CHAPTER 18 : The Joints of the wrist , hand and fingers

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Organization of the Hand

Hand Osteology


  • Includes the carpus, metacarpus and phalanges
  • Carpal bones are 8 and are arranged in proximal and distal rows.
  • Can you name them in order?
  • Scaphoid, lunate and triquetral form a convex articulating surface for the radiocarpal joint
  • Pisiform articulates with palmar surface of triquetral bone
  • Palmar surfaces of the bones form a concavity bridged by flexor retinaculum to form carpal tunnel.
  • Are the carpal bones at the borders of the tunnel projected on the surface?
  • The trapezium and hamate are palpable proximal to the thenar and hypothenar eminence
  • The retinaculum strengthens the carpus and enhances flexor efficiency
  • Attached to the bones are various ligaments: radiocarpal, intercarpal & carpometacarpal

The Scaphoid bone


  • To it is attached flexor retinaculum, abductor pollicis brevis, and radial collateral ligament.
  • Has a body, neck and head. In a proportion (13%), the blood supply to the body is from the distal end
  • Scaphoid fractures are common. Why?
  • How can you clinically detect a fracture of the scaphoid?
  • Why are X-rays initially negative for scaphoid fractures?

Other carpal bones  

  • Dislocations are common with the Lunate
  • Triquetral makes contact with ulna at adduction
  • The tendon of the flexor carpi ulnaris, pisohamate and piso-metacarpal ligament attach to the pisiform
  • Trapezium characterized by grove for tendon of flexor carpi radialis. To it is attached the flexor retinaculum and radial collateral ligament
  • Capitate is centrally placed and is the largest carpal bone
  • Hamate affords attachment to flexor retinaculum and has rough dorsal and palmar surfaces for ligament.
  • Capitate is first to ossify. Pisiform is last ( What is the order for the other? )


metacapals and phallanges :  

  • Metacarpals are long bones with head, shaft and base. The second metacarpal has the largest base and shaft
  • The 14 phalanges bear heads, shafts and bases
  • Note primary ossification centers for the shafts and secondary centers for base of 1 st and heads of other metacarpals