KINESIOLOGY FINGER & HAND JOINTS (EXTRINSIC AND INTRINSIC)
POSTERIOR DEEP LAYER
-4 MUSCLES 1. abductor pollicis longus (extrinsic hand) 2. e. pollicis brevis (extrinsic hand) 3. e. pollicis longus (extrinsic hand) 4. e. indicis (extrinsic hand)
ANTERIOR SUPERFICIAL LAYER FOREARM
-4 MUSCLES 1. pronator teres (elbow/forearm) 2. F. carpi radialis (wrist) 3. Palmaris longus (wrist) 4. f. carpi ulnaris (wrist)
POSTERIOR SUPERFICIAL LAYER
-6 MUSCLES 1. brachioradilis (elbow) 2. e. carpi longus (wrist) 3. e. carpi radialis brevis (wrist) 4. e. digitorium (extrinsic hand) 5. e. digiti minimi (extrinsic hand) 6. e. carpi ulnaris (wrist)
WHAT ARE THE EXTENSORS OF EXTRINSIC MUSCLES? 6 MUSCLES
-Abductor pollicis longus (APL) -Extensor pollicis brevis (EPB) -Ex. pollicis longus (EPL) -Extensor digitorum (ED) -Extensor indicis (EI) -Extensor digitorum minimi (EDM) *ALL 6 EXTENSORS EXTRINSIC RADIAL NERVE
THUMB MOTIONS slide 5
-FLEXION -EXTENSION -HYPEREXTENSION -OPPOSITION -REPROSITION -ABD -ADD
HAND LIGAMENTS AND OTHER STRUCTURES slide 8-12
-Flexor Retinaculum -Extensor Retinaculum -Extensor Expansion Mechanism
LUMBRICAL INTRINSIC MUSCLE ORIGIN AND INSERTION
-LUMBRICAL GROUP 4 MUSCLES O=
PLANES, AXES, AND MOVEMENTS
-SAGGITAL PLANE-FRONTAL AXIS=F/E -FRONTAL/CORONAL PLANE-SAGGITAL AXIS=ABD, ADD, ELEVATOR, DEPRESSOR -TRANSVERSE/HOR PLANE-VERTICAL AXIS=H. ABD, I. ROTATION, E. ROTATION, PRO, AND SUP
Thumb reposition
-adductor pollicis, -extensor pollicis longus, -extensor pollicis brevis
THUMB FLEXION
-flexor pollicis longus -flexor pollicis brevis
Thenar Group 3 Muscles
-median nerve on thumb side 1. flexor pollicis brevis FPB (superficial layer) 2. Abductor pollicis brevis APB (Superficial) 3. Opponens Pollicis (deep layer) OAF
TWO TYPES OF HAND MUSCLES slide
1. Extrinsic Hand Muscle 2. Intrinsic Hand Muscle
What are the 5 groups of intrinsic muscles of the hand?
1. Thenar Group 3 Muscles 2. Lumbricals Group 3 3. Hypothenar group 3 muscles 4. Palmar Interossei PI 5. Dorsal Interossei DI
FINGER JOINTS SLIDE 4
= -Head -Base -Head Base
Thumb opposition
= opponens pollicis opponens digiti minimi
greenstick fracture
= bending and incomplete break of a bone; most often seen in children
What is an intrinsic muscle? List the intrinsic muscles of the hand?
= has both attachments below the wrist - 9 muscles op, apb, fpb, Odm, adm, fdm, lumbricals, pi, di, and ap.
gamekeeper's thumb
= injury to the thumb that results in tearing or stretching of the MP joint or rupture of the ulnar collateral ligament
Keinbock's disease
= lunate fracture; blood supply to one of the small bones of the wrist is interrupted
Intrinsic Hand Muscle slide
= move the finger joints. Origins: inside the hand - on carpal bones, metacarpals, or tendons of other muscles. Insertions: inside the hand. - on the phalanges or tendon of other muscles.
Intrinsic Hand Muscle slide 25
= move the finger joints. Origins: inside the hand -Inserts= inside the hand -Total of 20 muscles -has 5 muscle groups -median and ulnar nerves
Extrinsic Hand Muscle
= moves finger joints Origin: outside of the hand. -on the humerus, radius or ulna. Insertions: inside the hand. -on the phalanges TOTAL OF 9 MUSCLES 3 FLEXORS AND 6 EXTENSORS
Depuytren's contracture
= progressive disease in which the fascia in the palm of the hand becomes thickened and shortened
skier's thumb
= tear of ulnar collateral ligament of thumb
Ganglion cyst
=a harmless fluid-filled swelling that occurs most commonly on the outer surface of the wrist
Dequivarian disease
=an overuse injury of the thumb extensor tendons, often occurs from repetitive tapping of the space bar
Thumb Abduction
=away from thumb -abductor pollicis longus -abductor pollicis brevis
THUMB EXTENSION
=extends/straighten-extensor pollicis longus -extensor pollicis brevis
Flexor Retinaculum slide 8
=made of two ligaments that join the ulnar and radial side of the anterior carpal bones. -holds tendons close to the wrist and prevents carpal bones from spreading/separating. -forms a "roof" carpal tunnels ex. median nerve and several tendons move fingers.
FUNCTIONAL POSITION OF HAND
=most effective position for the hand in terms of strength and precision
Carpal tunnel syndrome
=painful condition resulting from compression of the median nerve within the carpal tunnel
HAND: POWER GRIPS SLIDE 51
=used when object must be held forcefully while being moved about by more proximal joint muscles
HAND: PRECISION GRIP SLIDE 52-
=used when object must be manipulated in a finer type movement.
1. Which finger and thumb motions occur in A. The frontal plane around Sagittal axis? B. The sagittal plane around frontal axis? C. The transverse plane around vertical axis?
A. Finger: mcp abd and add. thumb: cmcflexion ext, mcp and ip B. Finger; mcp, pip, dip flexion, and ext. thumb: cmc abd add, C. Thumb: opposition and reposition
Identify the type of power or precision grip used in the following functions SLIDE 54
A. Spherical grip B. Hook grip
2. Compare thumbs and finger A. Number of bones -thumb -fingers B. Number of joints -thumb -fingers C. Name of joints -thumb -fingers
A. Thumb: 4 fingers: 5 B. Thumb: 3 joints finger: 4 C. Thumb: cmc, mcp, ip. Finger: cmc, mcp, pip, dip
ULNAR NERVE
ANYTHING GOING PINKY
MEDIAN NERVE
ANYTHING GOING TO THE THUMB
RADIAL NERVE
ANYTHING POSTERIOR AND THUMB
Lone Wolf Intrinsic Muscle
Adductor Pollicis adducuts the thumb, ulnar nerve o= mc 2nd and 3rd capitate
HAND LIGAMENTS AND OTHER STRUCTURES
Arches= contributes to the function of various grasps.
-CARPOMETACARPAL JOINT (CMC)
Articulations between carpals and metacarpals
Thumb opposition is a combination of what motions?
CMC flexion, abduction, and rotation
Touch the tip of your thumb to the tip of the little finger
Cmc flexion, abd, and rotation
Holding the handle of a skillet?
Cylinder grip
Of the two extrinsic prime movers for finger flexion which one has the longer moment arm at the McPherson's joint and why?
Fds, superficial and fdp, crosses further away from mcp joint axis rotation
Coles fracture
Fracture at the distal end of the radius that displaces the smaller fragment posteriorly.
Keeping the fingers straight spread them wide apart and bring them together.
Joint motion: finger mcp abd followed by mcp add. Prime movers are: di, adm, and pi.
-Extensor pollicis longus (EPL) origin and insertion slide 20
O= ulna(middle, posterior) interosseous membrane I= digit 1 base of distal phalanx -deep layer
RADIOULNAR JOINT
ONLY MOVEMENT/MOTION SUPINATION AND PRONATION
Turning pages on a book?
Pad to pad or pad to side prehension
Holding an apple?
Spherical grip
What is the purpose of flexor and extensors retinaculum?
They hold extrinsic tendons close to the wrist.
What is phalanx?
a bone of the finger or toe
-Abductor pollicis longus (APL) action and innnervation slide 18
a= abducts CMC digit 1 n= radial n c6 c7
-Extensor pollicis brevis (EPB) action and innnervation slide
a= extends CMC and MCP of thumb digit 1
-Extensor pollicis longus (EPL) action and innnervation slide 20
a= extends CMC, MCP, and IP digit 1 thumb n= radial n c6-c8
-Extensor indicis (EI) action and innnervation slide
a= extends MCP, PIP, and DIP digit 2 fingers n- radial n c6-c8
-Extensor digitorum minimi (EDM) action and innnervation slide
a= extends MCP, PIP, and DIP digit 5 finger n= radial nerve
-Extensor digitorum (ED) action and innnervation slide 22
a= extends MCP, PIP, and DIP digits 2-5 fingers n=radial n c6-c8
Flexor Pollicis Longus (FDL) innervation and action
a= flexes CMC, MCP, and IP digit 1 n= median n. c8 t1
flexor digitorium superficialis (FDS) "whale tail hook grip" Innervation and action
a= flexes MCP digits 2-5 and flexes PIP digits 2-5 n= median nerve c7-t1
flexor digitrium profundus (FDP) innervation and action
a= flexes MCP, PIP, and DIP digits 2-5 n= median n digits 2&3, ulnar n digits 4&5 c8-t1
middle phalanges
articulate with the proximal and distal phalanges
-INTERPHALANGEAL JOINT (IP)
articulation between the proximal phalanx with the adjacent intermediate phalanx of the first digit of the hand or foot
What is the longitudinal arch? slide 11
begins at the wrist and runs the length of the MC phalanges each digit. -perpendicular to the carpal arches.
-proximal interphalangeal joint (PIP)
between proximal and middle phalanges
Metacarpals
bones of the hand
Smiths fracture
complete fracture of the distal radius with palmar displacement.
Palmar Interossei PI
deep palm ulnar nerve -PAD (PALM ADDUCTS) -adducts pulls fingers towards midline.
What are carpal (palmer) arch? slide 11
formbed by the MC heads
What are proximal carpal (palmer) arch? slide 11
formed by the proximal end of the MCs base and carpal bones. -maintained by flexors retinaculum.
Dorsal Interossei DI
in btwn abducts mc ulnar nerve -PAB( PAM ABDUCTS)
metacarpophalangeal joint (MCP)
joint between metacarpal and proximal phalanx
- DISTAL INTERPHALANGEAL JOINT (DIP)
joint between middle and distal phalanges
-Abductor pollicis longus (APL) origin and insertion slide 18
o= radius(posterior) ulna(middle) interosseous membrane I= 1st MC base
flexor digitrium profundus (FDP) "under whale tail" slide 15 origin and insertion
o= ULNA upper 3/4 I= digits 2-5 distal phalanx -deep layer
-Extensor digitorum minimi (EDM) origin and insertion slide 24
o= humerus (lateral epicondyle) i= digit 5 base of distal phalanx -superficial layer
-Extensor digitorum (ED) origin and insertion slide 22
o= humerus (lateral epicondyle) i= digits 2-5 base of distal phalanx -superficial layer
Flexor Pollicis Longus (FDL) origin and insertion slide 17
o= radius anterior surface I= digit 1 distal phalanx -deep layer
-Extensor pollicis brevis (EPB) origin and insertion slide 19
o= radius(distal and posterior) I= digit 1 base of proximal phalanx -deep layer
-Extensor indicis (EI) origin and insertion slide 23
o= ulna (distal) I= digit 2 base of distal phalanx -deep layer
flexor digitorium superficialis (FDS) "whale tail hook grip" origin and insertion slide 14
o=humerus: medial epicondyle-common flexor tendon. i= Digits 2-5 slides middle of phalanx (Front/Anterior) -intermediate layer
Carpals
pertaining to the wrist
FINGER BONES
phalanges
Hand sensory innervation SLIDE 46
sensory innervation of hand - radial (back of hand on thumb side) - median (palm of hand and tips of fingers and fingernails) - ulnar (half of 4th finger, all of 5th, and connecting hand on both sides)
-Extensor Retinaculum
span of the wrist on posterior side in mediolateral direction. -holds extensor tendons close to the wrist particularily during EXT.
proximal phalanges
the phalanges closest to the wrist
Distal phalanges
the phalanges furthest from the wrist
Hypothenar group 3 muscles
ulnar nerve on pinky side 1. flexor digiti minimi (superficial) 2. Abductor digiti minimi (superfical) 3. Opponens digiti minimi (deep) OAF
Lumbricals Group
wraps the palm most superficial -4 MUSCLES -safe positon 1&2 median nerve 3&4 ulnar nerve
EXTRINSIC MUSCLES OF THE HAND FLEXORS 3 muscles slide 13
(ANTERIOR) -Flexor digitorum superficialis (FDS) -Flexor digitorum profundus (FDP) -Flexor pollicis longus (FPL) *ALL 3 MUSCLES FLEXORS EXTRINSIC MEDIAN NERVE
Hand Bones & Joints
- DISTAL Interphalangeal JOINT (DIP) - PROXIMAL Interphalangeal JOINT (PIP) -Interphalangeal JOINTS (IP) Metacarpalphalangeal JOINT (MCP) -Carpophalangeal JOINT (CMC)
-Extensor Expansion Mechanism
- Refers to the flattened tendons (aponeurosis) of extensor muscles that run into the back of the hand - Spans the proximal and middle phalanges -at the distal end of the metacarpals, extensor tendon will expand to form a hood.
HAND:GRASPS SLIDE 50
- prehension= the action of reaching for and grasping an object that may be stationary or moving
ANTERIOR INTERMEDIATE LAYER
-1 MUSCLE 1. f. digitorium superficialis (extrinsic hand muscle)
ANTERIOR DEEPEST LAYER
-1 MUSCLE 1. pronator quadratus (elbow/forearm)
ANTERIOR DEEP LAYER
-2 MUSCLES 1. f. digitorium profundus (extrinsic hand muscle) 2. f. pollicis longus (extrinsic hand muscle)
