00:01
So, now, let's move most distally away from the shoulder
joints, the glenohumeral joints and the elbow joint.
00:08
And look at the numerous joints
associated with the hand.
00:11
And there's a lot here. Let's first of all
start by looking at the wrist joint.
00:15
And here on the anterior surface of the wrist
on the right-hand side, we see the radius.
00:19
The left-hand side, we see the ulna.
00:22
We can see the articulation of the
wrist joint here via the carpal bones.
00:26
Here, we can then see the carpometacarpal joints
where the carpal bones are connected to the metacarpals.
00:33
And then, most distally, we'll see
the interphalangeal joints.
00:37
We'll come to those in a moment.
So, let's have a look at the articular surfaces.
00:42
Here, we've got the articular surfaces
at the distal end of the radius and the ulna.
00:46
We can see the articular discs.
And these are articulating
with the scaphoid and the lunate bones
for the radius and the triquetrum for the ulna.
00:56
So, we can see, we have a whole series
of these carpal bones that are sitting against
the distal end of the radius and the ulnar.
And they form these articulations.
01:07
There's a number of numerous ligaments
associated to these bones
and that really is to hold these bones in place.
If you think we've got eight pebbles
really connecting the distal end of the radius
and the ulna to the carpal bones in the hand.
01:24
Obviously, we have these to enable a wide range
of movement and flexibility within our wrist joints.
01:30
But that means we have to have a number
of ligaments to hold these in place.
01:34
So, here, we can see a whole
series of radiocarpal ligaments.
01:38
Positioned on the palmar surface
so that the palmar radiocarpal ligaments.
01:43
We have some specific ones here.
We can see the radial collateral ligament
and then, we have some equivalent on the
ulna side, these palmar ulnocarpal ligaments,
helping to hold the carpal
bones to the ulna.
01:56
And again, we have an ulnar collateral
ligament observed as well.
02:00
These ligaments really are here
to hold those bones together
and hold them against the articular
surfaces of the radius and the ulna.
02:08
If you were to look on the posterior aspect,
we can again pick out the radial and ulnar collateral ligaments.
02:14
But importantly, we can see this quite prominent
ligament which is the dorsal radiocarpal ligaments.
02:20
We can see these again running similar to the palmar
ones but connecting the radius to these carpal bones.
02:27
These are really important because
they allow a wide range of movement.
02:30
So, here, we have abduction
and here, we have adduction.
02:34
Similarly, we can see we
have flexion and extension.
02:38
So, a wide range of movements permitted
by these interconnected bony structures
between the radius, ulna, and the carpal bones,
supported by those numerous ligaments.
02:51
If we then look at the joints between the carpal bones themselves,
we have what are known as intercarpal joints.
02:57
Again, these are really just supported
by a number of ligaments
which are primarily concerned
with holding these bones together.
03:04
Holding them together so their
articulations can take place.
03:09
So, now, let's concentrate
on the carpometacarpal joints.
03:12
These are associated with the carpal bones
proximally and the metacarpals distally.
03:19
So, here, we can see we have that
distal row of carpal bones.
03:23
We can see these four bones situated
here and they're going to articulate
with the proximal end of those five metacarpals.
We can see them here, one, two, three, four five.
03:35
These are the five metacarpals. We have
quite limited movement in this space
but we have wide range of
mobility within the first one.
03:44
That means the thumb can assume a lot more different
positions compared to the digits two, three, four, and five.
03:51
And it's important to appreciate
these differences in movement.
03:55
So, now, let's look at the movement
of the carpometacarpal joints
and pay particular attention to the first
digit, the thumb, first of all.
04:04
Now, you have to remember, if you were standing
in the anatomical position, then, flexion
and extension really goes on
through the sagittal plain.
04:11
So, flexion and extension of your fingers, flexion
and extension of your forearm at the elbow joint,
these are occurring in the sagittal plain
whereas abduction and adduction of your fingers
or abduction and adduction of your arm,
is occurring in the coronal plane.
04:30
We have to remember for the thumb, we have
to realize that it's really being rotated 90 degrees.
04:37
So, if you think of the orientation
of your fingers and the thumb,
you can see the thumb appears to have
been rotated 90 degrees.
04:44
So, where flexion and extension of your
fingers occurs in that sagittal plane,
if we imagine we've rotated that plane
because of the thumb, extension and flexion
and extension of the thumb
occurs in the coronal plane.
05:00
So, as we can see in the image here,
flexion of the thumb moves across
in the coronal plane across
the surface of the palm.
05:08
Extension then moves again in the
coronal plane but away from the palm
because the planes in which
it moves has been rotated.
05:17
That means that again, in the resting position,
if we were to abduct and adduct our thumb,
we would now move abduction and adduction as if we
were in the sagittal plane because it's being rotated.
05:31
So, for the rest of the body, abduction,
adduction occurs in the coronal plane.
05:35
Now, for the thumb, it works
in the sagittal plane.
05:39
So, now, we have abduction which moves it away and
adduction which brings it towards the side of the palm.
05:47
So, abduction and adduction
is now occurring in the sagittal plane
whereas flexion and extension
works in the coronal plane.
05:56
Because if you look at the thumb,
it's clearly been rotated 90 degrees.
06:01
So, these movements in the muscles
that move the thumb in this direction
is important to recognize
how different they are.
06:08
Also occurring within the carpometacarpal
joints is we have rotation
and circumduction, allowing the wrist to move.