PRESENTER:INAS ISMAIL

MODERATOR-DR.IMTHIAZ AHAMMED
CO-MODERATOR-DR SAVITH SHETTY
 Complex biaxial synovial joint that bridges
the hand to the forearm-ellipsoid variety
 Involves the proximal carpal bones –
scaphoid, lunate and triquetrum
 It also involves the distal end of the radius
and an articular disc which lies over the
ulna.
 The capsule is double layered.
 The fibrous outer layer attaches to the distal
ends of radius, ulna and the proximal row of
the carpal bones.
 The internal layer,comprised of synovial
membrane which extends up to the margins
of the articular surfaces.
- Chondroligamentous
supports attaching
distal radius and ulnar
side of carpus to distal
ulna
- located on the ulnar
aspect of the wrist joint
- Attaches to the base of
ulnar styloid,ulna head
and lunate fossa(ulnar
aspect)
 stabilizer of distal radio ulnar joint(DRUJ) and
ulnocarpal joints
 buttress to support proximal carpal row
 allows for transmission of a portion of axial
load from the carpus to the ulna
 EXTRINSIC-connect the carpus with the
forearm bones.
 They tend to be longer than the intrinsic
ligaments and are approximately one-third as
strong.
 INTRINSIC- attached to carpal bones .
 Stronger and shorter than extrinsic
ligaments.
EXTRINSIC PALMAR CARPAL LIGAMENTS
 Radioscaphocapitate ligament
 Long radiolunate ligament
 Short radiolunate ligamnet
 Radioscapholunate (ligament of Testut)
 Ulnolunate ligament
 Ulnotriquetral (ulnar collateral) ligament
 Ulnocapitate ligament
 Dorsal radiolunotriquetral ligament
 Attached to carpal bones
 Stronger and shorter than extrinsic ligaments
and are connected with the extrinsic ligament
complexes by interdigitating fibres.
 Proximal row interosseous ligaments
 Distal row interosseous ligaments
 Palmar midcarpal ligaments
 Dorsal midcarpal ligaments
 The distance between a line drawn from the
tip of radial styloid perpendicular to the long
axis of radius and a second perpendicular line
to the long axis of radius and tangential to
the most distal point of ulnar head
 NORMALLY 8-18mm
 Represents angle between one line
connecting the radial styloid tip and the ulnar
aspect of the distal radius and a second line
perpendicular to the longitudinal axis of the
radius.
 NORMAL 20-25 DEGREES
 Represents the angle between a line
connecting the most distal points of volar and
dorsal lips of radius and the line
perpendicular to the longitudinal axis of the
radius at the joint margin.
 AVERAGE – 11 DEGREES
 Ulnar variance
 The relative lengths of
the radius and ulna
are variable. The
difference between
the lengths of these
bones is called ulnar
variance.
 Normally it is about
1mm.
 The wrist joint receives blood from branches
of the dorsal and palmar carpal arches, which
are derived from the ulnar and radial arteries.
 Innervation to the wrist is delivered by
branches of three nerves:
–Median nerve – Anterior interosseous
branch.
–Radial nerve – Posterior interosseous
branch.
–Ulnar nerve – deep and dorsal branches.
R, radial artery; U, ulnar
artery;
1, palmar branch, anterior
interosseous artery; 2,
palmar radiocarpal arch; 3,
palmar intercarpal arch;
4,deep palmar arch; 5,
superficial palmar arch; 6,
radial recurrent
artery; 7, ulnar recurrent
artery; 8, medial branch,
ulnar artery;
9, branch off ulnar artery
contributing to dorsal
intercarpal arch.
(i) the tendon of
the palmaris
longus,
(ii)the palmar
cutaneous
branch of the
median nerve,
(iii)the palmar
cutaneous
branch of the
ulnar nerve
(iv) the ulnar
vessels, and
(v) the ulnar
nerve.
(i) the median nerve,
(ii)the tendons of the
flexor digitorum
superficialis,
(iii) the tendons of the
flexor digitorum
profundus
(iv) the tendons of the
flexor pollicis longus
(v) the ulnar bursa
(vi) the radial bursa.
 Flexion and extension occur along the
transverse axis, and abduction and adduction
occur along the anteroposterior axis.
 The movements at the wrist joint associated
with movements at the midcarpal joint
 The wrist and midcarpal joints together are
considered as link joint.
FLEXION
 PRIMARY -FLEXOR CARPI RADIALIS
-FLEXOR CARPI ULNARIS
-PALMARIS LONGUS
 SECONDARY -FLEXOR DIGITORUM
SUPERFICIALIS AND PROFUNDUS
- FLEXOR POLLICIS LONGUS
EXTENSION
 PRIMARY - EXTENSORS CARPI RADIALIS
LONGUS, BREVIS AND ULNARIS
 SECONDARY- EXTENSORS DIGITORUM, DIGITI
MINIMI, INDICIS AND POLLICIS LONGUS
ULNAR DEVIATION
Flexor carpi ulnaris and extensor carpi ulnaris

RADIAL DEVIATION
 PRIMARY- Flexor carpi radialis,
-extensors carpi radialis longus
-extensor carpi radialis brevis
 SECONDARY- abductor pollicis longus
-extensor pollicis brevis
Movement Range
Flexion 0-80°
Extension 0-80°
Abduction(radial 0-20°
deviation)
Adduction(ulnar 0-35°
deviation)
 The motion begins with wrist in full flexion.
 Active Extension is initiated at distal carpal row
and metacarpal by wrist extensors.
 Distal carpals glide on the relatively fixed
proximal row.
 Wrist attains neutral position
 Continued Extensor force moves distal carpal
rows and scaphoid as a unit on relatively fixed
lunate and triquetrum.
 At approximately 45 degree of hyper
extension the scapho-lunate interosseus
ligament brings scaphoid and lunate into
closed packed position thus uniting all the
carpal into one unit.
 Wrist extension is completed as proximal
articular surface of carpals move as a solid
unit on radius and radioulnar disc.
 All ligaments become taut & wrist complex
is closed packed in full extension.
 Wrist flexion from a position of full
extension occurs in reverse sequence
 Wrist position in sagittal plane (i.e. flexion or
extension) affects the radial/ulnar deviation
ROM
 Wrist in neutral – Max ROM of radial & ulnar
deviation.
 Wrist in full extension – Very little
radial/ulnar deviation possible.
 Wrist in full flexion- little Radial/Ulnar
deviation.
 During ulnar deviation - at radiocarpal joint-
schaphoid , lunate, & triquetrum role ulnarly
and slide radially.
 At mid carpal joint - capitate rolls ulnarly &
slides slightly radially.
 Full range of ulnar deviation causes the
triquetrum to contact articulating disc.
 Compresion of hamate against the triquetrum
pushes the proximal row of carpal bones
radially against radial styloid process
 During Radial deviation
 Movement at wrist occurs through similar
arthrokinematics as for ulnar deviation,
except the following differences.
 The amount of Radial deviation at the
Radiocarpal joint is limited as radial side of
carpus impinges against styloid process of
radius.
Therefore Radial deviation occurs at mid
carpal joint.
 Hamate and triquetrum separate by the end
of full radial deviation.
 CAMPBELL’S OPERATIVE
ORTHOPEDICS THIRTEENTH
EDITION
 GRAY’S ANATOMY
 BD CHAURASIA HUMAN ANATOMY
 ROCKWOOD AND GREENS’S
FRACTURES IN ADULTS