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The wrist
complex
Submitted by : Gaganpreet kaur
(14204104)
Submitted to: Dr.Supreet Bindra
The wrist (carpus) consists of two
compound joints:
The radiocarpal joint
The midcarpal joints
Referred to collectively as the wrist
complex
Radiocarpal joint structure:
The radiocarpal joint
is formed by
radius and radioulnar
disc as part of the
triangular
fibrocartilage complex
(TFCC) proximally
and by the
scaphoid,lunate and
triquetrum distally.
The distal radius has a
single ,continuous ,biconcane
curvature that is long and shallow
from side to side
And shorter and sharper
anteroposteriorly.
The proximal joint
surface is composed
of
The lateral radial
facet-scaphoid
The medial radial
facet lunate
The triangular
fibrocartilage
complex -triquetrum
The compound
proximal
radiocarpal joint
surface is oblique
and angled
slightly volarly
and ulnarly .
The average
inclination of
distal radius is
23.
The distal radius is
also tilted 11
degree volarly with
the posterior radius
slightly longer than
volar radius.
The triangular fibrocartilage
complex :
Consists of :
The radioulnar
disc
And the various
attachments that
provide the
primary support
for the distal
radioulnar joint.
The articular disc is a
fibrocartilaginous
continuation of the
articular cartilage of the
distal radius.
The disc is connected
medially via two dense
fibrous connective
tissue laminae
The upper laminae
include the dorsal and
volar radioulnar
ligaments which attach
to ulnar head and
styloid
The lower lamina has
connections to the
sheath of the
extensor carpi
ulnaris tendon and to
triquetrum ,hamate
and the base of fifth
metacarpal through
fibers from the ulnar
collateral ligament
The so called
meniscus homolog .
The scaphoid ,lunate and triquetrum
compose the proximal carpal row .
Proximal carpal row articulates with
the distal radius.
Ulnar variance
Ulnar negative variance is described
as a short ulna in comparison with
the radius at the distal end.
Ulnar positive variance the distal
ulna is ling in relation to distal radius.
Avascular necrosis of the lunate
,kienbocks disease
Radiocarpal capsule and
ligaments:
Joint is enclosed by a strong but
somewhat loose capsule and is
reinforced by capsular and
intracapsular ligaments.
Most ligaments that cross the
radiocarpal joint also contribute to
stability at the midcarpal joint .
Midcarpal joint structure:
The midcarpal joint is the articulation
between the scaphoid ,lunate and
triquetrum proximally
The distal carpal row composed of
the trapezium,trapezoid,capitate and
hamate.
The capitate and hamate are most
strongly bound together with,at the
most a small amount of play
between them.
It is also foundation for the
transverse and longitudinal arches of
the hand.
Ligaments of wrist complex:
The ligaments of the wrist complex are
designated either
Extrinsic or intrinsic
The extrinsic ligaments are those that
connect the carpals to the radius or ulna
proximally or to metacarpals distally.
The intrinsic ligaments are those that
interconnect the carpals themselves and
are also known as interosseous or
intercarpal ligaments.
Volar carpal ligaments:
Volar extrinsic ligaments into two groups:
The radiocarpal
The ulnocarpal ligaments
The composite ligament known as the volar
radiocarpal ligament.
Three bands:
The radioscaphocapitate (radiocapitate)
Short and long radiolunate
(radiolunotriquetral)
Radioscapholunate ligaments
The radial collateral ligament may be
considered an extension of the volar
radiocarpal ligament and capsule.
The ulnocarpal ligament complex is
composed of the triangular
fibrocartilage complex .
The ulnolunate ligament
The ulnar collateral ligament.
Two volar intrinsic ligaments:
The scapholunate interosseous
ligament, which is being key factor in
maintaining scaphoid stability.
The second key intrinsic is the
lunotriquetral interosseous ligament .
This ligament is credited with
maintaining stability between the
lunate and triquetrum.
Injury to this leads to lunate
instability.
Dorsal carpal ligaments :
Dorsal radiocarpal ligament major
wrist ligament
The ligament whole converges on the
triquetrum from the distal radius
with possible attachments along thw
way to the lunate and the
lunotriqutral interosseous ligament.
A second dorsal
ligament is the
dorsal intercarpal
ligament which
course horizontally
from the triquetrum
to the lunate
,scaphoid and
trapezium.
The two together
from horizontal V
that contributes to
radiocarpal stability .
Function of wrist complex
The proximal row is an intercalated
segment, a relatively unattched
middle segment of three segments
linkage
It function as an intercalated
segment between the distal radius
and the relatively immobile segment.
Flexion and extension:
Range of flexion and extension:
65 to 85-flexion
60 to 85 extension
During flexion scaphoid seems to
show the greatest motion whereas
lunate moves least.
Conceptual framework for flexion
and extension:
Wrist flexion
Active extension is initiated at the distal
carpal row and at the firmly attached
metacarpals by the wrist extensor muscles
attached .
The distal carpals glide relatively fixed
proximal bones.
The ligaments spanning the capitate and
scaphoid draw the capitate and scaphoid
together into closed packed position.
Continued extensor
force noe moves the
combined unit of distal
carpal row and the
scaphoid on relatively
fixed lunate and
triquetrum.
At approximately 45
degree of extension of
the wrist complex the
scapholunate
interosseous ligament
brings the scaphoid and
lunate into closed
packed position.
Completion occurs as the proximal
articular surface of the carpals move
as a relatively solid unit on the radius
and triangular fibrocartilage
complex.
Radial and ulnar deviation:
Range of deviations:
15 to 21 of radial deviation
20 to 45 of ulnar deviation
The proximal row displays a unique
reciprocal motion .
In full radial deviation both the
radiocarpal and midcarpal joints are
in closed pack position.
Wrist instability
Injury to one or more of the
ligaments attached to the scaphoid
and lunate may diminish or remove
the synergistic stabilization of the
lunate and scaphoid.
When this occurs the scaphoid
behaves as an unconstrained
segment following its natural
tendency to collapse into flexion on
the volarly inclined surface of the
The base of the flexed scaphoid slides
dorsally on the radius and subluxes.
Released from scaphoid stabilization the
lunate and triquetrum together act as
an unconstrained segment following
their natural tendency to extend.
The muscular forces that bypass the
proximal carpals apply force to distal
carpals cause them to flex on the
extended lunate and triquetrum.
The flexed distal carpals glide dorsally
on the lunate and triquetrum
accentuating the extension of them.
This zigzag pattern of the three
segments is known as intercalated
segmental instability.
When the lunate assumes an
extended posture the presentation is
referred to as dorsal intercalated
segmental instability(DISI).
Scapholunate advanced collapse: