Hand complex

SNEHA.V
RA2221001010052
BPT 3rd semester
Skeleton of the left
hand: Palmar aspect
Carpal bones: The 8 bones that
create the wrist. The carpal
bones are connected to 2 bones
of the arm, the ulnar bone, and
the radius bone.
Metacarpal bones:
They are 5 miniature long bones,
which are numbered from the
lateral to medial side.
Phalanges :
There are 14 phalanges in each
hand, three for each finger(the
distal, middle, and proximal) and
two for the thumb.
JOINTS OF HAND COMPLEX
• The hand consists of five digits: four
fingers and a thumb.
• The hand complex includes several
joints such as:
1. Carpometacarpal joint
2. Metacarpophalangeal joint (MP)
3. Interphalangeal joint (proximal and
distal)
• *in thumb proximal interphalangeal
joint is absent*
Joint Proximal Distal Type Movement
articulation Articulation
Carpometacarpal trapezium 1st metacarpal Saddle Flexion-extension;
joint (thumb) Abduction-adduction;
circumduction; opposition
Carpometacarpal trapezoid, trapezium 2nd metacarpal Ellipsoidal Flexion-extension
joint (fingers) capitate 3rd metacarpal
capitate, hamate 4th metacarpal
hamate 5th metacarpal

MCP joints Metacarpals phalangeal Ellipsoidal Flexion, extension,

abduction, adduction,
circumduction

Interphalangeal Proximal phalangeal Distal Hinge Flexion (lots) Extension

phalangeal (minimal)
CARPOMETACARPAL JOINT(of thumb)
Flexion: Extension:
 Flexor pollicis brevis  Extensor pollicis brevis
 Opponens pollicis  Extensor pollicis longus
Abduction: Adduction:
 Abductor pollicis brevis  Adductor pollicis
 Abductor pollicis longus
Opposition
 Opponens pollicis
 Flexor pollicis brevis
CARPOMETACARPAL JOINT(of fingers)
Ligaments:

• Deep transverse metacarpal

ligament – contributes to • Range of motion:
carpometacarpal stability.
• Shows increasing mobility from
• Proximal transverse arch – the radial to the ulnar side of the
formed by trapezoid, trapezium, hand.
capitate and hamate.
• 2nd and 3rd carpometacarpal J
• Transverse carpal ligament and are immobile.
intercarpal ligaments maintains
the arch. • 5th carpometacarpal joint has
limited amount of opposition.
 Carpal tunnel
• The transverse carpal lig. And intercarpal
lig. That link the 4 distal carpals maintain
the relatively fixed concavity that will
contribute to arches of the palm.
• These structures form the carpal tunnel.
• It contains the median nerve.

When the median nerve becomes

compressed within the carpal tunnel, it
may develop carpal tunnel
syndrome(CTS).
 Arches of the Hand
• The hand, when in at rest, forms a hollow at
the palm, with the fingers flexed and the
thumb in slight opposition. There are three
distinct arches, longitudinal, oblique and
transverse, that are formed by the bones,
ligaments and tendons these are of vital
importance when gripping and manipulating
objects.
• Longitudinal Arches (Brown)
• Oblique Arch (Red)
• Transverse Arches (Light green and Dark
Green)
 METACARPOPHALANGEAL JOINT
2nd to 5th MCP joints MCP of thumb:
• Flexion: interossei & lumbricals
• Flexion: Flexor pollicis longus and flexor
• Extension: extensor pollicis
longus and extensor pollicis pollicis brevis
brevis
• Abduction: dorsal interrosei • Extension : extensor pollicis longus and
• Adduction: palmar interrosei extensor pollicis brevis
• Circumduction : above muscles
in sequence • Abduction : abductor pollicis brevis

• Adduction : adductor pollicis

 METACARPOPHALANGEAL JOINT
• LIGAMENTS
1. Capsular ligament ROM:
2. Volar plate-increases joint congruence, • Index finger having
limits hyperextension. 90 degree of MCP
joint flexion
3. Palmar ligament – various palmar • Little finger 110
ligaments are joined by the deep degrees
transverse metacarpal ligament.
4. Radial & ulnar collateral ligament has two
parts: collateral lig. Proper & accessory
collateral lig.
 Movements of the thumb
INTERPHALANGEAL JOINT
Muscles responsible at 2nd to 5th digits:
Flexion:
flexor digitorum superficialis at the
proximal interphalangeal joint
Flexor digitorum profundus at the distal
joint

Extension:
Interrosei
Lumbricals
Flexor mechanism: Hand pulleys
Flexor digitorum superficialis and flexor
digitorum profundus tendons of each finger
pass through a fibro-osseous tunnel that is
composed of:
• Palmar Aponeurosis Pulley
• 5 Annular Pulleys (A1-A5)
• 3 Cruciform pulleys.
Envelops the flexor tendon at the wrist and
palm-ulnar bursa
Envelops the flexor pollicis longus-radial
bursa
 Function of pulleys
• Facilitates smooth gliding of the tendons.
• Pulleys provide a mechanical advantage to
flexion.
• Without pulleys, the tendon would pull
away from the joint’s axis of rotation during
flexion and decrease the functionality of the
system.
• The pulleys allow us to selectively bend the
PIP or DIP joints.
Extensor Hood mechanism Hood: a flexible covering

• The extensor hoods are triangular aponeuroses by

which the extensor tendons insert onto the phalanges.

• The tendons of the extensor digitorum flatten as they

reach the metacarpals and become extensor hoods
which fan out and wrap around the metacarpal and
proximal phalanx joining onto the palmar plate

• The extensor hood spreads out further distally into a

median band which attaches to the middle phalanx and
two lateral bands which attach to the distal phalanx.
Extensor mechanism • Passive components
Extensor mechanism is formed are triangular lig.
by And saggital bands.
• the tendons of the extensor
digitorum communis muscle • Active components
• extensor hood are doesal interossei,
• central tendon volar interossei, and
• lateral bands that merge into
lumbricals.
the terminal tendon.

The extensor digitorum communis tendon and all its complicated active and passive
interconnections at the MCP joint are known together as the extensor mechanism.
 PREHENSION
• Prehension activities of the hand involve the
grasping or taking hold of an object between any
two surfaces in the hand, the thumb participates in
most but not all prehension tasks.

• Prehension can be categorized as either power grip

(full hand prehension) or precision handling
(finger-thumb prehension).
 POWER GRIP
• Forceful act resulting in flexion at all finger joints.
• The object makes full contact with the palm and is moved through
space by the proximal joints.
• Its sequence:
i. Opening the hand
ii. Positioning the hand
iii. bringing the fingers to the object
iv. Maintaining a static phase that actually constitutes the grip
 PRECISION HANDLING
• Skilful placement of an object between
fingers or between the finger and thumb.
(palm is not involved)
• In precision handling, the fingers and
thumb grasp the object for the purpose
of manipulating it btw the fingers or
within the hand.
• Precision handling shares the first three
steps of the sequence, it does not contain
a static phase at all.
 FUNCTIONAL POSITION
OF WRIST AND HAND
It is the position from which optimal hand
function is most likely to occur. The
functional position is:
Wrist
• In slight extension(20⁰)
• In slight ulnar deviation(10⁰)
Thumb
Digits 2 through 5 • 1st CMC joint partially abducted and opposed
• MP joints flexed 45 ⁰ • MP joint flexed 10 ⁰
• PIP joints flexed 30-45 ⁰ • IP joint flexed 5 ⁰
It is the position In which all wrist muscles are
• DIP joints flexed 10-20 ⁰
under equal tension.