wrist

Synonyms

Radiocarpal joint, ulna (Ulna), Spoke (radius), Carpal bones (Os naviculare / scaphoideum = Scaphoid bone), Os triquetum (Triangular leg) wrist

English: wrist

introduction

The wrist is a joint on the hand of mammals that is composed of several partial joints. In humans, the wrist denotes:

  • proximal wrist:
    a joint between the spoke and the carpal bone (lat. Articulatio radiocarpalis)
  • distal wrist:
    The joint between the two rows of the carpal bones (lat. Articulatio mediocarpalis)
  • Remaining carpal joints:
    are also included in the wrist in a broader sense. These are called tight joints (Amphiarthroses), which support the wrist in its mobility, but are hardly mobile themselves.

anatomy

The wrist is made up of several bone together. The most important bone of the wrist is that spoke (radius). It forms the wrist on the thumb side. On the little finger side, a small part of the wrist is removed from the Cubit with its stylus extension (Ulna styloid process) educated.
On the wrist side, the first row of wrist roots, especially the scaphoid and lunar bone, form the joint - antagonist.

The wrist is supported by a tighten capsuleBand apparatus stabilized and restricted in its range of motion.

The so-called extensor tendons run through the back of the hand 6 tendon compartments as a guardrail.
On the flexor side, all tendons run together with the Median nerve under the Carpal band (Transverse carpal ligament) through the so-called Carpal tunnel.

Appointment with ?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You will find me:

  • Lumedis - orthopedic surgeons
    Kaiserstrasse 14
    60311 Frankfurt am Main

You can make an appointment here.
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
For more information about myself, see Lumedis - Orthopedists.

Illustration hand

Right hand shown from the palm side (palmar): A - structure (joint lines green) and B - bones of the right hand

Outline of the hand
(Joint lines green)
I - Upper (proximal) wrist
II - Lower (distal) wrist
III - carpal - metacarpal
Joints
IV - metacarpal joint
V - median joint
(missing on thumb)
VI - interphalangeal joint
VII - thumb joint

  1. Distal phalanx -
    Phalanx distalis
  2. Phalanx -
    Phalanx media
  3. Phalanx -
    phalanx proximalis
  4. Metacarpal bones - Metacarpals
  5. Trapezoidal leg - Trapezium
  6. Trapezoid leg - Trapezoid bone
  7. Head leg - Os capitatum
  8. Hook leg - Hamate bone
  9. Scaphoid bone of the hand -
    Scaphoid bone
  10. Moonbone - Lunate bone
  11. Triangular leg - Os triquetrum
  12. Pea bone - Os pisiform
  13. Sesame bone - Os sesamoideum
  14. Cubit - Ulna
  15. Spoke - radius

You can find an overview of all Dr-Gumpert images at: medical illustrations

Illustration muscles of the hand

Right hand image: A - palm (superficial and middle layer) and B - back of the hand

Hand muscles
I - muscles of the ball of the little finger
Hypothenary group (green)
II - muscles of the ball of the thumb
Thenar muscles (blue)
III - Metacarpus muscles (red)

  1. Little finger spreader -
    Abductor digiti minimi muscle
  2. Short little finger flexor -
    M. flexor digiti minimi brevis
  3. Short palm tendon tensioner -
    Muscle palmaris brevis
  4. Little finger counteracting device -
    M. opponens digiti minimi
  5. Thumb pull -
    Muscle abductor pollicis
  6. Short thumb flexor -
    Muscle flexor pollicis brevis
  7. Short thumb spreader -
    Muscle abductor pollicis brevis
  8. Thumb counter -
    Muscle opponens pollicis
  9. Spinal muscles -
    Lumbrical muscles
  10. Palm side intermediate
    bone muscles -
    Palmar interossei muscles
  11. Elbow-sided hand flexor -
    Flexor carpi ulnaris muscle
  12. Spoke-sided hand flexor -
    Flexor carpi radialis muscle
  13. First back intermediate
    bone muscle -
    Muscle interosseus dorsalis I
  14. Long thumb stretcher -
    Extensor pollicis longus muscle
  15. Short thumb stretcher -
    Extensor pollicis brevis muscle
  16. Short spoke-side hand straightener -
    Extensor carpi radialis brevis muscle
  17. Long spoke-side hand straightener -
    Extensor carpi radialis longus muscle
  18. Backhand intermediate
    bone muscles -
    Dorsal interossei muscles
  19. Finger extensor -
    Extensor digitorum muscle
  20. Klenfingerstrecker -
    Extensor digiti minimi muscle
  21. Extensor tendon strap -
    Retinaculum musculorum extensorum
  22. Elbow side hand extensor -
    Extensor carpi ulnaris muscle

You can find an overview of all Dr-Gumpert images at: medical illustrations

Figure carpal bones

Illustration of the carpal bones of the right hand seen from the palm side (palmar)

The eight carpal bones
Upper (proximal) row - blue
Lower (distal) row - red

  1. Scaphoid bone of the hand -
    Scaphoid bone
  2. Moonbone - Lunate bone
  3. Triangular leg - Os triquetrum
  4. Pea bone - Os pisiform
  5. Large polygonal leg
    (Trapezoidal leg) - Trapezium
  6. Small polygonal bone
    (Trapezoid leg) -
    Trapezoid bone
  7. Head leg - Os capitatum
  8. Hook leg - Hamate bone
  9. Cubit - Ulna
  10. Spoke - radius
  11. Metacarpal bones - Metacarpals
  12. Phalanx - Ph. Proximalis

You can find an overview of all Dr-Gumpert images at: medical illustrations

function

The wrist is a so-called Ellipsoid joint (Egg joint with two main axes, similar to a ball joint).

All partial joints of the wrist function as one unity and enable the complex movements of the wrist. They enable one diffraction (Flexion) towards the palm of the hand (Palmar flexion) by approx. 80 °, as well as the Elongation (Extension) Towards the back of the hand (Dorsiflexion) by about 70 °.

In addition, the wrist allows Splaying movements (Abduction) Towards the thumb (Radial abduction) and towards the little finger (Ulnar abduction) by approx. 30 to 40 °.

X-ray wrist

  1. Cubit (Ulna)
  2. Spoke (radius)
  3. wrist
  4. Stylus process (Ulna styloid process)
  5. Moonbone (Lunate bone)
  6. Scaphoid (Navicular bone)

Proximal wrist

The proximal wrist, which is closer to the center of the body, is formed by the articular surfaces of:

  • Cubit (Ulna)
  • spoke (radius)
  • body-hugging series of Carpal bones (proximal carpal bones) consisting of the 3 carpal bones navicular bone (Scaphoid bone), Moonbone (Lunate bone) and triangular leg (Os triquetrum).

Together they make that Articulatio radiocarpalis. The capsule the joint is slack and thin.
On the side of the back of the hand (dorsal) the joint capsule is through different Tapes reinforced. The collateral ligaments between the carpal bones and the ulna (ulna) or radius (radius) the stability. In addition, 2 ligaments between the carpal bones and the spoke from above and below strengthen the wrist (Palmar and dorsal radiocarpal ligament).
The entire joint is elliptical built up (ellipsoid joint or egg joint) and thus allows 2 different movements (2 degrees of freedom): The diffraction (Palmar flexion) and elongation (Dorsiflexion), as well as the splay in two directions (Ulnar abduction and Radial abduction).
The proximal wrist is mainly used for flexion (Palmar flexion), while in the distal wrist especially the Elongation (Dorsiflexion) takes place.

Distal wrist

The one away from the middle of the body distal wrist is used by the two rows the carpal bone (proximal and distal row) educated.
This creates a picture between the individual carpal bones Joint space, which one S-shaped is constructed.
There is also one here Joint capsule. This is rather tight on the inside of the hand, but rather slack on the back of the hand.
The distal wrist adjusts due to its structure toothed hinge joint which by its curved course, the ligaments and joint capsule severely restricted in its movement is. Together with the proximal wrist, it acts as a functional unit.
While the proximal wrist is mainly involved in flexion (palmar flexion), the distal wrist is particularly involved in the Stretching (dorsiflexion) instead of.

Articulationes intercarpales

This is the individual small joints between the carpal bones of a number. The individual bones are different Ligaments fixed tightly (Ligg. Intercarpalia interossea). The connections of the distant (distal) Line (Amphiarthroses).

Articulationes carpometacarpales

The distant (distal) Row of carpal bones forms together with the body-near (proximal) Finger bones (Ossa metacarpi 2- 5) stiffened joints (Amphiarthroses). These joints are drawn from the side of the palm (palmar) and the side of the back of the hand (dorsal) by tight ligaments fixed (Ligg. Metacarpalia dorsalia, palmaria and interossea).

The base of the thumb is an exception and for this reason it is much more flexible than the other individual fingers.

Metacarpophalangeal joint

in the Saddle thumb joint (Articulatio carpometacarpalis pollicis) interact the large polygonal leg (Trapezium) and metacarpal (Os metacarpale 1) of the thumb.
Since it is a saddle joint, 3 different directions of movement of the thumb are possible (3 degrees of freedom):

  • diffraction (Flexion) and Elongation (Extension),
  • Splaying movements
  • and the Facing the thumb against the other fingers (Opposition and reposition). This is especially necessary for the so-called tweezer grip and without the opposition movement a person could hardly grasp.

Carpal band

Across the individual carpal bones that is tense Carpal band (Flexor retinaculum). It runs between the hook leg (Hamulus ossis hamatis) and the pea bone (Os pisiform) to the cusp of the large polygonal bone (Tuberculum ossis trapezi) and the navicular bone (Tuberculum ossis scaphoidei). This creates an imagination connective tissue canalthat as Carpal tunnel is designated and the Median nerve leads in its midst.

Wrist disorders

This is particularly common in the wrist Carpal tunnel syndrome on. This is caused by pressure and overload on the median nerve, which is located in the tunnel of the carpal ligament (Retinaculum flexorum) runs. The reason for this pressure damage can be previous Wrist fractures, rheumatic diseases, or overuse be.
The most common injuries to the wrist are a Break in the part of the spoke near the wrist (distal radius fracture), as well as a Fracture of the scaphoid bone (Scaphoid bone). In principle, all wrist bones can break, but this is the most commonly affected.
Another common condition is one Tendinitis in the area of ​​the tendon sheath compartments on the back of the hand. In addition, a Arthrosis in the metatarsophalangeal joint occur. This is then saved as a Rhizarthrosis designated.

The X-ray image, of the Ultrasonic and the MRI of the hand used.

Wrist in pain

Wrist pain can have many different causes.
Often there is only one temporary pain in the wrist overload of the joint, especially after intense sporting activities that strain the wrist, repetitive repetitive movements, for example when gardening or a cramped position of the wrist over a long period of time, for example when working at the computer for a long time.
Pain in the wrist that can be traced back to one of the causes mentioned will usually go away on its own after a short time if the wrist relaxed becomes. However, the symptoms can also have other causes.

If you fall, you often reflexively support yourself with your hands. This can be painful Upsetting or to one Broken bone come in the hand area. In addition, this one can also Torn ligament on the wrist cause.
Persistent pain in the wrist after trauma should therefore definitely be clarified by a doctor in order to be able to recognize and treat a serious injury at an early stage.

Often there is also an advancing one Wear and tear of the wrist cause of the pain. In the long run, osteoarthritis develops in the wrist, which is accompanied by worsening pain and later also with one Restriction of movement connected is. Initially, patients with osteoarthritis of the wrist only feel pain when they put more strain on the wrist, later the pain occurs even when the patient is resting and becomes increasingly severe over time. In this case, treatment is first carried out with pain relievers and anti-inflammatory drugs.
In the final stage of osteoarthritis, these measures usually no longer help, so that the joint either has to be replaced with a prosthesis or stiffened in order to achieve lasting freedom from pain.

People who work a lot with computers are more likely to suffer from the so-called Mouse hand. In this case, the wrist hurts due to a cramped posture when using the mouse and keyboard. Special mousepads with a raised surface for the palm of your hand can help. Such overloading of the wrist can also lead to tendinitis, which can also cause pain in the wrist. Often the wrist is also swollen.

Another possible cause of wrist pain is that Carpal tunnel syndrome. This is a bottleneck syndrome in the area of ​​the wrist, which leads to a narrowing of the median nerve under the connective tissue plate on the wrist. The increased pressure on the nerve leads to unpleasant tingling and numbness, as well as pain in the wrist, which occurs especially at night.
Tapping the inside of the wrist can also trigger electrifying pain (so-called Hoffmann-Tinel sign). Overall, there are many different causes for pain in the wrist, so that a doctor should be consulted if the symptoms persist.

You can find much more information on this topic at: Wrist pain

Sprained wrist

A wrist sprain occurs when it is severely overstretched, i.e. when the joint moves beyond the normal range of motion of the joint. As a result, ligaments and joint capsules are greatly stretched and, depending on the extent, can also tear.

A wrist sprain is very painful. The joint usually swells up a lot and a bruise can form if vessels were damaged when the joint was overstretched. If the pain is so severe that the joint can no longer be moved, it could also be a broken bone. Normally, if you have a sprain, you can still move your wrist to a certain extent despite the pain.
The final diagnosis of the sprain is made by a doctor. If there is uncertainty as to whether a bone has not broken, an x-ray is usually taken for clarification.

If it is only a sprain, conservative therapeutic measures can be used. First and foremost, the wrist should be immobilized. All you need to do is wrap the joint with an elastic bandage or put on a wrist splint. In addition, the wrist should be cooled extensively and elevated. This will reduce swelling and pain. Cooling or decongestant ointments can also be used. As a rule, the symptoms should have subsided after two weeks. If it lasts longer or gets worse over time, there may be a more serious injury after all. In this case, a doctor should be consulted so that appropriate therapy can be initiated. This is the only way to avoid consequential damage to the wrist.

Athletes can do a lot to avoid a wrist sprain in the first place. It is important that the joints are sufficiently warmed up and stretched before strenuous exercise. This means that they are better prepared for the coming stress and can absorb the forces better. Taping the wrists is also helpful, especially if there has been a history of a wrist injury. The bandage stabilizes the wrist and is less prone to injury.

You might also be interested in: Sprain on the thumb

wrist broken

Colloquially it is called a broken wrist when there is a fracture at the bottom of the wrist spoke (Radius) is present. This is one of the most common broken bones and affects all ages.
In older age women are particularly affected because they are through osteoporotic changes are more prone to fracture. Overall, the most common cause of a broken spoke is direct violence, for example a fall on the outstretched hand, an impact trauma or a sports injury.

The break occurs immediately severe pain in the wrist area, which is accompanied by severe swelling and often bruising. Sometimes the fracture is already visible on the outside when the ends of the bones stand apart and cause a deformity in the forearm. Otherwise, the diagnosis of the fracture is made using a X-ray image posed. The fracture gap is then visible.
In addition, the doctor can use the X-ray image to decide which therapy is appropriate for the type of fracture present. If the fracture ends of the bone are not shifted against each other, it is often enough Forearm castused to fix the wrist. This is to prevent the fracture from slipping and the misaligned bone ends from healing together. If the break is postponed from the start, the pieces of bone must be brought back into their correct position. This is usually a operational approach necessary in which the bone fragments through Screws, Wires or plates be fixed again in their correct anatomical position. Then the bone can heal. After several weeks to months (depending on the type of operation), the pieces of metal are usually removed again. The plaster of paris usually remains on adults for between three and six weeks.
During follow-up treatment, it is important that physiotherapy exercises to restore normal functionality of the wrist. Nevertheless, under certain circumstances slight restrictions in the function of the joint may remain. However, these are usually not severe, so that no significant restriction in professional or everyday life is to be expected. Long-term complications from a spoke fracture are primarily the development of osteoarthritis or the occurrence of one Stunted growth with children.

Tap your wrist

To tape the wrist you need Kinesiotape strips from 3.75cm Width. The ends of the strips should be ready before gluing rounded as they won't come off as quickly that way.

To apply the tape, the affected arm is placed loosely on a table. It is easiest if a second person attaches the tape strips.
First, make a strip just before your wrist circular to the forearm wrapped. A second strip is around in the same way Palm and back of Hand glued just before the beginning of the fingers. These two strips are then connected to one another by the strips that are glued on below. First the back of the hand is glued.
It starts with a strip on the side of the thumb, which must also be the Saddle thumb joint should include. The other strips are attached next to it at regular intervals and each end at the circular strip in front of the wrist.
Then two strips of tape diagonal glued. The first starts on back of Hand at the level of the little finger, then runs across the back of the hand and ends at the circular strip of tape on the wrist on the side of the thumb. The second strip runs so that it crosses the first. It begins on the back of the hand on the thumb side and runs across the direction of the circular tape on the wrist on the little finger side.

Once all of these tape strips have been stuck on the back of the hand, you can do the same with the Palm proceed. Finally, the hand and wrist are completely covered with horizontally glued tape strips so that the previously glued strips are no longer visible. The wrist is then sufficiently stabilized. Overall, when taping, care should be taken that the strips are not stretched too much, and ultimately the tape not too tight sits.
It shouldn't be found uncomfortable.

Summary

The wrist is a very complex jointwhich is made up of different partial joints composed. It consists of:

  • a proximal joint close to the body
  • and a distal wrist distal from the body.
  • In addition, the individual carpal bones and their joint surfaces belong to the wrist in a broader sense.

Only in the cooperation of the individual partial joints is the great mobility of our wrist.
The articular surfaces are through numerous tapes fixed so that some joints have significantly less mobility (Amphiarthroses) than others.
Due to the complex structure of the wrist, the numerous structures and bone can the wrist hurt quickly will and is with it endangered with every fall on the hand. Because of the numerous activities that humans perform with the wrist every day, it is robust, but can also overexerted be and then to painful inflammation or wear and tear (arthrosis) to lead.

Illustration wrist pain

Illustration of hand pain: right hand seen from the palm side (palmar)

A - Chronic causes
B - Acute causes

  1. Rheumatoid Arthritis (RA) -
    inflammatory disease
    the joints
  2. Arthrosis -
    Joint wear
  3. Carpal Tunnel Syndrome (KTS) -
    constriction of the median nerve
  4. Ganglion (upper leg) -
    benign tumor formation
  5. Torn ligament -
    Rupture of a joint ligament
  6. Finger dislocation -
    Dislocated finger
  7. Broken finger (finger fracture) -
    a - distal
    b - medial
    c - promaximal
  8. Wrist hernias
    (here scaphoid fracture)
    I - I - metacarpal joint -
    Articulatio metacarpophalangea
    II - II - Carpal-metacarpal joints -
    Articulationes carpometacarpales
    III - III - Lower wrist -
    (distal)
    Articulatio mediocarpalis
    IV - IV - Upper wrist -
    (proximal)
    Articulatio radiocarpalis

You can find an overview of all Dr-Gumpert images at: medical illustrations