Module on the Wrist and Hand 09-10

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010), of the College ofAllied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Prepared byEnrico C. Aguila, OTR, OTRP

College of Allied Medical ProfessionsUniversity of the Philippines

Manila

OTPT102: Applied Anatomy and Kinesiology


Small Group Discussion

Objectives:A. Describe the bones that comprise the wrist and hand.

1. Distal segment of the radius – (refer to Module on the Elbow and Forearm)2. Distal segment of the ulna – (refer to Module on the Elbow and Forearm)3. Carpal Bones4. Metacarpal bones5. Phalanges

B. Identify and locate the landmarks on the bones of the wrist and hand.C. Describe the different joints of the wrist and hand in terms of:

1. Type2. Articulating surfaces3. Possible movements4. Axis of motion of the movements5. Factors and structures that limit the motions.

D. Identify and locate the ligaments that are present in the wrist joint.E. Identify and locate the ligaments that are present in the joints of the hand.F. Describe the muscles that act on the wrist and describe them in terms of:

1. Origin2. Insertion3. Actions4. Innervation

G. Describe the muscles that act on the carpometacarpal (CMC) joint of the thumb interms of:


H. Describe the muscles that act on the metacarpophalangeal (MCP) joint of the thumbin terms of:


I. Describe the muscles that act on the interphalangeal (IP) joint of the thumb in termsof:


J. Describe the muscles that act on the metacarpophalangeal joints of the fingers interms of:


K. Describe the muscles that act on the proximal interphalangeal joints of the fingers interms of:


L. Describe the muscles that act on the distal interphalangeal joints of the fingers interms of:

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AYAllied Medical Professions, University of the Philippines,


M. Classify the muscles that act on the wrist and hand in terms of:1. Extrinsic muscles2. Intrinsic muscles

N. Using mounted skeletons, attach representations of elbow on their origins andinsertions.

_______________________________________________________

A. Bones of the Wrist and Handspecimens and in the illustrations below

1. Carpal Bonesa. Proximal row

i. ScaphoidScaphoid tubercle

ii. Lunateiii. Triquetraliv. Pisiform

b. Distal rowi. TrapeziumTubercle of trapezium

ii. Trapezoidiii. Capitateiv. Hamate

Hook of the hamate2. Metacarpalsa. Headsb. Bodiesc. Bases3. Phalangesa. Thumb (proximal and distal)

i. Headii. Bodyiii. Base

b. Fingers (proximal, middle and distal)i. Headii. Bodyiii. Base

c. Small sesamoid bones

Bones of the hand (dorsal

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

Classify the muscles that act on the wrist and hand in terms of:Extrinsic musclesIntrinsic muscles

Using mounted skeletons, attach representations of elbow on their origins and

____________________________________________________________

Bones of the Wrist and Hand: Identify the bones and landmarks in the bonespecimens and in the illustrations below

Scaphoid tubercle

Tubercle of trapezium

Hook of the hamate

(proximal and distal)

(proximal, middle and distal)

Small sesamoid bones

Carpal Bones (dorsalview)

Carpal Bones (palmarview)

Bones of the hand (dorsalview)

Bones of the hand(palmar view)

2010), of the College of

Using mounted skeletons, attach representations of elbow on their origins and

_________________

Identify the bones and landmarks in the bone

Carpal Bones (dorsalview)

Carpal Bones (palmarview)

Bones of the hand(palmar view)


B. Joints of the Wrist and Hand:

Radiocarpal (wrist) Joint1. What type of joint is the radiocarpal joint?2. What structures form the articulations at thewrist joint? Which of the structures articulatewith one another?

12345

3. What motions are available at the wristjoint? (4 Answers)

1234

4. In what planes and axes of motion do thesemovements occur?

Motion Axis Plane1234

5. Identify activities that use the motions of thewrist (list 3 activities per motion)

Motions Activities1 A

BC

2 ABC

3 ABC

4 ABC

Intercarpal Joints1. What joints comprise the intercarpal joints?

Which structures articulate with eachother?

123

2. What type of joint are the differentintercarpal joints?

3. What type of movements are available atthese joints?

Ligaments of the Radiocarpal and Intercarpal JointsLigaments Functions and Attachments

Radial collateralUlnar collateralDorsal radioulnarDorsal radiocarpalDorsal radioulnarDorsal ulnocarpalDorsal carpometacarpalLigamentsDorsal metacarpalligaments


Palmar radioulnarPalmar Ulnocarpal(ulnolunate part)Palmar Ulnocarpal(ulnotriquetral part)Palmar Radiocarpal(radioscapulohamate part)Palmar Radiocarpal(radiotriquetral part)Palmar Radiocarpal(radiocapitate part)CapitotriquetralPisohamatePisometacarpalPalmar carpometacarpalLigaments

Palmar metacarpalLigaments

Label the ligaments on the illustrations below.

Ligaments of the wrist (dorsal view) Ligaments of the wrist (palmar view)


Carpometacarpal (CMC) Joint of the Thumb1. What type of joint is the CMC joint of the

thumb?2. What structures articulate to form the

CMC joint of the thumb?3. What movements are possible in the

CMC joint?12345

4. In what axes and planes of motion dothese movements occur?

Motion Axis Plane12345

Metacarpophalangeal (MCP) Joints of the Thumb and Fingers1. What type of joint are the MCP joints?2. What structures articulate to form the

MCP joints?12

3. What movements are possible in theMCP joints?

1234

4. In what axes and planes of motion dothese movements occur?

Motion Axis Plane1

2

3

4

Interphalangeal Joints of the Thumb (IP joint) and Fingers (PIP and DIP joints)1. What type of joint are the interphalangeal

joints?2. What structures articulate to form the IP

joints?Joints Articular surfaces

IP joint of thumb

PIP joints

DIP joints

3. What movements are possible at the IPjoints?

12

4. In what axis and plane of motion dothese movements occur?

Motion Axis Plane1

2


Ligaments of the Joints of the FingersLigaments Functions and Attachments

Dorsal metacarpal ligamentsPalmar metacarpal ligamentsCollateral ligaments of the MCPjointsCollateral ligaments of the thumb IPjointCollateral ligaments of the PIP jointsCollateral ligaments of the DIPjointsDeep transverse metacarpalligamentsPalmar ligamentsJoint Capsules

Label the ligaments on the illustrations below.

Ligaments of the finger joints(palmar view)

Ligaments of the finger joints(lateral view)


C. Muscles Acting on the Wrist and Hand

Muscles Acting on the WristMuscle Origin Insertion Action Nerve Supply

Extensor carpiradialis brevisExtensor carpiradialis longus

Extensor carpiulnarisFlexor carpiradialisFlexor carpiulnarisPalmaris longus

Muscles Acting on the CMC and IP Joints of the ThumbMuscle Origin Insertion Action Nerve Supply

Abductor poliicislongusAbductor pollicisbrevisAdductor pollicis

Extensor pollicisbrevisExtensor pollicislongusFlexor pollicisbrevisFlexor pollicislongusOpponens pollicis

Muscles Acting on the Joints of the FingersMuscle Origin Insertion Action Nerve Supply

Abductor digitiminimiDorsal interossei

Extensor digitiminimiExtensordigitorumExtensor indicis

Flexor digitiminimiFlexor digitorumprofundus


Flexor digitorumsuperficialisLumbricales

Opponens digitiminimiPalmar interossei

Palmaris brevis

Identify the Muscles on the Illustrations BelowForearm

SuperficialLayer

(palmar view)

ForearmIntermediate

Layer(palmar view)

ForearmDeepLayer

(palmar view)

ForearmSuperficial

Layer(dorsal view)

ForearmDeepLayer

(dorsal view)

Wrist Flexors Thumb andFinger Flexors

Thumb and FingerFlexors

Wrist andFinger

Extensors

Wrist andFinger

Extensors

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AYAllied Medical Professions, University of the Philippines,

ExtensorTendons at the

Wrist

AnatomicalSnuffbox

Flexor and extensor Tendons of the Finger

Classify the muscles acting on the hand betweenHow are they different from each other?

Extrinsic Muscles

This material was developed for use by students of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2010Allied Medical Professions, University of the Philippines, Manila. Please obtain permission before use.

AnatomicalSnuffbox

Lumbricales DorsalInterossei

Intrinsic Muscles of the Hand

Flexor and extensor Tendons of the Finger

Classify the muscles acting on the hand between extrinsic and intrinsic muscles.How are they different from each other?

Extrinsic Muscles Intrinsic Muscles

2010), of the College of

PalmarInterossei

extrinsic and intrinsic muscles.

Intrinsic Muscles


Small Group Activity

I. Palpation of MusclesInstructions:

A. Identify the approximate locations of the muscles that act on the elbow and forearm.B. Place your hand on the bulk/body of the muscle that you are aiming to palpate.C. Stabilize the body segment proximal to the joint that you are going to instruct your

partner to move.D. Instruct your partner to perform the necessary action in order for the target muscle to

contract.E. Provide resistance to the motion in order to strengthen the contraction and make the

muscle more palpable.F. Indicate your procedures on the table provided below.

*These are the same items that are going to be the components of your grade for the nextpalpation exam.

TargetMuscles

Location Point ofStabilization

Instruction Placement ofResistance

Extensor carpiradialis brevisExtensor carpiradialis longusExtensor carpiulnarisFlexor carpiradialisFlexor carpiulnarisPalmaris longus

Abductor poliicislongusAbductor pollicisbrevisAdductor pollicis

Extensor pollicisbrevisExtensor pollicislongusFlexor pollicisbrevisFlexor pollicislongusOpponenspollicisAbductor digitiminimiDorsalinterosseiExtensor digitiminimiExtensordigitorumExtensor indicis


Flexor digitiminimiFlexor digitorumprofundusFlexor digitorumsuperficialisLumbricales

Opponens digitiminimiPalmarinterosseiPalmaris brevis

II. Palpation of bony landmarks and other structures.Palpate for the following structures and mark their locations with a pen or an eyebrowpencil.

1. Capitate2. Scaphoid3. Pisiform4. Hook of the hamate5. Ulnar Styloid6. Radial styloid7. Dorsal tubercle of the radius8. CMC joint of the thumb

9. MCP joints of the thumb and thefingers

10. IP joint of the thumb11. PIP joints of the fingers12. DIP joints of the fingers13. Radial pulse14. Ulnar pulse

III. Creases of the Hand: Creases are lines or folds on the skin.Locate for the following creases and mark their locations by drawing lines using a pen oran eyebrow pencil through them. Also mark them in the illustration provided.

1. Proximal wrist crease2. Distal wrist crease3. Thenar crease4. Proximal palmar crease5. Distal palmar crease6. Longitudinal palmar crease7. Finger creases

IV. Tenodesis Function of the HandAlternately flex and extend the wrist with the fingers relaxed. What happens to the fingerswhen the wrist is extended? What happens to the fingers when the wrist is flexed? Whatare the reasons for these events?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

V. Stable and Mobile Components of the HandRapidly and alternately open and close the hand. Are all parts of the hand moving? If not,which parts remain stable? Why do they remain stable?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


VI. Collateral Ligaments of the MCP, PIP and DIP Joints Extend the fingers with the wrist extended and then abduct the fingers. Flex the MCP joints fully (close the hand). Abduct the fingers.Is there a difference in finger abduction when the MCP joints are extendedand when the MCP joints are flexed? What would account for thisdifference?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

With a finger extended, try to push the middle phalanx laterally such that it woulddeviate from the PIP joint. Attempt to do the same with the PIP joint fully flexed.

Is there a difference in lateral deviation of the middle phalanx when the PIP joint isextended as opposed to when the PIP joint is flexed? In which position of the PIP joint isthere more and easier lateral deviation of the middle phalanx? Why is this so?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

With a finger extended, try to push the distal phalanx laterally such that it would deviatefrom the DIP joint. Attempt to do the same with the DIP joint fully flexed.

Is there a difference in lateral deviation of the distal phalanx when the DIP joint is extendedas opposed to when the DIP joint is flexed? In which position of the DIP joint is there moreand easier lateral deviation of the distal phalanx? Why is this so?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

VII. Prehension Patterns of the HandDescribe the positions of the hand, thumb and fingers when doing the following activities.Which components of the hand are involved? How do you refer to the prehension patternbeing used? Give at least three more activities that use the same pattern.

Carrying groceries in a grocery bag________________________________________________________________________________________________________________________________________________________________________________________________________________________ Drinking from a glass of water________________________________________________________________________________________________________________________________________________________________________________________________________________________ Throwing a baseball________________________________________________________________________________________________________________________________________________________________________________________________________________________ Writing a sentence using a pen________________________________________________________________________________________________________________________________________________________________________________________________________________________


Inserting an ATM card into its slot________________________________________________________________________________________________________________________________________________________________________________________________________________________ Inserting a thread into the eye of a needle________________________________________________________________________________________________________________________________________________________________________________________________________________________

VIII. Anatomical Snuff BoxPerform radial abduction of the thumb against resistance in order for the tendonscomprising the anatomical snuff box to become prominent. To which muscles do thesetendons belong to? Which tendons form the lateral border, floor and the medial border ofthe anatomical snuff box?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

References:

Published:McMinn. R.M.H., Hutchings, R.T., Pegington, J., Abrahams, P. (1993). Color Atlas of

Human Anatomy, Third Edition. St. Louis MO. Mosby Year Book, Inc.Pedretti, L.W., Early, M.B. (2001). Occupational Therapy Practice Skills for Physical

Dysfunctions, Fifth Edition. St. Louis, MO. Mosby, Inc.Snell, R.S. (2004). Clinical Anatomy for Medical Students (7th ed.). USA: Lippincott

Williams & Wilkins.

Electronic:DxR Development Group. (1999). F. Netter, M.D. Interactive Atlas of Human Anatomy.

East Hanover, NJ. Novartis Medical FoundationRarey, K. E., Romrell, L.J., Pawlina, W., Rathe, R.J., Rosenberg, J. (1990). Human

Anatomy, An Interactive Tutorial and Reference. Florida. University of Florida andGold Standard Multimedia, Inc.

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Module on the Wrist and Hand 09-10