Wrist
Encyclopedia
In human anatomy
Human anatomy
Human anatomy is primarily the scientific study of the morphology of the human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross anatomy is the study of anatomical structures that can be seen by the naked eye...

, the wrist is variously defined as 1) the carpus
Carpus
In tetrapods, the carpus is the sole cluster of bones in the wrist between the radius and ulna and the metacarpus. The bones of the carpus do not belong to individual fingers , whereas those of the metacarpus do. The corresponding part of the foot is the tarsus...

 or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand;
(2) the wrist joint or radiocarpal joint, the joint between the radius
Radius (bone)
The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally...

 and the carpus; and
(3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel
Carpal tunnel
In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the middle compartment of the deep plane of the palm. The tunnel consists of bones and connective tissue...

, the anatomical snuff box
Anatomical snuff box
The anatomical snuffbox is a triangular deepening on the radial, dorsal aspect of the hand—at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor...

, the flexor retinaculum
Flexor retinaculum of the hand
The flexor retinaculum is a strong, fibrous band that arches over the carpus, converting the deep groove on the front of the carpal bones into a tunnel, the carpal tunnel, through which the Flexor tendons of the digits and the median nerve pass.It is attached, medially, to the pisiform and the...

, and the extensor retinaculum
Extensor retinaculum of the hand
The extensor retinaculum is an anatomical term for the thickened part of the antebrachial fascia that holds the tendons of the extensor muscles in place. It is located on the back of the forearm, just proximal to the hand...

.

As a consequence of these various definitions, fractures to the carpal bones are referred to as carpal fractures, while fractures such as distal radius fracture
Distal radius fracture
A distal radius fracture is a common bone fracture of the radius in the forearm. Because of its proximity to the wrist joint, this injury is often called a wrist fracture...

 are considered fractures to the wrist.

Etymology

The English
English language
English is a West Germanic language that arose in the Anglo-Saxon kingdoms of England and spread into what was to become south-east Scotland under the influence of the Anglian medieval kingdom of Northumbria...

 word "wrist" is etymologically
Etymology
Etymology is the study of the history of words, their origins, and how their form and meaning have changed over time.For languages with a long written history, etymologists make use of texts in these languages and texts about the languages to gather knowledge about how words were used during...

 derived from the ancient German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....

 word wristiz from which are derived modern German rist ("instep", "wrist") and modern Swedish
Swedish language
Swedish is a North Germanic language, spoken by approximately 10 million people, predominantly in Sweden and parts of Finland, especially along its coast and on the Åland islands. It is largely mutually intelligible with Norwegian and Danish...

 vrist ("instep", "ankle"). The base writh- and its variants are associated with Old English words "wreath", "wrest", and "writhe". The wr- sound of this base seems originally to have been symbolic of the action of twisting.

Anatomy

Articulations

The radiocarpal, intercarpal, midcarpal, carpometacarpal, and intermetacarpal joints often intercommunicate through a common synovial cavity.

Extrinsic hand

The distal radioulnar joint
Distal radioulnar articulation
The distal radioulnar articulation is a pivot-joint formed between the head of the ulna and the ulnar notch on the distal radius.-Ligaments:The articular surfaces are connected together by the following ligaments:...

 is a pivot joint located between the bones of the forearm
Forearm
-See also:*Forearm flexors*Forearm muscles...

, the radius
Radius (bone)
The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally...

 and ulna
Ulna
The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form...

. Formed by the head of ulna
Head of ulna
The head of ulna presents an articular surface, part of which, of an oval or semilunar form, is directed downward, and articulates with the upper surface of the triangular articular disk which separates it from the wrist-joint; the remaining portion, directed lateralward, is narrow, convex, and...

 and the ulnar notch of radius
Ulnar notch of the radius
The articular surface for the ulna is called the ulnar notch of the radius; it is narrow, concave, smooth, and articulates with the head of the ulna....

, this joint is separated from the radiocarpal joint by an articular disk lying between the radius and the styloid process of ulna
Ulnar styloid process
The styloid process of the ulna projects from the medial and back part of the bone; it descends a little lower than the head, and its rounded end affords attachment to the ulnar collateral ligament of the wrist-joint....

. The capsule of the joint is lax and extends from the inferior sacciform recess to the ulnar shaft. Together with the proximal radioulnar joint, the distal radioulnar joint permits pronation
Pronation
In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a...

 and supination
Supination
Supination is a position of either the forearm or foot; in the forearm when the palm faces anteriorly, or faces up . Supination in the foot occurs when a person appears "bow-legged" with their weight supported primarily on the anterior of their feet.The hand is supine in the anatomical position...

.
The radiocarpal joint or wrist joint is an ellipsoid joint formed by the radius and the articular disc proximally and the proximal row of carpal bones distally. The carpal bones on the ulnar side only make intermittent contact with the proximal side — the triquetrum only makes contact during ulnar abduction. The capsule, lax and un-branched, is thin on the dorsal side and can contain synovial folds. The capsule is continuous with the midcarpal joint and strengthened by numerous ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...

s, including the palmar and dorsal radiocarpal ligament
Dorsal radiocarpal ligament
The dorsal radiocarpal ligament less thick and strong than the volar, is attached, above, to the posterior border of the lower end of the radius; its fibers are directed obliquely downward and medialward, and are fixed, below, to the dorsal surfaces of the navicular , lunate, and triangular, being...

s, and the ulnar
Ulnar collateral ligament (wrist)
The ulnar collateral ligament is a rounded cord, attached above to the end of the styloid process of the ulna, and dividing below into two fasciculi, one of which is attached to the medial side of the triquetral bone, the other to the pisiform and flexor retinaculum....

 and radial collateral ligaments
Radial collateral ligament (wrist)
The radial collateral ligament extends from the tip of the styloid process of the radius and attaches to the radial side of the scaphoid , immediately adjacent to its proximal articular surface and some fibres extend to the lateral side of the trapezium The radial collateral ligament (external...

.
The parts forming the radiocarpal joint are the lower end of the radius
Radius (bone)
The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally...

 and under surface of the articular disk
Articular disk
The articular disk is a thin, oval plate of fibrocartilage present in several joints which separates synovial cavities. This separation of the cavity space allows for separate movements to occur in each space....

 above; and the scaphoid, lunate
Lunate bone
The lunate bone is a carpal bone in the human hand that may be distinguished by its deep concavity and crescentic outline. It is situated in the center of the proximal row of the carpus region between the fore arm and hand...

, and triquetral bones below. The articular surface of the radius and the under surface of the articular disk
Articular disk
The articular disk is a thin, oval plate of fibrocartilage present in several joints which separates synovial cavities. This separation of the cavity space allows for separate movements to occur in each space....

 form together a transversely elliptical concave surface, the receiving cavity. The superior articular surfaces of the scaphoid, lunate, and triquetrum form a smooth convex surface, the condyle, which is received into the concavity.

Intrinsic hand

In the hand proper a total of 13 bones form part of the wrist: eight carpal bones
Carpus
In tetrapods, the carpus is the sole cluster of bones in the wrist between the radius and ulna and the metacarpus. The bones of the carpus do not belong to individual fingers , whereas those of the metacarpus do. The corresponding part of the foot is the tarsus...

—scaphoid, lunate
Lunate bone
The lunate bone is a carpal bone in the human hand that may be distinguished by its deep concavity and crescentic outline. It is situated in the center of the proximal row of the carpus region between the fore arm and hand...

, triquetral, pisiform, trapezium
Trapezium (bone)
The trapezium bone is a carpal bone in the wrist.The trapezium is distinguished by a deep groove on its palmar surface. It is situated at the radial side of the carpus, between the scaphoid and the first metacarpal bone...

, trapezoid
Trapezoid bone
The trapezoid bone is a carpal bone in tetrapods, including humans. It is the smallest bone in the distal row. It may be known by its wedge-shaped form, the broad end of the wedge constituting the dorsal, the narrow end the palmar surface; and by its having four articular facets touching each...

, capitate, and hamate— and five metacarpal bones—the first
First metacarpal bone
The first metacarpal bone or the metacarpal bone of the thumb is the first bone of the thumb. It is connected to the trapezium of the carpus at the first carpometacarpal joint and to the proximal thumb phalanx at the first metacarpophalangeal joint....

, second, third
Third metacarpal bone
The third metacarpal bone is a little smaller than the second.The dorsal aspect of its base presents on its radial side a pyramidal eminence, the styloid process, which extends upward behind the capitate; immediately distal to this is a rough surface for the attachment of the extensor carpi...

, fourth
Fourth metacarpal bone
The fourth metacarpal bone is shorter and smaller than the third.The base is small and quadrilateral; its superior surface presents two facets, a large one medially for articulation with the hamate, and a small one laterally for the capitate.On the radial side are two oval facets, for articulation...

, and fifth metacarpal bone
Fifth metacarpal bone
The fifth metacarpal bone is the most lateral metacarpal.-Surfaces:It presents on its base one facet on its superior surface, which is concavo-convex and articulates with the hamate, and one on its radial side, which articulates with the fourth metacarpal.On its ulnar side is a prominent tubercle...

s.

The midcarpal joint
Midcarpal joint
The midcarpal joint is formed by the scaphoid, lunate, and triquetral bones in the proximal row, and the trapezium, trapezoid, capitate, and hamate bones in the distal row. The distal pole of the scaphoid articulates with two trapezial bones as a gliding type of joint...

 is the S-shaped joint space separating the proximal and distal rows of carpal bones. The intercarpal joints, between the bones of each row, are strengthened by the radiate carpal
Radiate carpal ligament
The Radiate carpal ligament is a group of about seven fibrous bands which diverge in all directions on the palmar surface of the carpal bones. The majority of the bands radiate from the capitate to the scaphoid, lunate, and Triquetral bone bones....

 and pisohamate ligament
Pisohamate ligament
The pisohamate ligament is a ligament in the hand. It is the volar ligament that connects the pisiform to the hamate. It is a prolongation of the tendon of the Flexor carpi ulnaris.It serves as part of the origin for the abductor digiti minimi....

s and the palmar
Palmar intercarpal ligaments
The palmar intercarpal ligaments are fibrous bands that extend transversely across the palmar surfaces of the carpal bones, connecting adjacent carpals. These are the ligaments that define the structure of the palmar arch....

, interosseous
Interosseous intercarpal ligaments
The Interosseous intercarpal ligaments are short fibrous bands that connect the adjacent surfaces of the various carpal bones....

, and dorsal intercarpal ligament
Dorsal intercarpal ligament
The dorsal intercarpal ligament consists of a series of fibrous bands that extend transversely across the dorsal surfaces of the carpal bones, connecting them to each other....

s. Some degree of mobility is possible between the bones of the proximal row while the bones of the distal row are connected to each others and to the metacarpal bones —at the carpometacarpal joint
Carpometacarpal joint
The carpometacarpal joints are five joints in the wrist that articulates the distal row of carpal bones and the proximal bases of the five metacarpal bones....

s— by strong ligaments —the pisometacarpal
Pisometacarpal ligament
The pisometacarpal ligament joins the pisiform to the base of the fifth metacarpal bone.-External links:* http://classes.kumc.edu/sah/resources/handkines/ligaments/wvdpisometa.htm...

 and palmar
Palmar carpometacarpal ligament
The Palmar carpometacarpal ligaments are a series of bands on the palmar surface of the carpometacarpal joints that connect the carpal bones to the second through fifth metacarpal bones. The second metacarpal is connected to the trapezium. The third metacarpal is connected to the trapezium, to the...

 and dorsal carpometacarpal ligament— that makes a functional entity of these bones. Additionally, the joints between the bases of the metacarpal bones —the intermetacarpal articulations
Intermetacarpal articulations
Intermetacarpal Articulations - The bases of the second, third, fourth and fifth metacarpal bones articulate with one another by small surfaces covered with cartilage, and are connected together by dorsal, volar, and interosseous ligaments....

— are strengthened by dorsal, interosseous, and palmar intermetacarpal ligaments.

Movements and muscles

The extrinsic hand muscles are located in the forearm where their bellies form the proximal fleshy roundness. When contracted, most of the tendons of these muscles are prevented from standing up like taut bowstrings around the wrist by passing under the flexor retinaculum
Flexor retinaculum of the hand
The flexor retinaculum is a strong, fibrous band that arches over the carpus, converting the deep groove on the front of the carpal bones into a tunnel, the carpal tunnel, through which the Flexor tendons of the digits and the median nerve pass.It is attached, medially, to the pisiform and the...

 on the palmar side and the extensor retinaculum
Extensor retinaculum of the hand
The extensor retinaculum is an anatomical term for the thickened part of the antebrachial fascia that holds the tendons of the extensor muscles in place. It is located on the back of the forearm, just proximal to the hand...

 on the dorsal side. On the palmar side the carpal bones form the carpal tunnel
Carpal tunnel
In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the middle compartment of the deep plane of the palm. The tunnel consists of bones and connective tissue...

 through which some of the flexor tendons pass in tendon sheath
Tendon sheath
A tendon sheath is a layer of membrane around a tendon. It permits the tendon to move.It has two layers:* synovial sheath* fibrous tendon sheathFibroma of the tendon sheath has been described....

s that enable them to slide back and forth through the narrow passageway (see carpal tunnel syndrome
Carpal tunnel syndrome
Carpal Tunnel Syndrome is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression...

).
Starting from the mid-position of the hand, the movements permitted in the wrist proper are (muscles in order of importance):
  • Marginal movements: radial deviation (abduction, movement towards the thumb) and ulnar deviation (adduction, movement towards the little finger). These movements take place about a dorsopalmar axis (back to front) at the radiocarpal and midcarpal joints passing through the capitate bone.
    • Radial abduction: extensor carpi radialis longus
      Extensor carpi radialis longus muscle
      Extensor carpi radialis longus is one of the five main muscles that control movements at the wrist. This muscle is quite long, starting on the lateral side of the humerus, and attaching to the base of the second metacarpal bone .-Function:As the name suggests, this muscle is an extensor at the...

      , abductor pollicis longus
      Abductor pollicis longus muscle
      The abductor pollicis longus muscle is one of the extrinsic muscles of the hand. It lies immediately below the supinator muscle and is sometimes united with it.-Origin and insertion:...

      , extensor pollicis longus
      Extensor pollicis longus muscle
      In human anatomy, the extensor pollicis longus is a skeletal muscle located dorsally on the forearm. It is much larger than the extensor pollicis brevis, the origin of which it partly covers, and acts to stretch the thumb together with this muscle....

      , flexor carpi radialis
      Flexor carpi radialis muscle
      In anatomy, flexor carpi radialis is a muscle of the human forearm that acts to flex and abduct the hand.-Origin and insertion:This muscle originates on the medial epicondyle of the humerus...

      , flexor pollicis longus
      Flexor pollicis longus muscle
      The flexor pollicis longus is a muscle in the forearm and hand that flexes the thumb...

    • Ulnar abduction: extensor carpi ulnaris
      Extensor carpi ulnaris muscle
      In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. It acts to extend and adduct at the carpus/wrist.Being an extensor muscle, extensor carpi ulnaris is on the posterior side of the forearm....

      , flexor carpi ulnaris
      Flexor carpi ulnaris muscle
      The flexor carpi ulnaris muscle is a muscle of the human forearm that acts to flex and adduct the hand.-Origin and insertion:Flexor carpi ulnaris muscle arises by two heads - humeral and ulnar, connected by a tendinous arch beneath which the ulnar nerve and ulnar artery pass.* The humeral head...

      , extensor digitorum
      Extensor digitorum muscle
      The extensor digitorum muscle is a muscle of the posterior forearm present in humans and other animals...

      , extensor digiti minimi
      Extensor digiti minimi muscle
      The extensor minimi digiti is a slender muscle of the forearm, placed on the ulnar side of the Extensor digitorum communis, with which it is generally connected....

  • Movements in the plane of the hand: flexion (palmar flexion, tilting towards the palm) and extension (dorsiflexion, tilting towards the back of the hand). These movements take place through a transverse axis passing through the capitate bone. Palmar flexion is the most powerful of these movements because the flexors, especially the finger flexors, are considerably stronger than the extensors.
    • Extension: extensor digitorum
      Extensor digitorum muscle
      The extensor digitorum muscle is a muscle of the posterior forearm present in humans and other animals...

      , extensor carpi radialis longus
      Extensor carpi radialis longus muscle
      Extensor carpi radialis longus is one of the five main muscles that control movements at the wrist. This muscle is quite long, starting on the lateral side of the humerus, and attaching to the base of the second metacarpal bone .-Function:As the name suggests, this muscle is an extensor at the...

      , extensor carpi radialis brevis
      Extensor carpi radialis brevis muscle
      The Extensor carpi radialis brevis is shorter and thicker than the extensor carpi radialis longus. The longus muscle can be found above the distal end of the Extensor carpi radialis brevis.-Origin and insertion:...

      , extensor indicis, extensor pollicis longus
      Extensor pollicis longus muscle
      In human anatomy, the extensor pollicis longus is a skeletal muscle located dorsally on the forearm. It is much larger than the extensor pollicis brevis, the origin of which it partly covers, and acts to stretch the thumb together with this muscle....

      , extensor digiti minimi
      Extensor digiti minimi muscle
      The extensor minimi digiti is a slender muscle of the forearm, placed on the ulnar side of the Extensor digitorum communis, with which it is generally connected....

    • Palmar flexion: flexor digitorum superficialis
      Flexor digitorum superficialis muscle
      Flexor digitorum superficialis is an extrinsic flexor muscle of the fingers at the proximal interphalangeal joints....

      , flexor digitorum profundus
      Flexor digitorum profundus muscle
      - References :...

      , flexor carpi ulnaris
      Flexor carpi ulnaris muscle
      The flexor carpi ulnaris muscle is a muscle of the human forearm that acts to flex and adduct the hand.-Origin and insertion:Flexor carpi ulnaris muscle arises by two heads - humeral and ulnar, connected by a tendinous arch beneath which the ulnar nerve and ulnar artery pass.* The humeral head...

      , flexor pollicis longus
      Flexor pollicis longus muscle
      The flexor pollicis longus is a muscle in the forearm and hand that flexes the thumb...

      , flexor carpi radialis
      Flexor carpi radialis muscle
      In anatomy, flexor carpi radialis is a muscle of the human forearm that acts to flex and abduct the hand.-Origin and insertion:This muscle originates on the medial epicondyle of the humerus...

      , abductor pollicis longus
      Abductor pollicis longus muscle
      The abductor pollicis longus muscle is one of the extrinsic muscles of the hand. It lies immediately below the supinator muscle and is sometimes united with it.-Origin and insertion:...

  • Intermediate or combined movements


However, movements at the wrist can not be properly described without including movements in the distal radioulnar joint in which the rotary actions of supination
Supination
Supination is a position of either the forearm or foot; in the forearm when the palm faces anteriorly, or faces up . Supination in the foot occurs when a person appears "bow-legged" with their weight supported primarily on the anterior of their feet.The hand is supine in the anatomical position...

 and pronation
Pronation
In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a...

 occur and this joint is therefore normally regarded as part of the wrist.

See also

  • Distal radius fracture
    Distal radius fracture
    A distal radius fracture is a common bone fracture of the radius in the forearm. Because of its proximity to the wrist joint, this injury is often called a wrist fracture...

  • Brunelli Procedure
    Brunelli Procedure
    The Brunelli Procedure is a surgical procedure that can be used to correct instability in the wrist. Instability in the wrist can be caused by a torn Scapholunate ligament. The Brunelli Procedure does not fix the torn ligament. A hole is drilled through the Scaphoid bone and a part of a tendon...

    , related to instability in the wrist
  • Knuckle-walking
    Knuckle-walking
    Knuckle-walking is a form of quadrupedal walking in which the forelimbs hold the fingers in a partially flexed posture that allows body weight to press down on the ground through the knuckles....

    , a kind of quadrupedal locomotion involving wrist bone specialization
  • Wristlocks
    Wristlock
    A Wristlock is a joint lock primarily affecting the wrist-joint and possibly the radioulnar joints through rotation of the hand. A wristlock is typically applied by grabbing the opponent's hand, and bending and/or twisting it. Wristlocks are very common in martial arts such as Aikido, Hapkido and...

    use movement extremes of the wrist for martial applications.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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