Topic 7 - Forearm Wrist and Hand

Faculty of Health and Social Care
School of Health Sciences

MSc Physiotherapy (pre-registration)
Anatomy Access Course
Topic 7: The Forearm, Wrist and Hand
1
Anatomy Access Course July 2009
Topic 7: The Forearm, Wrist, and Hand
By the end of this topic you should be able to:

 Identify the bones that make up the forearm, wrist and hand.
 Orientate each of the bones relative to the anatomical position.
 Identify on each of the bones the major bony features such as articular
surfaces.
 Name, identify and classify the joints of the forearm, wrist and hand.
 Describe the surface markings of bony points, and joint lines of the
forearm, wrist and hand.
 State the movements available at the forearm, wrist and hand joints,
and be aware of the factors and structures which may limit movement.
 Describe the muscles acting over the forearm, wrist and joints of the
hand, and explain their actions.
 Identify the major muscle groups of the forearm, wrist and hands, the
insertions and origins, and their function.
 Describe the pathways of upper limb nerves
.
Introduction to the Forearm
The forearm is part of the upper limb distal to the elbow and proximal to the
wrist is called the forearm.
The forearm is made up of two bones, the radius and the ulna, which
articulate to form the bony skeleton of the forearm. Proximally these bones
articulate with the humerus at the elbow joint and distally with the carpal
bones at the wrist joint.
Surface Anatomy
Task 1.
Can you identify the radius and ulna on the diagram below? Use colour to highlight
each. Palpate your own radius and ulna.
Surface Anatomy
Task 2.
Label the diagrams of the radius and ulna below.
Ensure that you are able to identify the following features:
Head of radius Olecranon process of ulna

Neck of radius Coronoid process of ulna
Radial tuberosity Radial notch of ulna
Shaft of radius Shaft of ulna
Head of ulna
Dorsal tubercle of radius Styloid process of radius
Ulnar notch of radius Styloid process of ulna
ROM at the Proximal and Distal Radioulnar Joints.

There are two joints within the forearm:
i. Proximal (superior) Radioulnar joint
ii. Distal (inferior) Radioulnar joint
The proximal radioulnar joint is a pivot type synovial joint, which allows
movement of the head of radius on the ulna. The head of the radius
articulates with the radial notch of the ulna, and it is held together by the
annular ligament of the radius.
Task 3.
Using the recommended text complete the table below
Joint Joint Type Articulation Movements Range
Proximal
Radioulnar
Joint
Distal
Radioulnar
Joint
Movements at the Radioulnar Joints

Muscle Groups of the Radioulnar Joints
Task 4.
For each movement which occurs at the radioulnar joints list the main muscles
involved.
Action Muscles
Pronation
Supination
Surface Anatomy of the Forearm

Task 5.
Label the following Diagram
Superficial Muscles of the Forearm (Flexors)
Task 6.
Label the diagram opposite from the
list of muscle below:
 Palmaris Longus
 Flexor Carpi Ulnaris
 Flexor Carpi Radialis
 Brachioradialis
 Prontator Teres
Deep Muscles of the Forearm

Task 7.
Label the diagram opposite from
the list below.
 Flexor Pollics Longus
 Pronator Quadratus
 Supinator
 Flexor Digitorum Profundus
Muscle attachments – Forearm Flexors.
Muscle attachments – Muscles of the Arm – Anterior Aspect
Task 8.
Complete the following table. Try and refrain from copying from your text book, use this task
as a self-test .
Muscle Proximal Distal attachment Nerve Function

attachment Supply
Pronator Teres
Flexor Carpi
Radialis
Palmaris longus
Flexor digitorum
Superficialis
Muscle attachments – Muscles of the Arm – Anterior Aspect
Task 9.
as a self-test .

attachment Supply
Flexor Carpi
Ulnaris
Flexor Digitorum
Profundus
Flexor Pollicis Longus
Pronator Quadratus
Extensor Muscles of the Forearm
Task 10.
Label the bones on the diagram
opposite.
Superficial Forearm Extensor

Muscles
Task 11.
Label the opposite diagram from the
list below:
 Flexor Carpi Ulnaris
 Extensor Digiti Minimi
 Extensor Digitorum
 Anconeus
 Brachioradialis
 Extensor Carpi Ulnaris
 Extensor Carpi Radialis
Longus
 Common Extensor Origin
 Abductor Pollicis Longus
 Extensor Pollicis Brevis
 Tenson to Extensor Pollicis
Longus
Deep Forearm Extensors
Task 12.
Label the opposite diagram from the list
below:
 Extensor Pollicis Longus
 Extensor Pollicis Brevis
 Extensor Indicis
 Supinator (ulnar head)
 Supinator (radial head)
 Abductor Pollicis Longus
 Ulna Bone
Muscle attachments – Forearm Extensors
Task 13.
as a self-test .
Muscle Proximal attachment Distal attachment Nerve Function

Supply
Brachioradialis
Radialis Longus
Extensor Carpi
Extensor Carpi
Radialis brevis
Extensor Digitorum
Task 14.
as a self-test .

Supply
Extensor Digiti Minimi
Extensor Carpi
Ulnaris
Supinator
Extensor Indicis
Task 15.
as a self-test .

Supply
Abductor Pollicis Longus
Extensor pollicis Longus
Extensor Pollicis brevis
Introduction to the Wrist Complex
The wrist (carpus) is the proximal segment of the hand, and is a complex of
eight carpal bones, which articulate proximally with the forearm via the wrist
joint and distally with the five metacarpals.
The wrist joint is a composite joint. As can be seen from the diagrams above
it includes the radiocarpal joint, midcarpal joint & intercarpal joints. All are
classified as synovial joints. At the radiocarpal joint the inferior surfaces of the
radius and the articular disc articulate with the proximal row of the carpal
bones (the pisiform is excluded, because it sits proud of the other carpal
bones). The intercarpal joints, interconnect all of the carpal bones, and are
plane type synovial joints. The midcarpal joint is a complex joint between the
proximal and distal rows of the carpal bones.
The eight carpal bones as you can see are arranged in 2 rows with the
scaphoid, lunate, triquetral and pisiform in the proximal row and the
trapezium, trapezoid, capitate and hamate in the distal row. The arrangement
of the bones is easy to remember if you use a mnemonic. An example might
be:
"She loves to play the tin-can harp"
The first letters in this sentence correspond to: scaphoid, lunate, triquetral,
pisiform, trapezium, trapezoid, capitate and hamate. You can easily
remember that the bone nearest the thumb in the distal row is the trapezium,
because trapezium rhymes with thumb!
Joint Line of the Wrist Complex
Task 16.
In the space below describe the joint line of the wrist, naming the two articular
surfaces, and the line which can be palpated.
ROM at the Wrist Complex
Task 17.
Complete the following table for the wrist complex.
Movement Plane Normal AROM

Muscle Groups of the Wrist Joint
Task 18.
For each movement which occurs at the wrist complex list the main muscles
involved. Remember in some instances one muscle may have more than one
function.
Action Muscles
Introduction to the Hand
By looking at your own hand you have probably realised that several joints
make up the hand. Firstly you need to be familiar with the names of all of the
bones, after which the joint names will make more sense to you.
Bony Anatomy of the Hand
Task 19.
Label the diagrams of the hand below. Use colour to clarify these diagrams
Ensure that you are able to identify the following features:
Digits I - V Thumb Index finger Middle finger
Ring finger Little finger Proximal, middle & distal phalanges
Metacarpals I - V Hamate Triquetral Pisiform
Lunate Scaphoid Capitate Trapezium
Trapezoid
Interphalengeal joints – proximal and distal and metacarpal joints

Bony Anatomy of the Hand
The Phalanges (singular - phalanx)

The phalanges are the bones of the digits, and are described in relation to the
digit they belong to i.e. thumb, index, middle, ring or little finger. Each finger
has 3 phalanges (proximal, middle & distal) but the thumb only has 2
(proximal & distal). The heads of the distal phalanges differ slightly, being
expanded to support the pads of the digits. Can you palpate the metacarpals
and phalanges of your own hand?
Palpation
Task 20.
By flexing your fingers into a fist, the heads of the proximal and middle phalanges
can be easily palpated. The shafts of the phalanges are also easily followed
through out their length, especially on the dorsal surface. Take some time to
palpate you these bones on your own hand, and then on a colleague/friend as it will
be easier on some than it is on others, and each of us has slight variations in out
anatomy.
Joints within the Hand.
As mentioned already there are several joints within the hand. Firstly, there is
the Carpometacarpal (CMC) joints and the intermetacarpal joints both of
which are the plane type of synovial joint. However, there is an exception, as
the CMC joint of the thumb is a saddle joint. The thumb joint is complicated,
and several movements occur in the thumb, with the essential movement
being opposition, without this grasping objects would be impossible. We will
touch on grip at the end of this workbook. In recognition of this the thumb
will be addressed in a specific section, where the thumb as a whole will be
addressed. Almost no movement occurs at the CMC joint of the 2 nd and 3rd
fingers, the 4th is only slightly mobile. The 5th is the most mobile, in that it
flexes and rotates slightly when grasping an object tightly. The reason for this
is related to function, this degree of immobility contributes to the stability of
the palm which acts as a base for and against which the fingers can operate.
Task 21.
Complete the following table.
Joint Classification Bones Articulating

Surfaces
First
Carpometacarpal
Joint
(CMC)
Common
Carpometacarpal
Joint
(CMC)
Intermetacarpal Joints
(IM)
Metacarpophalangeal and Interphalangeal Joints
These joints are considerably more mobile than the CMC joints covered in the
earlier. Each finger has 2 Interphalengeal joints can be further classified as
proximal and distal interphalegeal joints.
Task 22.
Complete the following tables. NB: consider only the MCP and IP joints of the
fingers not of the thumb as this will be covered in the next section.
Joint Classification Bones Articulating

Surfaces
Metacarpophalangeal
Joints
(MCP)
Interphalangeal
Joints
(IP)
Joint Lines of the Hand

Joint Palpable Articular Articular Surface 2

Structures to be identified. Surface 1
Yes posteriorly.
Radio carpal joint
Ellipsoid joints
Anteriorly- curved line-

concave proximally from
styloid process of radius to
head of ulna.
Yes – posteriorly
Metacarpo-phalangeal
Crease line anteriorly- gently

Condyloid joints
curved, concave distally
Yes- posteriorly
1st carpo metacarpal
Saddle joint
Yes- anteriorly and

Inter-phalangeal
posteriorly
Hinge joint
Joints
ROM at the MCP and IP joints of the Fingers.
Task 23.
Complete the following table using your recommended texts.
Joint Movement Plane Normal AROM Limiting factors

of movement
1.
Metacarpalphalangeal Joint (MCP)
2.
3.
4.
1.
Interphalangeal Joint (IP)
2.
Muscle Groups of the Finger Joints.
Task 24.
For each movement which occurs at the MCP and IP joints list the main muscle
involved. Remember in some instances one muscle may have more than one
function.
Action Muscles
Introduction to the Thumb

The CMC joints of the 2nd to the 4th digits provide little motion as described
earlier. In contrast, the CMC joint of the thumb is highly mobile. The CMC
joint provides the thumb with the majority of the movement, and specifically
provides opposition. Opposition is the key to the effectiveness of the human
hand. However, the MP joints of the four medial fingers offer a greater range
of movement (flexion-extension, abduction-adduction), whereas the MP joint
of the thumb is limited to only flexion and extension.
ROM at the CMC, MCP and IP joints of the Thumb.
Task 25.
Joint Movement Plane Normal AROM Normal End

Feel
1.
Carpometacarpal Joint (CMC)
2.
3.
4.
ROM at the CMC, MCP and IP joints of the Thumb.

Task 25. continued.

Joint Movement Plane Normal AROM Normal End

Feel
1.
Metacarpalphalangeal Joint (MCP)
2.
1.
Interphalangeal Joint (IP)
2.
Muscle Groups of the Thumb Joints.
Task 26.
For each movement which occurs at the CMC, MCP and IP joints list the main
muscle involved. Remember in some instances one muscle may have more than
one function.
Action Muscles
Muscles of the hand – Thenar Muscle

Task 27.
as a self-test .

Supply
Opponens Pollicis
Abductor Pollicis
Flexor Pollicis
Brevis
Adductor Pollicis
Muscles of the hand – Hypothenar Muscle
Task 28.
as a self-test .

attachment Supply
Abductor
Digiti
Minimi
Flexor
Digiti
Minimi
Opponens
Digiti
Minimi
Muscles of the hand – Short Muscles
Task 29.
Complete the following table. So to assist you in learning the attachments of muscles, try
and refrain from copying from your text book, use this task as a self-test .

attachment Supply
Lumbricals
1 and 2
Lumbricals
3 and 4
Dorsal
Interossei
Palmar
Interossei
Function of the Hand
Grip Activity – Four Stages:
1. Hand opens.
2. Fingers close about the object.
3. Increase force to a level appropriate for task.
4. Hand reopens to release object.
5. Two types – Power grip, prehension grip
Power Grip/Prehension Grip

Pinch Grip
Dermatomes
Upper limb dermatomes
Areas where
overlap of
dermatomes is
minimal include
 The
upper
lateral
region of
the arm
C5
 The
palmar
pad of
the
thumb
C6
 The pad
of the
index
finger
C7
 The pad of the little finger C8
 The skin on the medial aspect of the elbow T1.

Nerves of the Upper Limbs
Course
Nerve, plexus and Important Functions
spinal roots Beginning End relations &
involved muscles/skin
supplied
Axillary nerve- Posterior to Divides into Shoulder Activities which
brachial plexus axillary artery, branches supplying joint, surgical involve the arm
(posterior cord) passes deltoid, teres neck of being used
C5,6 posteriorly major. humerus away from the
inferiorly to the body
shoulder joint, Deltoid, teres
and winds around major, skin of
the surgical neck ‘epaulette’
of the humerus.
Radial nerve – Posterior to the Passes anterior to All weight
Shaft of
brachial plexus brachial artery, lateral epicondyle bearing
humerus
(posterior cord) C5- passes and divides into activities of
C8 posteriorly and branches- deep Supplies upper limb, all
diagonally round branch to all triceps, and all pushing
the posterior extensor muscles extensor activities,
surface of the of forearm, and muscles of the protective
humerus in the superficial to skin forearm (and extension,
radial groove. of forearm and hand.) release
back of hand. Supplies activities of the
sensation on hand.
dorsum of
hand and
fingers.
Nerves of the Upper limb.
Course
Nerve, plexus Important Functions
and spinal Beginning End relations &
roots involved muscles/skin
supplied
Median nerve- Anterior to the Passes through In carpal tunnel – Grasp, all
brachial plexus, brachial artery the carpal tunnel supplies all activities
lateral and down the centre then divides into muscles of the involving thumb.
medial cords, of the arm to terminal branches thumb and
C6,7,8,T1) elbow joint. supplying small lumbricals to Precision
Passes down the thumb muscles fingers 2 and 3. activities
centre of the and skin of thumb Skin sensation – to involving
forearm, to the and fingers 2 & 3. lateral palm, & fingers.
wrist. Under flexor palmar surface of
retinaculum with thumb, index,
long flexor middle and half of
tendons. ring finger
Ulnar nerve- Medial to artery- Passes over Supplies all Assists with
brachial plexus passes posteriorly flexor muscles of little power grip,
medial cord mid arm to pass retinaculum. finger, all important for
C8T1 behind the medial In the hand it interossei, and fine activities of
epicodyle at the passes with the lumbricals fingers the fingers.
elbow. Lies ulnar artery to 4,5.
among ulnar form a palmar Skin sensation
muscles of arch across the ulnar side palm,
forearm, passes palm, dividing into and palmar surface
on anteromedial branches to fingers 4,5.
side of wrist- muscles and skin.
lateral to pisiform
bone
Nerves of the Upper Limb.
Course
Nerve, plexus and Important Functions
spinal roots Beginning End relations &
involved muscles/skin
supplied
Musculocutaneous Lateral to artery, Anterior to elbow BBC- biceps, All hand to
nerve.- lateral cord passes anteriorly joint under biceps brachialis and mouth , and
brachial plexus in the arm, lying tendon- emerges to coraco- hand to midline
C5,6 among flexors become lateral brachialis- activities.
muscles which it cutaneous nerve of All flexor
supplies. forearm muscles in
anterior
compartment
of the arm.
Self Check List
Task 30.
Before progressing on to the trunk, read the following learning outcomes and check
that you feel happy that you have met the learning outcomes.
Learning Outcome Yes/No

 Identify the bones that make up the forearm, wrist and hand.

 Orientate each of the bones relative to the anatomical position.
 Identify on each of the bones the major bony features such as
articular surfaces.
 Name, identify and classify the joints of the forearm, wrist and
hand.
 Describe the surface markings of bony points, and joint lines of the
forearm, wrist and hand.
 State the movements available at the forearm, wrist and hand
joints, and be aware of the factors and structures which may limit
movement.
 Describe the muscles acting over the forearm, wrist and joints of the
hand, and explain their actions.
 Identify the major muscle groups of the forearm, wrist and hands,
the insertions and origins, and their function.
 Describe the pathways of upper limb nerves

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Faculty of Health and Social Care

School of Health Sciences

Topic 7: The Forearm, Wrist, and Hand

By the end of this topic you should be able to:

Introduction to the Forearm

Ensure that you are able to identify the following features:

Head of radius Olecranon process of ulna

ROM at the Proximal and Distal Radioulnar Joints.

Joint Joint Type Articulation Movements Range

Movements at the Radioulnar Joints

Muscle Groups of the Radioulnar Joints

Surface Anatomy of the Forearm

Superficial Muscles of the Forearm (Flexors)

Deep Muscles of the Forearm

Muscle attachments – Forearm Flexors.

Muscle attachments – Muscles of the Arm – Anterior Aspect

Muscle Proximal Distal attachment Nerve Function

Muscle attachments – Muscles of the Arm – Anterior Aspect

Muscle Proximal Distal attachment Nerve Function

Extensor Muscles of the Forearm

Superficial Forearm Extensor

Deep Forearm Extensors

Muscle attachments – Forearm Extensors

Muscle Proximal attachment Distal attachment Nerve Function

Muscle attachments – Forearm Extensors

Muscle Proximal attachment Distal attachment Nerve Function

Muscle attachments – Forearm Extensors

Muscle Proximal attachment Distal attachment Nerve Function

Introduction to the Wrist Complex

Introduction to the Wrist Complex

Introduction to the Wrist Complex

"She loves to play the tin-can harp"

Joint Line of the Wrist Complex

ROM at the Wrist Complex

Complete the following table for the wrist complex.

Movement Plane Normal AROM

Muscle Groups of the Wrist Joint

Introduction to the Hand

Bony Anatomy of the Hand

Ring finger Little finger Proximal, middle & distal phalanges

Metacarpals I - V Hamate Triquetral Pisiform

Lunate Scaphoid Capitate Trapezium

Interphalengeal joints – proximal and distal and metacarpal joints

The Phalanges (singular - phalanx)

Joints within the Hand.

Joint Classification Bones Articulating

Metacarpophalangeal and Interphalangeal Joints

Joint Classification Bones Articulating

Joint Lines of the Hand

Joint Palpable Articular Articular Surface 2

Anteriorly- curved line-

Crease line anteriorly- gently

curved, concave distally

Yes- anteriorly and

ROM at the MCP and IP joints of the Fingers.

Joint Movement Plane Normal AROM Limiting factors

Muscle Groups of the Finger Joints.