Bone & Joint Expert Care

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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.

In this article, we shall look at the structures of the wrist joint, the movements of the joint, and the relevant clinical syndromes.

Structures of the Wrist Joint

Articulating Surfaces

The wrist joint is formed by:

  1. Distally – The proximal row of the carpal bones (except the pisiform). 
  1. Proximally - The distal end of the radius, and the articular disk (see below).

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 fibrocartilginous ligament, called the articular disk, 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.

 

Vasculature and Innervation

The wrist joint receives blood from branches of the dorsal and palmar carpal arches, which are derived from the ulnar and radial arteries

 

Innervation to the wrist is delivered by branches of three nerves:

  1. Median nerve – Anterior interosseous branch.
  2. Radial nerve – Posterior interosseous branch.
  3. Ulnar nerve – deep and dorsal branches.

Stability of the Wrist Joint

The joint capsule and ligaments contribute to the stability of the wrist.

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

  1. 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.
  1. 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.
  1. 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.
  1. 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 ellipsoid 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.

Flexion - Produced mainly by the flexor carpi ulnaris, flexor carpi radialis, with assistance from the flexor digitorum superficialis.

Extension - Produced mainly by the extensor carpi radialis longus and brevis, and extensor carpi ulnaris, with assistance from the extensor digitorum.

Adduction - Produced by the extensor carpi ulnaris and flexor carpi ulnaris

Abduction - Produced by the abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus and brevis.