Understanding the Anatomy of the Wrist Complex

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WRIST COMPLEX
 
DR. DIGVIJAY SHARMA
DEPARTMENT OF PHYSIOTHERAPY
U.I.H.S
KANPUR
 
 
Radiocarpal joint
Midcarpal joint
 
    RADIOCARPAL JOINTS-
This joint is formed by radius and radioulnar disc
proximally and by the scaphoid, lunate and triquetral
distally.
The proximal joint surface is composed of
I.
Lateral radial facet which articulate with scaphoid.
II.
Medial Radial facet articulates with lunate
III.
The triangular fibro cartilage complex that articulate
with triquetrum predominantly and lunate with up to
some extent .
 
When the wrist is in neutral position ulna does not
participate as the part of the radiocarpal joint Other
than an attachment site for the TFCC(triangular fibro
cartilage complex).
 
It is the articulation between a scaphoid, lunate and triquetrum proximally and
distal carpal row composed of the trapezium, trapezoid , capitate and hamate.
The mid carpal joint surfaces are complex with an overall reciprocally concavo-
convex configuration.
Functionally the distal carpal row moves as an almost fix unit. The capitate and
hamate are most strongly bound together, So only small amount of play is
possible between them. The union of distal carpal also results in nearly equal
distribution of load across -
 
A scaphoid – trapezium-
trapezoid,
Scaphoid-capitate, lunate-
capitate , the triquetrum-
hamate articulations.     Together
the bones of the distal carpal
row contribute 2
0
 of freedom of
wrist complex with varying
amounts of radial/ulnar
deviation and flexion/extension
credited to the joint .
 
The ligaments of the wrist
complex are divided into-
I.
Extrinsic ligaments
II.
Intrinsic ligaments
 
The extrinsic ligaments connect the carpals
to the radius or ulna proximally and to the
metacarpals distally.
The intrinsic ligaments interconnect the
carpals also known as intercarpal or
interosseous ligaments.
 The intrinsic ligaments lie within the
synovial lining and therefore rely on the
synovial fluid for nutrition rather than
contiguous vascularized tissue as do the
extrinsic ligaments.
 
The ROM of the entire complex are variable and depends upon the
factors like ligamentous laxity , shape of articular surface and
muscular force.
Normal Range Are :-
i.
Flexion                                   80
0
- 85
0
ii.
Extension                              80
0
 – 90
0
iii.
Radial Deviation                  15
0
 – 20
0
iv.
Ulnar Deviation                   40
0
 – 45
0
 
Motion at the radiocarpal and midcarpal joint are caused
by the combination of active muscular and passive
ligamentous and joint reaction force.
Although there are several passive forces applied on the
proximal carpal rows but there is no direct muscular
force are applied.
Therefore the proximal carpal row is a mechanical link
between the radius and distal carpals and metacarpals
to which direct muscular forces are applied.
Hence this  row is also called as intercalated segment a
relatively unattached middle segment of a three
segment linkages.
When compressive forces are applied across the
intercalated segment, the middle segment tends to
collapse and moves in opposite direction.
 
Application of compressive forces
towards extension of wrist complex
would cause collapse of mid carpel row
in flexion. An intercalated segment
require some type of stabilizing
mechanisms to prevent collapse of mid
carpel segment and to normalize and
combined mid carpel/ radio carpel
motion, which is appear to be provided
by scaphoid and its functional and
anatomic connection both to the
adjacent lunate and the distal carpal
rows.
 
The motion begins with the wrist in full flexion.
Active extension is initiated at distal carpal rows
and metacarpal by the wrist extensor to which
they are attached.
The distal carpels glide with relatively fixed
proximal bones in the same direction as the
motion of the hand.
When the wrist complex reaches neutral (long
axis of 3
rd
 metacarpal is lined with the long axis of
the forearm).
 
The ligament Spanning the capitate and scaphoid
draw the capitates and scaphoid together into a close
packed position.
Continued extensors force now moved the combined
unit of distal carpal row and scaphoid on the relatively
fixed lunate and triquetrum. At approx.  45
0
hyperextension of the wrist complex, the
scapholunate interosseus ligament bring the scaphoid
and lunate into close packed position.
This unites all the carpels and causes them to function
as a single unit.
 Wrist extension is completed as the proximal
articular surface of the carpals move as a solid unit on
the radius and radioulnar disc.
All ligament become taut as full extension is reached
and the entire wrist complexes close packed. Wrist
motion from full extension to full flexion occurs in the
reverse sequence.
 
These are even more complex motion
than flexion and extension but perhaps
the variation is less.
Radial deviation produces not only
deviation of the proximal and distal
carpal rows radially, but simultaneously
flexion of proximal rows and extension
of distal carpal rows.
 
The opposite motion of the proximal and
distal carpal occur with ulnar deviation.
During these motion the distal rows again
moves as a fixed unit but the magnitude of
motion between the proximal carpal bones
may differ.
The range of radial and ulnar deviation is
greatest when the wrist is in neutral position.
When the wrist so extended or flexed the
ROM is very little, because in closed packed
position the carpals are locked and in lose
pack position the bones are splayed.
 
Thank YOU
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The wrist complex consists of the radiocarpal joint and midcarpal joint, formed by various bones and ligaments. The radiocarpal joint involves the radius, radioulnar disc, scaphoid, lunate, and triquetral bones. In a neutral position, the ulna does not participate in this joint. The midcarpal joint articulates the scaphoid, lunate, triquetrum, trapezium, trapezoid, capitate, and hamate bones, providing flexibility to the wrist. Ligaments, both extrinsic and intrinsic, play a crucial role in connecting and supporting the carpal bones.


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  1. WRIST COMPLEX WRIST COMPLEX DR. DIGVIJAY SHARMA DEPARTMENT OF PHYSIOTHERAPY U.I.H.S KANPUR

  2. It consist of 2 compound joints- Radiocarpal joint Midcarpal joint

  3. STRUCTURE- RADIOCARPAL JOINTS- This joint is formed by radius and radioulnar disc proximally and by the scaphoid, lunate and triquetral distally. The proximal joint surface is composed of Lateral radial facet which articulate with scaphoid. I. II. Medial Radial facet articulates with lunate III. The triangular fibro cartilage complex that articulate with triquetrum predominantly and lunate with up to some extent .

  4. When the wrist is in neutral position ulna does not participate as the part of the radiocarpal joint Other than an attachment site for the TFCC(triangular fibro cartilage complex).

  5. MIDCARPAL JOINT It is the articulation between a scaphoid, lunate and triquetrum proximally and distal carpal row composed of the trapezium, trapezoid , capitate and hamate. The mid carpal joint surfaces are complex with an overall reciprocally concavo- convex configuration. Functionally the distal carpal row moves as an almost fix unit. The capitate and hamate are most strongly bound together, So only small amount of play is possible between them. The union of distal carpal also results in nearly equal distribution of load across -

  6. A scaphoid trapezium- trapezoid, Scaphoid-capitate, lunate- capitate , the triquetrum- hamate articulations. Together the bones of the distal carpal row contribute 20 of freedom of wrist complex with varying amounts of radial/ulnar deviation and flexion/extension credited to the joint .

  7. LIGAMENTS- The ligaments of the wrist complex are divided into- Extrinsic ligaments I. Intrinsic ligaments II.

  8. The extrinsic ligaments connect the carpals to the radius or ulna proximally and to the metacarpals distally. The intrinsic ligaments interconnect the carpals also known as intercarpal or interosseous ligaments. The intrinsic ligaments lie within the synovial lining and therefore rely on the synovial fluid for nutrition rather than contiguous vascularized tissue as do the extrinsic ligaments.

  9. FUNCTION The ROM of the entire complex are variable and depends upon the factors like ligamentous laxity , shape of articular surface and muscular force. Normal Range Are :- Flexion 800- 850 i. ii. Extension 800 900 iii. Radial Deviation 150 200 iv. Ulnar Deviation 400 450

  10. Motion at the radiocarpal and midcarpal joint are caused by the combination of active muscular and passive ligamentous and joint reaction force. Although there are several passive forces applied on the proximal carpal rows but there is no direct muscular force are applied. Therefore the proximal carpal row is a mechanical link between the radius and distal carpals and metacarpals to which direct muscular forces are applied. Hence this row is also called as intercalated segment a relatively unattached middle segment of a three segment linkages. When compressive forces are applied across the intercalated segment, the middle segment tends to collapse and moves in opposite direction.

  11. Example- Application of compressive forces towards extension of wrist complex would cause collapse of mid carpel row in flexion. An intercalated segment require some type of stabilizing mechanisms to prevent collapse of mid carpel segment and to normalize and combined mid carpel/ radio carpel motion, which is appear to be provided by scaphoid and its functional and anatomic connection both to the adjacent lunate and the distal carpal rows.

  12. FLEXION/EXTENSION OF THE WRIST- The motion begins with the wrist in full flexion. Active extension is initiated at distal carpal rows and metacarpal by the wrist extensor to which they are attached. The distal carpels glide with relatively fixed proximal bones in the same direction as the motion of the hand. When the wrist complex reaches neutral (long axis of 3rd metacarpal is lined with the long axis of the forearm).

  13. The ligament Spanning the capitate and scaphoid draw the capitates and scaphoid together into a close packed position. Continued extensors force now moved the combined unit of distal carpal row and scaphoid on the relatively fixed lunate and triquetrum. At approx. 450 hyperextension of the wrist complex, the scapholunate interosseus ligament bring the scaphoid and lunate into close packed position. This unites all the carpels and causes them to function as a single unit. Wrist extension is completed as the proximal articular surface of the carpals move as a solid unit on the radius and radioulnar disc. All ligament become taut as full extension is reached and the entire wrist complexes close packed. Wrist motion from full extension to full flexion occurs in the reverse sequence.

  14. RADIAL/ULNAR DEVIATION These are even more complex motion than flexion and extension but perhaps the variation is less. Radial deviation produces not only deviation of the proximal and distal carpal rows radially, but simultaneously flexion of proximal rows and extension of distal carpal rows.

  15. The opposite motion of the proximal and distal carpal occur with ulnar deviation. During these motion the distal rows again moves as a fixed unit but the magnitude of motion between the proximal carpal bones may differ. The range of radial and ulnar deviation is greatest when the wrist is in neutral position. When the wrist so extended or flexed the ROM is very little, because in closed packed position the carpals are locked and in lose pack position the bones are splayed.

  16. Thank YOU

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