HAND, WRIST, & THUMB ANATOMY AND FUNCTION

IN THE CONTEXT OF SPLINTING

Reading Assignen!" Pages 35-56 Coppard & Lohman, 2001
Pages 530-540 Pedretti & Early, 2001
When immoili!ing a hand in a splint, it is "ery important to maintain the ar#hes o$ the
hand%
Longit&dinal
'istal
Pro(imal
)aintaining the ar#hes and positioning the hand in the $&n#tional position pro"ides the
est alan#e o$ resting length and $or#e prod&#tion so the hand #an $&n#tion *hen the
person mo"es it again%
Coordinated th&m, *rist, and $inger mo"ements enale the $ollo*ing grasp and
prehensile patterns+
,ip to ,ip
Palmar
Lateral Pin#h
Cylindri#al
-pheri#al
.oo/
0ntrinsi# pl&s
,he role o$ the e(tensor me#hanism and intrinsi# hand m&s#les d&ring 1inger E(tension
What happens *hen the lateral ands shi$t2
Boutonniere
Swan Neck
Mallet
E$$e#ts o$ ner"e in3&ries on the hand
Simian Hand
Claw Hand
Wrist Drop
Re#e$en%es"
Coppared, 4%)%, & Lohman, .% 520016% Introduction to splinting: A critical-reasoning
and problem soling approac! 52
nd
ed%6% -t% Lo&is, )7+ )osy%
.ertling, '%, & 8essler, 9% )% 51::66% Management o" common musculoskeletal
disorders: #!$sical t!erap$ principles and met!ods% 53rd ed%6%Philadelphia+ ;%4%
Lippin#ott%
<or/in, C%C%, & Le"angie, P%8% 51::26% %oint structure and "unction& 52nd ed%6%
Philadelphia+ 1%=% 'a"is%
Pedretti, L% )%% & Early, )%4% 5Eds%6% 520016% 'ccupational t!erap$ practice skills "or
p!$sical d$s"unction 55th ed%6% -t% Lo&is, )7+ )osy%
-mith, L%8%, Weiss, E%L% & Lehm/&hl, L%'% 51::66% Brunnstrom(s clinical kinesiolog$%
55th ed%6% Philadelphia+ 1%=% 'a"is%

Bi&e%'ani%s &# !'e 'and
G(enda S'a$) OTR and Da*e T'&)s&n PT

-ome iologists elie"e that the de"elopment o$ the h&man hand a##orded an ad"antage
to the de"elopment o$ a large and #omple( rain%
,he hand>s "ery e(isten#e potentiated rain de"elopment y allo*ing h&mans to
manip&late, intera#t *ith, e(plore, and gain in$ormation $rom their en"ironment%
'e"elopment o$ a more #omple( rain permitted &s in t&rn to ma/e and &se tools and to
de"elop lang&age, *hi#h in t&rn led to the gro*th o$ an elaorate system o$ shared
meanings, *hat *e /no* as #&lt&re%
O+!,ine

,ypes o$ grasp
=r#hes o$ the hand
1&n#tional position o$ the hand
;oints o$ the hand
)e#hanism $or $inger $le(ion
)e#hanism $or $inger e(tension? the e(tensor me#hanism
)&s#les that transmit $or#e to the e(tensor me#hanism
.o* does the e(tensor me#hanism *or/2
Clini#al appearan#e o$ peripheral ner"e in3&ries in the hand
0nternet lin/s related to the hand
,ypes o$ grasp
,*o types o$ grasp are di$$erentiated 5-mith, Weiss, & Lehm/&hl, 1::5, pp% 216-21:?
.ertling & 8essler, 1::6, pp%25:-2606 a##ording to the position and moility o$ the
th&m>s C)C and )P 3oints%
1% P7WE9 grasp 5,he terms grasp, grip, and prehension are inter#hangeale%6
5,he add&#tor polli#is staili!es an o3e#t against the palm? the hand>s position is
stati#%6

#ylindri#al grip 5$ist grasp is a small diameter #ylindri#al grasp6
spheri#al grip
hoo/ grip 5)P e(tended *ith $lattening o$ trans"erse ar#h? the person may or may
in#l&de the th&m in this grasp6
lateral prehension 5this #an e a po*er grip i$ the th&m is add&#ted, a pre#ision grip
i$ the th&m is ad&#ted6%

2% P9EC0-07<
5)&s#les are a#ti"e that ad&#t or oppose the th&m? the hand>s position is
dynami#%6

palmar prehension 5p&lp to p&lp6, in#l&des >#h&#/> or tripod grips
tip-to-tip 5*ith 1'P a#ti"e to maintain '0P $le(6
lateral prehension 5pad-to-side? /ey grip6
T'$ee a$%'es -a,an%e
s!a-i,i!. and &-i,i!. in
!'e 'and/
T'e )$&0ia, !$ans*e$se
a$%' is $igid, -+! !'e &!'e$
!(& a$%'es a$e #,e0i-,e, and
a$e ain!ained -. a%!i*i!.
in !'e 'and1s in!$insi%
+s%,es/

1. P97@0)=L ,9=<-AE9-E =9C.
He$!,ing and 2ess,e$ 3)/ 4567 des%$i-e !'is a$%' as a %&)&si!e &# !(&
a$%'es, !'e )$&0ia, and dis!a, %a$)a, a$%'es/7

a stale ony ar#h that $orms the posterior order o$ the #arpal t&nnel%

,he ar#h>s integrity is maintained y a so$t tiss&e Bstr&tB $ormed y the $le(or
retina#&l&m or trans"erse #arpal ligament 5also #alled the "olar #arpal ligament6% ,his
ligamento&s str&t #onne#ts the s#aphoid and trape!i&m on the ar#h>s radial side *ith
the hamate on its &lnar side, and $orms the anterior order o$ the #arpal t&nnel%

2. '0-,=L ,9=<-AE9-E =9C.

He$!,ing and 2ess,e$ 3)/ 4567 %a,, !'is !'e e!a%a$)a, a$%', -e%a+se i! is
#&$ed -. !'e e!a%a$)a, 'eads8 e!a%a$)a,s 4 and 9 a$e s!a-,e ('i,e :
and 5 a$e $e,a!i*e,. &-i,e/ Y&+ %an &-se$*e !'e a$%'1s %&-ina!i&n &#
;$adia,; s!a-i,i!. and ;+,na$; &-i,i!. -. ,&&se,. %,&sing .&+$ #is!, !'en
s<+ee=ing &$e !ig'!,., ('en .&+ (i,, &-se$*e &*een! in !'e &$e
&-i,e #&+$!' and #i#!' e!a%a$)a,s/

3. L7<C0,D'0<=L =9C.
7ser"e this ar#h>s eha"ior as yo& loosely #lose yo&r $ist% ,ighten the $ist and
*at#h the $o&rth and $i$th meta#arpals%
,he ar#hes pro"ide a alan#e et*een staility and moility $or grasping% 1or instan#e,
*e prod&#e the so-#alled B#h&#/ graspB y &sing the more stale se#ond and third
meta#arpals, instead o$ the more moile $o&rth and $i$th meta#arpals%
,herape&ti# splints m&st s&pport these three ar#hes%
F+n%!i&na, )&si!i&n &# !'e 'and
3N&$>in & Le*angie, ?@@4, )/ 4@A8 He$!,ing & 2ess,e$, ?@@A, )/ 4AB7

Wrist
e(tended 20 degrees
&lnarly de"iated 10 degrees

'igits 2 thro&gh 5
)P 3oints $le(ed 45degrees
P0P 3oints $le(ed 30-45 degrees
'0P 3oints $le(ed 10-20 degrees

,h&m
$irst C)C 3oint partially ad&#ted and
opposed
)P 3oint $le(ed 10 degrees
0P 3oint $le(ed 5 degrees
C&)a$e !'is #ig+$e (i!' !'e &ne
in He$!,ing and 2ess,e$ 3?@@A,
Fig/??C457/
When therapists immoili!e a patient>s hand, they o$ten position it this *ay% '&ring a
period o$ immoili!ation, the resting lengths o$ the hand>s ligaments and m&s#les
#hange% ,his hand position pro"ides the est alan#e o$ resting length and $or#e
prod&#tion so the hand #an $&n#tion *hen the patient moili!es it again%
D&in!s &# !'e 'and
DOINT STRUCTURE AXIS MOTION
CLOSEC
PAC2ED
POSITION
Me!a%a$)&C
)'a,angea, 3MP7
-ia0ia,
3%&nd.,a$7
,a!e$a,
ACP
#,e0i&nEe0!ensi&n
a-d+%!i&nEadd+%!i&n
#i$s!" e0!ensi&n
4ndC5!'"
#,e0i&n
P$&0ia,
In!e$)'a,angea,
3PIP7
+nia0ia, ,a!e$a, #,e0i&nEe0!ensi&n E0!ensiFn
Dis!a,
In!e$)'a,angea,
3DIP7
+nia0ia, ,a!e$a, #,e0i&nEe0!ensi&n E0!ensiFn

)eta#arpophalangeal 5)P6

#ondyloid, ia(ial 3oints
3oint>s palmar aspe#t is palpale at le"el o$ distal palmar #rease
pro(imal 3oint s&r$a#e is #on"e( and distal s&r$a#e is #on#a"e
roll and glide o##&r in same dire#tion
anterior *ith $le(ion
posterior *ith e(tension%
large meta#arpal 3oint s&r$a#e
a $iro#artilagino&s "olar plate is lined *ith hyaline #artilage so that it a&gments or
enlarges the pro(imal phalan(> relati"ely small arti#&lar s&r$a#e%
s&per$i#ial to "olar plate is the trans"erse meta#arpal ligament
3oint #aps&le s&pported y t*o #ollateral ligaments
#lose-pa#/ed position+
)P 3oints o$ digits 2 thro&gh 5+ #lose-pa#/ed in $le(ion? yo& #annot ad&#t or
add&#t these 3oints *hen they are $le(ed%
)P 3oint o$ th&m+ #lose-pa#/ed in e(tension
0nterphalangeal 50P6
&nia(ial hinge 3oints
s&pported y t*o #ollateral ligaments, and y smaller "ersions o$ a "olar plate%
Li/e )P 3oint, pro(imal 3oint s&r$a#e is #on"e( and distal s&r$a#e is #on#a"e
roll and glide o##&r in same dire#tion
anterior *ith $le(ion
posterior *ith e(tension
#lose-pa#/ed in e(tension
Me%'anis #&$ #inge$ #,e0i&n

1'P+ $le(or digitor&m pro$&nd&s 5the deeper o$ the t*o6
1'-+ $le(or digitor&m s&per$i#ialis 5the more s&per$i#ial m&s#le6
=ltho&gh the 1'P is deep to the 1'- o"er most o$ its #o&rse, it atta#hes to the s/eleton
more distally, e#a&se it passes thro&gh a >split> in the 1'- tendon%
Me%'anis #&$ #inge$ e0!ensi&n

We #an e(tend the P0P and '0P 3oints *itho&t also e(tending the )P 3oints%
4&t *e #an>t e(tend the P0P 3oint *itho&t e(tending the '0P 3oint at the same time%
1le(ing only the '0P 3oint *itho&t also $le(ing the P0P 3oint is di$$i#&lt%
1&ll 5a#ti"e or passi"e6 $le(ion o$ the P0P 3oint pre"ents a#ti"e e(tension o$ the '0P
3oint%
We #an &nderstand these $inding y learning the str&#t&re o$ the E@,E<-79
)EC.=<0-), also /no*n as the+

e(tensor e(pansion
e(tensor assemly
e(tensor apparat&s

dorsal apone&rosis
apone&roti# slee"e

T'e e0!ens&$ e%'anis is an e,a-&$a!i&n &# !'e e0!ens&$ digi!&$+ %&+nis
3EDC7 !end&n &n !'e d&$s+ &# ea%' )'a,an0/ T'e e0!ens&$ indi%is 3EI7 and !'e
e0!ens&$ digi!i inii 3EDM7 inse$! in!& !'e e0!ens&$ e%'aniss &# !'e se%&nd
and #i#!' digi!s, $es)e%!i*e,./
Se*e$a, !endin&+s s!$+%!+$es %&)$ise !'e e0!ens&$ e%'anis"

1. ,he )DC tendon atta#hes y
a tendino&s slip to the
pro(imal phalan(, thro&gh
*hi#h it e(tends the )P
3oint%

2. ,he central tendon 5or BslipB6
pro#eeds dorsally to atta#h to
ase o$ middle phalan(,
*here tension #an e(tend the
P0P 3oint%
9/ !'e lateral bands )$&%eed &n ei!'e$ side
&# d&$sa, id,ine and $eG&in -e#&$e
a!!a%'ing !& !'e dis!a, )'a,an0/ Tensi&n in
!'e ,a!e$a, -ands e0!ends !'e DIP G&in!/
:/ !'e extensor hood s+$$&+nds !'e
MP G&in! ,a!e$a,,., edia,,., and
d&$sa,,., and $e%ei*es !endin&+s
#i-e$s #$& !'e ,+-$i%a,es and
in!e$&ssei/
5/ Fi-e$s &# !'e oblique retinacular ligament 3ORL7 a!!a%' a! !'e sides &# !'e
)$&0ia, )'a,an0 and digi!a, !end&n s'ea!'s, and )$&%eed !& dis!a, )&$!i&n &#
,a!e$a, -ands/ T'+s, !'e ORL1s ,ine &# a)),i%a!i&n is *&,a$ !& !'e PIP G&in!1s ,a!e$a,
a0is and d&$sa, !& !'e DIP G&in!1s ,a!e$a, a0is/
PIP e0!ensi&n 3)$&d+%ed -. &!'e$ !iss+es in
!'e e0!ens&$ e%'anis7 e,&nga!es !'e
ORL, %$ea!ing )assi*e !ensi&n !'a! e0!ends
!'e DIP/ T'e DIP e0!ensi&n 'e,)s &)en !'e
'and/
DIP #,e0i&n 3)$&d+%ed -. !'e FDP7
e,&nga!es !'e ORL, %$ea!ing )assi*e
!ensi&n !'a! #,e0es !'e PIP/ T'e PIP
#,e0i&n assis!s in #inge$ %,&s+$e/
M&$e *ie(s &# !'e e0!ens&$ e%'anis, ada)!ed #$& Si!', Weiss, & Le'>+',
3?@@A, Fig/ AC?47"

lateral "ie* *ith )P 3oint $le(ed
lateral "ie* *ith )P 3oint e(tended
dorsal "ie*
M+s%,es !'a! !$ansi! #&$%e !& !'e &!'e$(ise n&nC%&n!$a%!i,e e0!ens&$
e%'anis"


1. 'orsal interossei 5'06
,he dorsal interossei atta#h pro(imally et*een ad3a#ent meta#arpals%

,hey atta#h distally either to one 5pro(imal phalan(6 or to so$t tiss&e 5e(tensor
me#hanism6%
Appl$ resistance as $ou attempt to abduct t!e second and "ourt! M# *oints& Abduction
is stronger at t!e second M# *oint because t!e most o" t!e "irst DI(s muscle "ibers
attac! directl$ to t!e second pro+imal p!alan+& Abduction o" t!e "ourt! M# *oint is
relatiel$ weak because t!e "ourt! DI attac!es largel$ to t!e e+tensor mec!anism
itsel"&

,he dorsal interossei prod&#e )P ad&#tion and, in #ertain instan#es, )P $le(ion%
4e#a&se they atta#h to the e(tensor me#hanism, they also prod&#e P0P and '0P
e(tension%
2. Palmar interossei 5P06+

1o&r palmar interossei 5anatomists o$ten in#l&de the &lnar head o$ $le(or polli#is
re"is in this gro&p6 atta#h pro(imally to a meta#arpal, and distally to the same digit>s
pro(imal phalan( andEor its e(tensor me#hanism%

,hey prod&#e )P add&#tion and, in #ertain instan#es, )P $le(ion% ,hey also prod&#e
P0P and '0P e(tension *hen they introd&#e tension into the e(tensor me#hanism%

3. L&mri#ales+

,he $o&r l&mri#ales atta#h pro(imally to the tendons o$ the $le(or digitor&m
pro$&nd&s, and distally to the e(tensor me#hanism on its radial side at the le"el o$ the
lateral ands% ,he m&s#les pass on the "olar side o$ the trans"erse meta#arpal
ligament%

0$ they a#t alone, they prod&#e )P $le(ion% ,hey also prod&#e P0P and '0P e(tension
*hen they introd&#e tension into the e(tensor me#hanism%

,he l&mri#ales permit a dynami# intera#tion et*een $le(ors and e(tensors% ,heir
atta#hments transmit their $or#e to oth the 1'P tendon and the e(tensor me#hanism%
-pe#i$i#ally, l&mri#al a#ti"ity+
1. in#reases passi"e tension in the e(tensor me#hanism%
2. de#reases passi"e tension in 1'P tendon>s distal portion%

Palpate the l&mri#als on yo&rsel$
H&( d&es !'e e0!ens&$ e%'anis (&$>H
A,!'&+g' !'e e0!ens&$ e%'anis1s #i-e$s a$e !endin&+s, and !'e$e#&$e in%a)a-,e
&# )$&d+%ing a%!i*e #&$%e, !'e. s!i,, !$ansi! #&$%e !& !'ei$ a!!a%'en!s/
1or#e de"elops in the e(tensor me#hanism in t*o *ays+
1. )any o$ the hand>s intrinsi# m&s#les atta#h to the e(tensor me#hanism% =#ti"ity
in any o$ these m&s#les prod&#es $or#e that the e(tensor me#hanism
#omm&ni#ates to its distal atta#hments%

2. ,he e(tensor me#hanism de"elops passi"e tension *hene"er it is elongated%
.and mo"ements that passi"ely elongate either the e(tensor me#hanism or a
str&#t&re that atta#hes to the e(tensor me#hanism prod&#e $or#e in the e(tensor
me#hanism itsel$%
,he e(tensor me#hanism>s $iers ha"e lines o$ appli#ation that are al*ays dorsal to the
lateral a(es o$ the P0P and '0P 3oints% ,here$ore,
1. a#ti"ity in the intrinsi# m&s#les that atta#h to the e(tensor me#hanism al*ays
prod&#es '0P and P0P e(tension%

2. Passi"e $le(ion o$ the )P 3oint 5try it yo&rsel$F6 elongates the e(tensor
me#hanism and e(tends the P0P and '0P 3oints%
,he $iro&s lines o$ appli#ation in the hood and lateral ands pass "ery near the )P
3oint>s lateral a(is% Whether these str&#t&res mo"e the )P 3oint in the sagittal plane
depends on *hether the )P 3oint is already $le(ed or e(tended%

1. in )P $le(ion+
)P $le(ion o##&rs *hen a#ti"ity in the 1'- or 1'P $le(es the )P 3oint%

,he e(tensor me#hanism is not >stret#hy%> When the digits $le( 5at the )P, P0P, or '0P
3oints6, passi"e tension in the lateral ands and #entral slip p&ll the hood distally%

When the )P 3oint is already $le(ed, the lines o$ appli#ation o$ the interossei $all on
"olar side o$ the )P 3oint, and so prod&#e )P $le(ion%

,he distal shi$t in the e(tensor hood also in#reases the l&mri#ales> moment arm so
they #an prod&#e a greater $le(or moment at the )P 3oint% .o*e"er, yo&r te(t
des#ries E)C st&dies *hi#h sho* G&ite #onsistently that the l&mri#ales do not a#t
at the same time as the 1'PF ,he l&mri#ales> $&n#tion e"idently does not in#l&de
#los&re o$ the hand%
2.
3. in )P e(tension+

=#tion in the e(tensor digitor&m e(tends the )P 3oint, and also p&lls the e(tensor
me#hanism 5in#l&ding the hood6 pro(imally%

0n this position, the interosseo&s m&s#les> lines o$ appli#ation are "ery #lose to the )P
3oint>s lateral a(is%

With s&#h small moment arms, these m&s#les ha"e little e$$e#t on )P 3oint mo"ement
in the sagittal plane% .o*e"er, they still prod&#e )P ad&#tionEadd&#tion *hen the
)P 3oint is e(tended%
CLINICAL APPEARANCE OF PERIPHERAL NERIE INDURIES IN
THE HAND
1% )edian+

7$ten d&e to #arpal t&nnel sd%
Wasting o$ thenar eminen#e
'e#reased th&m $&n#tion, espe#ially opposition%
,h&m mo"es into plane o$ palm%

2% Dlnar+

'amage to &lnar ner"e #an o##&r *ith tra&ma to elo* region% Dlnar ne&ropathy is a
$reG&ent #ompli#ation o$ diaetes mellit&s

Wasting o$ *e spa#e and interosseo&s spa#es%

=$$e#ts strength o$ intrinsi# m&s#les o$ hand, so person #an>t hold a pie#e o$ paper
et*een e(tended &t add&#ted $ingers

=$$e#ts add&#tor polli#is and &lnar head o$ 1P4% = person *ho la#/s strength in these
m&s#les #annot grasp *ith the th&m &nless he or she $le(es the 0P 3oint y
s&stit&ting *ith the $le(or polli#is long&s%

3% 9adial+

=sso#iated *ith g&nshot or sta *o&nds, $ra#t&re o$ h&mer&s, B-at&rday night palsy%B

person demonstrates a Bdropped *rist,B and #annot reposition th&m%

la#/ o$ *rist e(tension may #a&se hand grip to e *ea/%
Re#e$en%es"
He$!,ing, D/, & 2ess,e$, R/ M/ 3?@@A7/ Management of common musculoskeletal
disorders: Physical therapy principles and methods/ 39$d ed/7/P'i,ade,)'ia" D/B/
Li))in%&!!/
<or/in, C%C%, & Le"angie, P%8% 51::26% %oint structure and "unction& 52nd ed%6%
Philadelphia+ 1%=% 'a"is%
-mith, L%8%, Weiss, E%L% & Lehm/&hl, L%'% 51::66% Brunnstrom(s clinical kinesiolog$%
55th ed%6% Philadelphia+ 1%=% 'a"is%
WRIST DOINT COMPLEX

=(es and motions
9e"ie*+ 4ones o$ the *rist
=rthro/inemati#s
)&s#les that mo"e the *rist
E(amples o$ m&s#le synergies in *rist $&n#tion
Carpal t&nnel
A0es and &!i&ns
D&in! A0is M&!i&n
C,&seC
)a%>ed
)&si!i&n
W$is!
radio-#arpal
mid-#arpal
,a!e$a,
#,e0i&n E
e0!ensi&n
e0!ensi&n
ACP
+,na$ and
$adia,
de*ia!i&n
E*en !'&+g' #,e0i&n and e0!ensi&n &%%+$ a! -&!' &# !'e ($is!1s a$!i%+,a!i&ns,
M&s! ($is! e0!ensi&n &%%+$s a$&+nd !'e
id%a$)a, G&in!1s ,a!e$a, a0is/
M&s! ($is! #,e0i&n &%%+$s a$&+nd !'e
$adi&%a$)a, G&in!1s ,a!e$a, a0is/
U,na$ and $adia, de*ia!i&n &%%+$ a$&+nd an
a0is !'a! )asses !'$&+g' !'e %a)i!a!e/
T(& ($is! %$eases &n !'e 'and1s )a,a$ 3&$ *&,a$7 s+$#a%e a$e ,anda$>s #&$ !'e
,&%a!i&ns &# !'e $adi&%a$)a, and id%a$)a, G&in!s/
Re*ie(" B&nes &# !'e ($is!
#$& C'a$,es Ea!&n MD, 'and s+$ge$. )ages/
W$is! a$!'$&>inea!i%s
In &)en %'ain &*een!, !'e %&n*e0 s+$#a%es &# !'e s%a)'&id and ,+na!e &*e &n
!'e %&n%a*e s+$#a%es &# !'e $adi+s and +,na/
d+$ing #,e0i&n"
s#aphoidEl&nate roll anteriorly 5to*ard
palm6 and glide posteriorly5to*ard
dors&m6
d+$ing e0!ensi&n"
s#aphoidEl&nate roll posteriorly5to*ard
dors&m6 and glide anteriorly5to*ard
palm6%
D+$ing +,na$ de*ia!i&n"
s#aphoidEl&nate roll to*ard &lna and glide to*ard radi&s%
D+$ing $adia, de*ia!i&n"
s#aphoidEl&nate roll to*ard radi&s and glide to*ard &lna%
M+s%,es !'a! &*e !'e ($is!
T& )$edi%! a +s%,e1s a%!i&n, .&+ +s! >n&("

the 3oint5s6 that the m&s#le #rosses
the a(isEa(es o$ ea#h o$ those 3oints
the m&s#le>s line o$ appli#ation 5L7=6 lo#al to ea#h o$ the a(es%

E(tensors ha"e L7= dorsalEposterior to *rist>s lateral a(is%

1le(ors ha"e L7= "entralEanterior to *rist>s lateral a(is%

9adial de"iators ha"e L7= on the radial side o$ the *rist>s =P a(is%

Dlnar de"iators ha"e L7= on the &lnar side o$ the *rist>s =P a(is%
list o$ *rist and hand m&s#les
E0a),es &# +s%,e s.ne$gies in ($is! #+n%!i&n

I. palpate the EC9L as yo& ma/e a $ist or $irmly grasp an o3e#t+

role o$ the 1'P+
the only m&s#le that $le(es the '0P 3oints% =lso $le(es the P0P, )P, and *rist%

role o$ the 1'-+
$le(es the )P and P0P 3oints? &sed $or more $or#e$&l grasp

role o$ *rist e(tensors 5EC94, EC9L, ECD6+
maintain appropriate length and tension 5$or#e6 in $inger $le(ors so they #an prod&#e
strong grip%

II. 7pen yo&r $ingers $or#e$&lly and oser"e that the *rist $le(es a&tomati#ally%

role o$ the e(tensor digitor&m+
the only m&s#le that #an open the $ingers? also e(tends the *rist%

role o$ the *rist $le(ors+
maintain appropriate length and tension in $inger e(tensors they #an $or#e$&lly open
the hand

III. Palpate the ECD as yo& G&i#/ly mo"e the th&m a*ay $rom the se#ond digit%
Why is the ECD a#ti"e d&ring this mane&"er2

aplEep mo"e th&m &t also radially de"iate *rist?
e#& a#ts as tr&e synergist%

IV. Carpal m&s#les a#t in helping synergies to prod&#e+
*rist $le(ion+
*rist e(tension+
&lnar de"iation+
radial de"iation+
Ca$)a, !+nne,"

T'e ;s!$+!; !'a! ain!ains
!'e !+nne,1s s'a)e is !'e #,e0&$
$e!ina%+,+, a,s& %a,,ed !'e
!$ans*e$se %a$)a, ,igaen! &$
!'e *&,a$ %a$)a, ,igaen!/
T'is ,igaen! %&nne%!s !'e
s%a)'&id and !$a)e=i+ &n
!'e 'and1s $adia, side (i!' !'e
'aa!e &n !'e +,na$ side/
T'e 9CD iage is &di#ied
#$& C'a$,es Ea!&n MD
,he #arpal t&nnel #ontains 5$rom radial to &lnar side6+
1C9 tendon
1PL tendon
median nn%
tendons o$ 1'- and 1'P
also #ontains "as#&lar str&#t&res
9epetiti"e motion #an prod&#e a tenosyno"itis in the tendon sheaths o$ the long $le(or
m&s#les% ,his, in t&rn, #an in#rease hydrostati# press&re in the t&nnel, #a&sing
#ompression damage to median ner"e% BCarpal t&nnel syndrome>sB impairments in#l&de
pain and paresthesia in the distri&tion o$ the median ner"e% ,hey also in#l&de *ea/ness
o$ m&s#les inner"ated y the median ner"e, the thenar m&s#les, and the $irst and se#ond
l&mri#ales%
,he t&nnel>s #ontents are also prone to #ompression in3&ry d&e to tra&ma, #ongenital
stenosis, a#romegaly, or hormonal #hanges%

1&rther dis#&ssion o$ #arpal t&nnel syndrome $rom a Charles Eaton )'>s hand
s&rgery pages%

Cross-se#tional area o$ the #arpal t&nnel in di$$erent *rist positions
Last updated 1-31-03
$e!+$n !& C&n!$&, &# H+an M&*een! ?, ,e%!+$e s%'ed+,e
,Dae -!ompson #-
Bi&e%'ani%s &# !'e !'+-

D&in!s A0es M&*een!s C,&seC)a%>ed )&si!i&n
Fi$s! %a$)&Ce!a%a$)a,
3CMC7
AP
,a!e$a,
a-Eadd+%!i&n
#,e0i&n E e0!ensi&n
e0!$ees &# &))&si!i&n &$
$e)&si!i&n
Fi$s! e!a%a$)&C)'a,angea,
3MP7J
AP
,a!e$a,
a-Eadd+%!i&n
#,e0i&n E e0!ensi&n
e0!ensi&n
Fi$s! in!e$)'a,angea, 3IP7J ,a!e$a, #,e0i&nEe0!ensi&n e0!ensi&n
JS!$+%!+$e and #+n%!i&n &# !'e MP and IP G&in!s a$e sii,a$ !& !'&se &# !'e &!'e$
digi!s/
,he th&m also has an e(tensor me#hanism%
Charles Eaton )' ,h&m home page
T'+- +s%,es
linical !inesiology ,is!s nine !'+- +s%,es"

e(trinsi# m&s#les o$ the th&m 546+
$le(or polli#is long&s
3 sn&$$o( m&s#les
1% e(tensor polli#is long&s
2% e(tensor polli#is re"is
3% ad&#tor polli#s long&s
intrinsi# m&s#les o$ the th&m 556+
,henar m&s#les
1. ad&#tor polli#is re"is
2. $le(or polli#is re"is
51P4>s &lnar head is o$ten #lassi$ed as "irst
palmar interosseous6
3. opponens polli#is

add&#tor polli#is
Part o$ $irst dorsal interosseo&s atta#hes to $irst
meta#arpal, &t #rosses second M# *oint%
C'a$,es Ea!&n MD
'and +s%,es )age
Re*ie(" inne$*a!i&n &# !'+- +s%,es
%&+$!es. &# C'a$,es Ea!&n MD
S.ne$gies !'a! )$e*en! s'&$!ening &# !'e !'+-1s +,!iCa$!i%+,a$ e0!$insi% +s%,es

1. 9apid $le(ion o$ the th&m>s 0P 3oint in"ol"es the $le(or polli#is long&s 51PL6,
and is o$ten a##ompanied y palpale a#ti"ity in the ad&#tor polli#is long&s%
,he $irst C)C 3oint may e"en ad&#t% ,he =PL a#ti"ity #o&nters 1PL>s tenden#y
to $le( the C)C 3oint in the plane o$ the palm%

2. 9apid e(tension o$ the th&m>s 0P 3oint in"ol"es the e(tensor polli#is long&s
5EPL6, and is o$ten a##ompanied y palpale a#ti"ity in the thenar m&s#les% ,he
$irst C)C 3oint may e"en $le( in the plane o$ the palm% =#ti"ity in the opponens
polli#is #o&nters the EPL>s tenden#y to e(tend the $irst C)C 3oint or add&#t it in
a plane perpendi#&lar to the palm%

3. ,he ad&#tor polli#is long&s 5the =PL, a sn&$$o( m&s#le6 a#ts in syn#hrony
*ith any a#tion o$ the thenar m&s#les% 0ts a#ti"ity staili!es the $irst meta#arpal
so that the thenar m&s#les do not prod&#e mo"ement at the $irst C)C 3oint%
-in#e the =PL also prod&#es radial de"iation o$ the *rist, the e(tensor #arpi
&lnaris 5ECD6 may also a#t to pre"ent *rist motion%
E0!ens&$ Me%'anis &# T'+-
T'e #i$s! digi!1s e0!ens&$ e%'anis $e%ei*es #i-e$s #$& !'e"
1% ad&#tor polli#is re"is 5median nn%6
2% add&#tor polli#is 5&lnar nn6
3% &lnar head o$ $le(or polli#is re"is E $irst palmar interosseo&s 5&lnar nn6
4% e(tensor polli#is long&s 5radial nn%6
4e#a&se a "ariety o$ ner"es s&pply these m&s#les, th&m e(tension is possile e"en i$
one o$ the peripheral ner"es is in3&red%
,his arrangement permits the /ind o$ alan#e et*een $le(ion and e(tension in the
th&m that the l&mri#ales pro"ide in the other digits%
Last updated "-#"-0#
$e!+$n !& C&n!$&, &# H+an M&*een! ? ,e%!+$e s%'ed+,e