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The wrist is a complex joint that allows for a wide range of movements, including flexion, extension, adduction, and abduction. These movements are made possible by the intricate network of bones, muscles, nerves, tendons, ligaments, and blood vessels that make up the wrist and hand. In this article, we will focus specifically on the muscles responsible for adduction at the wrist and their functions.
| Characteristics | Values |
|---|---|
| Muscle that adducts the wrist | Extensor Carpi Ulnaris, Flexor Carpi Ulnaris |
| Type of joint | Synovial joint |
| Type of muscle | Intrinsic, Extrinsic |
| Location of muscles | Forearm, Wrist, Hand |
| Ligaments | Palmar Intercarpal Ligaments, Flexor Retinaculum (aka Transverse Carpal Ligament), Extensor Retinaculum |
| Bones | Carpal Bones, Radius, Ulna |
| Nerves | Radial Nerve, Median Nerve, Ulnar Nerve |
| Tendons | Extensor Tendons, Flexor Tendons |
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What You'll Learn
Flexor Carpi Ulnaris
The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint. It is the most powerful wrist flexor and the only anterior forearm compartment muscle completely innervated by the ulnar nerve. The FCU tendon is a landmark for locating the ulnar nerve and artery during surgery.
The FCU originates from two separate heads, the humeral head and the ulnar head, which are connected by a tendinous arch. The humeral head arises from the medial epicondyle of the humerus via the common flexor tendon. The ulnar head arises from the medial margin of the olecranon of the ulna and the upper two-thirds of the dorsal border of the ulna by an aponeurosis. The FCU is the most medial of the superficial flexors.
The FCU inserts onto the pisiform, hook of the hamate, and the base of the fifth metacarpal. The muscle attaches to the hook of the hamate via the pisohamate ligament and to the fifth metacarpal bone through the pisometacarpal ligament. The FCU flexes and adducts at the wrist joint and is innervated by the ulnar nerve.
The FCU is involved in ulnar deviation of the hand, which is the movement of the hand and wrist towards the pinky and ulna. This motion is important in weight-bearing activities such as those performed on a balance beam or in gymnastics. The FCU works together with the extensor carpi ulnaris muscle to produce this movement.
The FCU can be strengthened by exercises that resist its flexion, such as wrist rollers and wrist curls with dumbbells. These exercises help prevent injury to the ulnar collateral ligament of the elbow joint.
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Extensor Carpi Ulnaris
The extensor carpi ulnaris (ECU) is a skeletal muscle located on the ulnar side of the forearm. It is a key contributor to the extension and adduction of the wrist, playing a crucial role in various activities involving these movements. The ECU is the most medial muscle of the posterior forearm. It originates from the lateral epicondyle of the distal humerus and the posterior aspect of the ulna. It inserts onto the dorsal base of the fifth metacarpal after passing through the sixth compartment of the extensor retinaculum. The extensor retinaculum anchors the extensor tendons and assists in supporting the posterior structure of the wrist.
The ECU is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, and extensor digiti minimi muscles. Like all the muscles of this compartment, the ECU works as an extensor of the wrist. The ECU is innervated by the posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve. Blood supply to the ECU is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.
The ECU holds considerable clinical relevance in the context of wrist and forearm function, susceptibility to injuries, and the manifestation of related conditions. Athletes engaged in activities requiring forceful wrist movements are particularly prone to ECU injuries. These injuries may result from repetitive stress on the tendon during activities such as gripping, throwing, or racket sports. Repetitive flexion and extension of the wrist can lead to tenosynovitis, characterised by inflammation of the tendon and its sheath. Overuse of the ECU may result in tendinopathy, marked by thickening and painful stiffness of the tendon.
The oblique course of the ECU orientates its direction of pull posterolaterally, resulting in a combined extension and adduction (ulnar deviation) of the hand. Working together with the extensor carpi radialis brevis and extensor carpi radialis longus, the ECU contributes to a balanced extension of the wrist without deviating the hand in the transverse plane. This action is important for activities such as strongly clenching a fist or making a power grip.
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Flexor Carpi Radialis
The FCR originates from the medial epicondyle of the humerus, via the common flexor tendon, and surrounding fascia (antebrachial fascia and intermuscular septa). This common flexor tendon is a common origin for the six long flexor muscles in the forearm: flexor carpi radialis, palmaris longus, flexor carpi ulnaris, pronator teres, flexor digitorum superficialis, and profundus. From the medial epicondyle, the muscle belly courses obliquely, crossing from the ulnar to the radial part of the forearm. In the lower third of the forearm, it gives off a long tendon that passes below the flexor retinaculum into the palmar surface of the hand.
The FCR is mostly supplied by a branch arising high in the forearm from the anterior or posterior recurrent ulnar arteries. The rest of its nutritional needs are fulfilled by 6-8 branches of the radial artery. The innervation of this muscle is provided by the median nerve (C6-C7). The FCR tendon uses the scaphoid tuberosity as a pulley to reach its distal insertion onto the second metacarpal. It has been hypothesized that FCR muscle contraction generates a dorsally directed vector that resists the scaphoid from rotating into flexion.
The FCR is visible on the anterior surface of the forearm, just proximal to the wrist, when the wrist is flexed. It is the tendon seen most lateral, closest to the thumb. The radial artery runs between the tendons of the FCR and brachioradialis muscles, marking a common site for its palpation to measure someone's radial pulse.
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Flexor Digitorum Superficialis
The Flexor Digitorum Superficialis is a key muscle that controls wrist and finger flex. It is an extrinsic flexor muscle of the fingers at the proximal interphalangeal joints. It is located in the anterior compartment of the forearm. The muscle is sometimes considered to be the deepest part of the superficial layer of this compartment, and sometimes considered to be a distinct "intermediate layer".
The flexor digitorum superficialis courses along the volar aspect of the forearm, superficial to the flexor digitorum profundus and flexor pollicis longus muscles. It is deep to the palmaris longus, flexor carpi radialis, flexor carpi ulnaris, and pronator teres. The muscle has two origins or heads. The humeroulnar head originates off the common origin of wrist flexors, i.e., the medial epicondyle of the humerus and the medial border of the coronoid process of the ulna. The radial head originates on the anterior oblique line of the shaft of the radius.
The primary function of the flexor digitorum superficialis is flexion of the middle phalanges of the four fingers (excluding the thumb) at the proximal interphalangeal joints. However, under continued action, it also flexes the metacarpophalangeal joints and wrist joint. The flexor digitorum superficialis is innervated by the median nerve.
The flexor digitorum superficialis is tested by asking the patient to flex the proximal interphalangeal (PIP) joint of one of the digits from the second to the fifth, while the other three digits are held in extension to inactivate the flexor digitorum profundus.
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Pronator Teres
The pronator teres is a muscle located mainly in the forearm. It is a long, round muscle that has two points of origin: the humeral head and the ulnar head. The humeral head is larger and more superficial, while the ulnar head is deeper and joins the former at an acute angle, forming one muscle belly. The ulnar head can be more tendinous, more muscular, or even absent in some cases.
The pronator teres muscle fibres work optimally when the elbow is not excessively flexed. If the elbow is flexed, the muscle fibres shorten and produce less force. This muscle works synergistically with the pronator quadratus. The median nerve typically runs between the two heads of the pronator teres, making it a possible site for nerve entrapment. This entrapment can lead to pain and paresthesia, similar to carpal tunnel syndrome.
The pronator teres pronates the forearm, turning the hand so that the palm faces the ground. It also assists in flexion at the elbow joint. The main action of this muscle is to pull the radius medially, causing the head to rotate around the proximal part of the ulna at the proximal radioulnar joint. This action also rotates the palm of the hand, bringing it into a pronated position.
The pronator teres is innervated by the median nerve and nerve roots C6 and C7. The signal to stimulate the muscle originates in the precentral gyrus of the brain and travels through the internal capsule, midbrain, and pons before reaching the medullar pyramids. The signal then continues through the lateral corticospinal tract and the ventral rami until it reaches the root ganglions of C5, C6, C7, C8, and T1, forming the brachial plexus. Finally, the signal stimulates the pronator teres to contract through the median nerve branch of the brachial plexus.
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Frequently asked questions
Adduction of the wrist is produced by the Extensor Carpi Ulnaris and Flexor Carpi Ulnaris muscles.
Adduction is the movement of bending your wrist in, towards the centre of your body.
The wrist joint, also known as the radiocarpal joint, is a synovial joint in the upper limb, marking the transition between the forearm and the hand.
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