2 Forearm and Elbow Joint

The forearm extends from the elbow proximally to the wrist

distally and is composed of two bones, the radius laterally and COLOR each bone and note each bone’s labeled features:
the ulna medially. The radius is the shorter of the two bones. n 1. Radius
The region just anterior to the elbow is known as the cubital n 2. Ulna
fossa (a cubit is an ancient term for linear measurement and was
the length from the elbow to the tip of the middle finger) and is
a common site for venipuncture (access to a vein to withdraw The elbow joint is composed of the following joints, and its
blood or administer fluids). ­ligaments and features are summarized in the table below:
• Humero-ulnar: for flexion and extension, the ulnar trochlear
An interosseous membrane connects the radius and ulna and notch articulates with the trochlea of the humerus
is a type of fibrous joint. The movements of supination (palm • Humero-radial: for flexion and extension, the head of the radius
facing forward in anatomical position) and pronation (palm articulates with the capitulum of the humerus
facing backward) are unique movements of the wrist and • Proximal radio-ulnar: for supination and pronation, the radial
hand but occur exclusively in the forearm with the radius head articulates with the radial notch of the ulna
­crossing over the ulna (pronation) or back alongside the ulna
(supination) (see parts A-C).

LIGAMENT ATTACHMENT COMMENT

Humero-ulnar (Uniaxial Synovial Hinge [Ginglymus]) Joint
Capsule Surrounds joint Provides flexion and extension
Ulnar (medial) collateral Medial epicondyle of humerus to coronoid process Is triangular ligament with anterior, posterior,
and olecranon of ulna and oblique bands
Humeroradial Joint
Capsule Surrounds joint Capitulum of humerus to head of radius
Radial (lateral) collateral Lateral epicondyle of humerus to radial notch of ulna Is weaker than ulnar collateral ligament but
and anular ligament ­provides posterolateral stability
Proximal Radio-ulnar (Uniaxial Synovial Pivot) Joint
Anular ligament Surrounds radial head and radial notch of ulna Keeps radial head in radial notch; allows
­pronation and supination

COLOR the following key ligaments of the elbow joint (parts Clinical Note:
D-F ), using a different color for each ligament: Elbow dislocations are third in frequency after shoulder and
finger dislocations. Dislocation often occurs from a fall on an
n 3. Radial collateral ligament: on the lateral side of the
outstretched hand, and a dislocation in the posterior direction is
elbow
the most common type.
n 4. Anular ligament: surrounds the radial head in the
proximal radio-ulnar articulation
n 5. Ulnar collateral ligament: on the medial side of the
elbow

Plate 2-12 See Netter: Atlas of Human Anatomy, 6th Edition, Plates 422, 424, and 425. Skeletal System
 Forearm and Elbow Joint 2
A. Right radius and ulna B. Right radius and ulna
in supination: anterior view in pronation: anterior view

Olecranon Olecranon C. Opened joint: anterior view

Trochlear notch
Trochlear notch
Coronoid
process Coronoid
Head process
Neck Radial notch Humerus
of ulna Joint capsule (cut edge)
Radial
tuberosity
Ulna Fat pads
tuberosity
2
1 Synovial membrane

2 1
Articular cartilage

1
Humerus
Medial epicondyle
Capitulum
Trochlea
Head
D. In 90 flexion: medial view
Neck
Styloid Tuberosity
process
of ulna Radius
Interosseous
membrane
Styloid process
Ulna
Humerus
Tuberosity Coronoid process
Trochlear notch Olecranon

Humerus

Joint Joint
capsule capsule
Triceps
brachii 4 Biceps brachii tendon 1 4 Triceps
tendon brachii
Biceps brachii tendon tendon

3
5
2
E. In 90 flexion: lateral view F. In 90 flexion: medial view

Netter’s Anatomy Coloring Book Plate 2-12

2 Wrist and Hand

The wrist and hand are composed of the following 29 bones: The carpal bones are not aligned in a flat plane but form an arch,
• 8 carpal (wrist) bones, arranged in proximal and distal rows of the carpal arch, with its concave aspect facing anteriorly. Ten-
4 bones each dons from forearm muscles, vessels, and nerves pass through
• 5 metacarpals, which span the palm of the hand or across this arch to gain access to the hand. A tight band of
• 14 phalanges, 2 for the thumb (1st digit) and 3 each for the connective tissue, the flexor retinaculum, spans the carpal arch
remaining 4 digits forming a “carpal tunnel” for the structures passing through this
• 2 sesamoid bones, situated at the distal end of the thumb archway.
metacarpal

These bones and their features are summarized in the table COLOR the following bones of the wrist and hand, using
below. different colors for each carpal bone, a uniform color for the
metacarpals, another uniform color for all the phalanges of the
digits, and a new color for the sesamoid bones:

FEATURE CHARACTERISTICS
n 1. Scaphoid: some clinicians refer to this bone as the
navicular (“little ship”)
Proximal Row of Carpals
Scaphoid (boat shaped) Lies beneath anatomical snuffbox
n 2. Trapezium

Lunate (moon or crescent shaped) Is most commonly fractured

n 3. Trapezoid
carpal n 4. Lunate
Triquetrum (triangular) All three bones (scaphoid, lunate, n 5. Triquetrum
triquetrum) articulate with distal
radius n 6. Pisiform
Pisiform (pea shaped) n 7. Hamate
Distal Row of Carpals n 8. Capitate
Trapezium (four sided) Distal row articulates with n 9. Metacarpals
­ roximal row of carpals and
p
with metacarpals 1-5 n 10. Phalanges of each digit
Trapezoid n 11. Sesamoid bones (two at the distal end of the thumb
Capitate (round bone)
metacarpal)

Hamate (hooked bone)

Metacarpals
Numbered 1-5 Possess a base, shaft, and head
(thumb to little finger) Are triangular in cross section
Fifth metacarpal most commonly
fractured
Two sesamoid bones Are associated with head of first
metacarpal
Phalanges
Three for each digit except thumb Possess a base, shaft, and head
Termed proximal, middle, and
distal
Distal phalanx of middle finger
commonly fractured

Plate 2-13 See Netter: Atlas of Human Anatomy, 6th Edition, Plates 439 and 443. Skeletal System
 Wrist and Hand 2

Ulna
Ulna
Radius
Radius

4
4
1 5
5
6
1
2 7 7
2
3 8 8
3

A. Anterior (palmar) view B. Posterior (dorsal) view

1
6
2 8

11
10

C. Anterior (palmar) view

Netter’s Anatomy Coloring Book Plate 2-13

2 Wrist and Finger Joints and Movements

The classification and ligaments of the wrist and finger joints are
summarized in the following table. The wrist joint is a radiocarpal COLOR the following major ligaments, using a different
(biaxial synovial ellipsoid) joint between the distal radius of the color for each ligament:
forearm and the scaphoid, lunate and triquetrum carpals, and n 1. Palmar radiocarpal ligaments
the articular disc at the distal ulna. On the facing page, note the n 2. Dorsal radiocarpal ligament
finger movements associated with these joints.
n 3. Articular disc of the wrist joint
n 4. Capsule of a metacarpophalangeal joint
n 5. Capsule of a proximal interphalangeal joint
n 6. Capsule of a distal interphalangeal joint
n 7. Collateral ligament of a metacarpophalangeal joint
n 8. Palmar ligament (plate)

LIGAMENT ATTACHMENT COMMENT

Radiocarpal (Biaxial Synovial Ellipsoid) Joint
Capsule and disc Surrounds joint; radius to scaphoid, lunate, Provides little support; allows flexion, extension, abduction,
and triquetrum ­adduction, circumduction
Palmar (volar) radiocarpal ligaments Radius to scaphoid, lunate, and triquetrum Are strong and stabilizing
Dorsal radiocarpal Radius to scaphoid, lunate, and triquetrum Is weaker ligament
Radial collateral Radius to scaphoid and triquetrum Stabilizes proximal row of carpals
Distal Radiocarpal (Uniaxial Synovial Pivot) Joint
Capsule Surrounds joint; ulnar head to ulnar notch of radius Is thin superiorly; allows pronation, supination
Palmar and dorsal radio-ulnar Extends transversely between the two bones Articular disc binds bones together
Intercarpal (Synovial Plane) Joints
Proximal row of carpals Adjacent carpals Permits gliding and sliding movements
Distal row of carpals Adjacent carpals Are united by anterior, posterior, and interosseous ligaments
Midcarpal (Synovial Plane) Joints
Palmar (volar) intercarpal Proximal and distal rows of carpals Is location for one third of wrist extension and two thirds of
flexion; permits gliding and sliding movements
Carpal collaterals Scaphoid, lunate, and triquetrum to capitate Stabilize distal row (ellipsoid synovial joint)
and hamate
Carpometacarpal (CMC) (Plane Synovial) Joints (Except Thumb)
Capsule Carpals to metacarpals of digits 2-5 Surrounds joints; allows some gliding movement
Palmar and dorsal CMC Carpals to metacarpals of digits 2-5 Dorsal ligament strongest
Interosseous CMC Carpals to metacarpals of digits 2-5
Thumb (Biaxial Saddle) Joint
Same ligaments as CMC Trapezium to first metacarpal Allows flexion, extension, abduction, adduction, circumduction
Is common site for arthritis
Metacarpophalangeal (Biaxial Condyloid Synovial) Joint
Capsule Metacarpal to proximal phalanx Surrounds joint; allows flexion, extension, ­abduction, adduction,
circumduction
Radial and ulnar collaterals Metacarpal to proximal phalanx Are tight in flexion and loose in extension
Palmar (volar) plate Metacarpal to proximal phalanx If broken digit, cast in flexion or ligament will shorten during
healing
Interphalangeal (Uniaxial Synovial Hinge) Joints
Capsule Adjacent phalanges Surrounds joints; allows flexion and extension
Two collaterals Adjacent phalanges Are oriented obliquely
Palmar (volar) plate Adjacent phalanges Prevents hyperextension

Plate 2-14 See Netter: Atlas of Human Anatomy, 6th Edition, Plates 441, 442, and 445. Skeletal System
 Wrist and Finger Joints and Movements 2
Radius Ulna Ulna Radius Ulna
Radius
Interosseous Dorsal 3
membrane radio-ulnar Lunate
ligament Scaphoid
Palmar Triquetrum Scaphoid
radioulnar Ulnar
1
ligament collateral Radial
Lunate ligament collateral
Radial ligament
collateral Hamate
ligament Hook of 2
hamate Trapezium
Hamate
Palmar
Capitate metacarpal Capitate
ligaments
Dorsal carpometacarpal ligaments Trapezium
Trapezoid
A. Flexor retinaculum removed: palmar view B. Posterior (dorsal) view C. Coronal section: dorsal view

4
Metacarpal bone Dorsal surface 5 6
Deep transverse
metacarpal ligaments
Palmar surface
Proximal Middle Distal
E. In extension: medial view 7
Phalanges

8
F. In flexion: medial view

Joint capsule
D. Anterior (palmar view)

Adduction Extension
Reposition

Flexion
Abduction
G. Thumb movements
Opposition

Netter’s Anatomy Coloring Book Plate 2-14