The wrist joint (also known as the radiocarpal joint) is a synovial joint in the upper limb, marking the area of transition between the forearm and the hand.

Structures of the Wrist Joint

The wrist joint is formed by:

Proximally – The distal end of the radius, and the articular disk.

Distally – The proximal row of the carpal bones.

The ulna is not part of the wrist joint – it articulates with the radius, just proximal to the wrist joint, at the distal radioulnar joint. It is prevented from articulating with the carpal bones by a fibrocartilaginous ligament (called the articular disk or triangular fibrocartilage), which lies over the superior surface of the ulna.

Together, the carpal bones form a convex surface, which articulates with the concave surface of the radius and articular disk.

Joint Capsule

Like any synovial joint, the capsule is dual layered. The fibrous outer layer attaches to the radius, ulna and the proximal row of the carpal bones. The internal layer is comprised of a synovial membrane, secreting synovial fluid which lubricates the joint.

Ligaments

There are four ligaments of note in the wrist joint, one for each side of the joint

Palmar radiocarpal – It is found on the palmar (anterior) side of the hand. It passes from the radius to both rows of carpal bones. Its function, apart from increasing stability, is to ensure that the hand follows the forearm during supination.

Dorsal radiocarpal – It is found on the dorsum (posterior) side of the hand. It passes from the radius to both rows of carpal bones. It contributes to the stability of the wrist, but also ensures that the hand follows the forearm during pronation.

Ulnar collateral – Runs from the ulnar styloid process to the triquetrum and pisiform. Works in union with the other collateral ligament to prevent excessive lateral joint displacement.

Radial collateral – Runs from the radial styloid process to the scaphoid and trapezium. Works in union with the other collateral ligament to prevent excessive lateral joint displacement.

Movements of the Wrist Joint

The wrist is an ellipsoidal (condyloid) type synovial joint, allowing for movement along two axes. This means that flexion, extension, adduction and abduction can all occur at the wrist joint.

All the movements of the wrist are performed by the muscles of the forearm.

Structure of the Hand:

The anatomy of the hand is very unique. The hand needs to be mobile in order to position the fingers and thumb to perform coordinated fine motor tasks with precision. The structures that form and move the hand require proper alignment and control in order for normal hand function to occur.

The carpals bones join with the two forearm bones, the radius and ulna, forming the wrist joint. Further into the palm, the carpals connect to the metacarpals.

There are five metacarpals forming the palm of the hand. One metacarpal connects to each finger and the thumb. Small bone shafts called phalanges line up to form each finger and thumb.

The main knuckle joints are formed between the phalanges and the metacarpals. These joints are called the metacarpophalangeal joints (MCP joints). The MCP joints work like a hinge and helps in bending and straightening our fingers and the thumb.

There are three phalanges in each finger forming two joints, called interphalangeal joints (IP joints). The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint). The joint near the end of the finger is called the distal IP joint (DIP joint). The thumb only has one IP joint between the two thumb phalanges. The IP joints of the digits also work like hinges allowing us to bend and straighten our fingers and thumb.

The joints of the hand, fingers, and thumb are covered on the ends with articular cartilage. This white, shiny material has a rubbery consistency and functions to absorb shock and provides smooth & frictionless movements.

Ligaments are tough bands of tissue that connect bones together. Two important structures, called collateral ligaments, are found on either side of each finger and thumb joint. The function of the collateral ligaments is to prevent abnormal sideways bending of each joint.

In the PIP joint (the middle joint between the main knuckle and the DIP joint), the strongest ligament is the volar plate. This ligament connects the proximal phalanx to the middle phalanx on the palm side of the joint. The ligament tightens as the joint is straightened and keeps the PIP joint from bending back too far (hyperextending). Finger deformities can occur when the volar plate loosens from disease or injury.

The tendons that allow each finger joint to straighten are called the extensor tendons. The extensor tendons of the fingers begin as muscles that arise from the backside of the forearm bones. As they travel into the fingers, the extensor tendons become the extensor hood. The extensor hood flattens out to cover the top of the finger and sends out branches on each side that connect to the bones in the middle and end of the finger.

The place where the extensor tendon attaches to the middle phalanx is called the central slip. When the extensor muscles contract, they tug on the extensor tendon and straighten the finger. Problems occur when the central slip is damaged, as can happen with a tear.

Muscles

Many of the muscles that control the hand start at the elbow or forearm. They run down the forearm and cross the wrist and hand. Some control only the bending or straightening of the wrist. Others influence motion of the fingers or thumb. Many of these muscles help position and hold the wrist and hand while the thumb and fingers grip or perform fine motor actions.

Most of the small muscles that work the thumb and pinky finger start on the carpal bones. These muscles connect in ways that allow the hand to grip and hold. Two muscles allow the thumb to move across the palm of the hand, an important function called thumb opposition.

The smallest muscles that originate in the wrist and hand are called the intrinsic muscles. The intrinsic muscles guide the fine motions of the fingers by getting the fingers positioned and holding them steady during hand activities.

All of the nerves that travel to the hand and fingers begin together at the shoulder: the radial nerve, the median nerve, and the ulnar nerve. These nerves carry signals from the brain to the muscles that move the arm, hand, fingers, and thumb. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.

The radial nerve runs along the thumb-side edge of the forearm. It wraps around the end of the radius bone toward the back of the hand. It gives sensation to the back of the hand from the thumb to the third finger. It also supplies the back of the thumb and just beyond the main knuckle of the back surface of the ring and middle fingers.

The median nerve travels through a tunnel within the wrist called the carpal tunnel. This nerve gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles help move the thumb and let you touch the pad of the thumb to the tips each of each finger on the same hand, a motion called opposition.

The ulnar nerve travels through a separate tunnel, called Guyon’s canal. This tunnel is formed by two carpal bones, the pisiform and hamate, and the ligament that connects them. After passing through the canal, the ulnar nerve branches out to supply feeling to the little finger and half the ring finger. Branches of this nerve also supply the small muscles in the palm and the muscle that pulls the thumb toward the palm.

The nerves that travel to the hand are subject to problems. Constant bending and straightening of the wrist and fingers can lead to irritation or pressure on the nerves within their tunnels and cause problems such as pain, numbness, and weakness in the hand, fingers, and thumb.

Blood Vessels

Traveling along with the nerves are the large vessels that supply the hand with blood. The largest artery is the radial artery that travels across the front of the wrist, closest to the thumb. The radial artery is where the pulse is taken in the wrist. The ulnar artery runs next to the ulnar nerve through Guyon’s canal (mentioned earlier). The ulnar and radial arteries arch together within the palm of the hand, supplying the front of the hand, fingers, and thumb. 

Other arteries travel across the back of the wrist to supply the back of the hand, fingers, and thumb.

What are the common problems affecting the wrist and hand?

The problems that affect the wrist or hand can arise from any of the structures forming these joints like the bones, muscles, tendons, ligaments, nerves or blood vessels.

Common wrist problems are:

• Wrist fractures
• Wrist synovitis
• Wrist arthritis due to osteoarthritis, rheumatoid arthritis or trauma
• Wrist TFCC tears
• Wrist ganglions
• Wrist tendinitis – De Quervain’s, Extensor tendinitis
• Scaphoid fractures, non-union or AVN
• Lunate fractures or AVN (Keinbock’s Disease)
• Other carpal bone fractures
• Carpal tunnel syndrome

Common hand problems are:

• Mallet finger
• Trigger finger
• Fractures of the metacarpals and phalanges
• Dislocations of finger joints
• Flexor or Extensor tendon injuries
• Dupytren’s contracture
• Infection of flexor sheath
• Rheumatoid deformities of the hand