FACULTY OF MEDICINE
MBBS YEAR 2 ( MSK BLOCK)
BONES, JOINTS & MUSCLES OF THE UPPER LIMB III
Presented by: Mr Yusuf
Upper limb
Wrist and hand
Bones
Three groups of bones:
• Carpal bones- 8
• Metacarpals- 5
• Phalanges- thumb has two
and the rest of the digits
have three
• Carpal bones – present in two rows:
1. Proximal row
•. Scaphoid (boat-shaped)
•. Lunate (crescent shape)
•. Triquetrum
•. Pisiform (pea-shaped)
2. Distal row
•. Trapezium is four sided bone
•. Trapezoid
•. Capitate has a head.
•. Hamate has a hook.
• The carpal bones do not lie in a flat plane; rather, they form an arch,
whose base is directed anteriorly. The lateral side of this base is formed by
the tubercles of the scaphoid and trapezium. The medial side is formed by
the pisiform and the hook of hamate.
• Each metacarpal consists of a base, a shaft and distally, a head.
• Each phalanx has a base, a shaft (body), and distally, a head.
Wrist joint
Articulating surfaces-
Superiorly- Inferior surface of lower end of the radius and the articular disc
overlying the distal end of the ulna, and
Inferiorly- the scaphoid, lunate, and triquetrum.
Type- Synovial joint
Supporting ligaments-
1. Capsule
2. palmar radiocarpal ligament
3. palmar ulnocarpal ligament
4. dorsal radiocarpal ligaments
5. Radial and ulnar collateral ligaments
1. Carpal joints- have common articular cavity.
2. Carpometacarpal joints
- between the metacarpals and the related distal row of carpal bones
- the saddle joint, between metacarpal I and the trapezium, imparts a wide
range of mobility to the thumb
3. Metacarpophalangeal joints
- between the distal heads of the metacarpals and the proximal phalanges of
the digits are condylar joints
4. Interphalangeal joints
- hinge joints, between the phalanges and allow only flexion and extension
.
Clinical
• Fracture of the scaphoid - fracture across the waist of the scaphoid.
• In approximately 10% of individuals, the scaphoid bone has a sole blood supply
from the radial artery, which enters through the distal portion of the bone to
supply the proximal portion.
• When a fracture occurs across the waist of the scaphoid, the proximal portion
therefore undergoes avascular necrosis. It is impossible to predict which
patients have this blood supply.
Carpal tunnel
Carpal arch: Formed
• Medially: by the pisiform and the hook of the hamate and
• Laterally: by the tubercles of the scaphoid and trapezium.
• Contents:
1. The Four tendons of the flexor digitorum profundus,
2. The four tendons of the flexor digitorum superficialis,
3. The tendon of the flexor pollicis longus
4. Median nerve
Also see the extensor compartment
Carpal tunnel syndrome
An entrapment syndrome.
• Cause: pressure on the median nerve within the carpal tunnel.
• Clinical features:
1. Pain
2. Pins and needles in the distribution of the median nerve.
3. Weakness and loss of muscle bulk of the thenar muscles may also occur.
4. Gently tapping over the median nerve (in the region of the flexor
retinaculum) readily produces these symptoms (Tinel’s sign).
Palmar aponeurosis Anatomical snuff box
Dorsal digital expansion/ dorsal
hood
Dorsal digital expansion/ dorsal hood-
• The tendons of the extensor digitorum and extensor pollicis longus muscles
expand over the proximal phalanges to form complex “extensor hoods” or
“dorsal digital expansions.”
• Each extensor hood is triangular, with the apex attached to the distal
phalanx.
• The central region attached to the middle phalanx (index, middle, ring, and
little fingers) or proximal phalanx (thumb).
Intrinsic muscles of hand
Intrinsic muscles of the hand are:
1. Palmaris brevis
2. Adductor pollicis
3. Thenar muscles
1. Opponens pollicis
2. Abductor pollicis brevis
3. Flexor pollicis brevis
4. Hypothenar muscles
1. Opponens digiti minimi
2. Abductor digiti minimi
3. Flexor digiti minimi brevis
ADDUCTOR POLLICIS THENAR AND HYPOTHENAR MUSCLES
Dorsal Interossei
• 4 dorsal interossei
Action-
• Abductors of the index, middle, and
ring fingers at metacarpophalangeal
joints
• Flexion
• Extension
Palmar Interossei
• 4 palmar interossei
Action-
• Adduct the thumb, index, ring,
and little fingers.
• Flexion and
• extension movements of the
digits
Lumbrical Muscles
• Four lumbrical muscles
• They link flexor tendons with extensor
tendons.
Action-
• They flex the metacarpophalangeal
joints and extend the interphalangeal
joints.
