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Prepared byEnrico C. Aguila, OTR, OTRP
College of Allied Medical ProfessionsUniversity of the Philippines
Manila
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Small Group Discussion
Objectives:A. Describe the bones that comprise the wrist and hand.
1. Distal segment of the radius (refer to Module on the Elbow and Forearm)2. Distal segment of the ulna (refer to Module on the Elbow and Forearm)3. Carpal Bones4. Metacarpal bones5. Phalanges
B. Identify and locate the landmarks on the bones of the wrist and hand.C. Describe the different joints of the wrist and hand in terms of:
1. Type2. Articulating surfaces3. Possible movements4. Axis of motion of the movements5. Factors and structures that limit the motions.
D. Identify and locate the ligaments that are present in the wrist joint.
E. Identify and locate the ligaments that are present in the joints of the hand.F. Describe the muscles that act on the wrist and describe them in terms of:1. Origin2. Insertion3. Actions4. Innervation
G. Describe the muscles that act on the carpometacarpal (CMC) joint of the thumb interms of:
1. Origin2. Insertion3. Actions4. Innervation
H. Describe the muscles that act on the metacarpophalangeal (MCP) joint of the thumbin terms of:
1. Origin2. Insertion3. Actions4. Innervation
I. Describe the muscles that act on the interphalangeal (IP) joint of the thumb in termsof:
1. Origin2. Insertion3. Actions4. Innervation
J. Describe the muscles that act on the metacarpophalangeal joints of the fingers interms of:
1. Origin2. Insertion3. Actions4. Innervation
K. Describe the muscles that act on the proximal interphalangeal joints of the fingers interms of:
1. Origin2. Insertion3. Actions4. Innervation
L. Describe the muscles that act on the distal interphalangeal joints of the fingers interms of:
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1. Origin2. Insertion3. Actions4. Innervation
M. Classify the muscles t1. Extrinsic muscl2. Intrinsic muscl
N. Using mounted skelinsertions.
_______________________
A. Bones of the Wrist aspecimens and in the illus
1. Carpal Bonesa. Proximal row
i. ScaphoidScaphoi
ii. Lunateiii. Triquetraliv. Pisiform
b. Distal rowi. TrapeziumTubercle
ii. Trapezoidiii. Capitateiv. Hamate
Hook of2. Metacarpalsa. Heads
b. Bodiesc. Bases3. Phalangesa. Thumb (proximal
i. Headii. Body
iii. Baseb. Fingers (proximal,
i. Headii. Body
iii. Basec. Small sesamoid b
Bones
ents of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2Philippines, Manila. Please obtain permission before use.
at act on the wrist and hand in terms of:les
s
tons, attach representations of elbow o
__________________________________
d Hand: Identify the bones and landmtrations below
tubercle
of trapezium
he hamate
nd distal)
middle and distal)
nes
Carpal Boneview
Carpal Boneview
f the hand (dorsalview)
Bones of th(palmar
010), of the College of
their origins and
_____________
arks in the bone
s (dorsal)
(palmar)
e handiew)
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B. Joints of the Wrist and Hand:
Radiocarpal (wrist) Joint1. What type of joint is the radiocarpal joint?
2. What structures form the articulations at the
wrist joint? Which of the structures articulatewith one another?
1
23
4
5
3. What motions are available at the wrist
joint? (4 Answers)
1
2
3
4
4. In what planes and axes of motion do these
movements occur?Motion Axis Plane
1
2
3
45. Identify activities that use the motions of the
wrist (list 3 activities per motion)Motions Activities
1 A
B
C
2 A
B
C
3 A
B
C
4 A
B
C
Intercarpal Joints1. What joints comprise the intercarpal joints?
Which structures articulate with each
other?
1
2
3
2. What type of joint are the different
intercarpal joints?
3. What type of movements are available at
these joints?
Ligaments of the Radiocarpal and Intercarpal JointsLigaments Functions and Attachments
Radial collateral
Ulnar collateral
Dorsal radioulnar
Dorsal radiocarpal
Dorsal radioulnar
Dorsal ulnocarpal
Dorsal carpometacarpal
Ligaments
Dorsal metacarpal
ligaments
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Palmar radioulnar
Palmar Ulnocarpal
(ulnolunate part)
Palmar Ulnocarpal
(ulnotriquetral part)
Palmar Radiocarpal
(radioscapulohamate part)
Palmar Radiocarpal
(radiotriquetral part)
Palmar Radiocarpal
(radiocapitate part)
Capitotriquetral
Pisohamate
Pisometacarpal
Palmar carpometacarpal
Ligaments
Palmar metacarpal
Ligaments
Label the ligaments on the illustrations below.
Ligaments of the wrist (dorsal view) Ligaments of the wrist (palmar view)
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Carpometacarpal (CMC) Joint of the Thumb1. What type of joint is the CMC joint of the
thumb?
2. What structures articulate to form theCMC joint of the thumb?
3. What movements are possible in theCMC joint? 12345
4. In what axes and planes of motion dothese movements occur?
Motion Axis Plane
1
2
3
4
5
Metacarpophalangeal (MCP) Joints of the Thumb and Fingers1. What type of joint are the MCP joints?
2. What structures articulate to form theMCP joints?
12
3. What movements are possible in theMCP joints?
1234
4. In what axes and planes of motion dothese movements occur?
Motion Axis Plane1
2
3
4
Interphalangeal Joints of the Thumb (IP joint) and Fingers (PIP and DIP joints)1. What type of joint are the interphalangeal
joints?
2. What structures articulate to form the IPjoints?
Joints Articular surfaces
IP joint of thumb
PIP joints
DIP joints
3. What movements are possible at the IPjoints?
12
4. In what axis and plane of motion dothese movements occur?
Motion Axis Plane
1
2
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C. Muscles Acting on the Wrist and Hand
Muscles Acting on the Wrist
Muscle Origin Insertion Action Nerve Supply
Extensor carpi
radialis brevisExtensor carpiradialis longus
Extensor carpiulnaris
Flexor carpiradialis
Flexor carpiulnaris
Palmaris longus
Muscles Acting on the CMC and IP Joints of the ThumbMuscle Origin Insertion Action Nerve Supply
Abductor poliicislongus
Abductor pollicisbrevis
Adductor pollicis
Extensor pollicisbrevis
Extensor pollicislongus
Flexor pollicisbrevis
Flexor pollicislongus
Opponens pollicis
Muscles Acting on the Joints of the Fingers
Muscle Origin Insertion Action Nerve Supply
Abductor digiti
minimiDorsal interossei
Extensor digitiminimi
Extensordigitorum
Extensor indicis
Flexor digitiminimi
Flexor digitorumprofundus
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Flexor digitorumsuperficialis
Lumbricales
Opponens digiti
minimiPalmar interossei
Palmaris brevis
Identify the Muscles on the Illustrations BelowForearm
SuperficialLayer
(palmar view)
ForearmIntermediate
Layer(palmar view)
ForearmDeepLayer
(palmar view)
ForearmSuperficial
Layer(dorsal view)
ForearmDeepLayer
(dorsal view)
Wrist Flexors Thumb andFinger Flexors
Thumb and FingerFlexors
Wrist andFinger
Extensors
Wrist andFinger
Extensors
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ExtensorTendons at the
Wrist
AnatoSnuff
Flexo
Classify the muscles actinHow are they different fro
Extrinsic Muscl
ents of OTPT 102: Applied Anatomy and Kinesiology (AY 2009-2Philippines, Manila. Please obtain permission before use.
icalbox
Lumbricales DorsalInterossei
Intrinsic Muscles of the Hand
r and extensor Tendons of the Finger
g on the hand between extrinsic and ieach other?
es Intrinsic Mu
010), of the College of
PalmarInterossei
ntrinsic muscles.
scles
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Small Group Activity
Instructions:
A. Identify the approximate locations of the muscles that act on the elbow and forearm.
B. Place your hand on the bulk/body of the muscle that you are aiming to palpate.
C. Stabilize the body segment proximal to the joint that you are going to instruct your
partner to move.
D. Instruct your partner to perform the necessary action in order for the target muscle to
contract.
E. Provide resistance to the motion in order to strengthen the contraction and make the
muscle more palpable.
F. Indicate your procedures on the table provided below.
*These are the same items that are going to be the components of your grade for the next
palpation exam.
TargetMuscles
Location Point of Stabilization
Instruction Placement ofResistance
Extensor carpiradialis brevis
Extensor carpiradialis longus
Extensor carpiulnaris
Flexor carpiradialis
Flexor carpiulnaris
Palmaris longus
Abductor poliicislongus
Abductor pollicisbrevis
Adductor pollicis
Extensor pollicisbrevis
Extensor pollicislongus
Flexor pollicisbrevis
Flexor pollicislongus
Opponenspollicis
Abductor digitiminimi
Dorsalinterossei
Extensor digitiminimi
Extensordigitorum
Extensor indicis
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Flexor digitiminimi
Flexor digitorumprofundus
Flexor digitorum
superficialisLumbricales
Opponens digitiminimi
Palmarinterossei
Palmaris brevis
II. Palpation of bony landmarks and other structures.Palpate for the following structures and mark their locations with a pen or an eyebrowpencil.
1. Capitate2. Scaphoid3. Pisiform4. Hook of the hamate5. Ulnar Styloid6. Radial styloid7. Dorsal tubercle of the radius8. CMC joint of the thumb
9. MCP joints of the thumb and thefingers
10. IP joint of the thumb11. PIP joints of the fingers12. DIP joints of the fingers13. Radial pulse14. Ulnar pulse
III. Creases of the Hand: Creases are lines or folds on the skin.Locate for the following creases and mark their locations by drawing lines using a pen oran eyebrow pencil through them. Also mark them in the illustration provided.
1. Proximal wrist crease2. Distal wrist crease3. Thenar crease4. Proximal palmar crease5. Distal palmar crease6. Longitudinal palmar crease7. Finger creases
IV. Tenodesis Function of the HandAlternately flex and extend the wrist with the fingers relaxed. What happens to the fingers
when the wrist is extended? What happens to the fingers when the wrist is flexed? Whatare the reasons for these events?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
V. Stable and Mobile Components of the HandRapidly and alternately open and close the hand. Are all parts of the hand moving? If not,which parts remain stable? Why do they remain stable?
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
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VI. Collateral Ligaments of the MCP, PIP and DIP Joints Extend the fingers with the wrist extended and then abduct the fingers. Flex the MCP joints fully (close the hand). Abduct the fingers.Is there a difference in finger abduction when the MCP joints are extendedand when the MCP joints are flexed? What would account for thisdifference?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
With a finger extended, try to push the middle phalanx laterally such that it woulddeviate from the PIP joint. Attempt to do the same with the PIP joint fully flexed.
Is there a difference in lateral deviation of the middle phalanx when the PIP joint isextended as opposed to when the PIP joint is flexed? In which position of the PIP joint isthere more and easier lateral deviation of the middle phalanx? Why is this so?
________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
With a finger extended, try to push the distal phalanx laterally such that it would deviatefrom the DIP joint. Attempt to do the same with the DIP joint fully flexed.
Is there a difference in lateral deviation of the distal phalanx when the DIP joint is extendedas opposed to when the DIP joint is flexed? In which position of the DIP joint is there moreand easier lateral deviation of the distal phalanx? Why is this so?
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________
VII. Prehension Patterns of the HandDescribe the positions of the hand, thumb and fingers when doing the following activities.Which components of the hand are involved? How do you refer to the prehension patternbeing used? Give at least three more activities that use the same pattern.
Carrying groceries in a grocery bag________________________________________________________________________________________________________________________________________________________________________________________________________________________ Drinking from a glass of water
________________________________________________________________________________________________________________________________________________________________________________________________________________________ Throwing a baseball
________________________________________________________________________________________________________________________________________________________________________________________________________________________ Writing a sentence using a pen
________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Inserting an ATM card into its slot________________________________________________________________________________________________________________________________________________________________________________________________________________________ Inserting a thread into the eye of a needle
________________________________________________________________________________________________________________________________________________________________________________________________________________________
VIII. Anatomical Snuff BoxPerform radial abduction of the thumb against resistance in order for the tendonscomprising the anatomical snuff box to become prominent. To which muscles do thesetendons belong to? Which tendons form the lateral border, floor and the medial border ofthe anatomical snuff box?
__________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________
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