1. How are wrist curls done?

- nong ryan

National Institute on Aging at National Institute of Health (US)

- Rest your forearm on the arm of a sturdy chair with your hand over the edge.
- Hold weight with palm facing upward.
- Slowly bend your wrist up and down.
- Repeat 10-15 times.
- Repeat with other hand 10-15 times.
- Repeat 10-15 more times with each hand.
- This exercise will strengthen your wrists. It also will help ensure good form and prevent injury
when you do upper body strength exercises

2. What are the biochemical mechanisms on how the muscle works?

What is the Ratchet Theory?
(Guyton and Hall Textbook of Medical Physiology, 13th ed)
- AKA “Walk-along” Theory of Contraction
o Actin Filament is activated by Calcium ions
o The heads of the cross bridges from the myosin filaments become attracted to the
active sites of the actin filament
o Contraction occurs
o When a head attaches to an active site, this attachment simultaneously causes pro-
found changes in the intramolecular forces between the head and arm of its cross-
bridge.
o The new alignment of forces causes the head to tilt toward the arm and to drag the
actin filament along with it. This tilt of the head is called the power stroke.
o Immediately after tilting, the head then automatically breaks away from the active site.
o Next, the head returns to its extended direction. In this position, it combines with a new
active site farther down along the actin filament; the head then tilts again to cause new
power stroke, and the actin filament moves another step. Thus, the heads of the cross-
bridges bend back and forth and step by step walk along the actin filament, pulling the
ends of two successive actin filaments toward the center of the myosin filament.
o Each one of the cross-bridges is believed to operate independently of all others, each
attaching and pulling in a continuous repeated cycle. Therefore, the greater the
number of cross-bridges in contact with the actin filament at any given time, the
greater the force of contraction.

3. What are the bones of the wrist, hands and the forearm?
● Radius
o Lateral sideof the forearm
o Articulates with the:
▪ Proximally
● capitulum of humerus
 ● radial notch of ulna in the elbow joint
▪ Distally:
● Head of ulna
● Scaphoid
● Lunate
● Ulna
o Medial side of the forearm
o Characterized by the hook-shaped proximal end
o Articulation:
▪ Proximal
● Trochlea of the humerus
● Head of radius
▪ Distal
● Ulnar notch of the radius
● Carpal Bones
o Composed of 8 small bones composing the wrist; arranged in two rows
o Arrangement of bones forms a deep concave groove on the ventral
aspect of the wrist
▪ Roofed over by the flexor retinaculum
▪ Forms the carpal tunnel (contains flexor tendons, median nerve)
o Some lovers try positions that they cannot handle (lateral to medial)
▪ Proximal Row
● Scaphoid- largest, most lateral, fractured frequenty
● Lunate- semilunar-shaped carpal bone
● Triquetrum- pyramidal shaped, most medial
● Pisiform- small, pea-shaped, sesamoid bone
▪ Distal Row
● Trapezium- forms saddle joint with the first metacarpal
bone= allowing mobility of the thumb
● Trapezoid
● Capitate - capit means head; central and largest carpal
bone
● Hamate- distinguishing feature is the hook/ hamulus=
attachment point of the flexor retinaculum
▪ Carpal Arch
● Metacarpal Bones
▪ Parts of a metacarpal bone
● Base- expanded proximal end of the bone; -
o articulate with the distal ro of the carpal bones
● Body (shaft)- elongate, slender midportion of the bone
● Head- rounded distal end of the bone
o Articulates with proximal phalanx of the finger
o Forms the knuckle of the hand
▪ Metacarpal Bone Development
 ▪ Metacarpal I- thumb; shortest and most mobile;
● does not lie on the same plane as others
● occupies a more anterior position
● rotated medially through a right angle so that its extensor
surface is directed laterally rather than posteriorly
▪ Phalanges- digits of the hand; has a base, body and head;
● Thumb- proximal distal
● Other digits- proximal, middle, distal
● Each hand has 14 phalanges
4. What are the joints found in the wrist and fingers?
1. Radiocarpal Joints-
1. synovial condylar joint formed superiorly by the radius, articular disk and
inferiorly by the proximal row of carpal bones
2. allows flexion and extension, abduction, and adduction, and circumduction
2. Midcarpal Joint
1. Synovial plane joint between proximal and distal rows of carpal bones
2. Allows gliding and sliding movememnts
3. Carpometacarpal Joint
1. Forms synovial saddle joint between trapezium and first metacarpal bone
2. Allows flexion and extension, abduction and adduction and circumduction
3. Also forms plane joint betweel carpal bones and medial four metacarpal
bones
4. Thumb Carpometacarpal Joint
5. Metacarpopharyngeal Joint
1. Condyloid joints
2. Allows flextion and extension, abduction and adduction
6. Interphalangeal Joint
1. Hinge joint
2. Allows flexion and extenison
5. What are the different ligaments found in the wrist and what structures do they attach ?
● Types of ligaments
▪ Based on presence of capsule
1. Intracapsular
2. Extracapsular
▪ Based on Connection
1. Extrinsic
2. Intrinsic
Major Wrist Ligaments
▪ Dorsal radiocarpal ligament
▪ Ulnar and radial collateral ligaments
▪ Volar(palmar) radiocarpal ligament
▪ Ulnocarpal Ligament
▪ Intercarpal ligament
6. What are the tendons in the wrist and what structures do they connect? How are they
organized?
- Two strong bands of deep fascia which hold the long flexor and extensor tendons in the region
of the wrist.
● Flexor Retinaculum
1. Thickening of deep fascia which holds the long flexor tendonds in the
position at the wrist
2. Converts the anterior surface of the wrist into the carpal tunnel
3. Attaches
1. medially to pisiform bone and hook of hamate
2. laterally to the tubercle of the scaphoid and the trapezium bones
● Extensor Retinaculum
1. Thickening of deep fascia that stretches across the back of the wrist and
holds the long extensor tendons in place
2. Converts the grooves on the posterior surface of the distal ends of the
radius and ulna into six separate tunnels for the passage of the long
extensor tendons
1. Tunnels are separated by fibrous septa which extends from the
deep surface of the retinaculum to the underlying bones
● Palmar aponeurosis
1. Triangular and occupies the central area of the palm
2. Attachments
1. Distal border of the flexor retinaculum
2. Receives the insertion of the palmaris longus tendon
3. Base of the aponeurosis divides at the bases of the finger into four slips
1. Each slip is further divided ino two bands
1. Passing superficially to the skin
2. One passing deeply to the root of the finger
2. Facial spaces of the palm
1. Thenar space
2. Midpalmar space
3. Lumbrical canal
● Flexor tendons
1. Flexor Digitorum Profondus Tendon
2. Flexor Digitorum Superficialis Tendon

● Extensor tendons
1. Extensor digitorum Tendon
2. Extensor Digiti Minimi Tendon
3. Extensor Indicis Proprius Tendon

● Thumb Tendons
1. Abductor Pollicis Longus
2. Flexor Pllicis Longus
3. Extensor Pollicis Longus
4. Extensor Pollicis Brevis
 ● Wrist Tendons
1. Flexor Carpi Radialis
2. Flexor Carpi Ulnaris
3. Palmaris Longus Tendon- used to repair other tendons
4. Extensor Carpi Radiali Brevis
5. Extensor Carpi Radialis Longus
6. Extensor Carpi Ulnaris
7. What are the muscles involved in flexing and in extending the wrist (origin and
insertion)?
▪ Muscle of the Dorsal Forearm

● Superficial group
o Brachioradialis
o Extensor carpi radialis longus
o Extensor carpi radialis brevis
o Extensor digitorum comunis
o Extensor digiti minimi
o Extensor carpi ulnaris
● Deep group
o Supinator
 o Abductor pollicis longus
o Extensor pollicis brevis
o Extensor pollicis longus
o Extensor indicis proprius

▪ Muscle of the Volar Forearm

● Superficial group- wrist flexors

o Pronator teres
o Flexor carpi radialis
o Palmaris longus
o Flexor carpi ulnaris
● Intermediate group
o Flexor digitorum superficialis
● Deep group
o Flexor digitorum profundud
o Flexor pollicis longus
o Pronator quadratus

▪ Muscles of the hand

 ● Extrinsic palmar hand muscles
o Palmaris longus
o Flexor digitorum superficialis
o Flexor digitorum profundus
o Flexor pollicis longus
● Intrinsic palmar hand muscles
● Dorsal interossei
● Palmar interossei
● Lumbricals
● Adductor, flexor and opponens digit minimi
● Palmar brevis

▪ Dorsal muscles of the hand

● Extensor digitorum communis
● Extensor indicis proprius
● Extensor pollicisl ongus
 ● Extensor pollicis brevis
● Abductor pollicis longus

8. What are the nerves involved in innervating these muscles?

- British Journal of hospital medicine, 2016

● Median Nerve- innervates all the extrinsic muscles within the flexor compartment
except for the flexor carpi ulnaris and ulnar half of the flexor digitorum profundus
muscle (
● Ulnar Nerve- innervates flexor carpi ulnaris and ulnar half of the flexor digitorum
profundus muscle
● Radial Nerve- innervates all the extrinsic muscles of the hand within the extensor
compartment

9. What blood vessels provide for the vascular supply in this region?
● Radial artery
● Ulnar Artery
● Superficial Veins
o Begins with the dorsal venous arch
▪ Cephalic vein
▪ Basilic vein

10. What are different movements of the wrist and fingers? -

● Wrist Flexion
● Wrist Extension
● Abduction/ Radial Deviation
● Adduction/ Ulnar Deviaiton
● Finger motions
● Thumb Motion
11. What are the structures involved in flexion and extension of the wrist and the flexion
and extension of the fingers?
● Wrist flexion and extension
● Finger flexion and extension
12. What are the antagonistic muscles and synergistic muscles used in extension and
flexion of the wrist and fingers? *

13. What are the different kinds of grips? - ulah

● Prehension – grasping or taking hold of an object between any two surfaces in the hand
• The two categories of prehension are:
1. Power grip – a forceful act resulting in flexion of all finger joints
● Types of power grip are:
● Cylindrical grip (e.g. holding a cylinder)
● Spherical grip (e.g. holding a ball)
● Hook grip (e.g. carrying a bag)
 ● Lateral prehension – holding something between 2 adjacent fingers (e.g.
holding a cigarette)
2. Precision handling/grip – skillful placement of an object between fingers, or
fingers and thumb
- Manipulation of an object

● Pad-to-pad prehension – between the pads of the

● thumb and index or other digits
● Tip-to-tip prehension – between the tip of the thumb
● and tip of a digit (e.g. picking up a screw)
● Pad-to-side prehension – between the pad of the thumb and side of the
index finger (e.g. inserting keys/ATM card)

14. How does wrist position affect the strength of the grip?

(International Journal of Physiotherapy and Research, 2015)

A biomechanical perspective, the length tension relationship (LTR) of the muscles is the essential
when testing the grip strength. So the wrist and forearm are position in such a way that multijoint
muscle should not hinder the range of the joints. For example the flexor digitorum superficialis is
crossing both the elbow and wrist, so the flexion of elbow and wrist will affect the range of finger
flexion due to its shortened position. However passive insufficiency of the finger flexors due to
extension of wrist and elbow also affect the grip strength. But still there is a controversy that grip
strength had a significant increase in flexed elbow and neutrally placed wrist.

15. What is the optimal angle of wrist for efficient grip (maximal angle of wrist?)

Optimal grip force is produced with the wrist in 35° extension and 5° ulnar deviation. As the wrist is flexed,
grip force is reduced.
Muscle Origin Insertion Action
Flexor Digitorum Medial epicondyle, Middle phalanges of Flexes proximal
Superficialis coronoid process, finger interphalangeal
oblique line of joints, flexes
radius hand and
forearm
Flexor Digitorum Anteromedial Bases of distal Flexes distal
Profundus surface of ulna, phalanges of fingers interphalangeal
interosseous joints and hand
membrane

Muscle Origin Insertion Action

Extensor digitorum Lateral epicondyle Extensor expansion, Extends fingers
of humerus base of middle and and hand
digital phalanges
Extensor digiti minimi Common extensor Extensor expansion, Extends little
tendon and base of middle and finger
interosseous distal phalanges
membrane
Extensor Indicis Posterior surface of Extensor expansion Extends index
Proprius ulna and of index finger finger
interosseous
membrane