Wrist Joint: Anatomy, BioMechinics, Presentation.

The wrist joint, also called the radiocarpal joint, is a synovial ellipsoid joint formed by the proximal row of carpal bones and the distal end of the radius. Scaphoid fracture is the most common carpal bone injury, often resulting from a fall on an outstretched hand which puts the wrist in hyperextension. Clinical evaluation looks for tenderness and deformity while radiological evaluation with x-rays, CT, MRI, and arthrography can diagnose fractures and ligament injuries. Common fractures include Colles' fracture of the distal radius and fractures of the scaphoid and lunate bones.

1. WRIST JOINT Dr. NITIN SAINI

2. The Wrist Joint CONTENTS :- Introduction Definition Function Ligaments Movements Muscle Work Nerves supply Indication Contra- Indication

3. The wrist joint (also known as the radio-carpal joint ) is a ellipsoid type of synovial joint in the upper limb. The wrist is  a complex joint that bridges the hand to the forearm . It is not one big joint. It is one of the smaller joints in our body. It has several small joints. INTRODUCTION

4. DEFINATION The wrist joint is actually a collection of multiple bones and joints. Synonymn : Wrist Joint: Radio-Carpal Joint Type: Synovial Joint Sub type: Ellipsoid Joint (Biaxial joint) Wrist Complex: RadioCarpal Joint MidCarpal Joint

5. Structures of the Wrist Joint Articulating Surfaces: The bones comprising the wrist include the 1. Radius - distal ends ( Styloid Process) 2. Ulna The ulna is  not  part of the wrist joint  – it articulates with the radius, just proximal to the wrist joint, at the distal radioulnar joint. It is prevented from articulating with the carpal bones. 3. Carpal bones The  carpus  or carpal bones, the complex of eight bones forming the proximal skeletal segment of the  hand . It involves the proximal row of the carpal bones - Scaphoid , lunate and Triquetrum (except the pisiform ).

6. Together, the carpal bones form a  convex  surface, which articulates with the  concave  surface of the radius and articular disk.

7. Joint Capsule The  joint capsule  of the wrist joint attaches to the end of radius, ulna and the proximal row of the carpal bones. It is lined internally by a  synovial membrane , which produces synovial fluid to reduce friction between the articulating structures. Synovial Membrane

8. LIGAMENTS

9. Ligaments Collateral ligaments  – strong ligaments on either side of the finger and thumb joints, which prevent sideways movement of the joint. Volar plate  – a ligament that connects the proximal phalanx to the middle phalanx on the palm side of the joint. As the joint in the finger is straightened, this ligament tightens to keep the PIP joint from bending backward. Radial and ulnar collateral ligaments  – a pair of ligaments which bind the bones of the wrist and provide stability Volar radiocarpal ligaments  – a complex web of ligaments that support the palm side of the wrist Dorsal radiocarpal ligaments  – ligaments that support the back of the wrist Ulnocarpal and radioulnar ligaments  – two sets of ligaments that provide the main support for the wrist.

10. MOVEMENTS And MUSCLES: Our wrist is capable of many diverse movements and positions. All the movements of the wrist are performed by the muscles of the forearm. These movements can be broken down into distinct types : A. Neutral Position The neutral position for our wrist refers to the handshake position.  

11. B. Wrist Flexion It refers to the downward bending of your wrist. Produced by the: Flexion: Mainly at Midcarpal Joint Ranges: 0- 60 Degrees Muscles : Flexor Carpi Ulnaris Flexor Carpi Radialis Palmaris Longus Assisted by: Flexor Digitorum Superficialis Flexor Digitorum Profundus Flexor Pollicis Longus

12. C. Wrist Extension Its refers to bending your wrist backwards towards the posterior section of your forearm. Produced by the: Extension : Mainly at occurs more at wrist joint. Ranges: 0- 50 Degrees Muscles : Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Carpi Ulnaris Assisted by: Extensor Digitorum Extensor Digiti Minimi Extensor Pollicis Longus Extensor Indicis

13. D. Radial Deviation ( Abduction   ) Its points to the bending of the wrist towards the thumb or radial bone. It is the opposite of ulnar deviation. It is also referred to as radial flexion. Produced by the: Extension : Mainly occurs more at midcarpal joint. Ranges: 0- 20 Degrees Muscles : Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Flexor Carpi Radialis Assisted by: Abductor Pollicis Longus Extensor Pollicis Longus Extensor Pollicis Brevis

14. E. Ulnar Deviation ( Adduction ) It refers to the pivoting of the wrist towards the little finger or ulnar bone. It is also referred to as ulnar flexion. Produced by: Extension : Mainly occurs more at wrist joint. Ranges: 0- 30 Degrees Muscles : Flexor Carpi Ulnaris Extensor Carpi Ulnaris Circumduction : Flexion Adduction Extension Abduction

15. F. Addition Movement: 1. Pronation: It refers to the rotation of the forearm counter clock wise so the back of your hand is facing up. Produced by: Pronation : Mainly occurs more at proximal RadioUlnar joint. Ranges: 0- 90 Degrees Muscles : Protanor Quadratus Pronator Teres 2. Supination: It refers to the rotation of the forearm clockwise so the palm of your hand is is facing up. Produced by: Pronation : Mainly occurs more at proximal RadioUlnar joint. Ranges: 0- 90 Degrees Muscles : Supinator Biceps Brachi

16. 2. INTERCARPAL JOINT Articulation: Between the Proximal & Distal Row of Carpals. Type: Synovial Joint Sub – type: Plane Joint Capsule: Synovial Membrane

17. Ligaments: Dorsal intercarpal ligaments Palmar intercarpal ligaments Interosseous intercarpal ligaments Innervation : The intercarpal joint are innervated by the anterior interosseous and posterior interosseous nerves, which are the branches of the  median  and  radial nerves , respectively. Movements: Small amount of gliding movement.

18. 3. CARPO-METACARPAL & INTER-METACARPAL JOINT Articulation: Between the Distal Row of Carpals & metacarpal bones. Type: Synovial Joint Sub – type: Plane Joint Capsule: Synovial Membrane

19. Ligaments: Dorsal intercarpal ligaments Palmar intercarpal ligaments Interosseous intercarpal ligaments Innervation : The intercarpal joint are innervated by the anterior interosseous and posterior interosseous nerves, which are the branches of the  median  and  radial nerves , respectively. Movements: Small amount of gliding movement.

20. 4. CARPOMETACARPAL JOINT OF THUMB Articulation: Between trapezium & 1 ST metacarpal bones. Type: Synovial Joint Sub – type: Shaddle Shaped Capsule: Synovial Sheet Ligaments: Posterior ligament Anterior ligament Ulnar Collateral ligament Radial Collateral ligament 1 st intercarpal ligament Movements: Rotation, Flexion, Extension, Abduction, Adduction

21. 5. METACARPOPHALANGEAL JOINT Articulation: Between head of metacarpal bone & base of phalanges. Type: Synovial Joint Sub – type: Condyle Joint Capsule: Synovial Sheet Ligaments: Palmar collateral ligaments Movements: Flexion, Extension Abduction, Adduction

22. 6. INTERPHALANGEAL JOINT Articulation: Between head of Proximal phalangeal & base of Distal phalangeal . Proximal Interphalangeal Distal Interphalangeal Type: Synovial Joint Sub – type: Condyle Joint Capsule: Synovial Membrane Ligaments: Ulnar Collateral ligament Radial Collateral ligament Movements: Flexion, Extension

23. NEUROVASCULAR SUPPLY The wrist joint recieves blood from branches of the dorsal and palmar carpal arches, which are derived from ulnar and radial arteries. Innervation to the wrist joint is delivered by branches of three nerves. They are as follows: Median nerve – Anterior interosseous branches. Radial nerve - Posterior interosseous branches. Ulnar nerve – deep And dorsal branches.

24. Clinical Examination Wrist & Hand Examination Special Tests Allen Test Bunnell -Littler Test CPR for Carpal Tunnel Syndrome Finkelstein Test Fovea Sign Froment’s Sign Kaltenborn of Hand Phalen’s Sign Scaphoid (Watson) Shift Test Supination Lift Test Sweater finger Sign Thumb CMC Grind Tinel’s Test Valgus Stress to UCL

25. T h a n k s !