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Elbow, Wrist, and Hand

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Anterior: abductor pollicis longus, extensor pollicis brevis, extensor pollicis ... Abductor digiti minimi: abducts MCP joint of 5th digit. ulnar nerve ... – PowerPoint PPT presentation

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Title: Elbow, Wrist, and Hand


1
Elbow, Wrist, and Hand
  • Chapter 6

2
Elbow
  • Bones humerus, radius, ulna
  • Joints humeroulnar, humeroradial, radioulnar
  • Humeroulnar hinge joint
  • Humeroradial gliding joint (restricted ball and
    socket joint)
  • Radioulnar
  • Movements flexion, extension (humeroulnar,
    -radial joints) pronation, supination (radioulnar
    joint)

3
Elbow muscles
  • Anterior biceps brachii, brachialis,
    brachioradialis, pronator teres
  • Posterior triceps brachii, supinator

4
Elbow muscles
  • Brachioradialis elbow flexion
  • radial nerve (C5, C6)
  • Pronator Teres forearm pronation, assists elbow
    flexion
  • median nerve (C6, C7)

5
Elbow muscles
  • Brachialis true elbow flexion
  • musculocutaneous nerve
  • Supinator supination of forearm
  • radial nerve (C6)

6
Elbow muscles
  • Triceps Brachii elbow extension
  • radial nerve
  • Biceps Brachii flexion of forearm, flexion of
    shoulder, extension of forearm, supination of
    forearm, stabilization of shoulder
  • musculocutaneous nerve (C5, C6)

7
Muscular analysis
  • Flexion
  • Brachialis is a flexor under all conditions
  • During Isometric contractions
  • Biceps is most active in supination
  • Brachioradialis most active in midposition or in
    supination
  • Pronator teres, a moderate flexor, most active in
    a position of pronation
  • Isometric flexion greatest in midposition or
    supination
  • Extension
  • Triceps anconeus, when not by gravity
  • Pronation
  • Pronator teres Pronator quadratus
  • Supination
  • Supinator Biceps Long head more active with
    greater muscle length, while short head more
    active with shorter muscle length

8
Wrist
  • Bones radius, ulna, carpals (scaphoid, lunate,
    triquetrum, pisiform, trapezium, trapezoid,
    capitate, hamate), metacarpals (I through V)
  • Joint radiocarpal joint (condyloid)
  • Movements flexion (palmar flexion), extension
    (neutral), hyperextension (dorsiflexion),
    abduction (radial deviation) adduction (ulnar
    deviation) circumduction

9
Hand
  • Hand mobility due to generous supply of joints
  • Radiocarpal joint, Articulation between two rows
    of carpal bones, and Carpometacarpal joint
  • Proximal and distal rows of carpal bones permit
    only a slight gliding motion (modified hinge)
  • Anterior surface of carpal bone are slightly
    concave form side to side, referred to as the
    Carpal Tunnel

10
Wrist and hand
  • Anterior flexor carpi radialis, flexor carpi
    ulnaris, palmaris longus, flexor digitorum
    superficialis, flexor digitorum profundus, flexor
    pollicis longus
  • Posterior extensor carpi radialis brevis,
    extensor carpi radialis longus, extensor carpi
    ulnaris, extensor digitorum, extensor, digiti
    minimi, extensor indicis

11
Fingers
  • Bones carpals, metacarpals, proximal/middle/dista
    l phalanges
  • Joint CMC joints (irregular), MCP joint
    (condyloid), PIP joint (hinge), DIP (hinge)
  • Movements CMC none, MCP flexion, extension,
    hyperextension, ab/adduction, PIP/DIP flexion,
    extension
  • Joints between adjacent palanges of any of the
    five digits.
  • All are hinge joint, permit only flexion
    extension
  • Hyperextension is slight, if present at all
  • Each enclosed in a capsule
  • Strengthen by collateral ligaments and a in front
    by a volar ligament

12
Wrist muscles
  • Flexor Carpi Radialis flexes hand
  • median nerve (C6, C7)
  • Flexor Carpi Ulnaris wrist flexion, ulnar
    deviation
  • ulnar nerve (C8, T1)
  • Palmaris Longus wrist flexion
  • median nerve (C6, C7)
  • Flexor pollicis longus thumb CMC and IP flexion
  • Median nerve (C8, T1)

13
Wrist and finger muscles
  • Extensor Carpi Radialis Brevis wrist extension
  • radial nerve (C6, C7)
  • Extensor Carpi Radialis Longus wrist extension,
    radial deviation
  • radial nerve (C6, C7)
  • Extensor Carpi Ulnaris wrist extension, ulnar
    deviation
  • Innervation radial nerve (C6, C7)
  • Extensor digiti minimi MCP extension of 5th
    finger
  • Radial nerve (C6-C8)
  • Extensor digitorum MCP extension of 4 fingers,
    wrist extension
  • Radial nerve (C6-C8)

14
Finger muscles
  • Flexor digitorum superficialis flexes MCP and
    PIP joints of 4 fingers
  • median nerve
  • Flexor digitorum profundus flexes all three
    finger joints
  • median and ulnar nerves

15
Wrist and thumb muscles
  • Extensor indices MCP extension of 3rd finger
  • Radial nerve (C7)
  • Extensor pollicis longus Wrist and thumb
    extension
  • Radial nerve (C6-C8)
  • Extensor pollicis brevis MCP extension at thumb
  • Radial nerve (C6-C8)
  • Abductor pollicis longus CMC abduction of
    thumb, wrist abduction
  • Radial nerve C6, C7

16
Thumb
  • Bones proximal distal phalanges, 1st
    metacarpal and trapezium
  • Joint carpometacarpal joint (saddle shaped)
  • Movements abduction, adduction, flexion,
    extension, circumduction, opposition

Hyperadduction
Abduction
Extension
Opposition
Flexion
Hyperflexion
17
Thumb and hand muscles
  • Anterior abductor pollicis longus, extensor
    pollicis brevis, extensor pollicis longus, flexor
    pollicis longus
  • Posterior abductor pollicis brevis, adductor
    pollicis, flexor pollicis brevis, opponens
    pollicis
  • Extrinsic muscles of wrist and hand muscles
    that span wrist as well as hand
  • Proximal attachment is above wrist, assist in
    wrist function
  • Intrinsic muscles have proximal attachment at or
    distal to carpal bones, fine motor control
  • Thenar muscles operate the thumb, hypothenar
    muscles operate little finger, deep palm muscles
    are in between

18
Thumb muscles
  • Opponens pollicis opposes thumb to fingers
    (intrinsic)
  • median nerve (C6, C7)
  • Adductor pollicis adducts thumb (intrinsic)
  • ulnar nerve (C8, T1)

19
Thumb muscles
  • Flexor pollicis longus thumb flexion
    (extrinsic)
  • median nerve (C8, T1)
  • Flexor pollicis brevis thumb flexion
    (intrinsic)
  • median nerve (C6, C7)
  • Abductor pollicis brevis abducts thumb
    (intrinsic)
  • median nerve
  • Abductor pollicis longus extends, rotates thumb
    (extrinsic)
  • radial nerve

20
  • Abductor digiti minimi abducts MCP joint of 5th
    digit
  • ulnar nerve
  • Opponens digiti minimi opposes 5th digit with
    thumb
  • ulnar nerve
  • Dorsal Interossei abduct fingers at MCP joint
  • ulnar nerve
  • Palmar Interossei adduct fingers at MCP joint
  • ulnar nerve
  • Lumbricals flexes MCP while extending IP joints
  • 1st /2nd median nerve, 3rd /4th ulnar nerve

21
Hand function
  • Grasp, prehension
  • Hand is adapted to hold and manipulate objects
  • How the hand is used depends on size, shape,
    weight of object, how object will be used,
    involvement of proximal segments of upper
    extremity
  • Shoulder joint/girdle places hand in space
  • Elbow moves hand closer to or further away from
    body
  • Wrist provides stability
  • Functional Position Optimal position for wrist
    and hand for the hand to be most effective in
    terms of strength and precision
  • Wrist slightly extended, MCP and PIP joints are
    flexed and thumb in opposition
  • Power Grip object needs to be held forcefully
    while being moved about by more proximal joints
  • Cylindrical all fingers flexed around an
    object, thumb wraps around object in other
    direction overlapping fingers
  • Spherical all fingers and thumb adducted around
    an object fingers spread apart
  • Hook 2nd-5th fingers flexed about an object in
    a hooklike manner, thumb is not involved

22
Spherical
Hook
Cylindrical
23
  • Precision Grip object needs to be manipulated
    in finer movements
  • Pinch thumb abducted, index finger MCP joint
    flexed, other joints extended
  • Three-Jaw Chuck thumb and first two digits
  • Lateral prehension pad of thumb presses against
    radial side of index finger inserting key
  • Side-to-side adduction of first two digits,
    thumb not involved
  • Lumbrical MCP and PIP joints flexed, DIP
    extended, thumb opposes fingers to hold an object
    horizontal (holding a plate or tray)
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