Copyright The McGraw-Hill Companies, Inc. Reprinted by permission.

The Wrist & Hand Joints

Many sports require precise functioning of
wrist & hand
Archery, bowling, golf, baseball, tennis, etc.
require combined use of wrist & hand joints
Chapter 7 Relate functional anatomy to joint actions
The Wrist and Hand Joints flexion, extension, abduction, & adduction of wrist
& hand
Manual of Structural Kinesiology 29 bones
R.T. Floyd, Ed.D, ATC, CSCS More than 25 joints
More than 30 muscles
18 are intrinsic
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Bones Bones

29 bones, including radius & ulna Eight carpal bones

8 carpal bones in 2 rows of 4 bones form wrist Proximal row from radial
5 metacarpal bones, numbered 1 to 5 from to ulnar side
thumb to little finger, join the wrist bones scaphoid (boat-shaped) or
14 phalanges (digits), 3 for each phalange navicular
except the thumb, which has only 2 lunate (moon-shaped)
Proximal, middle, & distal triquetrum (three-cornered)
Thumb has a sesamoid bone in its flexor pisiform (pea-shaped)
tendon
Other sesamoids may occur in joints of fingers
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Bones Bones

Eight carpal bones Carpal bones form a three-sided arch

Distal row, from the radial concave on palmar side
to ulnar side bony arch is spanned by transverse carpal & volar
carpal ligaments
trapezium (greater
multangular) creates the carpal
tunnel
trapezoid (lesser
multangular) frequently a
source of
capitate (head-shaped)
problems known
hamate (hooked) as carpal tunnel
syndrome
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 Bones Bones

Medial epicondyle, Key distal bony landmarks for

medial condyloid ridge, muscles involved in wrist
& coranoid process - motion
base of 2nd, 3rd, & 5th
origin for many wrist & metacarpals, pisiform, &
finger flexors hamate
Lateral epicondyle & Key bony landmarks for
lateral supracondylar finger muscles
ridge - origin for many base of proximal, middle, &
distal phalanxes
wrist & finger extensors base of 1st metacarpal, proximal
& distal phalanxes of thumb
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Joints Joints

Wrist joint Wrist joint

condyloid-type joint 70 to 90 degrees of
allows flexion, flexion
extension, abduction, & 65 to 85 degrees of
adduction
extension
motion occurs primarily
between distal radius & 15 to 25 degrees of
proximal carpal row abduction
(scaphoid, lunate, & 25 to 40 degrees of
triquetrum) adduction
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Joints Joints
Each finger has 3 joints
Metacarpophalangeal (MCP) joints
Each finger has 3 joints
Proximal interphalangeal (PIP) joints Metacarpophalangeal (MCP) joints
Distal interphalangeal (DIP) joints Condyloid
0 to 40 degrees of extension
85 to 100 degrees of flexion

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 Joints Joints

Each finger has 3 joints Each finger has 3 joints

Proximal interphalangeal (PIP) joints Distal interphalangeal (DIP) joints
Ginglymus Ginglymus
Full extension to 90 to 120 degrees of Flex 80 to 90 degrees from full extension
flexion

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Joints Joints

Thumb has 2 joints Thumb has 2 joints

Metacarpophalangeal (MCP) joint Interphalangeal (IP) joint
Full extension into 40 to 90 degrees of Flex 80 to 90 degrees
flexion Ginglymus
Ginglymus

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Joints Movements

Thumb has 2 joints Wrist

Carpometacarpal (CMC) joint of thumb Flexion & extension
Unique saddle-type joint Abduction & adduction
50 to 70 degrees of abduction
Fingers
Flex 15 to 45 degrees & extend 0 to 20 degrees
Flex & extend
MCP joints also abduct & adduct

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 Movements Movements

Middle phalange is reference point to Flexion

differentiate abduction & adduction movement of palm of
Thumb, index & middle fingers abduct when hand and/or phalanges
they move laterally toward radial side of hand
toward anterior or volar
Ring & little fingers abduction when they move
aspect of forearm
medially toward ulnar side of hand
Medial movement of thumb, index & middle
fingers toward ulnar side of hand is adduction
Lateral movement of ring & little finger toward
radial side of hand is adduction

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Movements Movements

Extension Abduction (radial

movement of back of hand flexion)
and/or phalanges toward movement of thumb
posterior or dorsal aspect side of hand toward
of forearm lateral aspect or
radial side of forearm
Also, movement of
fingers away from
middle finger
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Movements Movements

Adduction (ulnar flexion) Opposition

movement of little finger movement of thumb
side of hand toward across palmar aspect to
medial aspect or ulnar oppose any or all of the
phalanges
side of forearm
Also, movement of
Reposition
fingers toward middle movement of thumb as it
returns to anatomical
finger
position from opposition
with hand and/or fingers
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 Muscles Muscles
Extrinsic muscles of wrist & hand grouped
according to function & location 9 muscles primary movers of phalanges
6 muscles move wrist but not fingers & thumb Also involved in wrist joint actions
3 wrist flexors Generally weaker in their wrist actions
flexor carpi radialis
flexor carpi ulnaris Flexors
palmaris longus Flexor digitorum superficialis
3 wrist extensors Flexor digitorum profundus
extensor carpi radialis longus Flexor pollicis longus (thumb flexor)
extensor carpi radialis brevis
extensor carpi ulnaris

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Muscles Muscles
All wrist flexors generally have their origins on
Extensors anteromedial aspect of proximal forearm and
medial epicondyle of humerus with insertions
Extensor digitorum on anterior aspect of wrist & hand
Extensor indicis Median nerve & all flexor tendons except
Extensor digiti minimi flexor carpi ulnaris & palmaris longus pass
Extensor pollicis longus (thumb through carpal tunnel
extensor) Swelling & inflammation can cause increased
Extensor pollicis brevis (thumb extensor) pressure in carpal tunnel resulting in
Abductor of thumb & wrist decreased function of median nerve leading
to reduced motor & sensation function in its
Abductor pollicis longus
distribution
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Muscles Muscles

Wrist extensors generally have their origins Wrist abductors

on posterolateral aspect of proximal forearm Generally cross wrist joint anterolaterally &
& lateral humeral epicondyle with insertions posterolaterally to insert on radial side of
located on posterior aspect of wrist & hand hand
Flexor & extensor tendons immediately Flexor carpi radialis
proximal to wrist are held in place on palmar Extensor carpi radialis longus
& dorsal aspects by transverse bands of Extensor carpi radialis brevis
tissue known as flexor & extensor retinaculum Abductor pollicis longus
to prevent the tendons from bowstringing Extensor pollicis longus
during flexion & extension Extensor pollicis brevis
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 Muscles Muscles
Intrinsic hand muscles have origins &
Wrist abductors insertions on bones of hand
cross wrist joint anteromedially & Radial side - four muscles of thumb
posteromedially to insert on ulnar side of opponens pollicis
hand abductor pollicis brevis
flexor pollicis brevis
Flexor carpi ulnaris
adductor pollicis
Extensor carpi ulnaris Ulnar side - three muscles of little finger
opponens digiti minimi
abductor digiti minimi
flexor digiti minimi brevis
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Muscles Muscles

Intrinsic hand muscles Anteromedially at elbow &

Remainder of hand - 11 different muscles forearm and anterior at
4 lumbricals hand
3 palmar interossei Primarily wrist flexion
4 dorsal interossei Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus

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Muscles Muscles

Anteromedially at Posterolaterally at elbow &

elbow & forearm and forearm and posterior at
anterior at hand hand
Primarily wrist & Primarily wrist extension
phalangeal flexion Extensor carpi radialis
Flexor digitorum longus
superficialis
Flexor digitorum Extensor carpi radialis
profundus brevis
Flexor pollicis longus Extensor carpi ulnaris

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 Muscles Nerves
Posterolaterally at elbow & All wrist & hand muscles are innervated from
forearm and posterior at hand the radial, median, & ulnar nerves of the
Primarily wrist & phalangeal brachial plexus
extension
Extensor digitorum
Extensor indicis
Extensor digiti minimi
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus

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Nerves Nerves
Radial nerve from C6, C7, & C8 Median nerve - arising from C6, C7, C8, & T1
Extensor carpi radialis brevis Flexor carpi radialis
Extensor carpi radialis longus Palmaris longus
Posterior interosseous nerve from radial nerve Flexor digitorum superficialis
Extensor carpi ulnaris Anterior interossseous nerve from median nerve
Extensor digitorum Flexor digitorum profundus for index & long finger
Extensor digiti minimi Flexor pollicis longus
Abductor pollicis longus Intrinsic muscles
Extensor pollicis longus abductor pollicis brevis, flexor pollicis brevis
Extensor pollicis brevis (superficial head), opponens pollicis, and 1st &
Extensor indicis 2nd lumbrical
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Nerves Nerves

Ulnar nerve - branching Ulnar nerve - branching from C8 &

from C8 & T1
Flexor digitorum profundus
for 4th & 5th fingers
Flexor carpi ulnaris
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T1
Remaining intrinsic muscles
flexor pollicis brevis (deep head),
adductor pollicis, palmar interossei,
dorsal interossei, 3rd & 4th
lumbrical, opponens digiti minimi,
abductor digiti minimi, & flexor
digiti minimi brevis
Sensation to ulnar side of hand, ulnar
one-half of ring finger & entire little
finger
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 Flexor Carpi Radialis Muscle Palmaris Longus Muscle
Flexion of wrist Flexion of wrist

Abduction of Weak flexion

wrist of elbow
Weak flexion
of elbow

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Flexor Carpi Ulnaris Muscle Extensor Carpi Ulnaris Muscle

Flexion of wrist
Adduction of wrist, Extension of
together with wrist
extensor carpi
ulnaris muscle Adduction of wrist
Weak flexion of together with flexor
elbow carpi ulnaris muscle

Weak extension
of elbow

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Extensor Carpi Radialis Brevis Muscle Extensor Carpi Radialis Longus Muscle
Extension of Extension of
wrist
wrist
Abduction of wrist
Abduction of
wrist
Weak extension
of elbow
Weak extension
of elbow

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 Flexor Digitorum Superficialis Muscle Flexor Digitorum Profundus Muscle
Flexion of fingers at Flexion of 4 fingers at
metacarpophalangeal metacarpophalangeal,
& proximal proximal
interphalangeal joints interphalangeal, &
distal interphalangeal
Flexion of wrist joints

Weak flexion Flexion of wrist

of elbow

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Flexor Pollicis Longus Muscle Extensor Digitorum Muscle

Flexion of thumb Extension of 2nd, 3rd, 4th,
carpometacarpal, & 5th phalanges at
metacarpophalangeal, metacarpophalangeal
& interphalangeal joints
joints
Extension of wrist
Flexion of wrist
Weak extension
of elbow

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Extensor Indicis Muscle Extensor Digiti Minimi Muscle

Extension of little finger

at
Extension of index metacarpophalangeal
finger at joint
metacarpophalangeal Weak wrist extension
joint
Weak wrist
extension
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 Extensor Pollicis Longus Muscle Extensor Pollicis Brevis Muscle

Extension of wrist

Extension of thumb

Extension of thumb at
metacarpophalangeal
joint
Weak wrist
extension
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Abductor Pollicis Longus Muscle Intrinsic Muscles of the Hand

Abduction of
thumb at
carpometacarpal
joint

Abduction of wrist

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Intrinsic Muscles of the Hand Intrinsic Muscles of the Hand

Thenar eminence - muscular pad on
palmar surface of 1st metacarpal
abductor pollicis brevis
opponens pollicis
flexor pollicis brevis
adductor pollicis
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Hypothenar eminence - muscular pad
that forms ulnar border on palmar surface
abductor digiti minimi
flexor digiti minimi brevis
opponens digiti minimi
Intermediate muscles
three palmar interossei
four dorsal interossei
four lumbrical muscles
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 Intrinsic Muscles of the Hand Intrinsic Muscles of the Hand
Four muscles act on CMC of thumb Three palmar interossei
opponens pollicis - opposition in thumb adduct the 2nd, 4th, & 5th phalanges
metacarpal Four dorsal interossei
abductor pollicis brevis & flexor pollicis brevis flex & abduct index, middle, & ring proximal
abduct thumb metacarpal phalanxes
flexor pollicis brevis flexes thumb metacarpal assist with extension of middle & distal
adductor pollicis adducts thumb metacarpal phalanxes of index, middle, & ring fingers
flexor pollicis brevis & adductor pollicis flex Third dorsal interossei
proximal phalanx of thumb
adducts middle finger
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Intrinsic Muscles of the Hand Wrist Flexion

Four lumbricales
Agonists
flex index, middle, ring, & little proximal Flexor carpi
phalanxes radialis
extend middle & distal phalanxes of index, Flexor carpi
middle, ring, & little fingers. ulnaris
Three muscles act on little finger Palmaris longus
Flexor digitorum
opponens digiti minimi causes opposition of superficialis
little finger metacarpal Flexor digitorum
abductor digiti minimi abducts 5th metacarpal profundus
flexor digiti minimi brevis flexes 5th Flexor pollicis
metacarpal longus
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Wrist Flexion Wrist Extension

Agonists
Agonists Extensor carpi
Flexor carpi radialis longus
radialis Extensor carpi
Flexor carpi radialis brevis
ulnaris Extensor carpi
Palmaris longus ulnaris
Flexor digitorum Extensor digitorum
superficialis Extensor indicis
Flexor digitorum Extensor digiti minimi
profundus Extensor pollicis
longus
Flexor pollicis
longus Extensor pollicis
brevis
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 Wrist Extension Wrist Extension
Agonists Agonists
Extensor carpi Extensor carpi
radialis longus radialis longus
Extensor carpi Extensor carpi
radialis brevis radialis brevis
Extensor carpi
Extensor carpi ulnaris
ulnaris
Extensor digitorum Extensor digitorum
Extensor indicis Extensor indicis
Extensor digiti minimi Extensor digiti minimi
Extensor pollicis Extensor pollicis
longus longus
Extensor pollicis Extensor pollicis
brevis brevis
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Wrist Abduction Wrist Abduction

Agonists Agonists
Flexor carpi Flexor carpi
radialis radialis
Extensor carpi Extensor carpi
radialis longus radialis longus
Extensor carpi Extensor carpi
radialis brevis radialis brevis
Abductor pollicis Abductor pollicis
longus longus
Extensor pollicis Extensor pollicis
longus longus
Extensor pollicis Extensor pollicis
brevis brevis
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Wrist Adduction Phalangeal Flexion

Agonists Agonists
Flexor carpi Flexor
ulnaris digitorum
Extensor carpi superficialis
ulnaris Flexor
digitorum
profundus
Flexor pollicis
longus

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 Phalangeal Extension Phalangeal Extension
Agonists Agonists
Extensor
digitorum Extensor
digitorum
Extensor indicis
Extensor digiti
Extensor indicis
minimi Extensor digiti
Extensor pollicis minimi
longus Extensor pollicis
Extensor pollicis longus
brevis Extensor pollicis
brevis
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Web Sites Web Sites

Anatomy & Physiology Tutorials Wheeless' Textbook of Orthopaedics
www.gwc.maricopa.edu/class/bio201/index.htm www.ortho-u.net/
Radiologic Anatomy Browser This site has an extensive index of links to the fractures,
http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html joints, muscles, nerves, trauma, medications, medical topics,
This site has numerous radiological views of the lab tests as well as links to orthopaedic journals, other
musculoskeletal system. orthopaedic, and medical news.
University of Arkansas Medical School Gross Anatomy for Arthroscopy.Com
Medical Students www.arthroscopy.com/sports.htm
http://anatomy.uams.edu/htmlpages/anatomyhtml/gross.html Patient information on various musculoskeletal problems of
Dissections, anatomy tables, atlas images, links, etc. the upper and lower extremity.
Loyola University Medical Center: Structure of the Human Body Electronic Textbook of Hand Surgery
www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html www.e-hand.com/default.htm
An excellent site with many slides, dissections, tutorials, etc. Slides and Illustrations of Upper Extremity Musculoskeletal Anatomy
for study of human anatomy.

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Web Sites
Premiere Medical Search Engine
www.medsite.com
This site allows the reader to enter any medical condition and
it will search the net to find relevant articles.
Virtual Hospital
www.vh.org
Numerous slides, patient information, etc.
The Dynamic Human version 2.0 CD-ROM: The Visual Guide to
Anatomy & Physiology
www.mhhe.com/biosci/ap/dynamichuman2/
Web site that accompanies this CD-ROM

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