Guyon’s canal bordes

roof: pisohamate ligament

floor: pisiform, hook of hamate

Contents of Guyon’s canal

ulnar nerve

ulnar artery

Extensor Digitorum (extrinsic hand muscle)

MCP extension 2-5

PIP extension 2-5

DIP extension 2-5

flexor pollicis longus (extrinsic hand muscles)

thumb: IP, MCP, CMC flexion

composite flexion: CMC, MCP, IP joints move

isolated thumb IP flexion: isolated FPL action

Extensor Indicis (extrinsic hand muscles)

MCP extension

MCP adduction

of index finger

Extensor Digiti minimi (extrinsic hand muscles)

MCP extension of small finger

extensor pollicis longus (extrinsic hand muscles)

thumb IP, MCP, CMC extension

Extensor pollicis brevis (extrinsic hand muscles)

thumb MCP, CMC extension

Abductor pollicis longus (extrinsic hand muscle)

cmc abduction

cmc extension

of thumb

flexor digitorum superficialis (extrinsic hand muscles)

MCP flexion 2-5

PIP flexion 2-5

Flexor digitorum profundus (extrinsic hand muscles)

MCP flexion

PIP flexion

DIP flexion

Flexor Protective Structures at wrist

transverse carpal ligament

palmar carpal ligament

(FPL-1, FDS-4, FDP-4)

Flexor Protective Structures at palm

palmar aponeurosis: from distance edge of transverse carpal to proximal fingers

Flexor Protective structures at digits

flexor tendon sheath

protects FDS, FDP, FDL

attaches to sides of phalanges and to volar plates

Digital Synovial Sheath

secretes fluid to reduce friction between FDS and FDP

Fibrous Digital Sheath

protective tunnels guide extrinsic flexor tendons

Flexor tendon pulley

thick fibrous bands embedded in fibrous digital sheath

flexor tendon bowstringing

ruptured flexor pulley

palmar carpal ligament

continuous with extensor retinaculum

thenar muscles

OAF

Opponens pollicis

abductor pollicis brevis

flexor pollicis brevis

Hypothenar muscles

MINI OAF

opponens digiti minimi

abductor digiti minimi

flexor digiti minimi

opponens pollicis

thumb CMC opposition

Abductor pollicis brevis

CMC abduction

MCP abduction

for thumb

flexor pollicis brevis

CMC flexion

MCP flexion

for thumb

Opponens digiti minimi

small finger CMC opposition

abductor digiti minimi

small finger MCP abduction

flexor digiti minimi

small finger MCP flexion

Midpalm muscles

dorsal interossi, palmar interossi, lumbricals, adductor pollicis

adductor pollicis

CMC adduction

MCP adduction

for thumb

lumbricals

MCP 2-5 flexion

PIP 2-5 extension

DIP 2-5 extension

form the tabletop position

palmar interossei

MCP adduction of 2-5

assists MCP flexion, PIP extension, DIP extension

dorsal interossei

MCP abduction of 2-5 (away from 3rd ray)

assists with MCP flexion, PIP extension, DIP extension

Opponens pollicis (attachments)

Palmar attachment: flexor retinaculum/transverse carpal ligament, tubercule of trapezium

Dorsal attachment: radial surface of thumb

Abductor pollicis brevis ( attachments)

Palmar attachments: flexor retinaculum/transverse carpal ligament, tubercule of trapezium, tubercule of scaphoid

Dorsal attachment: radial base of proximal phalanx of thumb

Flexor pollicis brevis (attachments)

Palmar attachment: superficial head-flexor retinaculum/ transverse carpal ligament

deep head- trapezium, trapezoid, capitate

Opponens digiti minimi (attachments)

Palmar attachment: hook of hamate, flexor retinaculum

Dorsal attachment: ulnar side of 5th metacarpal

abductor digiti minimi (attachments)

palmar attachment: pisiform, tendon of flexor carpi ulnaris

Dorsal attachment: ulnar base of proximal phalanx of small finger

Flexor digiti minimi (attachments)

Palmar attachment: hook of hamate, flexor retinaculum

Dorsal attachment: palm base of proximal phalanx of small finger