Transcript Anatomy of the Hand and Wrist - PA

Anatomy of the Hand and
Wrist
She Likes To Play
Scaphoid
Lunate
In the moonlight
A boat
Triquetrum
The third T Bone
Mnemonic
for
Learning
Carpals
Pisiform
Pea-shaped
Hamate
A hambone
With a hook
Trapezium:
“It’s by the thumb”
Capitate
Trapezoid
“Is by its side”
Click R Button for Slideshow
Try To Catch Her
Bones of the Wrist (Which hand?
what view?)
Bones of Wrist (which hand?)
Flexor
Tendons
• The muscles that flex
your wrist are on the
palmer side.
• A group of the begin
at the medial
epicondyle of the
humerus at the elbow
Flexor Carpi Radialis
• Origin Medial
epicondyle of
humerus
• Insertion Base of 2nd
metacarpal
• Action Flexes and
radial deviates the
hand (at wrist)
• Innervation Median
nerve (C6 and C7)
Flexor Digitorum Superficialis
• Origin medial epicondyle
of humerus,
• Insertion middle
phalanges of digits 2 - 5
• Action Flexes middle
phalanges at proximal
interphalangeal joints
also flexes proximal
phalanges at
metacarpophalangeal
joints and hand
• Innervation Median
nerve (C7, C8 and T1)
Flexor Carpi Ulnaris
• Origin medial epicondyle
of humerus
• Insertion Pisiform bone,
hook of hamate bone,
and 5th metacarpal bone
• Action Flexes and ulnar
deviates hand (at wrist)
• Innervation Ulnar nerve
(C7 and C8)
Palmaris Longus
• Origin Medial epicondyle
of humerus
• Insertion Distal half of
flexor retinaculum and
palmar aponeurosis
• Action Flexes hand at
the wrist
• Innervation Median
nerve (C7 and C8)
Flexor Digitorum Profundus
• Origin Proximal 3/4 of
ulna
• Insertion Base of the
distal phalanx of digits 2 –
5
• Action Flexes distal
phalanges at distal
interphalangeal joints
• Innervation
• Medial part: ulnar nerve
Lateral part: median
nerve
Flexor Digiti Minimi Brevis
• Origin Hook of hamate
and flexor retinaculum
• Insertion Medial side of
base of proximal phalanx
of little finger
• Action Flexes proximal
phalanx of little (5th)
finger
• Innervation ulnar nerve
Flexor Pollicis Brevis
• Origin Flexor retinaculum
and tubercles of scaphoid
and trapezium
• Insertion Lateral side of
base of proximal phalanx
of thumb
• Action Flexes thumb
• Innervation Recurrent
branch of median nerve
(C8 and T1)
Flexor Pollicis Longus
• Origin Anterior surface of
radius and adjacent
interosseous membrane
• Insertion Base of distal
phalanx of thumb
• Action Flexes phalanges
of 1st digit (thumb)
• Innervation Anterior
interosseous nerve from
median nerve (C8 and
T1)
The 2 Muscles of Pronation
• Two muscles work
together to turn the
radius over the ulna
and put the hand in a
prone position
• Pronator teres and
pronator quadratus
Pronator Quadratus
• Origin Distal 1/4 of
anterior surface of
ulna
• Insertion Distal 1/4 of
anterior surface of
radius
• Action Pronates
forearm;
• Innervation median
nerve
Pronator Teres
• Origin Medial
epicondyle of
humerus
• Insertion Middle of
lateral surface of
radius
• Action Pronates
• Innervation Median
nerve (C6 and C7)
Abduction at Hand
• Abduction really only
occurs at the thumb
and little fingers
Abductor Digiti Minimi
• Origin Pisiform
• Insertion Medial side
of base of proximal
phalanx of little finger
• Action Abducts little
(5th) finger
• Innervation ulnar
nerve (C8 and T1)
Abductor Pollicis Brevis
• Origin scaphoid and
trapezium
• Insertion Lateral side
of base of proximal
phalanx of thumb
• Action Abducts
thumb
• Innervation median
nerve (C8 and T1)
Abductor Pollicis
Longus
• Origin Posterior
surfaces of ulna,
• Insertion Base of 1st
metacarpal
• Action Abducts
thumb
• Innervation the radial
nerve
Adduction
• Movement towards
the midline of the
body
Adductor Pollicis
• Origin 2nd and 3rd
metacarpals, capitate,
• Insertion Medial side
of base of proximal
phalanx of thumb
• Action Adducts
thumb
• Innervation ulnar
nerve
Wrist Extensors
• The extensors of the
wrist are on the
Dorsal side of the
forearm
• A majority of the wrist
extensors begin at the
lateral epicondyle
Extensor Carpi Radialis
Brevis
• Origin Lateral
epicondyle of
humerus
• Insertion Base of 3rd
metacarpal
• Action Extends and
radially deviates the
wrist
• Innervation radial
nerve (C7 and C8)
Extensor Carpi Radialis Longus
• Origin Lateral
supracondyle ridge of
humerus
• Insertion Base of 2nd
metacarpal
• Action Extends and
radially deviates at
the wrist
• Innervation Radial
nerve (C6 and C7)
Extensor Carpi Ulnaris
• Origin Lateral
epicondyle of
humerus
• Insertion Base of 5th
metacarpal
• Action Extends and
ulnar deviates hand at
wrist joint
• Innervation Radial
nerve
Extensor Digiti Minimi
Origin Lateral epicondyle of
humerus
Insertion 5th digit
Action Extends 5th digit at
metacarpophalangeal
and interphalangeal joints
Innervation Posterior
interosseous nerve
Extensor Digitorum
• Origin Lateral epicondyle
of humerus
• Insertion Extensor
expansions of medial four
digits
• Action Extends the four
digits and the wrist
• Innervation Posterior
interosseous nerve
Extensor Indicis
• Origin Posterior sufrace
of ulna and interosseous
membrane
• Insertion Extensor
expansion of 2nd digit
• Action Extends 2nd digit
and helps to extend hand
• Innervation Posterior
interosseous nerve
Extensor Pollicis Brevis
• Origin Posterior sufraces
of radius and
interosseous membrane
• Insertion Base of
proximal phalanx of
thumb
• Action Extends proximal
phalanx of thumb at
carpometacarpal joint
• Innervation Posterior
interosseous nerve
Extensor Pollicis Longus
• Origin Posterior surface
of middle 1/3 of ulna
• Insertion Base of distal
phalanx of thumb
• Action Extends distal
phalanx of thumb at
carpometacarpal and
interphalangeal joints
• Innervation Posterior
interosseous nerve
Supination Muscles
• There are two
muscles that return
you to the anatomical
position by
uncrossing the radius
and ulna
Biceps Brachii
• Origin
• Short head: tip of coracoid
process of scapula
Long head: supraglenoid
tubercle of scapula
• Insertion Tuberosity of radius
and fascia of forearm via
bicipital aponeurosis
• Action Supinates forearm and,
when it is supine, flexes
forearm
• Innervation
Musculocutaneous nerve (C5
and C6 )
Supinator
• Origin Lateral epicondyle
of humerus,
• Insertion Lateral,
posterior and anterior
surfaces of proximal 1/3
of radius
• Action Supinates
forearm
• Innervation Deep branch
of radial nerve (C5 and
C6)
Opposition
• The ability to touch
your thumb and pinky
Opponens Digiti Minimi
• Origin Hook of hamate
and flexor retinaculum
• Insertion Medial border
of 5th metacarpal
• Action brings little finger
(5th digit) into opposition
with thumb
• Innervation Deep branch
of ulnar nerve (C8 and
T1)
Opponens Pollicis
• Origin Flexor retinaculum
and tubercles of scaphoid
and trapezium
• Insertion Lateral side of
1st metacarpal
• Action Draws 1st
metacarpal laterally to
oppose thumb toward
center of palm
• Innervation Recurrent
branch of median nerve
(C8 and T1)
Test
• Test Wednesday
Review packet will
be given out
Monday, I won’t be
here
• The
Three
Nerves of
the wrist
and hand
The median nerve
• The median nerve
supplies feeling the
the palmer side of
your 1st, 2nd,3rd, and
medial 4th fingers.
• The Median nerve is
involved with carpal
tunnel syndrome
The Ulnar nerve
• The Ulnar nerve supplies feeling and motor
function to the lateral 4th and 5th fingers.
The Radial Nerve
• The radial nerve
innervates most of the
extensors and
supplies the feeling
on the dorsal side of
the first three digits
Joint – the place where
two bones come together
(4 types)
Ball and socket joint – greatest
range of motion allowing bones
to swing in a circle
Example: shoulder or hip
Pivot joint – one bone rotates
around another
Example: Neck and under the Elbow
Hinge joint – bones bend like a
hinge forward and backward
Example: Knee and Elbow
• Gliding joint – allows one bone
to slide over another
Example: Wrist and Ankle
Joint
Shapes
• Condyloid: egg-shape
articular surface + oval
concavity
– side-to-side, back+forth
movement
– (eg) metacarpophalangeal
(knuckle)
pg 225
Joint Shapes
• Saddle: articular surface
both concave + convex
– side-to-side, back-forth
movement
– (eg) carpometacarpal jt of
thumb
Hinge Joint
• In between the
Phalanges are Hinge
Joints
• They move in flexion
and extension
A Ligament
• A Ligament attaches
a bone to bone
• An Injury to a
Ligament is called a
Sprain
• A Tendon Attaches a
muscle to a bone
• An injury to a tendon
or Muscle is a strain
Ligaments of the hand
Collateral Ligaments
• collateral ligaments,
are found on either
side of each finger
and thumb joint. The
function of the
collateral ligaments is
to prevent abnormal
sideways bending of
each joint.
Volar Plate
• This ligament
connects the proximal
phalanx to the middle
phalanx on the palm
side of the joint.
• The ligament tightens
as the joint is
straightened and
keeps the PIP joint
from bending back
too far
(hyperextending).
palmar radiocarpal ligament
• broad membranous
band, attached above
to the anterior margin
of the lower end of the
radius, to its styloid
process, and to the
front of the lower end of
the ulna
• its fibers pass
downward to be
inserted into the volar
surfaces of the
scaphoid, lunate, and
some being continued
to the capitate.
dorsal radiocarpal ligament
• less thick and strong
than the palmer
ligament
• The ligament begins
on the radius
• its fibers are directed
downward and
medially, and are
fixed, below, to the
dorsal surfaces of the
scaphoid and lunate
ulnar collateral ligament
• is a rounded cord,
• attached above to the
end of the styloid
process of the ulna,
and dividing below
into two
• one of which is
attached to the medial
side of the triquetrium
and pisiform
The radial collateral carpal
ligament
• The radial collateral
carpal ligament
• attaches to the styloid
process of the radius
and the radial side of
the scaphoid bone.
transverse carpal ligament
• AKA The flexor
retinaculum
• a strong, fibrous band,
converting the deep
groove on the front of
the carpal bones into a
tunnel, the carpal
tunnel, through which
the Flexor tendons of
the digits and the
median nerve pass.
Hypothenar eminence
• is the body of muscle
on the palm of the
human hand just
beneath the 5th
phalange
• Abductor digiti minimi
& Flexor digiti minimi
Opponens digiti
minimi
• “OAF”
thenar eminence
• is the body of muscle
on the palm of the
human hand just
beneath the thumb.
• Abductor pollicis
brevis, Flexor pollicis
brevis, Opponens
pollicis, Adductor
pollicis
• “OA2F”
Deep muscles of thenar and
Hypothenar groups