Session 3: The Upper Extremity: The Elbow, Forearm,

Wrist, And Hand

COURSE: Introduction to Exercise Science Level I (Kinesiology)

Presentation Created byKen Baldwin, M.Ed

Copyright © EFS Inc. All Rights Reserved.

Objectives1. Name, locate, & describe the structures of

the elbow, forearm, wrist, and hand area2. Analyze the fundamental movements with

respect to joint & muscle actions3. Describe common injuries to elbow, forearm,

wrist, and hand area

THE ELBOW JOINT

• The Joints and muscles of elbow joint meant to serve the hand

• WHY? 15 Muscles that cross elbow complex act at shoulder or wrist

• Wrist and Shoulder linked by elbow• Example, eating, writing, and driving

THE ELBOW JOINT Structure

• Distal humerus - Trochlea- Capitulum– Coronoid fossa/

process– Olecranon fossa/

process• Radial head• Radial notch of ulna

Fig 6.1

THE ELBOW JOINT Structure• All 3 joints enveloped

in a capsule, lined by synovial membrane

• Strengthen by Radial & Ulnar collateral ligaments

• Annular ligament encircles the radial head & bind it to ulna

Fig 6.2Fig 6.3

THE ELBOW JOINT Structure

4 joints of Elbow• Humeroulnar

– Hinge joint • Humeroradial

– Gliding joint• Proximal/Distal

Radioulnar– Pivot joint

Fig 6.1

THE HUMEROULNAR JOINT• Hinge Joint- Articulation between –

Humerus & Ulna• Trochlea notch- slides into Trochlear

Groove• Medial (Ulnar) Collateral Ligaments= Lateral

stability- Valgus Stress• In Flexion- Coronoid process hits coronoid

fossa• Extension- Olecranon process hits

olecranon fossa

THE HUMERORADIAL JOINT

• Gliding Joint- Articulation between – Humerus & Radius

• Articulation- Radial head spins on Capitulum & Radial Notch on Ulna

• Annular Ligament- covers radial head, keeps head in place

• Lateral (Radial) Collateral Ligaments cover annular ligament and radial providing strength against Varus Stress

THE ELBOW – CARRYING ANGLE

• The carrying angle is made from the Long Axis of Humerus and Long Axis of forearm forming

• Angle for men 10 to 15°• Angle for women 20 to 25°• Application to fitness – Bicep Curls-Straight bar• Flexion- trochlear groove, Forearm in Flexion will

be centered, medial/lateral position

Elbow Joint Movements

• Flexion• Extension• Supination• Pronation

THE ELBOW JOINT Movements

Fig 6.4a

THE RADIOULNAR JOINTS Movements

Fig 6.4b

THE RADIOULNAR JOINTS Structure

Proximal:• Pivot joint• Radius articulates with

radial notch of ulnaDistal:• Pivot joint• Ulna Articulates with

ulnar notch of radius & articular disk-triangular

Fig 6.1

THE PROXIMAL RADIOULNAR JOINT

• Pivot joint• Radius articulates with radial notch of

ulna• ROTATION-Head of radius articulates

w/ capitulum of humerus

THE DISTAL RADIOULNAR JOINT

• Distal Radioulnar Joint-Pivot Joint• Articulation-Ulnar Notch on radius articulates

with end of Ulna• Articular Disk at end of Joint- a reinforcer• Strengthened by

– Volar radioulnar– Dorsal radioulnar

THE RADIOULNAR JOINT Interosseous Membrane

• Interosseous Membrane- Collaginous Sheet

• Reinforces proximal/distal radioulnar joints

• Provides stability and binds radius and ulna

• Under Tension, transmits forces• Movements- Supination and Pronation

Supination and Pronation

• Axis of Motion- Longitudinal axis-from radial/ulnar head

• In Supination- Radius and Ulna parallel (outward rotation, like humerus)

• In Pronation- Radius crosses over Ulna (inward rotation, like humerus)

• Ulna does not move much during either motion

• Range of Motion (150°) at 90° of flexion

MUSLCES OF ELBOW AND RADIOULNAR JOINTS

Location:• Anterior proximal (Elbow): Biceps brachii,

Brachialis, Brachioradialis, Pronator teres• Anterior distal (near wrist): Pronator

quadratus• Posterior: Triceps brachii, Anconeus,

Supinator

Biceps Brachii

Function: • Flexes and supinates

the forearm• Contracts more with

resistance Fig 6.5

Brachialis

Function: • Flexion of the elbow• Considered the “work

horse” of elbow flexor muscles Fig 6.7

BrachioradialisFunction: • Contributes to elbow

flexion• Mid-position-neutral grip

Pronator TeresFunction:• Pronates the forearm,

assists in elbow flexion

Fig 6.8

Pronator Quadratus

Function: • Pronation of the

forearm• Stronger of the two

pronator mucles Fig 6.9

Triceps BrachiiFunction: • Powerful extensor of

elbow

SupinatorFunction: • Supination of the

forearm

Fig 6.10

Anconeus

Function: • Working with the

triceps, extends the forearm

• Provides stability to posterior elbow joint

Fig 6.11

MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM

Flexion

1. Biceps is most active in supination, bicep curl2. Brachioradialis most active in midposition or

in supination3. Brachialis is a flexor under all conditions4. Pronator teres, a moderate flexor, most

active in a position of pronation

MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM

Extension • Triceps & anconeusPronation• Pronator teres & Pronator quadratusSupination• Biceps; Long more active with greater muscle

length (extension), while short head more active with shorter muscle length (flexion)

• Supinator-primary for supination

THE WRIST AND HAND

Mobility due to generous supply of joints

• Radiocarpal joint• Articulation between

two rows of carpal bones

• Carpometacarpal joint

Fig 6.12

Structure of the Wrist (Radiocarpal) Joint

• Condyloid joint• Radius & radioulnar

disk and 3 carpal bones

• 4 ligaments– Volar radiocarpal– Dorsal radiocarpal– Ulnar collateral– Radial collateral

Fig 6.14

Proximal/Distal Carpal bones

• Proximal = Scaphoid, Lunate, Triquetrum & pisiform

• Distal = Trapezium, Trapezoid, Capitate, & Hamate

• Proximal and distal carpal bones form the mid-carpal joint which is a Gliding Joint

Movements of the Hand at the Wrist Joint

Fig 6.16

Circumduction: fingertips describe a circle, hand describe a cone

Structure and Movements of the Midcarpal

• Proximal row of 4 carpal bones articulates with four carpal bones of distal row

• Permit only a slight gliding motion• However, the gliding add up to a modified

(hinge/condyloid?) joint• Anterior surface of carpal bone are slightly

concave form side to side, referred to as the Carpal Tunnel

Structure of the Carpometacarpal and Intermetacarpal Joints

• For all fingers (metacarpophalange al joints are modified condyloid joints, except thumb

• Thumb is known as carpometacarpal joint, or saddle joint

Fig 6.13

Movements of the Carpometacarpal Joint of the Thumb

Fig 6.19

AbductionHyperadduction

Extension

Flexion Hyperflexion Opposition

MUSCLES OF THE WRIST

• Flexors: Flexor carpi radialis, Flexor carpi ulnaris, Palmaris longus

• Extensors: Extensor carpi radialis brevis, Extensor carpi radialis longus, Extensor carpi ulnaris

• Adductors: Extensor carpi ulnaris, Flexor carpi ulnaris

• Abductors: Flexor carpi radialis, Extensor carpi radialis longus

Flexor Carpi radialisFunction: • Flexes wrist• Radial deviationFlexor Carpi UlnarisFunction: • Flexes wrist• Ulnar deviationPalmaris longusFunction: • Weakly flexes wrist

Fig 6.21

Extensor carpi radialisFunction: • Extends wrist• Radial deviationExtensor carpi ulnarisFunction: • Extends wrist• Ulnar deviation

Fig 6.23a

Extensor digitorumFunction: • Extends fingers & wristExtensor digiti minimiFunction: • Extends little finger &

wristFig 6.23b

Flexor digitorum superficialFunction: • flexes fingers & wrist

Fig 6.24a

Flexor digitorum profundus

Function: • Flexes fingers & wristFlexor pollicis longusFunction: • Flexes thumb

Fig 6.24b

Extensor pollicis longusFunction: • Extends thumbExtensor indicisFunction: • Extends index fingerAbductor pollicis longusFunction: • Abducts thumbExtensor pollicis brevisFunction: • Extends thumb

Fig 6.25

MUSCULAR ANALYSIS OF FUNDAMENTAL MOVEMENTS OF WRIST, FINGERS, & THUMB

Wrist• Flexion• Extension • Radial deviation

(Abduction)• Ulnar Deviation

(adduction)

Fingers • Flexion• Extension• Abduction• Adduction • Opposition

MUSCULAR ANALYSIS OF FUNDAMENTAL MOVEMENTS OF WRIST, FINGERS, & THUMB

Thumb Metacarpal• Flexion• Extension• Abduction• Adduction• Opposition

Thumb Phalanges • Flexion• Extension

COOPERATIVE ACTIONS OF WRIST AND DIGITS

• Long finger muscles do not have sufficient length to permit full ROM in joints of fingers & wrist at the same time

Example: make a tight fist, now flex wrist, fingers loosen their grip

Length of Long Finger Muscles Relative to Range of Motion in Wrist & Fingers

Examples of Using Hands for Grasping

• Power grip involves flexion of all fingers

Cylindrical Spherical Hook

Fig 6.30c Fig 6.30f Fig 6.30g

Examples of Using Hands for Grasping

• Precision involves thumb & two finger, depending on shape & size of object

Fig 6.30a Fig 6.30b

COMMON INJURIES OF THE FOREARM, ELBOW, WRIST, AND FINGERS

These areas may be presented for each injury • Fractures of the forearm- falling on

outstretched hand, usually both ulna & radius fracture

• Elbow dislocation-falling on outstretched hand with elbow extended or hyperextended, most common is backward displacement of ulna & radius in relation to humerus, Very serious: blood vessels & nerves

Medial Elbow Injuries

• Most common is to medial epicondyle fractures in minors, epiphyses not yet closed, pitching or serving

• Medial Collateral ligament tears-baseball pitchers, minors and adults

Sprained or Strained Wrist • Falling on palm of hand with wrist

hyperextended, usually a sprain of ligaments, May be a strain to tendons

Carpal Tunnel Syndrome • Overuse, repetitive stress injury• Long hours working with small hand tools and

keyboards• Median nerve & blood vessel compression at

they pass through carpal arch & transverse carpal ligament

• Pain, numbing of fingers

Epicondylitis• Lateral epicondylitis – “tennis elbow”• Medial epicondylitis – ‘Little league elbow”• Repetitive stress injury• Microtraumas or tears in muscle & soft tissue

at proximal attachments• Pain on activity• Rest, Ice, anti-inflammatory drugs, & possibly

cortisone injection