upper extremity - wrist & hand Flashcards
what movement is equivalent to adduction in the wrist?
ulnar deviation
what movement is equivalent to abduction in the wrist?
radial deviation
meaning of radial
towards the radius (lateral) side of a structure or bone
meaning of ulnar
towards the ulna (medial) side of a structure or bone
how many carpal bones are there?
8 carpal bones
what are the bones in the proximal row (lateral to medial)?
- scaphoid bone
- lunate bone
- triquetrum bone
- pisiform bone
what are the bones in the distal row (lateral to medial)?
- trapezium bone
- trapezoid bone
- capitate bone
- hamate bone
what does the scaphoid bone articulate with?
- radius
- capitate
- lunate
- trapezium
- trapezoid
muscles of the hypothenar eminence
- abductor digiti minimi
- flexor digiti minimi
- palmaris brevis
- opponens digiti minimi
origins of abductor digiti minimi
- pisiform
- tendon of flexor carpi ulnaris
insertion of abductor digiti minimi
medial aspect of base of P1 of fifth metacarpal
action of abductor digiti minimi
abduction of 5th finger
origin of flexor digiti minimi
- flexor retinaculum
- hamatum
insertion of flexor digiti minimi
P1 of fifth metacarpal
action of flexor digiti minimi
flexion of 5th finger
origin of palmaris brevis
- palmar aponeurosis
- flexor retinaculum
insertion of palmaris brevis
skin on medial side of the hand
action of palmaris brevis
assists in prehension
origin of opponens digiti minimi
- flexor retinaculum
- hook of hamatum
insertion of opponens digiti minimi
palmar aspect of 5th metacarpal
action of opponens digiti minimi
opposition of 5th digit
muscles of the thenar eminence
- flexor pollicis brevis
- abductor pollicis brevis
- opponens pollicis
- adductor pollicis (transverse & oblique heads)
origin of flexor pollicis brevis
- trapezium
- flexor retinaculum
insertion of flexor pollicis brevis
lateral aspect of P1 (base) of thumb
action of flexor pollicis brevis
P1 flexion
origin of abductor pollicis brevis
- flexor retinaculum
- scaphoid
- trapezium
insertion of abductor pollicis brevis
lateral aspect of P1 (base) of thumb
action of abductor pollicis brevis
thumb abduction
origins of opponens pollicis
- trapezium
- flexor retinaculum
insertion of opponens pollicis
lateral aspect of 1st metacarpal
actions of opponens pollicis
- thumb opposition
- assists in flexion
origins of adductor pollicis
oblique head: - capitate - bases of 2nd & 3rd metacarpals transverse head: - palmar aspect of 3rd metacarpal
insertion of adductor pollicis
base of P1 thumb
action of adductor pollicis
thumb adduction
what are the dorsal hand muscles?
dorsal interossei
origin of dorsal interossei
metacarpals 1-5
insertion of dorsal interossei
P1 of fingers 2-4
actions of dorsal interossei
- flexion of metacarpophalangeal joints
- abduction of fingers
- extension of proximal & distal intercarpal joints
what are the palmar hand muscles?
- palmar interossei
- lumbricals 1-4
origin of palmar interossei
palmar aspect of metacarpals 2, 4, 5
insertion of palmar interossei
base of P1 in digits 2, 4, 5
actions of palmar interossei
- flexion & adduction of metacarpophalangeal joints
- extension of proximal & distal intercarpal joints
origin of lumbrical 1
lateral aspect of flexor digitorum profundus in 2nd digit
insertion of lumbrical 1
lateral aspect of P1 in 2nd digit
action of lumbricals 1-4
- flexion of metacarpophalangeal joints
- extension of proximal & distal intercarpal joints
origin of lumbrical 2
lateral aspect of flexor digitorum profundus digit 3
insertion of lumbrical 2
lateral aspect of P1 in 3rd digit
origin of lumbrical 3
medial & lateral aspect of flexor digitorum profundus tendons of digits 3-4
insertion of lumbrical 3
lateral aspect of P1 in 4th digit
origin of lumbrical 4
medial & lateral aspect of flexor digitorum profundus tendons in digits 4-5
insertion of lumbrical 4
lateral aspect of P1 in 5th digit
origin of extensor pollicis brevis
posterior distal surface of radius & interosseous membrane
insertion of extensor pollicis brevis
dorsal aspect of P1
action of extensor pollicis brevis
P1 extension
origin of extensor pollicis longus
posterior distal surface of ulna & interosseous membrane
insertion of extensor pollicis longus
dorsal aspect of P2
actions of extensor pollicis longus
- P2 extension
- assists in wrist extension
origin of abductor hallucis longus
posterior aspect of radius, ulna, & interosseous membrane
insertion of abductor hallucis longus
base of 1st metacarpal (radial aspect)
actions of abductor hallucis longus
thumb abduction & extension
origin of flexor pollicis longus
anterior surface of radius & interosseous membrane
insertion of flexor pollicis longus
palmar surface of P2 (thumb)
actions of flexor pollicis longus
- P1 & P2 flexion
- thumb opposition
- assists in wrist flexion
origin of extensor digitorum
lateral epicondyle
insertion of extensor digitorum
P1-P3 via tendinous expansions of 2nd-5th digits
actions of extensor digitorum
- finger extension
- assists in wrist & elbow extension
origin of extensor indicis
distal posterior aspect of ulna & interosseous membrane
insertion of extensor indicis
2nd digit’s tendon of extensor digitorum
actions of extensor indicis
- index finger extension
- assists in wrist extension
origin of extensor digiti minimi
lateral epicondyle
insertion of extensor digiti minimi
P3 of pinky finger
actions of extensor digiti minimi
- pinky finger extension
- assists in wrist & elbow extension
origin of flexor digitorum superficialis
humeroulnar head: - medial epicondyle - coronoid process radial head: - proximal 1/2 of anterior surface of radius
insertion of flexor digitorum superficialis
palmar surface of P2 in fingers 2-5
actions of flexor digitorum superficialis
- P1 & P2 flexion
- assists in wrist & elbow flexion
origin of flexor digitorum profundus
medial & anterior surface of proximal 3/4 of ulna & interosseous membrane
insertion of flexor digitorum profundus
palmar surface of P3 in fingers 2-5
actions of flexor digitorum profundus
- P3 flexion
- assists in wrist flexion
origin of extensor carpi ulnaris
lateral epicondyle
insertion of extensor carpi ulnaris
base of 5th metacarpal
actions of extensor carpi ulnaris
- wrist extension
- ulnar deviation
- assists in elbow extension
origin of extensor carpi radialis longus
supracondylar ridge of lateral epicondyle
insertion of extensor carpi radialis longus
base of 2nd metacarpal
actions of extensor carpi radialis longus
- wrist extension
- radial deviation
- assists in elbow extension
origin of extenor carpi radialis brevis
lateral epicondyle
insertion of extensor carpi radialis brevis
base of 3rd metacarpal
actions of extensor carpi radialis brevis
- wrist extension
- radial deviation
- assists in elbow extension
origin of flexor carpi radialis
medial epicondyle
insertion of flexor carpi radialis
base of 2nd & 3rd metacarpals
actions of flexor carpi radialis
- wrist flexion
- radial deviation
- assists in elbow flexion
origin of flexor carpi ulnaris
medial epidonyle
insertion of flexor carpi ulnaris
- pisiforme
- hamate
- base of 4th & 5th metacarpals
actions of flexor carpi ulnaris
- wrist flexion
- ulnar deviation
- assists in elbow flexion
origin of palmaris longus
medial epicondyle
insertion of palmaris longus
- palmar aponeurosis
- palmar fascia
- palmar skin
actions of palmaris longus
- wrist flexion
- tension in palmar fascia
- assists in elbow flexion
describe the lunate bone
- most moveable & unstable bone of the wrist
- rounded shape
- poor ligament stability
- no muscular attachment
describe the triquetrum bone
- triangular bone
- most medial/ulnar bone of the wrist
describe the pisiform bone
- pea-shaped
- loose articulation with palmar surface of triquetrium bone
- embedded within tendon of flexor capi ulnaris
- attachment for abductor digiti minimi muscle
describe the trapezium bone
- articulates with scaphoid & trapezoid via 2 proximal concave surfaces
- distal surface articulates with first metacarpal
describe the trapezoid bone
- small & trapezoid shaped
- wedged between trapezium & capitate
- solid articulation with base of 2nd metacarpal
describe the capitate bone
- largest carpal bone
- articulates with trapezoid, scaphoid, lunate, hamate, & 2nd, 3rd, & 4th metcarpals
- solid articulation with 3rd metacarpal
- axis of motion for all wrist motions
describe the hamate bone
- hook found on palmar side that protects ulnar nerve
- articulates with capitate, triquetrum & 4th & 5th metcarapals
what are bony landmarks of the metacarpal bones?
- head
- neck
- base
- shaft
- posterior tubercle
what are the ligaments of the 1st carpometacarpal joint?
- anterior (palmar) oblique
- ulnar collateral
- intermetacarpal
- radial collateral
- posterior oblique
proximal attachment of anterior (palmar) oblique ligament
palmar tubercle on trapezium
distal attachment of anterior (palmar) oblique ligament
palmar base of thumb metacarpal
limits of the anterior (palmar) oblique ligament
- thin & weak
- tight & pulled back in full extension
proximal attachment of ulnar collateral ligament
radial side of transverse carpal ligament
distal attachment of ulnar collateral ligament
palmar-ulnar base of thumb metacarpal
limits of the ulnar collateral ligament
tight & pulled back in abduction & extension
proximal attachment of intermetacarpal ligament
dorsal-radial base of second metacarpal
distal attachment of intermetacarpal ligament
palmar-ulnar base of thumb metcarpal with ulnar collateral ligament
limits of the intermetacarpal ligament
tight & pulled back in opposition, flexion, & abduction
proximal attachment of radial collateral ligament
radial surface of the trapezium
distal attachment of radial collateral ligament
dorsal base of thumb metacarpal (adjacent to insertion of abductor pollicis longus)
limits of the radial collateral & posterior oblique ligaments
- relatively thick & strong
- densely populated with sensory fibres
- tight & pulled back in opposition, flexion, & abduction
- prime stabilizer for opposed carpometacarpal joint
proximal attachment of posterior oblique ligament
posterior-radial corner of trapezium
distal attachment of posterior oblique ligament
palmar-ulnar base of thumb metacarpal
what is the carpal tunnel
formed by the palmar surface of the wrist being concave & covered by transverse ligaments
structures within the carpal tunnel
- median nerve
- muscle tendons
- flexor carpi radialis
- Guyon’s canal
which muscles for the tendons located in the carpal tunnel belong to?
- flexor digitorum superficialis
- flexor pollicis longus
- flexor digitorum profundus
where is the flexor carpi radialis located in the carpal tunnel?
between deep & superficial layers of the flexor retinaculum
what is Guyon’s canal?
a small compartment found superficially to the tunnel on its medial aspect
what are the functions of the triangular fibrocartilage complex?
- primary stabilizer of distal radio-ulnar joint
- reinforces ulnar side of wrist
- forms part of the concavity of radiocarpal joint
- helps transfer part of the compression forces naturally cross bending the forearm
total compression force of triangular fibrocartilage complex to the
20% out of the total crossing the wrist passing through the fibrocartilage disc component
what are the movements allowed at the wrist?
- flexion/extension
- radial/ulnar deviation
what are the joints of the wrist?
- radiocarpal joint
- midcarpal joint
- intercarpal joint
what are the joints of the wrist?
- radiocarpal joint
- midcarpal joint
- intercarpal joint
bones articulating in radiocarpal joint
- radius & triangular fibrocartilage joint with scaphoid & lunate bones
- triquetrium & ulna make contact during ulnar deviation
what kind of joint is the radiocarpal joint?
condyloid joint
what articulates in the medial compartment of the midcarpal joint?
capitate & hamate bones (convex) with the scaphoid, lunate & triquetrium (concave)
what articulates in the lateral compartment of the midcarpal joint?
distal pole of scaphoid (convex) with trapzoium & trapezoid bones (concave)
direction of movement in midcarpal joint
medial to lateral
what kind of joint is the midcarpal joint?
bicondyloid joint
how many intercarpal joints are there?
13 joints
what are the possible shapes for intercarpal joints?
- flat
- convex
- concave
movements allowed by intercarpal joints
- gliding
- small rotatory motions
what kind of joint are the intercarpal joints?
planar joints
what nerve is compressed by flexor retinaculum in the carpal tunnel?
the median nerve
what kind of joint are the interphalangeal joints
hinge joints