Wrist

By
Hossein Khorrami, Ph.D, DOMP

khorrami4@yahoo.com
 Carpal bones
•  Scaphoid

•  Lunate

•  Pisiform

•  Trapezium

•  Trapesoid

•  Capitate

•  Hamate

•  Triquetral
 The skeleton of the hand

•  Bones of the carpus (wrist)

•  Bones of the metacarpus (palm)

•  Phalanges (bones of the fingers)

Ligaments of the wrist, palmar view
Ligaments of the wrist, posterior (dorsal) view
Muscles of the anterior compartment of the forearm acting on the right wrist and
fingers
Muscles of the posterior compartment of the right forearm
 Flexor Digitorum

•  Flexion of middle phalanges

•  Median N.
Summary of Actions of Muscles Acting on the Wrist and Fingers
Hand muscles, ventral views of right hand. (a) first superficial layer. (b) Second
layer
 Wrist muscles

•  Flexor Carpi Ulnaris(FCU)

•  Extensor Carpi Ulnaris(ECU)

•  Flexor Carpi Radilis(FCR)

•  Extensor Carpi Radialis(ECR)

 Wrist movements
•  Ulnar deviation…………FCU+ECU

•  Radial deviation…...…...FCR+ECR

•  Extension……………….ECR+ECU

•  Flexion………………….FCR+FCU
 Finger movements

•  Flexion

•  Extension

•  Abduction

•  Adduction

•  Opposition(just for thumb)

Wrist Bones & Joints
Carpal tunnel sign & symptoms

•  Median nerve involved

•  In carpal area
•  In brachial plexus

•  Pain, mostly at night

•  Tingling

•  Numbness

•  Pain with tapping on the carpal area

•  Atrophy and muscle weakness

 Carpal  Tunnel  Syndrome

-­‐  Pain,  tingling  because  of  pressure  on  the  median  

nerve  in  the  wrist  

-­‐  The  median  nerve  controls  movement  and  feeling  

in  thumb  and  first  three  fingers  

-  Reverse Phalen’s position, is painfull

 Carpal tunnel treatment

•  Avoid heavy lifting

•  Ultrasound

•  Paraffin bath

•  Massage in warm water

•  Exercises
 Exercises for carpal tunnel
•  Praying (Phalen’s position), is painfull

•  Palm up, straight hand extension + head tilt to the

opposite side
•  30sec, 3 sets

•  Medial nerve release ex, 5 steps of 5 sec

•  Massage the carpal area

 CTS exercise
•  This exercise stretches out the median nerve

•  Lift arm up from the side, parallel with the floor,

palm is facing upward

•  Tilt fingers towards the floor, stretching the skin on

palms

•  As hold this position, gently drop head towards

opposite shoulder

•  Hold that position for 30 seconds, and then relax

Carpal tunnel exercise
 Exercises
Wrist Flexion to Extension Forearm Rotation 
 Radial deviation

•  Strengthening deviator muscles

•  Hold the weight in the hand with the thumb pointing

up

•  Move the wrist up and down, much like hammering

a nail

•  All motion should occur at the wrist

 Wrist extensor muscles
•  Strengthening wrist extensor muscles
•  Hold the weight in the hand with the palm facing
down
•  Extend the wrist upward so that it is pulled back
•  Hold this position for 2 seconds and then lower
slowly
 Wrist flexion

•  Strengthening wrist flexor muscles: Hold the weight

in the hand with the palm up

•  Pull the wrist up

•  Hold for 2 seconds and lower slowly