Wrist Joint and Carpal Osteology

1
WRIST JOINT
AND CARPAL
OSTEOLOGY
OJORA K. A
Objectives 2
 Osteology of hand
 Joints:
 Classification, movements
 Muscles
 Applied anatomy
Osteology 3
 Wrist is a joint complex consisting of radio-carpal joint and

many relationships between the carpal bones
 Review of carpals
 Proximal row = Pisiform, Triquetrum, Lunate, and Scaphoid*
 Distal row = Hamate, Capitate, Trapezoid, and Trapezium
 *Scaphoid has a notoriously poor blood supply and recovers poorly

following injury
Bones 4
 29 bones including:
 distal aspect of the radius and ulna
 8 carpal (bulk of the hand)
 14 phalanges (the fingers)
 5 metacarpals
 total: 2+8+14+5=29
 These small bones give flexibility to the wrist

5
Bones 6
 Radius and Ulna

 the radius is more massive distally than the ulna
 the ulna is more massive proximally than the radius
 Remember, forearm pronation and supination are the

result of the radius rotating about the ulna
Proximal carpals 7
 From lateral to medial
 Scaphoid (G. skaphé, skiff, boat): a boat-shaped bone; articulates proximally
with the radius; has a prominent scaphoid tubercle; the largest bone in the
proximal row of carpals.
 Lunate (L. luna, moon): a moon-shaped bone between the scaphoid and the
triquetral bones; it articulates proximally with the radius and is broader
anteriorly than posteriorly.
 Triquetrum (L. triquetrus, three-cornered): a pyramidal bone on the medial
side of the carpus; it articulates proximally with the articular disc of the distal
radio-ulnar joint.
 Pisiform (L. pisum, pea), a small, pea-shaped bone that lies on the palmar
surface of the triquetrum.
 The pisiform is a sesamoid bone in the tendon of flexor carpi ulnaris and
articulates with the anterior surface of the triquetrum.
Distal carpals 8
 From lateral to medial
 Trapezium (G. trapeze, table): a four-sided bone on the lateral side of the
carpus; it articulates with the 1st and 2nd metacarpals, scaphoid, and
trapezoid bones.
 Trapezoid: a wedge-shaped bone that resembles the trapezium; it articulates
with the 2nd metacarpal, trapezium, capitate, and scaphoid bones.
 Capitate (L. caput, head): a head-shaped bone with a rounded extremity and
the largest bone in the carpus; it articulates primarily with the 3rd metacarpal
distally and with the trapezoid, scaphoid, lunate, and hamate.
 Hamate (L. hamulus, a little hook): a wedge-shaped bone on the medial side
of the hand; it articulates with the 4th and 5th metacarpal, capitate, and
triquetral bones; it has a distinctive hooked process, the hook of the
hamate, that extends anteriorly.
9
Osteology 10
Fracture of Scaphoid 11
 The scaphoid is the most frequently fractured carpal bone.
 It often results from a fall on the palm when the hand is abducted, the fracture
occurring across the narrow part of the scaphoid.
 Initial radiographs of the wrist may not reveal a fracture; often this injury is
(mis)diagnosed as a severely sprained wrist.
 Radiographs taken 10–14 days later reveal a fracture because bone resorption
has occurred there.
 Owing to the poor blood supply to the proximal part of the scaphoid, union of
the fractured parts may take at least 3 months.
 Avascular necrosis of the proximal fragment of the scaphoid (pathological death
of bone resulting from inadequate blood supply) may occur and produce
degenerative joint disease of the wrist.
 In some cases, it is necessary to fuse the carpals surgically (arthrodesis).
12
13
Scaphoid 14
Wrist Joint 15
 Classification - a condyloid (ellipsoid) type of
synovial joint.
 Articulating bones-
 The distal end of the radius and the articular disc of
the distal radio-ulnar joint articulate with the
proximal row of carpal bones, except for the
pisiform.
 The latter bone acts primarily as a sesamoid bone,
increasing the leverage of the flexor carpi ulnaris
(FCU).
Wrist Joint 16
LIGAMENTS OF WRIST JOINT
 The fibrous layer of the joint capsule is strengthened by
 strong dorsal and palmar radiocarpal ligaments.
 The palmar radiocarpal ligaments pass from the radius to
the two rows of carpals.
 They are strong and directed so that the hand follows the
radius during supination of the forearm.
 The dorsal radiocarpal ligaments take the same direction
so that the hand follows the radius during pronation of the
forearm.
 The joint capsule is also strengthened medially by the
ulnar collateral ligament, which is attached to the ulnar
styloid process and triquetrum.
 The joint capsule is also strengthened laterally by the
radial collateral ligament, which is attached to the radial
styloid process and scaphoid.
Wrist Joint 17
 MOVEMENTS OF WRIST JOINT
 The movements are flexion–extension,
 abduction–adduction (radial deviation–
ulnar deviation), and circumduction.
 The hand can be flexed on the forearm
more than it can be extended.
 Adduction of the hand is greater than
abduction .
Wrist Joint 18
 MUSCLES MOVING WRIST JOINT
 Movement at the wrist is produced primarily by the “carpi”
muscles of the forearm, the tendons of which extend along the
four corners of the wrist.
 The FCU does so via the pisohamate ligament, a continuation
of the FCU tendon if the pisiform is considered a sesamoid bone
within the continuous tendon.
 Flexion is produced by the FCR and FCU, with assistance from
the flexors of the fingers and thumb, the palmaris longus and the
APL.
 Extension of the wrist joint is produced by the ECRL, ECRB,
and ECU, with assistance from the extensors of the fingers and
thumb.
 Abduction of the wrist joint is produced by the APL, FCR,
ECRL, and ECRB; it is limited to approximately 15° because of
the projecting radial styloid process.
 Adduction of the wrist joint is produced by simultaneous
contraction of the ECU and FCU.
Wrist Joint 19
 BLOOD SUPPLY OF WRIST JOINT
 The arteries supplying the wrist joint are branches of the
dorsal and palmar carpal arches .
 INNERVATION OF WRIST JOINT
 The nerves to the wrist joint are derived from the anterior
interosseous branch of the median nerve, the posterior
interosseous branch of the radial nerve, and the dorsal and
deep branches of the ulnar nerve.
Colles fracture, dinner fork 20
deformity
 A complete transverse fracture of the distal 2 cm of the radius, called a Colles fracture,
is the most common fracture of the forearm.
 The distal fragment is displaced dorsally and is often comminuted (broken into pieces).
 The fracture results from forced dorsiflexion of the hand, usually as the result of trying
to ease a fall by outstretching the upper limb.
 Often the ulnar styloid process is avulsed (broken off).
 Normally the radial styloid process projects farther distally than the ulnar styloid;
consequently, when a Colles fracture occurs, this relationship is reversed because of
shortening of the radius.
 This clinical condition is often referred to as a dinner fork deformity because a posterior
angulation occurs in the forearm just proximal to the wrist and the normal anterior
curvature of the relaxed hand.
 The posterior bending is produced by the posterior displacement and tilt of the distal
fragment of the radius.
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THE END

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1

 Wrist is a joint complex consisting of radio-carpal joint and

 Distal row = Hamate, Capitate, Trapezoid, and Trapezium

 *Scaphoid has a notoriously poor blood supply and recovers poorly

 These small bones give flexibility to the wrist

 Radius and Ulna

 the ulna is more massive proximally than the radius

 Remember, forearm pronation and supination are the

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