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THE WRIST

WRIST- area from the imaginary line b/n radial styloid process and ulnar head (proximal)
to the imaginary line along the
bases of the thumb and the
metacarpals
...
SKIN
-

VOLAR SIDE- thick, callus, fascia is attached/adherent to the skin that forms
creases
DORSAL SIDE- loose, thin with loose fascia and mobileb
...
of RADIAL n
...
John Lorenz Beleno

Anatomy
Lecture Notes By: John Lorenz Beleno, RM, RN, MD

Fascial Compartments: area enclosed by fascial membranes
a
...

• FLEXOR POLLICIS BREVIS
...

• Tendon of FLEXOR POLLICIS LONGUS
• Palmar br of RADIAL ARTERY
b
...

• FLEXOR DIGITI MINIMI BREVIS m
...

c
...
ADDUCTOR: contents
• PALMAR and DORSAL INTEROSSEI m
...

• DEEP VOLAR arch
• DEEP br of ULNAR NERVE

ANATOMY

THE WRIST

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THE WRIST
ANATOMY

BORDERS:
*Anterolaterally- Abductor pollicis longus and Extensor pollicis brevis
*Posteromedially- Extensor pollicis longus
“ANATOMIC SNUFF BOX”

-

a
...

c
...


superficial to the EXTENSOR RETINACULUMthickening of deep fascia that stretches across the
back of the wrist and holds the long extensor tendons in position (also forms the dorsal compartments/tunnel of the wrist)
EXTENSOR RETINACULUM – a 2cm band attaching on both radius and ulna; there is a vertical
septa forming tunnels
from medial (ulnar) to lateral
DORSAL CUTANEOUS BR OF THE ULNAR NERVE
BASILIC VEIN
CEPHALIC VEIN
DORSAL CUTANEOUS BR OF THE RADIAL NERVE
*DORSAL Compartments of the Wrist
1st
...
–EXTENSOR CARPI RADIALIS BREVIS
- EXTENSOR CARPI RADIALIS LONGUS
3rd
...
-EXTENSOR DIGITORUM
5th
...
-EXTENSOR CARPI ULNARIS

DR
...
Structures Passing thru the WRIST from the FOREARM
1
...
Median nerve- most superficial
b
...
Flexor digitorum superficialis of 2nd and 5th fingers
d
...
John Lorenz Beleno

Clinical correlation of DORSAL COMPARTMENTS
*FINKELSTEIN TEST- confirms de Quervain's stenosing tenosynovitis (inflammation of tendons on the side of the wrist at
the base of the thumb; extensor pollicis brevis & abductor
pollicis longus tendons-1st DORSAL COMPARTMENT)

ANATOMY

II
...
FLEXOR CARPI ULNARIS TENDON
b
...
ULNAR ARTERY
d
...
PALMARIS LONGUS TENDON
f
...

MEDIAN NERVE
- leaves the cubital fossa by passing b/n 2 heads of
pronator teres
- before the flexor retinaculum, it gives rise to
PALMAR CUTANEOUS Br- skin of lateral part of
the palm
- passes thru the carpal tunnel, it gives rise to:
o LATERAL br(cutaneous & muscular br)muscular br supplies thenar muscles(abductor pollicis brevis, flexor pollicis brevis, opponens pollicis) and first
lumbrical
Jlb_MD

DR
...

1(cutaneous) supplies palmar aspect of
the lateral 3½ fingers and the distal ½ of
the dorsal aspect of each finger
...

-

ULNAR NERVE
before the wrist area, it has 1 branch (DORSAL
CUTANEOUS Br
...

Muscular br- supplies palmaris brevis
(function is for gripping)
ii
...
Also supplies the distal half of the
dorsal aspect of each finger)
2) Deep Br- supplies hypothenar eminence (abductor
digiti minimi and flexor digiti minimi)

DR
...


ANATOMY

i
...

Superficial br- gives cutaneous innervation to dorsal aspect of the hand
ii
...
Radial Artery- immediately entering the palm, it
gives off to:
i
...
Arteria princeps pollicis- divides into 2 and
supplies the lateral and medial sides of the
thumb
iii
...
DEEP PALMAR ARCH- direct continuation of
the radial artery; completed by deep ulnar artery on the ulnar side
b
...

4 digital arteries
i
...
John Lorenz Beleno

Phalen’s maneuver
Elicitation: Allow wrists to fall freely into maxi- mum flexion
and maintain the position for 60 seconds or more
Positive response: A sensation of tingling in the distribution
of the median nerve over the hand

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THE WRIST
ANATOMY

PALMAR VIEW

DEEP PALMAR VIEW
*ALLEN’S TEST

DR
...

• I-shorter and stouter
-has tubercle on lateral side of base
• II- longest with largest base
-base is notched for the TRAPEZOID, the medial
margin of the notch articulates with the CAPITATE
and the lateral boundary articulates with the
TRAPEZIUM
• III- smaller than II
-styloid process on base
-base articulates with CAPITATE
• IV- base has 2 facets on lateral sides (for III) and 1
facet on medial side (for V)
-base articulates with HAMATE; slightly with CAPITATE

V- smallest
-has tubercle on medial side of base and a metacarpal facet on its lateral side

DR
...
Proximal row (lateral to medial)
i
...
Lunate (Semilunar)*
-most commonly dislocated bone
iii
...
Pisiform
-sesamoid bone embedded within
flexor carpi ulnaris
-does not play in the mobility of wrist
joint
b
...
Trapezium (Greater multangular)
ii
...
Capitate (Os Magnum)
-largest
iv
...


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THE WRIST

INTRINSIC
-“INTEROSSOEUS LIGAMENTS”
▪ DISTAL “V”- formed by ULNOLUNATE (palmar ulnocarpal ligament) and RADIOTRIQUETRAL (palmar radiocarpal ligament)
o Apex: CAPITATE BONE
▪ PROXIMAL “V”- formed by ULNOTRIQUETRAL
up to the CAPITATE (of palmar ulnocarpal ligament) and RADIOCAPITATE (of palmar radiocarpal ligament)
o Apex: LUNATE BONE
*SPACE OF POIRIER- weak point b/n the V’s
• DORSAL EXTRINSIC/DORSAL CARPAL Ligaments
o DORSAL INTERCARPAL (DIC)
o DORSAL RADIOCARPAL (DRC)
o

ANATOMY

•

DR
...
John Lorenz Beleno

INTRINSIC LIGAMENTS

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