Wrist and Hand

Published on 16/03/2015 by admin

Filed under Orthopaedics

Last modified 16/03/2015

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Chapter 4

Wrist and Hand

A. Bobby Chhabra, Aaron M. Freilich

Regional Anatomy and Surgical Intervals

Regional Anatomy

Osteology (Fig. 4-1)

Distal Radius

Arthrology

Radiocarpal Joint (Fig. 4-2, A and B)

Carpometacarpal Joints (Fig. 4-3)

Muscles

Best considered in groups (Table 4-2)

Table 4-2

Hand Musculature

GROUP MUSCLES ORIGIN INSERTION INNERVATION ACTION
Thenar Opponens pollicis Flexor retinaculum and tubercle of trapezium Radial border of the first metacarpal Recurrent motor branch of the median nerve Thumb opposition
Abductor pollicis brevis Scaphoid tubercle and flexor retinaculum Base of the thumb proximal phalanx and the tendon of EPL Recurrent motor branch of the median nerve Thumb abduction
Flexor pollicis brevis Flexor retinaculum and tubercle of trapezium Base of the thumb proximal phalanx Dual innervation—deep head ulnar, superficial head median nerves Flexion of the thumb MCP joint
Adductor pollicis Transverse head—third MC; oblique head—trapezium, trapezoid, capitate, and bases of the second and third MC Ulnar side of the thumb proximal phalanx base Deep branch of the ulnar nerve Thumb adduction
Hypothenar Abductor digiti minimi Pisiform and pisohamate ligament, flexor retinaculum Fifth digit proximal phalanx base and extensor hood Deep branch of the ulnar nerve Abducts the fifth digit
Flexor digiti minimi Hook of hamate and flexor retinaculum Fifth digit proximal phalanx base Deep branch of the ulnar nerve Flexes the fifth digit at the MCP joint
Opponens digiti minimi Hook of hamate and flexor retinaculum Ulnar border of the fifth MC shaft Deep branch of the ulnar nerve Opposes the fifth finger
Intrinsic hand muscles Lumbrical muscles FDP tendons—first and second lumbricals are unipennate and arise on radial side of tendon; third and fourth lumbricals are bipennate and arise from adjacent tendons Radial side of the extensor hood at the level of the proximal phalanx First and second—median nerve; third and fourth—deep branch of the ulnar nerve Flex MCP and extend PIP joints
DI muscles 4 muscles—bipennate on metacarpal shafts Proximal phalanges and extensor hood; first DI—radial side of index finger; second DI—radial side of middle finger; third DI—ulnar side of middle finger; fourth DI—ulnar side of ring finger Deep branch of the ulnar nerve Abduct from the axis of the middle finger; flex MCP joints and extend PIP joints
PI muscles 3 muscles—unipennate on MC shafts; first PI—ulnar shaft of the second MC; second PI—radial shaft of the fourth MC; third PI—radial shaft of the fifth MC Proximal phalanges and extensor hoods; first PI—ulnar side of index finger; second PI—radial side of ring finger; third PI—radial side of small finger Deep branch of the ulnar nerve Adduct toward the middle finger; flex MCP joints and extend PIP joints

image

DI, Dorsal interossei; EPL, extensor pollicis longus; FDP, flexor digitorum profundus; MC, metacarpal; MCP, metacarpophalangeal; PI, palmar interossei; PIP, proximal interphalangeal.

Hypothenar Muscles

(See Fig. 4-6, B)

Intrinsic Muscles

(See Fig. 4-4, A and C)