Bones In The Wrist And Hand

Blood Supply And Lymphatics

The radial artery, ulnar artery, and anastomoses provide the blood supply of the wrist. The radial artery predominantly supplies the thumb and the lateral side of the index finger while the ulnar artery supplies the rest of the digits and the medial side of the index finger. In particular, vascular supply takes place via the anastomotic network consisting of three dorsal and three palmar arches, which arise from both the radial and ulnar arteries, that overlie the carpal bones. The scaphoid, capitate, and a small proportion of lunates all have one intraosseous vessel supply. Of note, the scaphoid has a single blood supply from the radial artery that enters from the distal portion of the bone to supply the proximal portion, thus making its proximal pole most vulnerable to avascular necrosis. The trapezoid and hamate both have two areas of blood supply without intraosseous anastomoses. The trapezium, triquetrum, pisiform, and most lunates have two areas of blood supply and consistent intraosseous anastomoses. Therefore, the rest of the carpal bones, excluding the scaphoid, capitate, and a small proportion of lunates, have a lower risk of developing avascular necrosis following a fracture.

Keeping Your Hands And Wrists Moving

Moving your hands, wrists and fingers as much as possible can help ease pain and stiffness. This will also maintain range of movement, function and strength.

We have some exercises you can do at home. Try to do them as regularly as you can, especially if your hands and wrists are feeling stiff.

If you have carpal tunnel syndrome, talk to a physiotherapist, GP or hand therapist for specific advice on exercise.

When To See A Doctor

Hand and wrist pain often gets better with things you can do at home.

However, youll need to visit your GP surgery if:

• your pain isnt getting better after treatment at home for two weeks
• the pain is getting worse
• the pain keeps returning
• the pain is stopping you from doing your everyday activities
• your hands are stiff and swollen, particularly in the mornings and these feelings dont get better after half an hour
• as well as being swollen and stiff, your hands are warm and red
• you also feel generally unwell, especially if you have a high temperature
• you have ongoing tingling, numbness or weakness in the hands or fingers.

Its important to get urgent medical attention, if:

• you think youve broken a bone
• you have extreme pain
• any part of your hand, wrist or fingers is a funny shape or colour
• you have lost the feeling of part or all of your hand
• there was a snap, grinding or popping noise when you injured your hand or wrist
• you cant move your hand, wrist or fingers properly.

If you have ongoing hand and wrist pain or a specific condition affecting the hand and wrist it could be helpful to see a hand therapist. These are healthcare professionals with expertise in treating conditions affecting the hand and wrist. Your GP, rheumatology department or orthopaedic department could refer you to one.

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Hand Muscles And Hand Tendons

The muscles in the forearm and palm all work together to keep the wrist and hand moving, stable, and well-aligned. The image below shows the bones of the hand from the back side. The red lines show where the tendons attach the muscles to the bones.

Many of the muscles that move the fingers and thumb originate in the forearm. Long flexor tendons extend from the forearm muscles through the wrist and attach to the small bones of the fingers and thumb. When you bend or straighten your fingers, these flexor tendons slide through snug tunnels, called tendon sheaths, that keep the tendons in place next to their respective bones. Within this sheath, a slippery coating called tenosynovium surrounds the tendons, and keeps the tendons moving smoothly under the ligaments when the hand is in motion.

Tendons are white, flexible rope-like cords at the ends of muscles that attach muscles to bone. When muscles contract, they pull on the tendons to move the bones. The tendons that run down our fingers are held in place by a series of ligaments, called pulleys, that form stable arches over tendons, forming a tunnel-like sheath. Normally, the tendons glide easily through the tunnel.

Clinical Relevance: Fractures Of The Metacarpals

There are two common fractures of the metacarpals:

• Boxers fracture A fracture of the 5th metacarpal neck. It is usually caused by a clenched fist striking a hard object. The distal part of the fracture is displaced anteriorly, producing shortening of the affected finger.

• Bennetts fracture A fracture of the 1st metacarpal base, caused by forced hyperabduction of the thumb. This fracture extends into the first carpometacarpal joint leading to instability and subluxation of the joint. As a result, it often needs surgical repair.

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Clinical Relevance: Scaphoid Fracture

The scaphoid bone of the hand is the most commonly fractured carpal bone – typically by falling on an outstretched hand .

In a fracture of the scaphoid, the characteristic clinical feature is pain and tenderness in the anatomical snuffbox.

The scaphoid is at particular risk of avascular necrosis after fracture because of its so-called retrograde blood supply which enters at its distal end. This means that a fracture to the middle of the scaphoid may interrupt the blood supply to the proximal part of the scaphoid bone rendering it avascular.

Patients with a missed scaphoid fracture are likely to develop osteoarthritis of the wrist in later life.

Ligaments Of The Wrist And Hand

Important ligaments of the hand are:

• Collateral ligaments strong ligaments on either side of the finger and thumb joints, which prevent sideways movement of the joint
• Volar plate a ligament that connects the proximal phalanx to the middle phalanx on the palm side of the joint. As the joint in the finger is straightened, this ligament tightens to keep the PIP joint from bending backward.
• Radial and ulnar collateral ligaments a pair of ligaments which bind the bones of the wrist and provide stability
• Volar radiocarpal ligaments a complex web of ligaments that support the palm side of the wrist
• Dorsal radiocarpal ligaments ligaments that support the back of the wrist
• Ulnocarpal and radioulnar ligaments two sets of ligaments that provide the main support for the wrist.

The stability of the wrist is provided by ligaments on the palmar aspect is the flexor retinaculum which together with the carpal bones forms a canal the carpal tunnel – which nerves, muscles and blood vessels run through, it is this area that is involved in carpal tunnel syndrome.

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How The Carpal Bones Make Up The Wrist:

The long bone on the thumb side, the radius, connects with the first three carpal bones. These bones are the scaphoid, lunate, and triquetrum bones. The radius to these 3 carpal bones makes up the radiocarpal joint on the thumb side of the wrist.

The long bone on the pinky side, the ulna, connects with the lunate and the triquetrum carpal bones. The ulnas connection to these 2 carpal bones makes up the ulnocarpal joint on the pinky side of the wrist.

The name of the bones in your fingers are metacarpals. These bones connect to the four carpal bones to make up the carpometacarpal joints. These four carpal bones are trapezium, trapezoid, capitate, and hamate.

What Is The Wrist Used For

The wrist joint also referred to as the radiocarpal joint is a condyloid synovial joint of the distal upper limb that connects and serves as a transition point between the forearm and hand. A condyloid joint is a modified ball and socket joint that allows for flexion, extension, abduction, and adduction movements.

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How Are The Hands And Wrists Structured

There are 27 small bones that make up each hand and wrist. Eight of those bones are in your wrist. Each finger has three bones, and the thumb has two. There are five bones in the palm of your hand, connecting each finger and the thumb with the wrist.

There are more than 30 muscles that control the hand and wrist. These are in your hands, wrists and forearms.

Muscles are attached to bones by tendons. These are small but very tough pieces of connective tissue. Tendons pass through a bony passage in your wrist, known as the carpal tunnel. The median nerve also passes through this tunnel.

Avoid Tasks That Make The Pain Worse

Try to avoid tasks that are causing the pain or making it worse. This may be anything that has a repetitive nature, such as using a screwdriver, painting or lifting heavy objects. You might be able to change the way you do some tasks to take the strain off your hands and wrists. Some conditions affecting the hand and wrist wont get better until you stop doing certain tasks.

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Carpus Hand And Wrist Bones

The eight bones that make up carpus are each called the trapezium, trapezoid, capitate, hamate, pisiform, triquetrum, lunate, and the scaphoid. the most commonly injured carpal bone is the scaphoid bone, located near the base of your thumb. The unique cluster of small bones in different shapes and sizes is what gives the wrist its strength and flexibility. If you look at your hand while you move your fingers and wrist, youll notice how pliable your hand and wrist is. If your hand were made up of 3 or 4 larger bones, your hand and wrist would not work the same.

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This content is not a substitute for expert medical advice or diagnosis and is for educational purposes only.

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Joints Of The Wrist And Hand

The wrist has two degrees of freedom, although some say three degrees of freedom because they include the movements of pronation and supination, which occur at the the radioulnar joint. The radioulnar joint is often referred to as a joint of the forearm but it is this articulation that gives the wrist more freedom of movement. The true joints of the wrist and hand are listed in the table below.

Carpal Bones In The Wrist

Your wrist is made up of eight small bones called the carpal bones, or the carpus. These irregularly shaped bones join your hand to the two long forearm bones: the radius and ulna.

The carpal bones are small square, oval, and triangular bones. The cluster of carpal bones in the wrist makes it both strong and flexible. Your wrist and hand wouldnt work the same if your wrist joint were only made up of one or two larger bones.

The eight carpal bones are:

• scaphoid, a long boat-shaped bone under your thumb
• lunate, a crescent-shaped bone beside the scaphoid
• trapezium, a rounded-square shaped bone above the scaphoid and under the thumb
• trapezoid, a wedge-shaped bone beside the trapezium
• capitate, an oval or head-shaped bone in the middle of the wrist
• hamate, a wedge-shaped bone under the pinky finger side of the hand
• triquetrum, a pyramid-shaped bone under the hamate
• pisiform, a small, pea-shaped sesamoid bone that sits on top of the triquetrum

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Anatomy : Wrist Joints

The wrist joints lie between the many different bones in the wrist and forearm. Many wrist injuries involve the joint surface. There are three joints in the wrist:

Learn more about the joints of the wrist and also the bones of the wrist in our Anatomy section. You can also visit www.HandCare.org for information on conditions and injuries of the hand, wrist, arm and shoulder.

Functional Position Of The Hand

When therapists immobilize a patient’s hand, they often position it this way. During a period of immobilization, the resting lengths of the hand’s ligaments and muscles change. This hand position provides the best balance of resting length and force production so the hand can function when the patient mobilizes it again.

Wrist

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Joints Located In Hand

While there are more joints connecting the distal, middle, and proximal phalanges, lets focus on the five joints between the distal carpals of the wrist and the metacarpals of the fingers. These five joints are known as the carpometacarpal joints and each serve seperate purposes. The carpometacarpal joint of the thumb is a saddle joint, which permits the thumb to move forward, backward, and side-to-side.The carpometacarpal joints of the other four fingers are gliding joints, which enables up and down and side-to-side movements. The synovium lines the joints and fills with a lubricating fluid called synovial fluid. Joints with synovium may form balloon like cysts called Ganglion cysts that may require surgical removal.

What Is The Relationship Between The Elbow And The Wrist

The ulna extends from the pinkie finger side of the wrist to the elbow, and the radius goes from the thumb side of the wrist to the elbow. The humerus, the large bone that makes the upper arm, meets the other two at the elbow. These three bones help form two joints which complete the anatomy of the elbow.

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Muscles Of The Wrist And Forearm

Most of the muscles which act on the wrist joint are situated within the forearm, with only the tendon crossing the joint and inserting it into the hand. The muscles on the back of the forearm act to extend the wrist or pull it back as if pulling a ring pull:

• Flexor pollicis longus

Some of these muscles also help to perform radial and ulnar deviation. Radial deviation is the act of tilting the wrist in a radial direction . Extensor carpi radialis brevis, longus and flexor carpi radialis all perform this movement.

Ulnar deviation is the opposite movement, of tilting the wrist so that the little finger leads. Extensor carpi ulnaris and flexor carpi ulnaris perform this movement.

Read more on wrist muscles.

Movements Of The Wrist And Hand

Thirty-four muscles act on the hand.

• Intrinsic muscles of the hand contain the origin and insertions within the carpal and metacarpal bones.
• Muscles originating in the forearm are the extrinsic muscles of the hand.
• The intrinsic muscles of the hand provide the fine motor movements while the extrinsic muscles permit strength.

A common rule of thumb is that any muscle tendon that crosses a joint will act on that joint. For example, muscles of the forearm that cross the carpometacarpal joint will produce flexion or extension at the wrist joint.

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Hand Bones And Wrist Bones

In this anatomy lesson, youll learn that the bones of the hand and wrist make up part of the appendicular skeleton. These bones consist mostly of long bones, except for the eight bones of the wrist, called carpals, which anatomists classify as short bones.

The bones of the hand and wrist can be broken down into 14 phalanges, 5 metacarpals, and 8 carpals. When you combine both hands/wrists, youll get a total of 54 bones out of the 206 human bones in the average adult skeleton.

Hand And Wrist Anatomy

The hand and wrist are made up of many different bones, muscles and ligaments that enable a wide range of movements.

Bones

The following are the main structures of the hands:

The wrist is formed where the two bones of the forearm the radius and the ulna meet the carpus. Rather than a single joint, the wrist is actually made up of multiple joints where the bones of the arm and hand meet to allow movement

The carpus is formed from eight small bones collectively referred to as the carpal bones. The carpal bones are bound in two groups of four bones:

• the pisiform, triquetrum, lunate and scaphoid on the upper end of the wrist
• the hamate, capitate, trapezoid and trapezium on the lower side of the hand.

Other bones of the hand are:

• the metacarpals the five bones that comprise the middle part of the hand
• the phalanges the 14 narrow bones that make up the fingers of each hand. Each finger has three phalanges the thumb has two.

Joints are formed wherever two or more of these bones meet. Each of the fingers has three joints:

• metacarpophalangeal joint the joint at the base of the finger
• proximal interphalangeal joint the joint in the middle of the finger
• distal interphalangeal joint the joint closest to the fingertip.

Each thumb has two joints.

Ligaments and Tendons

The ligaments are tough bands of connective tissue that connect the bones to support them and keep them in place. Important ligaments of the hand are:

The main tendons of the hand are:

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