Anatomy
Upper Limb
A 56 year old illustrator presents to the ED with a 3 day history of right wrist pain. He is concerned as this is affecting his work. On examination you note crepitations on flexion and extension of the wrist, you suspect an arthritis to be responsible. The wrist joint is formed by articulations between which of the following bones:
Answer:
The wrist joint is a synovial condyloid joint occurring between the distal end of the radius and the scaphoid, lunate and triquetrum. The ulna is prevented from articulating with the carpal bones by the presence of a fibrocartilaginous ligament, the articular disk. Instead, the ulna articulates with the radius just proximal to the wrist at the distal radioulnar joint.Wrist Joint
Anatomy / Upper Limb / Wrist and Hand
Last Updated: 1st December 2023
Table: Anatomical Overview of the Wrist Joint
| Joint | Wrist joint |
|---|---|
| Type | Synovial condyloid joint |
| Articulations | Distal end of the radius and articular disc with scaphoid, lunate and triquetrum |
| Stabilising factors | Joint capsule, palmar radiocarpal, palmar ulnocarpal and dorsal radiocarpal ligaments, radial and ulnar collateral ligaments of the wrist joint |
| Movements | Flexion and extension, abduction and adduction |
Articulations
The wrist joint is a synovial condyloid joint occurring between the distal end of the radius and the scaphoid, lunate and triquetrum. The ulna is prevented from articulating with the carpal bones by the presence of a fibrocartilaginous ligament, the articular disk. Instead, the ulna articulates with the radius just proximal to the wrist at the distal radioulnar joint.
![Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://primary-cdn.frcemsuccess.com/wp-content/uploads/2016/12/Wrist-Joint-1024x576.jpg)
Wrist Joint. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Ligaments
The capsule of the wrist joint is reinforced by palmar radiocarpal, palmar ulnocarpal and dorsal radiocarpal ligaments. The radial and ulnar collateral ligaments of the wrist joint reinforce the medial and lateral sides of the wrist joint.
Movements
The wrist joint allows movement around two axes; the hand can be abducted and adducted, and flexed and extended at the wrist joint.
Table: Movements of the Wrist Joint
| Movement | Main Muscles Involved | Main Nerves Involved |
|---|---|---|
| Flexion | Flexor carpi radialis, flexor carpi ulnaris, flexor digitorum profundus, flexor digitorum superficialis, palmaris longus | Median and ulnar nerves |
| Extension | Extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum | Radial nerve |
| Abduction | Flexor carpi radialis, extensor carpi radialis longus and brevis | Median and radial nerves |
| Adduction | Flexor carpi ulnaris, extensor carpi ulnaris | Ulnar and radial nerves |
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
