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At the completion of this chapter, the reader will be able to:

  1. Describe the anatomy of the joints, ligaments, muscles, blood, and nerve supply that comprise the forearm, wrist, and hand.

  2. Describe the forearm, wrist, and hand biomechanics, including open- and close-packed positions, normal and abnormal joint barriers, and stabilizers.

  3. Describe the purpose and components of the tests and measures for the forearm, wrist, and hand.

  4. Describe the relationship between muscle imbalance and functional performance of the forearm, wrist, and hand.

  5. Perform a comprehensive examination of the forearm, wrist, and hand, including palpation of the articular and soft-tissue structures, specific passive mobility, and passive articular mobility and stability tests.

  6. Outline the significance of the key findings from the tests and measures and establish a diagnosis.

  7. Summarize the various causes of forearm, wrist, and hand dysfunctions.

  8. Develop self-reliant intervention strategies based on clinical findings and established goals.

  9. Evaluate the intervention’s effectiveness to progress or modify an intervention.

  10. Plan an effective home program and instruct the patient in the same.



A hand is a very personal thing. It is the interface between the patient and his or her world. It is an emblem of strength, beauty, skill, sexuality and sensibility. When it is damaged, it becomes a symbol of vulnerability of the whole patient.

—Paul W. Brand (1914–2003)

In a sense, the shoulder, elbow, and wrist joints (Fig. 18-1) are merely anatomical devices that contribute to the usefulness of the hand. The correct synchronization of these biological devices, coupled with patient motivation, produces a remarkable level of dexterity and precision.

The carpus, or wrist, represents a highly complex anatomic structure, comprising a core structure of 8 bones; more than 20 radiocarpal, intercarpal, and carpometacarpal (CMC) joints; 26 named intercarpal ligaments; and 6 or more parts of the triangular fibrocartilage complex (TFCC). While these structures can be differentiated anatomically, they are functionally interrelated, with movement in one joint affecting the motion of neighboring joints. This relationship extends as far as the elbow.

The following sections describe the respective bones, joints, soft tissues, and nerves, detailing their individual and collective functions. For simplicity’s sake, the forearm, wrist, and hand are separated into their various compartments.


Arm, wrist, and hand joint structures. (Reproduced with permission from Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. 2nd ed. New York, NY: McGraw Hill; 2019.)


Distal Radioulnar Joint

The distal radioulnar joint (DRUJ) plays a significant role in wrist and forearm function. The DRUJ is a uniaxial pivot joint that joins the distal radius and ulna with an articular disk (Fig. 18-1). The articular disk, known as the TFCC, assists in binding the distal radius and is the main ...

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