Anatomy - Hand www.vompti.com The wrist The metacarpals Wrist and - PDF document

Property of VOMPTI, LLC Anatomy - Hand www.vompti.com • The wrist • The metacarpals Wrist and Hand • The Phalanges Anatomy/Biomechanics – Digit 1 – thumb – Digit 5 – digiti minimi Kristin Kelley, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 Orthopaedic Manual Physical Therapy Series 2017-2018 Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Osteology Carpal Arch • Proximal Row – Scaphoid • The carpal bones form • Tubercle – palpated on palmar an arch, concave surface – Lunate anteriorly – Triquetrum (triangular bone) – *Pisiform • The flexor retinaculum • Distal Row forms the roof of the – Trapezium – Articulates w/ 1 st MC carpal tunnel – Trapezoid – Articulates w/ 2 nd MC – Capitate – Articulates w/ 3 rd MC – Hamate – Articulates w/4 th & 5 th MC • *Hook of Hamate *Space between hook of Hamate and Pisiform = Guyon’s Canal Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 1

Property of VOMPTI, LLC Metacarpals Phalanges • Base • Each Phalange – Articulate with carpals – Base – Bases of MC bones of digits – Body articulate with one another – Head • Body • Proximal • Head – Articulate with the proximal • Middle phalanges of the digits – Thumb lacks a middle • MC 1 - Thumb phalange • MC 2-5 – Associated with • Distal digits 2-5 Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Joints of Wrist Radiocarpal Joint • Radio-carpal • Classification – Proximal: distal surface of – Synovial radius, radioulnar disc – Distal: scaphoid, lunate, – Ellipsoidal/Modified Ovoid triquetrum • Two degrees of movement • Mid-carpal – Proximal: 1 st row of carpals - – Flexion/Extension scaphoid, lunate, triquetrum – Radial and ulnar – Distal: 2 nd row of carpals – deviation trapezium, trapezoid, capitate, – Compound – more than one hamate articular surface – Pisiform does not participate – Complex – due to presence • Inter-carpal – The synovial joints between the of TFCC carpals The movements at these joints • contribute to hand position Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 2

Property of VOMPTI, LLC TFCC Midcarpal Joint • Triangular Fibrocartilage • Classification Complex (TFCC) – Synovial – Radioulnar disc – Modified ovoid – as a – Connective Tissue Wedge whole, convex on – Attachments concave • Apex – On ulna, between styloid process and – Compound articular surface of the head • Base – Fans out, on radius, between ulnar notch and articular surface of the carpal bones • It expands the articular surface of the RC joint Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Intercarpal Joints Wrist Motions • Classification • Frontal plane – Synovial – Radial deviation/abduction – Modified ovoid – Ulnar – Planar deviation/adduction – A lot of ligamentous • Sagittal plane support – not much movement – Flexion – Assess/treat in – Extension volar/dorsal glide Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 3

Property of VOMPTI, LLC Finger Abduction/adducton Thumb Movements • Abduction and Movements of the thumb are at right angles to the Adduction are defined movements of the other digits using the long axis of the middle finger as a reference • The 3 rd digit only abducts (radial or Abduction-Adduction Extension-Flexion Opposition ulnar) Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Wrist Ligaments Wrist Ligaments (highlights) • Palmar radiocarpal • Palmar Ulnocarpal ligaments ligaments – Resist – To lunate, triquetrum, extension/palmar glide and capitate of carpals – To scaphoid, capitate, triquetral, lunate Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 4

Property of VOMPTI, LLC Wrist Ligaments Wrist Ligaments • Dorsal radiocarpal • Dorsal Intercarpal ligament ligaments • Resists flexion/dorsal glide of carpals on the radius • Palmar Intercarpal Ligaments Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Wrist Ligaments Carpometacarpal Joints (CMC) • Radial (lateral) • 5 CMC joints between the base of each MC and the collateral ligament distal carpal bones – Resists varus stress to • 1 st CMC – 1 st the wrist MC/Trapezium • Ulnar • 2 nd CMC – 2 nd (medial)collateral MC/Trapezoid ligament • 3 rd CMC – 3 rd MC/Capitate – Resists valgus stress to • 4 th CMC – 4 th MC/Hamate the wrist • 5 th CMC – 5 th MC/Hamate Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 5

Property of VOMPTI, LLC 1 st CMC Joint 1 st Metacarpophalangeal Joint • Unique • Synovial • Synovial • Modified ovoid • Saddle shape • Unmodified sellar joint – • Condyloid allows 2 degrees of • Compound freedom – Sagittal plane – Abd/add. • 1 degree of freedom Convex MC on concave trapezium – Frontal plane: – Coronal plane – Flexion/Extension Flexion/extension. Concave 1 st MC on convex trapezium – Combined Motion – opposition (circumduction) Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com 2 nd -5 th CMP Joints MCP Joints • Synovial • Palmar Ligament • Ellipsoidal • Medial Collateral Ligament • Modified ovoid – Resists valgus stress • Compound • Lateral Collateral • 2 Degrees of Freedom ligament – Flexion/Ext – Resists varus stress – Abduction/Adduction Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 6

Property of VOMPTI, LLC Interphalangeal (IP) Joints Palmar Fascia • Synovial • Deep fascia that covers the palm. Anchored to skin • Modified ovoid distally • Hinge joints • Apex is continuous w/ • 1 degree of freedom – Palmaris longus tendon/flexor retinaculum Flex/ext • Distal fibers to base of • 2 nd degree – a little each digit rotation in transverse • Function: Protection of plane in full fist vessels, nerves, and tendons of the palm Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Extensor Hood Extensor Hood Extensor digitorum extends and • attaches to middle phalanx of each digit 2-5 by central tendon slip. If ruptured, lack of extension of proximal IP joint • Medial and lateral wing tendons from intrinsics (lumbricals, interrosei) of the hand extend dorsally to terminal tendon at distal phalanx. Rupture causes lack of ability to extend the DIP Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com Orthopaedic Manual Physical Therapy Series 2016-2017 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 7