Bones of the Wrist and Hand

Bone Structure Description Notes

carpal bones the bones of the wrist eight bones arranged in two rows; a pneumonic for memorizing the carpal bones is "
some lovers try positions that they can't handle" - the first letters of these eight words are
the first letters of the names of the eight carpal bones arranged from lateral to medial,
proximal row first: scaphoid, lunate, triquitrum, pisiform/trapezium, trapezoid, capitate,
hamate
proximal lateral to medial: scaphoid, the scaphoid and lunate bones of the proximal row articulate with the distal end of the
row lunate, triquetrum, pisiform radius
distal row lateral to medial: trapezium, the distal row of carpal bones articulates with the metacarpal bones of the hand
trapezoid, capitate, hamate
scaphoid the most lateral carpal bone of the scaphoid bone is located in the floor of the anatomical snuff box; it is frequently
the proximal row fractured by hyperextension and abduction of the wrist; scaphoid means "boat-shaped"
lunate the carpal bone located the lunate is so named because it is "moon-shaped" (crescent shaped) in longitudinal
between the scaphoid and section; the head of the capitate sits within the crescent of the lunate
triquetrum in the proximal
row
triquetrum the carpal bone between the it articulates with the pisiform which sits anterior to it
lunate and pisiform bones in
the proximal row of carpal
bones
pisiform a sesamoid bone in the tendon it articulates with the triquetrum; the pisiform bone provides a protective function for the
of the flexor carpi ulnaris m. flexor carpi ulnaris tendon by bearing the forces generated by the tendon riding across
the triquitrum, especially during wrist extension; pisiform means "pea-shaped"
trapezium the most lateral carpal bone of it forms a saddle joint with the metacarpal bone of the thumb; "the thumb swings on the
the distal row trapezium"
trapezoid the carpal bone located the trapezoid is named for its trapezoid shape
between the trapezium and the
capitate in the distal row
capitate the carpal bone located the capitate is the largest carpal bone; it is named for its rounded head; forces generated
between the trapezoid and the in the hand (as during a punching blow with the fist) are transmitted through the third
hamate in the distal carpal metacarpal bone to the capitate and proximally through the lunate to the radius
row
hamate the most medial carpal bone the hamulus (hook) of the hamate is its distinguishing characteristic; it is an attachment
 in the distal row point of the flexor retinaculum
metacarpal the bones located between the there are a total of five metacarpal bones in the hand; the metacarpals of digits 2-5 are
bones carpal bones (wrist) and the bound together by ligaments to form a firm foundation for finger movements; the
phalanges (fingers) of the metacarpal of the thumb is more independent in its range of motion
hand
base the proximal end of the it articulates with the distal row of carpal bones
metacarpal
body the slender shaft of the it is also known as the diaphysis
metacarpal
head the rounded distal end of the it articulates with the proximal phalanx of the corresponding digit
metacarpal
phalanx the distal two or three bones there are a total of 14 phalanges in the hand; the thumb has two phalanges (proximal and
(phalanges) in the digits of the hand distal) and each of the other digits has three phalanges (proximal, middle and distal);
phalanx means "line of soldiers"
base the proximal end of the the base of the proximal phalanx articulates with the head of the corresponding
phalanx metacarpal bone; the base of the middle or distal phalanx articulates with the head of the
next proximal phalanx
body the slender shaft of the also known as the diaphysis; the body of the distal phalanx is very short
phalanx
head the distal end of the phalanx the proximal, middle and distal phalanges each have a head; the head of a proximal or
middle phalanx articulates with the base of the next distal phalanx

Intrinsic Muscles of the Hand

Muscle Origin Insertion Action Innervation Artery Notes
abductor pisiform base of the abducts the 5th digit deep branch of ulnar a. abductor digiti minimi,
digiti minimi proximal phalanx the ulnar nerve flexor digiti minimi
(hand) of the 5th digit on brevis, and opponens
its ulnar side digiti minimi are located
in the hypothenar
compartment of the hand
abductor flexor base of the abducts the thumb recurrent branch superficial abductor pollicis brevis,
pollicis brevis retinaculum, proximal phalanx of median nerve palmar br. of flexor pollicis brevis, and
scaphoid, of the first digit the radial a. opponens pollicis are
trapezium located in the thenar
 compartment of the hand
adductor oblique head: base of the adducts the thumb ulnar nerve, deep deep palmar deep palmar arch and
pollicis capitate and base proximal phalanx branch arterial arch deep ulnar nerve pass
of the 2nd and 3rd of the thumb between the two heads of
metacarpals; adductor pollicis, which is
transverse head: in the adductor-
shaft of the 3rd interosseous compartment
metacarpal
dorsal four muscles, each base of proximal flex metacarpophalangeal, ulnar nerve, deep dorsal bipennate muscles;
interosseous arising from two phalanx and extend proximal and distal branch metacarpal remember DAB & PAD:
(hand) adjacent extensor expansion interphalangeal joints of digits aa. meaning Dorsal interossei
metacarpal shafts on lateral side of 2-4, abduct digits 2-4 (abduction ABduct and Palmar
2nd digit, lateral & of digits of hand is defined as interossei ADduct, then
medial sides of 3rd movement away from midline you can figure out where
digit, and medial of 3rd digit) they must insert
side of 4th digit
flexor digiti hook of hamate & proximal phalanx flexes the carpometacarpal and ulnar nerve, deep ulnar a. flexor digiti minimi
minimi brevis the flexor of the 5th digit metacarpophalangeal joints of branch brevis, abductor digiti
(hand) retinaculum the 5th digit minimi, and opponens
digiti minimi are in the
hypothenar compartment
of the hand
flexor pollicis flexor proximal phalanx flexes the carpometacarpal and recurrent branch superficial flexor pollicis brevis,
brevis retinaculum, of the 1st digit metacarpophalangeal joints of of the median palmar br. of abductor pollicis brevis,
trapezium the thumb nerve the radial a. and opponens pollicis are
the three muscles of the
thenar compartment of
the hand
lumbrical flexor digitorum extensor expansion flex the metacarpophalangeal median nerve superficial lumbricals, (lumbricus is
(hand) profundus tendons on the radial side joints, extend the proximal and (radial 2) via palmar Latin for "worm") arise
of digits 2-5 of the proximal distal interphalangeal joints of palmar digital arterial arch from the profundus
phalanx of digits digits 2-5 nerves & ulnar tendons and have the
2-5 nerve (ulnar 2) same pattern of
via deep branch innervation as does the
profundus muscle (ulnar
and median nn. split the
task equally)
opponens hook of hamate shaft of 5th opposes the 5th digit ulnar nerve, deep ulnar a. opposition is a rotational
digiti minimi and flexor metacarpal branch movement of the 5th
retinaculum metacarpal around the
long axis of its shaft;
opponens digiti minimi,
abductor digiti minimi,
and flexor digiti minimi
brevis are in the
hypothenar compartment
of the hand
opponens flexor shaft of 1st opposes the thumb recurrent branch superficial opposition is a rotational
pollicis retinaculum, metacarpal of median nerve palmar movement of the 1st
trapezium branch of the metacarpal around the
radial a. long axis of its shaft;
opponens pollicis,
abductor pollicis brevis,
and flexor pollicis brevis
are in the thenar
compartment of the hand
palmar three muscles, base of the flexes the metacarpophalangeal, ulnar nerve, deep palmar unipennate muscles;
interosseous arising from the proximal phalanx extends proximal and distal branch metacarpal remember PAD & DAB:
palmar surface of and extensor interphalangeal joints and aa. Palmar interossei ADduct
the shafts of expansion of the adducts digits 2, 4, & 5 and Dorsal interossei
metacarpals 2, 4, medial side of digit (adduction of the digits of the ABduct, and you will be
&5 2, and lateral side hand is in reference to the able to figure out where
of digits 4 & 5 midline of the 3rd digit) they must insert

Flexor Muscles of the Forearm That Move the Fingers

Muscle Origin Insertion Action Innervation Artery Notes
flexor posterior border of the base of the flexes the median nerve ulnar a., ulnar nerve innervates the
digitorum ulna, proximal two- distal phalanx metacarpophalangeal, (radial one-half); anterior portion of profundus that
profundus thirds of medial border of digits 2-5 proximal interphalangeal and ulnar nerve (ulnar interosseous a. acts on digits 4 & 5 (the
of ulna, interosseous distal interphalangeal joints one-half) ulnar 2 digits)
membrane
flexor humeroulnar head: shafts of the flexes the median nerve ulnar a. median nerve travels
digitorum common flexor middle metacarpophalangeal and distally in the forearm on
superficialis tendon; radial head: phalanges of proximal interphalangeal the deep surface of the
 middle 1/3 of radius digits 2-5 joints flexor digitorum
superficialis m.
flexor pollicis anterior surface of base of the flexes the median nerve anterior the tendon of flexor
longus radius and distal phalanx metacarpophalangeal and interosseous a. pollicis longus passes
interosseous of the thumb interphalangeal joints of the through the carpal tunnel
membrane thumb with the other long digital
flexor tendons and the
median nerve

Nerves of the Hand

Nerve Source Branches Motor Sensory Notes
common median n.; proper palmar digital sympathetic motor to the skin; skin of the palmar the proper branches of these
palmar superficial br. of the nn. motor nn. to the 1st & 2nd surfaces of the nerves also supply the dorsum
digital nn. ulnar n. lumbrical mm. are carried on adjacent sides of two of the tip of the digit (nail bed)
common palmar digital brs. of the digits
median n.
dorsal radial n. no named branches sympathetic motor innervation to dorsal skin of the the nail bed is supplied by
digital n. skin lateral 3 1/2 digits, palmar digital nn.
except the nail bed
median n. lateral and medial unnamed muscular pronator teres m., flexor carpi skin of the radial half the median n. is motor to the
cords of the branches, anterior radialis m., palmaris longus m., of the palm and flexor muscles of the forearm
brachial plexus interosseous n., flexor digitorum superficialis m., palmar side of the (except flexor carpi ulnaris and
palmar br., recurrent flexor digitorum profundus m. lateral 3 1/2 digits the medial 1/2 of the flexor
(motor) br., common (radial half), flexor pollicis longus (and nail bed for digitorum profundus),the
palmar digital nn. (for m., pronator quadratus m., abductor these digits) muscles of the thenar
digits 1-3) pollicis brevis m., flexor pollicis compartment and the lateral 2
brevis m., opponens pollicis m., lumbricals
lateral 2 lumbrical mm.
proper common palmar no named branches sympathetic motor to the skin median: palmar skin proper palmar digital nn.
palmar digital branches of and nail bed of digits supply the dorsum of the tip of
digital nn. the median n.; 1-3 and the lateral the digit (nail bed)
common palmar side of 4th digit;
digital branches of ulnar: palmar and
the superficial br. of dorsal skin on medial
the ulnar n. side of the 4th digit
and all of the 5th

ulnar n. medial cord of the palmar cutaneous br., flexor carpi ulnaris m., flexor
brachial plexus (C8, dorsal br., superficial digitorum profundus m. (ulnar
T1) and deep brs. half), abductor digiti minimi m.,
flexor digiti minimi brevis m.,
opponens digiti minimi m., ulnar 2
lumbrical mm., palmar and dorsal
interosseous mm.
digit
skin of the medial ulnar n. is motor to most of the
side of the wrist and muscles of the hand
hand; skin of the
medial 1 1/2 digits

Arteries of the Hand

Artery Source Branches Supply to Notes
common superficial palmar proper palmar digital palmar aspect two adjacent digits common palmar digital aa. anastomose
palmar digital arterial arch aa. (2) with palmar metacarpal aa.
deep palmar radial a., deep br. of palmar metacarpal aa. deep palm, digits including the dorsum of deep palmar arterial arch receives its
arch ulnar a. (2nd-4th), perforating the distal phalangeal segment major blood supply from the radial a.
brs.
digital, superficial palmar proper palmar digital palmar aspect two adjacent digits common palmar digital aa. anastomose
common arterial arch aa. (2) with palmar metacarpal aa.
palmar
digital, proper common palmar no named branches palmar aspect of each digit proper palmar digital aa. supply the
palmar digital a. dorsum of the distal phalangeal segment
and nail bed
dorsal carpal radial a., ulnar a. dorsal metacarpal aa. dorsum of the hand and digits, excluding dorsal carpal arterial arch receives the
arterial arch the distal phalangeal segment majority of its blood supply from the
radial a.
dorsal digital, dorsal metacarpal a. no named branches dorsal aspect of 1/2 digit, excluding the dorsal digital aa. do not supply the nail
of hand distal phalangeal segment bed
dorsal 1st: radial a.; 2-4: dorsal digital aa. (2) dorsum of 2 adjacent digits, excluding the each dorsal metacarpal a. gives off a
metacarpal dorsal carpal arterial distal phalangeal segment perforating br. that anastomoses with
arch the deep palmar arterial arch
palmar deep palmar arch proper palmar digital interosseous mm., deep hand palmar metacarpal aa. join with the
metacarpal aa. common palmar digital aa.
superficial ulnar a., superficial common palmar superficial palm, palmar surface of the superficial palmar arterial arch receives
palmar arch palmar br. of the digital aa. (3) digits excluding thumb, dorsum of the distal its major blood supply from the ulnar a.
 radial a. phalangeal segments of digits 2-5

Joints of the Hand and Fingers

Joint or ligament Description Notes
carpometacarpal joint, the articulation between the distal carpal bones and the a synovial plane joint; limited motion is permitted at the
finger proximal ends of the metacarpal bones of the hand carpometacarpal joint; the carpometacarpal joint is reinforced by
dorsal and palmar ligaments
carpometacarpal joint, the articulation between the trapezium and the proximal a synovial saddle (sellar) joint; this articulation permits two planes
thumb end of the metacarpal bone of the thumb of motion: flexion/extension and abduction/adduction which may
be combined to produce circumduction
intermetacarpal joint the articulation between the adjacent sides of the a synovial plane joint; limited motion is possible between at the
proximal ends of metacarpal bones 2-5 carpometacarpal joints or between adjacent metacarpal bones
intercarpal joint joints between adjacent carpal bones synovial plane joints; small gliding movements are permitted
between adjacent carpal bones
interphalangeal joints the articulations between the proximal and middle a synovial hinge joint; these joints are strengthened by medial and
phalanges (proximal interphalangeal joint, abbreviated lateral collateral ligaments
PIP) or the middle and distal phalanges (distal
interphalangeal joint, abbreviated DIP)
metacarpophalangeal the articulation between the head of a metacarpal and a synovial condyloid (or ellipsoid) joint; it is strengthened by
joint the base of a proximal phalanx medial and lateral collateral ligaments; the joint has two planes of
motion: flexion/extension and abduction/adduction which may be
combined to yield circumduction

Fasciae of the Forearm and Hand

Structure Location/Description Notes
fascia, fascia covering the hypothenar hypothenar fascia blends with the palmar aponeurosis and attaches to the fifth metacarpal bone;
hypothenar muscle group it defines the hypothenar compartment of the hand
fascia, thenar fascia covering the thenar muscle thenar fascia blends with the palmar aponeurosis and attaches to the first metacarpal bone it
group defines the thenar compartment of the hand
flexor a thickening of the deep fascia on flexor retinaculum spans the ventral surfaces of the carpal bones (medially - scaphoid and
retinaculum the ventral surface of the wrist trapezium; laterally - hamate and pisiform) to complete an osseofibrous tunnel for passage of the
flexor tendons; tendons are surrounded by synovial tendon sheathes where they pass deep to
retinacula
palmar a thickening of the deep fascia palmar aponeurosis is composed of very dense connective tissue that extends out into each of the
aponeurosis covering the palm of the hand fingers