Extrinsic extensor muscles of the hand

Last updated
Muscles of the posterior forearm
Gray418.png
Superficial
Gray419.png
Deep

The extrinsic extensor muscles of the hand are located in the back of the forearm and have long tendons connecting them to bones in the hand, where they exert their action. Extrinsic denotes their location outside the hand. Extensor denotes their action which is to extend , or open flat, joints in the hand. They include the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor digitorum (ED), extensor digiti minimi (EDM), extensor carpi ulnaris (ECU), abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL), and extensor indicis (EI).

Contents

Origins Gray214.png
Origins

Origin

The extensor carpi radialis longus (ECRL) has the most proximal origin of the extrinsic hand extensors. It originates just distal to the brachioradialis at the lateral supracondylar ridge of the humerus, the lateral intermuscular septum, and by a few fibers at the lateral epicondyle of the humerus. [1] Distal to this, the extensor carpi radialis brevis (ECRB), extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris (ECU) originate from the lateral epicondyle via the common extensor tendon. The ECRB has additional origins from the radial collateral ligament, the ECU from the dorsal border of the ulna (shared with the flexor carpi ulnaris and flexor digitorum profundus), and all four also originate from various fascia. Moving distally, there are the abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL), and extensor indicis (EI). The APL originates from the lateral part of the dorsal surface of the body of the ulna below the insertion of the anconeus and from the middle third of the dorsal surface of the body of the radius. The EPB arises from the radius distal to the APL and from the dorsal surface of the radius. [2] The EPL arises from the dorsal surface of the ulna and the EI from the distal third of the dorsal part of the body of ulna. The APL, EPB, EPL, and EI all have an additional origin at the interosseus membrane.

Course

The ECRL and ECRB, (with the brachioradialis) form the lateral compartment. Their muscle fibers end at the upper third and the mid forearm respectively, continuing as flat tendons along the lateral border of the radius, beneath the APL and EPB. They then pass beneath the extensor retinaculum and dorsal carpal ligament, where they lie in a groove on the back of the radius, immediately behind the styloid process, and continue into the second tendon compartment. [1] The ED divides into four tendons which, with the EI tendons, go through the fourth tendon compartment of the dorsal carpal ligament. On the back of the hand, the ED tendons diverge to follow the fingers and the EI tendon joins the ulnar side of one of the ED tendons along the back of the index finger. The EDM takes a similar course as the EI except it follows the ED tendon along the little finger. The ECU crosses from the lateral to the medial side of the forearm. The APL and EPB pass obliquely down and lateral, ending in tendons which run through a groove on the lateral side of the lower end of the radius. The EPL tendon passes through the third compartment and lies in a narrow, oblique groove on the back of the lower end of the radius.

Extensor digitorum tendons

The ED tendons are more complex in their course. Opposite the metacarpophalangeal joint each tendon is bound by fasciculi to the collateral ligaments and serves as the dorsal ligament of this joint; after having crossed the joint, it spreads out into a broad aponeurosis, which covers the dorsal surface of the first phalanx and is reinforced, in this situation, by the tendons of the Interossei and Lumbricalis.

Opposite the first interphalangeal joints this aponeurosis divides into three slips; an intermediate and two collateral: the former is inserted into the base of the second phalanx; and the two collateral, which are continued onward along the sides of the second phalanx, unite by their contiguous margins, and are inserted into the dorsal surface of the last phalanx. As the tendons cross the interphalangeal joints, they furnish them with dorsal ligaments. The tendon to the index finger is accompanied by the EI, which lies on its ulnar side. On the back of the hand, the tendons to the middle, ring, and little fingers are connected by two obliquely placed bands, one from the third tendon passing downward and lateralward to the second tendon, and the other passing from the same tendon downward and medialward to the fourth.

Occasionally the first tendon is connected to the second by a thin transverse band. Collectively, these are known as the sagittal bands; they serve to maintain the central alignment of the extensor tendons over the metacarpal head, [3] thus increasing the available leverage. Injuries (such as by an external flexion force during active extension) may allow the tendon to dislocate into the intermetacarpal space; the extensor tendon then acts as a flexor and the finger may no longer be actively extended. This may be corrected surgically by using a slip of the extensor tendon to replace the damaged ligamentous band [4]

Anatomical snuff box

The EPL tendon crosses obliquely the tendons of the ECRL and ECRB, and is separated from the EPB by a triangular interval, the anatomical snuff box, in which the radial artery is found.

Insertion and action

Insertions Gray220.png
Insertions

The ECRL inserts into the dorsal surface of the base of the second metacarpal bone on its radial side [1] to extend and abduct the wrist. [1] The ECRB inserts into the lateral dorsal surface of the base of the third metacarpal bone, with a few fibres inserting into the medial dorsal surface of the second metacarpal bone, also to extend and abduct the wrist. The ED inserts into the middle and distal phalanges to extend the fingers and wrist. Opposite the head of the second metacarpal bone, the EI joins the ulnar side of the ED tendon to extend the index finger. The EDM has a similar role for the little finger. The ECU inserts at the base of the 5th metacarpal to extend and adduct the wrist. The APL inserts into the radial side of the base of the first metacarpal bone to abduct the thumb at the carpometacarpal joint and may continue to abduct the wrist. The EPB inserts into the base of the first phalanx of the thumb [2] to extend and abduct the thumb at the carpometacarpal and MCP joints. [5] The EPL inserts on the base of the distal phalanx of the thumb. It uses the dorsal tubercle on the radius as fulcrum [2] to help the EPB with its action as well as extending the distal phalanx of the thumb. Because the index finger and little finger have separate extensors, these fingers can be moved more independently than the other fingers. [6]

Neurovascular supply

The ECU is supplied by the ulnar artery. The APL, EPB, EPL, EI, ED, and EDM are supplied by the Posterior interosseous artery, a branch of the ulnar artery. The ECRL and ECRB receive blood from the radial artery.

The ECRL is supplied by the radial nerve and the ECRB by its deep branch. The remaining extrinsic hand extensors are supplied by the posterior interosseus nerve, another branch of the radial nerve.

Summary table

MuscleOriginInsertionArteryNerveActionAntagonistGray's
Extensor carpi radialis longus lateral supracondylar ridge 2nd metacarpal, base radial radial extends, abducts wrist FCRM s125p452
Extensor carpi radialis breviscommon extensor tendon 3rd metacarpal, base radial nerve, deep branch
Extensor digitorum extensor expansion of 2nd–5th middle, distal phalanges [7] posterior interosseus posterior interosseus extends fingers, wrist FDS, FDP s125p451
Extensor digiti minimiextensor expansion, base of proximal phalanx, little fingerextends little finger at all joints FDMB
Extensor carpi ulnariscommon extensor tendon, ulna 5th metacarpal, base ulnar extends, adducts wrist FCU s125p454
Abductor pollicis longus ulna, radius, interosseous membrane first metacarpal, baseposterior interosseusabducts, extends thumb AP s125p455
Extensor pollicis brevis proximal phalanx, thumbextends thumb at MCP joint FPL, FPB
Extensor pollicis longus ulna, interosseous membrane thumb, distal phalanx extends thumb at MCP and IP joint FPL, FPB
Extensor indicis index finger, extensor hood extends index finger, wrist

See also

Related Research Articles

Carpal bones Eight small bones that make up the wrist (or carpus) that connects the hand to the forearm

The carpal bones are the eight small bones that make up the wrist that connects the hand to the forearm. The term "carpus" is derived from the Latin carpus and the Greek καρπός (karpós), meaning "wrist". In human anatomy, the main role of the wrist is to facilitate effective positioning of the hand and powerful use of the extensors and flexors of the forearm, and the mobility of individual carpal bones increase the freedom of movements at the wrist.

Thumb First digit of the hand

The thumb is the first digit of the hand, next to the index finger. When a person is standing in the medical anatomical position, the thumb is the outermost digit. The Medical Latin English noun for thumb is pollex, and the corresponding adjective for thumb is pollical.

Wrist Part of the arm between the lower arm and the hand

In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and; (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.

Extensor carpi radialis longus muscle

The extensor carpi radialis longus is one of the five main muscles that control movements at the wrist. This muscle is quite long, starting on the lateral side of the humerus, and attaching to the base of the second metacarpal bone.

In human anatomy, extensor carpi radialis brevis is a muscle in the forearm that acts to extend and abduct the wrist. It is shorter and thicker than its namesake extensor carpi radialis longus which can be found above the proximal end of the extensor carpi radialis brevis.

Radius (bone) One of the two long bones of the forearm

The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is usually slightly longer than the radius, but the radius is thicker. Therefore the radius is considered to be the larger of the two. It is a long bone, prism-shaped and slightly curved longitudinally.

Upper limb

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

Extensor digitorum muscle

The extensor digitorum muscle is a muscle of the posterior forearm present in humans and other animals. It extends the medial four digits of the hand. Extensor digitorum is innervated by the posterior interosseous nerve, which is a branch of the radial nerve.

In human anatomy, the extensor pollicis longus muscle (EPL) is a skeletal muscle located dorsally on the forearm. It is much larger than the extensor pollicis brevis, the origin of which it partly covers and acts to stretch the thumb together with this muscle.

In human anatomy, the abductor pollicis longus (APL) is one of the extrinsic muscles of the hand. Its major function is to abduct the thumb at the wrist. Its tendon forms the anterior border of the anatomical snuffbox.

Extensor pollicis brevis muscle

In human anatomy, the extensor pollicis brevis is a skeletal muscle on the dorsal side of the forearm. It lies on the medial side of, and is closely connected with, the abductor pollicis longus. The extensor pollicis brevis (EPB) belongs to the deep group of the posterior fascial compartment of the forearm.[1] It is a part of the lateral border of the anatomical snuffbox.

Palmar interossei muscles

In human anatomy, the palmar or volar interossei are three small, unipennate muscles in the hand that lie between the metacarpal bones and are attached to the index, ring, and little fingers. They are smaller than the dorsal interossei of the hand.

Finkelsteins test

Finkelstein's test is a test used to diagnose de Quervain's tenosynovitis in people who have wrist pain.

Carpometacarpal joint

The carpometacarpal (CMC) joints are five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones.

Abductor digiti minimi muscle of hand

In human anatomy, the abductor digiti minimi is a skeletal muscle situated on the ulnar border of the palm of the hand. It forms the ulnar border of the palm and its spindle-like shape defines the hypothenar eminence of the palm together with the skin, connective tissue, and fat surrounding it. Its main function is to pull the little finger away from the other fingers.

Extensor indicis muscle

In human anatomy, the extensor indicis [proprius] is a narrow, elongated skeletal muscle in the deep layer of the dorsal forearm, placed medial to, and parallel with, the extensor pollicis longus. Its tendon goes to the index finger, which it extends.

The posterior compartment of the forearm contains twelve muscles which are chiefly responsible for extension of the wrist and digits, and supination of the forearm. It is separated from the anterior compartment by the interosseous membrane between the radius and ulna.

Cervical spinal nerve 8

The cervical spinal nerve 8 (C8) is a spinal nerve of the cervical segment.

Mucous sheaths on back of wrist

The mucous sheaths of the tendons on the back of the wrist are protective coverings for tendons in the wrist. Between the dorsal carpal ligament and the bones six compartments are formed for the passage of tendons, each compartment having a separate mucous sheath. One is found in each of the following positions:

  1. on the lateral side of the radial styloid process, for the tendons of the Abductor pollicis longus and Extensor pollicis brevis;
  2. behind the styloid process, for the tendons of the Extensores carpi radialis longus and brevis;
  3. about the middle of the dorsal surface of the radius, for the tendon of the Extensor pollicis longus;
  4. to the medial side of the latter, for the tendons of the Extensor digitorum communis and Extensor indicis proprius;
  5. opposite the interval between the radius and ulna, for the Extensor digiti quinti proprius;
  6. between the head and styloid process of the ulna, for the tendon of the Extensor carpi ulnaris.
Muscles of the thumb

The muscles of the thumb are nine skeletal muscles located in the hand and forearm. The muscles allow for flexion, extension, adduction, abduction and opposition of the thumb. The muscles acting on the thumb can be divided into two groups: The extrinsic hand muscles, with their muscle bellies located in the forearm, and the intrinsic hand muscles, with their muscles bellies located in the hand proper.

References

  1. 1 2 3 4 Platzer 2004, p 164
  2. 1 2 3 Platzer 2004 , p. 168
  3. Lopez-Ben, Robert; Lee, Donald H.; Nicolodi, Daniel J. (September 2003). "Boxer Knuckle (Injury of the Extensor Hood with Extensor Tendon Subluxation): Diagnosis with Dynamic US—Report of Three Cases". Radiology. 228 (3): 642–646. doi:10.1148/radiol.2283020833. PMID   12869687. Archived from the original on 2012-08-09. Retrieved 2011-12-28.
  4. "Clinical Example: Sagittal band rupture reconstruction". Eaton Hand.
  5. "Thumb Articulations". ExRx.net.
  6. Ross & Lamperti 2006 , p. 300
  7. Moore, Keith; Anne Agur (2007). Essential Clinical Anatomy, Third Edition. Lippincott Williams & Wilkins. pp. INSERT PAGE NUMBER. ISBN   978-0-7817-6274-8.