GAP Topic 8 Wrist Bones of Upper Limb PDF

Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist TOPIC #8 – BONES OF THE UPPER LIMB – THE WRIST Clinical Orientated Anatomy Trail Guide WRIST & HAND • • • • • • The hand consists of carpals, metacarpals, and phalanges. The wrist or carpus is composed of eigh...

Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist TOPIC #8 – BONES OF THE UPPER LIMB – THE WRIST Clinical Orientated Anatomy Trail Guide WRIST & HAND • • • • • • The hand consists of carpals, metacarpals, and phalanges. The wrist or carpus is composed of eight bones arranged in proximal and distal rows of four. This allows for flexibility of the wrist. The two rows of carpals glide on each other and the individual bones also glide on adjacent bones. Proximal Row o Scaphoid, Lunate, Triquetrum, Pisiform Distal Row o Trapezium, Trapezoid, Capitate, Hamate Page 1 of 8 Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist CARPALS – BONEY LANDMARKS ➢ Proximal row of carpals: o Scaphoid: Boat shaped bone that articulates proximally with the radius Largest bone of the proximal row. ▪ Scaphoid Tubercle: eminence of bone on anterior surface o Lunate: Moon shaped bone between the scaphoid and triquetrum(triquetral) bones. Articulates proximally with the radius and distally with capitate o Triquetrum (aka Triquetral): Pyramidal shaped bone that articulates with the articular disc of the distal radio-ulnar joint and with hamate distally o Pisiform: Small pea shaped bone that lies on the anterior surface of the triquetrum ➢ Distal row of Carpals: o Trapezium: Four-sided bone on the lateral side of the carpus. Articulates with 1st and 2nd (slight) metacarpals, scaphoid and trapezoid o Trapezoid: Wedge-shaped bone that resembles the trapezium. Articulates with the 2nd metacarpal, trapezium, capitate and scaphoid o Capitate: Head-shaped bone with a rounded extremity and the largest bone in carpus. Articulates primarily with 3rd metacarpal, trapezoid, scaphoid, lunate and hamate o Hamate: Wedge-shaped bone on the medial side of the hand, has an anterior hook called the Hook of Hamate. Articulates with the 4th and 5th metacarpals, capitate, lunate, and triquetrum Page 2 of 8 Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist METACARPALS – BONEY LANDMARKS ➢ ➢ ➢ ➢ ➢ Forms the skeleton of the palm of the hand Composed of five metacarpal bones named 1-5 from lateral to medial Each has a base, shaft and head The bases are more proximal (articulate with carpals) The heads are more distal (articulate with phalanges) PHALANGES – BONEY LANDMARKS ➢ Each digit has three phalanges except the first and they are numbered like the metacarpals o The thumb only has a distal and proximal phalanx ➢ Each phalanx has a base proximally, shaft and head distally. ➢ Proximal phalanges are the largest and distal ones are the smallest. ➢ The distal phalanx tapers distally and has the nail bed over it Page 3 of 8 Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist PALPATIONS • The structures to be palpated in this lecture include: o Proximal Row of Carpals ▪ Scaphoid  Scaphoid tubercle ▪ Lunate ▪ Triquetrum ▪ Pisiform o Distal row of Carpals ▪ Trapezium ▪ Trapezoid ▪ Capitate ▪ Hamate  Hook of hamate o Metacarpals o Phalanges PALPATION OF PROXIMAL CARPALS PATIENT POSITION NEUTRAL LANDMARK TRAIL SCAPHOID • Seated • Styloid process of the radius • Slide thumb distally into a ditch, then onto the scaphoid • Perfom ulnar deviation of the wrist to feel scaphoid become more prominent, radial deviation will cause it to disappear. • Explore the scaphoid’s palmar and dorsal surfaces and notice the scaphoid tubercle on the palmar side  Scaphoid tubercle – when flexing digits 2-5 all will point to the location of the scaphoid tubercle DESCRIPTION FUNCTION • Articulates with lunate to form an intercarpal jt. • Scaphoid tubercle is an attachment for the transverse carpal ligament • Etc. Page 4 of 8 Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist PATIENT POSITION NEUTRAL LANDMARK TRAIL LUNATE • Seated • Lister’s Tubercle • With the wrist slightly extended, trail distally and notice how it falls into a small cavity • Place your thumb at proximal end of this cavity, flex wrist, and feel lunate press into your thumb DESCRIPTION FUNCTION • Articulates with scaphoid to form an intercarpal jt. • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Pisiform • Use your thumb to find pisiform, correspondingly pinch with your index finger on the dorsal surface. • Move your finger in a small circular direction to feel the triquetrum on the dorsal and medial sides • On the medial side of the wrist joint use ulnar and radial deviation to confirm your location on triquetrum. When radially deviating triquetrum with pop into your contact and on ulnar deviation it will disappear. TRIQUETRUM DESCRIPTION FUNCTION • Articulates with lunate to form an intercarpal jt. • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Styloid process of the Ulna • Move distally until you reach bone then laterally to the palmer surface of the hand • Rolling your thumb pad in circles, the pisiform will feel like a small round nugget PISIFORM DESCRIPTION FUNCTION • Attachment for FCU • Etc. Page 5 of 8 Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist PALPATION OF THE DISTAL CARPALS PATIENT POSITION NEUTRAL LANDMARK TRAIL TRAPEZIUM • Seated • Head of the first metacarpal • On the dorsal side of the hand move proximally along the shaft of the metacarpal and feel for the joint just after the base. Move just proximal to this joint and you are on trapezium. • Use a pincer grasp and explore the dorsal, lateral and palmer aspects of the bone DESCRIPTION FUNCTION • Articulates with the base of the first metacarpal to form a carpometacarpal joint • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Head of the 2nd metacarpal • On the dorsal side move proximally along the shaft of the metacarpal to the base. Slide just proximally off the base passing the little “dip” of the joint space. The next bump that you feel will be trapezoid. Explore the dorsal side of trapezoid TRAPEZOID DESCRIPTION FUNCTION • Articulates with the base of the 2nd metacarpal to form a carpometacarpal joint • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Lunate • Use flexion and extension to feel for lunate, from lunate move slight distally to feel the prominence of capitate. • Additionally, you could use the base of the 3rd metacarpal and move just proximally past the joint space to feel for capitate. • Explore the dorsal side of capitate CAPITATE DESCRIPTION Page 6 of 8 FUNCTION PATIENT POSITION NEUTRAL LANDMARK TRAIL HAMATE Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist • Articulates with the base of the 3rd metacarpal to form a carpometacarpal joint • Etc. • Seated • Head of the 4th or 5th metacarpal • On the dorsal side move proximally along the shaft of the 4th or 5th metacarpal until you reach the base. Move proximal to the base just past the joint space, you will then be on hamate. • Explore the dorsal, medial and palmer aspect of the bone. DESCRIPTION FUNCTION • Articulates with capitate to form an intercarpal jt. • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Pisiform • Draw an imaginary line on a 45-degree angle from pisiform to base of index finger • Use your thumb pad and slide off pisiform ½ inch along this line • Will feel a deep resistance of bone, confirm by feeling the soft tissue all around HOOK OF HAMATE DESCRIPTION FUNCTION • Attachment for the pisohamate ligament • Attachment for the Transverse carpal ligament • Attachment for FCU • Etc. GENERAL PALPATION OF THE METACARPALS & PHALANGES METACARPALS & PHALANGES (GENERAL PALPATION) PATIENT POSITION TRAIL • Seated • Palpate the dorsal surface of your partner’s hand and feel the superficial metacarpal shafts • Move them up and down • Turn hand over and palpate palmar surface • Move distally and see where metacarpal heads join phalanges to form MCP joints (“knuckles”) • Slide more distally and palpate all the phalanges Page 7 of 8 Canadian College of Massage & Hydrotherapy GAP – Topic #8 Bones of the Upper Limb – Wrist Page 8 of 8