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)