Wrist & Hand Surface Anatomy Lab Outline 2024 PDF

**[Clinical Conference I]** **Upper Extremity: The Wrist & Hand Complex** **[Introduction (Review on your own): identify each joint in terms of shape, number of articular surfaces, degrees of freedom and movements available:]** **[Distal Radio-ulnar joint]** Mechanically linked with the proximal...

**[Clinical Conference I]** **Upper Extremity: The Wrist & Hand Complex** **[Introduction (Review on your own): identify each joint in terms of shape, number of articular surfaces, degrees of freedom and movements available:]** **[Distal Radio-ulnar joint]** Mechanically linked with the proximal radial ulnar joint - Distal RU joint-complex - Pivot Joint - 1 DOF-2 directions of motion (pronation/supination) - Axis-longitudinal - from the radial head distally through the ulnar head - Demonstrate the motions available to these joints: supination/pronation **[ID all carpal bones: ]** - Proximal row from lateral to medial - Distal row from lateral to medial **[Radiocarpal Joint:]** - formed by the radius and radioulnar disc proximally - distally-scaphoid, lunate, and triquetrum - Classification according to shape: ovoid - Classification according to \# of articulating surfaces: complex - Classification according to DOF: 2 DOF; 4 directions of motion: flex/ext and ulnar/radial deviation **[Midcarpal Joint:]** - proximally-scaphoid, lunate, and triquetrum - distally-trapezium, trapezoid, capitate, hamate - reciprocally concave-convex configuration - Classification according to shape-condyloid or modified hinge - Movements-2 DOF - flexion/extension and ulnar/radial deviation - Classification according to \# of articulating surfaces: compound **[ID all CMC, MCP, PIP, DIP joints in the hand]** Identify the attachments for the following intrinsic muscles of the hand: - 3 groups - Thenar Eminence-Abd Poll Brev, Flexor Poll Brev, Opponens Poll - Hypothenar Eminence- Abductor Digiti Minimi, Flexor Digiti Minimi Brevis, Opponens Digiti Minimi - Lumbricals (4) & Palmar (3) and Dorsal Interossei (4) & Adductor Pollicis **Wrist & Hand Surface Anatomy** **I. Dorsal** **[Bony Structures]** - **Ulnar Styloid Process** - **Radial Styloid Process** - **Base of Metacarpal I-V** - **Capitate** **[Dorsal Bony Structures]** Although it is difficult to palpate the individual carpal bones the borders of the carpus are easy to define. **Ulnar styloid process** - found by starting at the olecranon - Palpate distally down the posterior border which will lead to the styloid - covered by the extensor carpi ulnaris (ECU) in the pronated position - with slight supination the ECU is moved off the ulnar styloid process and it can be palpated from a [distal to proximal] approach at the ulnar side of the wrist - this marks the ulnar border of the proximal border of the carpus of the wrist **Radial styloid process** - radial border of wrist - not as sharp as the ulnar styloid process - can be palpated by moving from proximal to distal along the shaft of the radius until the palpating hand ends at a round prominence - palpate its distal edge with hand in a slightly flexed and ulnar deviated position **Base of the** **2^nd^-5^th^ metacarpal bones** (i.e. distal border to the carpus) - slide down ulnar side of 5^th^ metacarpal distal to proximal until hit the base - slide down radial slide of 2^nd^ metacarpal distal to proximal until hit the base - slide down the 3^rd^ metacarpal until hit a small indentation where the base is - side down the 4^th^ metacarpal until hit the base - can also slide down in between each of the metacarpals and feel where they connect at the base **Capitate** - can first be found palpating the base of the 3^rd^ metacarpal. - Slide finger proximally you fall into a large concavity - takes up the width of the 3^rd^ metacarpal and often has a [slight] connection with the 2^nd^ and 4^th^ metacarpal as well. - takes up the [distal 2/3] of the space between the proximal and distal borders of the carpus. (so cut carpal area into 1/3's visually) **[Radial aspect of wrist: bony landmarks]** **Base of Metacarpal 1 and Radius** - extend thumb and will see snuff box; large indentation - follow 1^st^ metacarpal down and can palpate the base - follow radius around to more radial edge **Scaphoid** - with the thumb extended ask for an ulnar deviation - the proximal part of the anatomical snuff box fills in IMG\_4560 **[Dorsal Soft Tissue Structures]** - **Abductor Pollicis Longus** - **Extensor Pollicis Brevis** - **Extensor Pollicis Longus** - **Extensor Carpi Radials Longus** - **Extensor Carpi Radials Brevis** - **Extensor Indicis** - **Extensor Digitorum** - **Extensor Digiti Minimi** - **Extensor Carpi Ulnaris** **[Dorsal Soft Tissue Structures]** - when looking at soft tissue structures on the dorsum of the wrist and hand there are six dorsal compartments [1^st^ Dorsal Compartment] - is composed of tendons, which make up the volar edge of anatomical snuffbox - **abductor pollicis longus** - ask for thumb radial abduction and the anatomical snuff box is creates - makes up the most radial aspect of the compartment - attaches to the [base] of the 1^st^ metacarpal - this is involved in a DeQuervain Syndrome - **extensor pollicis brevis** - the more dorsal thinner (prominent) tendon the - attaches to the proximal aspect of the 1^st^ phalanx - this is involved in DeQuervain's Syndrome [3^rd^ Dorsal Compartment ] - the dorsal leg of the anatomical snuffbox - the **extensor pollicis longus** is here - EPL curves around the ulnar aspect of lister's tubercle - creates a lever around which this tendon is able to improve its function [2^nd^ Dorsal Compartment] - is found radial to lister's tubercle - components in this compartment: **extensor carpi radialis longus** & **extensor carpi radialis brevis** - ID this by keep thumb relaxed and give slight resistance into extension and radial deviation - two tendons become very clear - most radial tendon being the ECRL and it can be seen on its path to the base of the 2^nd^ metacarpal - ECRB is more ulnar and can be followed along its path to the base of metacarpal 3 and metacarpal 2 - both of these tendons travel underneath the EPL [4^th^ Dorsal Compartment] - the **extensor indicis** is here - ask for extension of the index finger - other tendons in this compartment include the **extensor digitorum** tendons - best activated by alternating extension of the fingers [5^th^ Dorsal Compartment] - more ulnar - the **extensor digiti minimi** here - find by rolling the finger of the head of the ulna while activating extension of the little finger [6^th^ Dorsal Compartment] - the **extensor carpi ulnaris** is here - locate just volar or palmar to the head of the ulna - activate via wrist extension and ulnar deviation - can be followed in palpation all the way to the base of the 5^th^ metacarpal IMG\_4575 IMG\_4573 **[II. Palmar]** **[Bony Structures]** - **Pisiform** - **Tubercle of the Scaphoid** - **Capitate** **[Soft Tissue Structures]** - **Flexor Carpi Ulnaris** - **Flexor Carpi Radialis** **[Palmar Bony Structures]** **Pisiform** - Locate flexor crease of partner's wrist - Slide over to the "pinkie" side - Roll your thumbpad in small circles exploring the nugget-like pisiform - activate the **flexor carpi ulnaris** (FCU) and follow the tendon distally to its insertion on the pisiform **Tubercle of the Scaphoid** - on the radial side of the wrist - activate the **flexor carpi radialis** (FCR) - follow the tendon of the FCR to the scaphoid tubercle (on its way to its insertion at the base of the 2^nd^ MCP) - with ulnar and radial deviation of the wrist we can appreciate more the tubercle when the wrist is positioned into radial deviation  **[Palmar Soft Tissue Structures]** - **Flexor Carpi Radialis** - **Radial Artery** - **Flexor Carpi Ulnaris** - **Ulnar Artery** - **Ulnar Nerve** - **Flexor Digitorum Superficialis** - **Palmaris Longus** - **Median Nerve** **Flexor Carpi Radialis (FCR)** - ID via flex and radial deviate the wrist - follow down to its insertion at the base of the 2^nd^ MCP **Radial Artery** - just radial to FCR - gives a branch that runs dorsally into the anatomical snuffbox and a pulsation can also be palpated there **Flexor Carpi Ulnaris (FCU)** - ID via flexion and ulnar deviation of the hand and wrist - follow to its insertion on the pisiform **Ulnar Artery** - directly radial FCU - goes between pisiform and hook of the hamate into Guyon's tunnel - some superficial branches of the **ulnar nerve** that can sometimes be palpated over the hook of the hamate **Flexor Digitorum Superficialis** - further radially (from ulnar structures) - ask for alternating finger **Palmaris Longus** - place the tip of the thumb and 5^th^ fingers together and flex the wrist - if present the **median nerve** can be found directly beneath it - can be absent, on either sides or just on one side of the hand and wrist IMG\_4572