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Wrist
Wrist
Wrist
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Wrist
A human showing the wrist in the centre
The carpal bones, sometimes included in the definition of the wrist
Details
Identifiers
Latinarticulatio radiocarpalis
MeSHD014953
TA98A01.1.00.026
TA2147
FMA24922
Anatomical terminology

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;[1][2] (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus[2] 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.[3][4] This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.

As a consequence of these various definitions, fractures to the carpal bones are referred to as carpal fractures, while fractures such as distal radius fracture are often considered fractures to the wrist.

Structure

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Posterior and anterior aspects of right human wrist
Ligaments of wrist. Posterior and anterior views

The distal radioulnar joint (DRUJ) is a pivot joint located between the distal ends of the radius and ulna, which make up the forearm. Formed by the head of the ulna (the bony knob on the back of the wrist) and the ulnar notch of the radius, the DRUJ is separated from the radiocarpal (wrist) joint by an articular disk lying between the radius and the styloid process of the ulna. The capsule of the joint is lax and extends from the inferior sacciform recess to the ulnar shaft. The DRUJ works with the proximal radioulnar joint (at the elbow) for pronation and supination.[5]

The radiocarpal (wrist) joint is an ellipsoid joint formed by the radius and the articular disc proximally and the proximal row of carpal bones distally. The carpal bones on the ulnar side only make intermittent contact with the proximal side — the triquetrum only makes contact during ulnar abduction. The capsule, lax and un-branched, is thin on the dorsal side and can contain synovial folds. The capsule is continuous with the midcarpal joint and strengthened by numerous ligaments, including the palmar and dorsal radiocarpal ligaments, and the ulnar and radial collateral ligaments. [6]

The parts forming the radiocarpal joint are the lower end of the radius and under surface of the articular disk above; and the scaphoid, lunate, and triquetral bones below. The articular surface of the radius and the undersurface of the articular disk form together with a transversely elliptical concave surface, the receiving cavity. The superior articular surfaces of the scaphoid, lunate, and triquetrum form a smooth convex surface, the condyle, which is received into the concavity.[7]

Carpal bones of the hand:

In the hand proper a total of 13 bones form part of the wrist: eight carpal bones—scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, and hamate— and five metacarpal bones—the first, second, third, fourth, and fifth metacarpal bones.[8]

The midcarpal joint is the S-shaped joint space separating the proximal and distal rows of carpal bones. The intercarpal joints, between the bones of each row, are strengthened by the radiate carpal and pisohamate ligaments and the palmar, interosseous, and dorsal intercarpal ligaments. Some degree of mobility is possible between the bones of the proximal row while the bones of the distal row are connected to each other and to the metacarpal bones —at the carpometacarpal joints— by strong ligaments —the pisometacarpal and palmar and dorsal carpometacarpal ligament— that makes a functional entity of these bones. Additionally, the joints between the bases of the metacarpal bones —the intermetacarpal articulations— are strengthened by dorsal, interosseous, and palmar intermetacarpal ligaments.[6]

The earliest carpal bones to ossify are capitate bone and hamate bone in the first six months of an infant life.[9]

Articulations

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The radiocarpal, intercarpal, midcarpal, carpometacarpal, and intermetacarpal joints often intercommunicate through a common synovial cavity. [10]

Articular surfaces

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It has two articular surfaces named, proximal and distal articular surfaces respectively. The proximal articular surface is made up of the lower end of the radius and a triangular articular disc of the inferior radio-ulnar joint. On the other hand, the distal articular surface is made up of proximal surfaces of the scaphoid, triquetral and lunate bones.[11]

Micro-radiography of 8-weeks human embryo hand

Function

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Movement

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The extrinsic hand muscles are located in the forearm where their bellies form the proximal fleshy roundness. When contracted, most of the tendons of these muscles are prevented from standing up like taut bowstrings around the wrist by passing under the flexor retinaculum on the palmar side and the extensor retinaculum on the dorsal side. On the palmar side the carpal bones form the carpal tunnel,[12] through which some of the flexor tendons pass in tendon sheaths that enable them to slide back and forth through the narrow passageway (see carpal tunnel syndrome).[13]

Starting from the mid-position of the hand, the movements permitted in the wrist proper are (muscles in order of importance):[14][15]

Magnetic resonance imaging (MRI) of radial abduction (rightwards in image) and ulnar adduction (leftwards in image)
Magnetic resonance imaging (MRI) of wrist extension and return to neutral position

However, movements at the wrist can not be properly described without including movements in the distal radioulnar joint in which the rotary actions of supination and pronation occur and this joint is therefore normally regarded as part of the wrist.[17]

Clinical significance

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Projectional radiograph of a normal wrist (left image) and one with a dorsal tilt due to wrist osteoarthritis (as well as osteoporosis). The angle of the distal surface of the lunate bone is annotated. A dorsal tilt of 10 to 15 degrees is considered normal.[18]

Wrist pain has a number of causes, including carpal tunnel syndrome,[16] ganglion cyst,[19] tendinitis,[20] and osteoarthritis. Tests such as Phalen's test involve palmarflexion at the wrist.

The hand may deviate at the wrist in some conditions, such as rheumatoid arthritis.

Ossification of the bones around the wrist is one indicator used in taking a bone age.

A wrist fracture typically refers to a distal radius fracture. It is more common in non-Hispanic women and is associated with factors such as alcohol consumption, smoking, high serum phosphate levels, osteoporosis, and obesity.[21]

History

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Etymology

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The English word "wrist" is etymologically derived from the Proto-Germanic word wristiz from which are derived modern German Rist ("instep", "wrist") and modern Swedish vrist ("instep", "ankle"). The base writh- and its variants are associated with Old English words "wreath", "wrest", and "writhe". The wr- sound of this base seems originally to have been symbolic of the action of twisting.[22]

See also

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Additional images

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  • Wrist joint. Deep dissection. Posterior view.
    Wrist joint. Deep dissection. Posterior view.
  • Wrist joint. Deep dissection. Posterior view.
    Wrist joint. Deep dissection. Posterior view.
  • Wrist joint. Deep dissection. Anterior, palmar, view.
    Wrist joint. Deep dissection. Anterior, palmar, view.
  • Wrist joint. Deep dissection. Anterior, palmar, view.
    Wrist joint. Deep dissection. Anterior, palmar, view.

References

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Sources

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Revisions and contributorsEdit on WikipediaRead on Wikipedia

Wrist

View on Grokipedia
from Grokipedia
The wrist is a complex in the human that connects the distal ends of the and bones of the to the proximal row of the eight of the hand, enabling a wide range of movements essential for hand function. Anatomically, it comprises the radiocarpal (a condyloid type), the ulnocarpal , and the distal radioulnar , forming a pivot-like structure that transitions smoothly between the and hand. This intricate arrangement includes a network of bones, ligaments, tendons, muscles, nerves, and blood vessels, making it one of the most mobile yet vulnerable joints in the body. The bony framework of the wrist features eight arranged in two rows: the proximal row (scaphoid, lunate, triquetrum, and pisiform) articulates with the and complex, while the distal row (trapezium, , capitate, and hamate) connects to the of the hand. Supporting ligaments, such as the palmar and dorsal radiocarpal ligaments and the radial and ulnar collateral ligaments, provide stability and prevent excessive motion, while the encloses the for lubrication. Muscles originating from the , including the flexor carpi radialis and extensor carpi ulnaris, control wrist movements, supplemented by intrinsic hand muscles for finer adjustments. Blood supply arises from the radial and ulnar arteries forming dorsal and palmar carpal arches, and innervation is provided by branches of the , radial, and ulnar nerves. Functionally, the wrist permits four primary movements: flexion (bending toward the palm), extension (bending backward), radial deviation (abduction toward ), and ulnar deviation (adduction toward the pinky), with a typical range of 70-80 degrees for flexion-extension and 20-30 degrees for deviation. These motions, combined with the hand's 27 total bones and 34 muscles, facilitate essential activities like grasping, manipulating objects, and precise touch, underscoring the wrist's role in daily functionality and occupational tasks. Clinically, the wrist is prone to injuries such as distal fractures and conditions like due to its compression in the —a narrow passageway formed by the and transverse .

Anatomy

Bones

The wrist's skeletal framework is primarily composed of eight , arranged in two transverse rows that form a flexible yet stable link between the and hand. The proximal row, positioned closest to the , consists of four bones from the radial (lateral) to ulnar (medial) side: the scaphoid, lunate, triquetrum, and pisiform. The distal row includes the trapezium, , capitate, and hamate, also oriented from radial to ulnar. These bones exhibit distinct shapes adapted to their roles in load transmission and mobility: the scaphoid is boat-shaped and lies in the floor of the ; the lunate is crescent- or moon-shaped; the triquetrum is pyramidal with three facets; and the pisiform is a small, pea-shaped embedded in the flexor carpi ulnaris . In the distal row, the trapezium has a saddle-shaped surface for articulation; the is wedge-shaped; the capitate, the largest carpal, features a rounded head; and the hamate possesses a hook-like process (hamulus) on its palmar surface. The articulate with one another via , creating a series of synovial interfaces that allow gliding motions, and they connect proximally to the distal ends of the and . Specifically, the scaphoid and lunate articulate directly with the distal to form the radiocarpal , while the does not directly contact the carpals; instead, stability on the ulnar side is maintained by the complex (TFCC), a cartilaginous disc and ligamentous structure that cushions the ulnar head and binds it to the triquetrum and lunate. The TFCC enhances wrist stability by distributing compressive forces and limiting excessive translation between the and during rotation. Distally, the carpal bones transition to the hand via the five , whose concave bases articulate with the distal row carpals to form carpometacarpal joints, providing a stable base for finger movements. The overall arrangement of the carpals forms a concave arch on the palmar side, with the proximal and distal rows curving to create the , an osteofibrous canal bounded by the inferiorly and the flexor retinaculum superiorly, through which the and flexor tendons pass.

Joints

The wrist comprises several s that facilitate its complex mobility. The primary joints include the radiocarpal , an ellipsoid formed by the articulation between the distal and the proximal row of ; the ulnocarpal , a plane involving the and the proximal carpals via the complex (TFCC); the midcarpal , a double plane between the proximal and distal rows of ; and the carpometacarpal joints, which consist of a at the thumb (first carpometacarpal) and plane s for the other four digits. The articular surfaces of these joints exhibit specific morphologies to enable smooth interaction. In the radiocarpal joint, the concave distal articulates with the convex surfaces of the proximal , while the ulnocarpal joint features relatively flat surfaces between the ulnar head, the TFCC disc, and the lunate and triquetrum. The midcarpal joint involves gliding between the convex distal aspects of the proximal carpals and the concave proximal aspects of the distal carpals, and the carpometacarpal joints display saddle-shaped () or plane configurations between distal carpals and metacarpal bases. Incongruencies in these surfaces, particularly at the radiocarpal and ulnocarpal interfaces, are compensated by the of the TFCC, which provides a smooth, congruent articulating surface and load distribution. Each wrist joint is enclosed by a capsule consisting of an outer fibrous layer for structural integrity and an inner synovial layer that secretes lubricating fluid. The capsules attach proximally to the and and distally to the carpals, with volar (palmar) aspects being thicker and more reinforced for stability during load-bearing, while dorsal aspects are relatively thinner but contribute to overall containment. These capsules form continuous compartments around the synovial joints, preventing excessive . Functionally, the wrist joints are divided into proximal and distal compartments to optimize motion distribution. The proximal compartment encompasses the radiocarpal and , which primarily handle flexion-extension and deviation, while the distal compartment includes the midcarpal and carpometacarpal joints, facilitating finer adjustments and . This division allows for coordinated, multi-planar movement across the wrist complex.

Ligaments and tendons

The wrist's stability and motion transmission rely on a network of ligaments and tendons that interconnect the , , and while facilitating the passage of muscle tendons from the to the hand. Intrinsic ligaments connect adjacent within the carpus, providing intercarpal stability, whereas extrinsic ligaments link the carpus to the bones, offering broader reinforcement. Tendons of the flexor and extensor muscles traverse the wrist under specialized retinacula, which prevent displacement and maintain mechanical efficiency during movement. Intrinsic ligaments, situated entirely between , are crucial for maintaining the alignment and stability of the proximal and distal carpal rows. The scapholunate ligament, a C-shaped structure connecting the scaphoid and lunate, features a thick dorsal component that acts as the primary stabilizer against shear forces, preventing scaphoid dissociation from the lunate. The lunotriquetral ligament, horseshoe-shaped and linking the lunate to the triquetrum, has its thickest palmar portion resisting rotational , thus preserving the of the proximal carpal row during wrist motion. These ligaments collectively inhibit excessive intercarpal translation and rotation, ensuring coordinated carpal . Extrinsic ligaments extend from the radius and ulna to the carpal bones, serving as key stabilizers of the radiocarpal and ulnocarpal joints. The radiocarpal ligaments include the palmar radioscaphocapitate ligament, which originates from the anterolateral and inserts into the capitate, forming a supportive sling for scaphoid rotation and overall wrist stability. Dorsal radiocarpal ligaments arise from the dorsal and insert into the triquetrum and lunate, countering volar . The ulnocarpal complex comprises the ulnolunate and ulnotriquetral ligaments, which originate from the volar radioulnar and attach to the lunate and triquetrum, respectively, providing ulnar-sided support against varus forces. These extrinsic structures, particularly the radioscaphocapitate, are essential for preventing carpal and load distribution across the wrist. Flexor tendons pass through the volar aspect of the wrist beneath the flexor retinaculum, also known as the transverse carpal ligament, which forms the roof of the . This retinaculum, a fibrous band approximately 3 cm long and 2.5 cm wide, attaches laterally to the scaphoid tuberosity and trapezial ridge and medially to the pisiform and hamate hook, enclosing nine s—the four flexor digitorum superficialis, four flexor digitorum profundus, and one flexor pollicis longus—along with their synovial sheaths. These sheaths reduce during tendon gliding, while the retinaculum functions as a to enhance flexor and prevent bowstringing, where tendons would otherwise displace volarly under tension. Extensor tendons course dorsally through six discrete compartments formed by fibrous septa beneath the extensor retinaculum, a broad oblique ligamentous sheet that maintains dorsal alignment. The retinaculum attaches proximally to the distal radius near the styloid process and distally to the pisiform and triquetrum, without direct ulnar attachment to allow supination flexibility. The compartments house specific tendons: the first contains abductor pollicis longus and extensor pollicis brevis; the second, extensor carpi radialis longus and brevis; the third, extensor pollicis longus; the fourth, extensor digitorum and indicis; the fifth, extensor digiti minimi; and the sixth, extensor carpi ulnaris. Each compartment is lined by a synovial sheath that lubricates movement, with the retinaculum preventing bowstringing by holding tendons close to the bone axis during extension.

Muscles

The muscles acting on the wrist are divided into extrinsic and intrinsic groups, with the extrinsic muscles originating in the and providing the primary force for wrist movements through long tendons, while the intrinsic muscles, located within the hand, offer finer control and supplementary stability.

Extrinsic Muscles

The extrinsic muscles are responsible for the major motions of wrist flexion, extension, radial deviation, and ulnar deviation. The forearm flexors include the flexor carpi radialis, which originates from the and inserts at the base of the second metacarpal, primarily acting to flex and abduct the wrist; the flexor carpi ulnaris, originating from the and of the and inserting into the pisiform, hook of the hamate, and base of the fifth metacarpal, which flexes and adducts the wrist; and the palmaris longus, originating from the and inserting into the and flexor retinaculum, aiding in wrist flexion. The forearm extensors comprise the extensor carpi radialis longus, originating from the lateral supracondylar ridge of the and inserting at the base of the second metacarpal, which extends and abducts the wrist; the extensor carpi radialis brevis, originating from the and inserting at the base of the third metacarpal, also extending and abducting the wrist; and the extensor carpi ulnaris, originating from the and posterior border of the and inserting at the base of the fifth metacarpal, which extends and adducts the wrist.
MuscleOriginInsertionPrimary Action
Flexor carpi radialisMedial of Base of 2nd metacarpalFlexion and abduction of wrist
Flexor carpi ulnarisMedial , Pisiform, hook of hamate, 5th metacarpal baseFlexion and adduction of wrist
Palmaris longusMedial of , flexor retinaculumFlexion of wrist
Extensor carpi radialis longusLateral supracondylar ridge of Base of 2nd metacarpalExtension and abduction of wrist
Extensor carpi radialis brevisLateral of Base of 3rd metacarpalExtension and abduction of wrist
Extensor carpi ulnarisLateral , Base of 5th metacarpalExtension and adduction of wrist

Intrinsic Muscles

The intrinsic , including the thenar and hypothenar groups, play a secondary role in wrist function by providing stability through their attachments to and the flexor retinaculum. The thenar muscles at the base of —such as the abductor pollicis brevis (originating from the scaphoid and trapezium, inserting on the proximal phalanx of ), opponens pollicis (originating from the trapezium, inserting on the first metacarpal), and flexor pollicis brevis (originating from the trapezium and flexor retinaculum, inserting on the proximal phalanx of )—contribute to wrist stability by anchoring thumb opposition and counterbalancing forces on the radial side of the wrist. Similarly, the hypothenar muscles at the base of the little finger—abductor digiti minimi (originating from the pisiform, inserting on the proximal phalanx of the fifth digit), flexor digiti minimi brevis (originating from the hamate and flexor retinaculum, inserting on the proximal phalanx of the fifth digit), and opponens digiti minimi (originating from the flexor retinaculum, inserting on the fifth metacarpal)—enhance ulnar-side stability by supporting the pisiform and retinaculum during grip activities.

Synergistic Actions

The extrinsic forearm muscles enable wrist motion through their long tendons that cross the wrist joint, allowing coordinated flexion and extension while the radial and ulnar pairs oppose each other in deviation to maintain balanced movement. These actions are supported by basic innervation from the (flexor carpi radialis and palmaris longus), (flexor carpi ulnaris and hypothenar muscles), and (extensors and some thenar components).

Comparative Anatomy

In humans, the wrist muscles are adapted for precision grip, featuring a more mobile with enlarged intrinsic thenar muscles and enhanced extrinsic flexors like the flexor pollicis longus for fine manipulation and power grips during tool use. In contrast, quadrupedal such as chimpanzees have wrist muscles optimized for locomotion, with restricted extension, smaller intrinsic muscles, and elongated curved fingers suited for hook grips in arboreal suspension rather than precise opposition.

Nerves and blood supply

The wrist is innervated primarily by the median, ulnar, and radial nerves, which provide both sensory and motor functions to the hand and forearm structures. The median nerve, formed by contributions from the lateral and medial cords of the brachial plexus (C5-T1 roots), enters the wrist through the carpal tunnel, a fibro-osseous passageway bounded by the carpal bones and flexor retinaculum. Within the carpal tunnel, it lies superficial to the flexor tendons and gives off motor branches, including the recurrent motor branch, which innervates the thenar muscles such as the abductor pollicis brevis, flexor pollicis brevis (superficial head), and opponens pollicis. Sensory branches emerge distal to the tunnel, supplying the palmar aspect of the thumb, index finger, middle finger, and radial half of the ring finger, while the palmar cutaneous branch arises proximal to the tunnel to innervate the proximal lateral palm. The (C8-T1 roots, with occasional C7 contribution), arising from the medial cord of the , courses along the medial and enters the wrist through Guyon's canal, a fibro-osseous approximately 40-45 mm long, bounded by the medially, the hook of the hamate laterally, the volar carpal ligament superiorly, and the transverse carpal ligament and pisohamate ligament inferiorly. In Guyon's canal, the and artery travel together, and distal to the canal, the nerve bifurcates (in 66-86% of cases) into superficial (sensory) and deep (motor) branches; the superficial branch provides sensation to the palmar and dorsal aspects of the and ulnar half of the ring finger, while the deep branch innervates the hypothenar muscles, interossei, adductor pollicis, and the third and fourth lumbricals. The (C5-T1 roots), originating from the of the , contributes minimally to wrist motor function but provides sensory innervation via its superficial branch. This branch emerges in the distal , travels deep to the brachioradialis tendon, and crosses the at the wrist, becoming subcutaneous to supply sensation to the dorsal aspect of the lateral three-and-a-half digits (proximal phalanges) and the dorsolateral wrist and hand. It is purely sensory at this level and lacks motor branches to wrist intrinsics. The arterial blood supply to the wrist and hand derives mainly from the radial and ulnar arteries, terminal branches of the brachial artery, forming interconnected palmar arches for redundancy. The radial artery passes laterally over the wrist through the anatomical snuffbox, giving off the superficial palmar branch that anastomoses with the ulnar artery to form the superficial palmar arch, which lies superficial to the long flexor tendons and deep to the palmar aponeurosis, supplying the palmar digital arteries to the fingers. The deep palmar arch is primarily formed by the radial artery's continuation, joined by the deep branch of the ulnar artery after it traverses Guyon's canal, and lies deep to the flexor tendons, providing branches to the palmar metacarpal arteries that interconnect with the superficial arch. Key anastomoses occur between the radial and ulnar systems at the wrist, including the dorsal carpal arch (formed by dorsal branches of both arteries) and palmar metacarpal connections, ensuring collateral circulation. Venous drainage of the wrist follows the arterial pattern, with superficial veins forming the dorsal venous network over the wrist and hand, which drains laterally into the and medially into the ; these ascend the to join the . Deep veins accompany the arteries, forming palmar venous arches that connect to the dorsal network. Lymphatic drainage from the wrist and hand occurs via superficial and deep pathways to the cubital (epitrochlear or supratrochlear) nodes at the medial , located 4-5 cm above the humeral epitrochlea in the superficial . Superficial lymphatics from the skin and subcutaneous tissues of the hand and wrist drain primarily to these 1-3 cubital nodes, which in turn connect to axillary nodes; deep lymphatics follow the neurovascular bundles along tendons and joints to the same cubital nodes before proceeding centrally. The neurovascular bundles at the wrist are clinically significant due to their confined spaces, predisposing to compression; for instance, the in the is vulnerable to pressure increases (e.g., 20-30 mmHg) from synovial swelling or repetitive flexion, potentially impairing blood flow and causing ischemia. Similarly, the in Guyon's canal can be compressed in three zones—proximal (mixed deficits), deep motor branch (motor only), or superficial sensory—often due to anatomical variations like aberrant muscles, leading to localized sensory or motor impairment.

Function

Movements

The wrist joint complex enables a variety of movements essential for hand function, primarily occurring at the radiocarpal and midcarpal s. These include flexion, extension, radial deviation (abduction), ulnar deviation (adduction), and circumduction, which is a resulting from the sequential combination of these primary movements. The normal range of wrist flexion is approximately 70-80 degrees, allowing the palm to move toward the anterior , while extension reaches about 70 degrees, directing the back of the hand posteriorly. Radial deviation typically measures 20 degrees, moving the hand toward side, and ulnar deviation ranges from 30-40 degrees, shifting the hand toward the side. These ranges can vary slightly based on individual and measurement techniques. In addition to isolated movements, the wrist exhibits coupled motions that integrate flexion-extension with radial-ulnar deviation, such as the dart-thrower's motion. This functional plane extends from extension to ulnar flexion and is prominent in daily activities like throwing or pouring, optimizing stability and efficiency. Flexion and extension primarily occur at the radiocarpal joint, which connects the to the proximal carpal row, while radial and ulnar deviation are predominantly facilitated by the midcarpal joint between the proximal and distal carpal rows. Factors influencing the wrist's include age, with reductions observed in older adults due to tissue degeneration; sex, where females often exhibit greater flexibility; laxity, which can increase mobility but risk ; and measurement methods like goniometry, which standardize assessment using an or protractor for precision.

Biomechanics

The biomechanics of the wrist involves efficient load transmission across its complex carpal architecture to support hand function while maintaining stability. In neutral position, approximately 80% of axial compressive forces are transmitted through the radiocarpal joint via the scaphoid and lunate to the distal carpal row, with the remaining 20% passing through the joint primarily involving the triquetrum. This distribution ensures balanced force handling during weight-bearing activities, but variations in ulnar variance significantly alter it; positive ulnar variance ( longer than ) increases ulnar-sided loading to about 42%, while negative variance reduces it to roughly 3-5%, potentially leading to uneven stress on carpal structures. Wrist stability relies on a combination of ligamentous tension, muscular co-contraction, and joint surface congruence to resist shear and translational forces. Intrinsic ligaments, such as the scapholunate interosseous , maintain alignment between the scaphoid and lunate under tension, preventing scapholunate dissociation that can result in dorsal intercalated segment instability (DISI) with scaphoid palmar flexion and lunate dorsal extension. Extrinsic ligaments like the radioscaphocapitate further constrain excessive motion, while congruence from the ellipsoidal radial surfaces and reciprocal carpal shapes provides passive resistance to dislocation. Muscle co-contraction, particularly of radial wrist stabilizers such as the extensor carpi radialis longus and abductor pollicis longus, actively reduces scapholunate gapping and restores proximal row alignment in cases of compromise, whereas ulnar deviators like the extensor carpi ulnaris may exacerbate instability if imbalanced. Kinematic models describe wrist motion through instantaneous centers of (ICRs), which shift dynamically to accommodate multiplanar movements. During flexion-extension, ICRs are located near the capitate head, allowing the proximal carpal row to act as an intercalated segment linking the and distal row in a coordinated arc of approximately 120-140 degrees. The dart-thrower's arc, an oblique plane from radial extension to ulnar flexion spanning about 120 degrees, features relatively stationary proximal row motion with primary at the midcarpal joint, enhancing stability for functional tasks like or pouring. In occupational settings, repetitive wrist tasks involving sustained force vectors—such as axial compression, radial/ulnar deviation, and palmar flexion—contribute to biomechanical overload and repetitive strain injuries. High-force gripping combined with awkward postures, as seen in work or tool use, amplifies shear stresses on the carpus, increasing risk of attenuation and without adequate recovery periods.

Development

Embryonic formation

The development of the wrist begins with the formation of the bud around day 26 of embryonic gestation, arising from mesenchymal cells in the that protrude and become encased by . This bud's proximal-distal axis is primarily directed by the apical ectodermal ridge (AER), a thickened ectodermal structure at the distal tip that secretes fibroblast growth factors (FGFs), such as FGF8 and , to promote outgrowth and maintain undifferentiated cells in the underlying progress zone. Concurrently, the anterior-posterior axis is patterned by the zone of polarizing activity (ZPA), located in the posterior of the limb bud, which expresses Sonic hedgehog (Shh) to establish digit identity and radial-ulnar polarity, with disruptions leading to mirror-image duplications or deficiencies. By weeks 4 to 6 of , mesenchymal cells within the distal autopod region undergo to form cartilaginous precursors of the , marking the initial skeletal anlage of the wrist; this process is evident as early chondrified structures identifiable around 8 weeks . These , regulated by bone morphogenetic proteins (BMPs) and the SOX9, create the models that prefigure the eight , with the hand plate emerging and a wrist constriction appearing to delineate the carpus from the . Genetic regulation of carpal patterning involves from the HOXA and HOXD clusters, which are expressed in nested domains along the proximal-distal axis to specify skeletal elements, including the zeugopod-autopod transition critical for wrist formation; for instance, mutations can alter carpal morphology. Wnt signaling pathways complement this by influencing dorso-ventral polarity and Shh expression in the ZPA, with Wnt7a from the dorsal ectoderm inducing LMX1 to dorsalize the limb and support proper carpal alignment. Embryonic anomalies of the wrist, such as , often originate from failures in mesenchymal segmentation or formation during these early limb bud stages, potentially due to disruptions in Shh signaling or mesodermal development, resulting in underdevelopment of the radius and radial .

Ossification

The of the in the wrist follows a predictable postnatal sequence, beginning with the appearance of primary ossification centers shortly after birth and progressing through mineralization and eventual fusion with adjacent bones by late . The capitate and hamate are the first to ossify, typically between 1 and 3 months of age, followed by the triquetrum at 2 to 3 years, the lunate at 3 to 4 years, the trapezium and at 4 to 5 years, the scaphoid at 4 to 6 years, and the pisiform at 8 to 12 years as a . Full skeletal maturity in the wrist is achieved with the fusion of these centers to the epiphyses of the radius and , generally by 16 to 18 years in females and 18 to 20 years in males. Sex differences influence this timeline, with females typically exhibiting 1 to 2 years earlier than males across most , a pattern attributed to hormonal influences on skeletal maturation. Ethnic variations also contribute to timing differences; for instance, children of African descent often show advanced compared to those of European or Asian descent, with exceeding chronological age by several months in some populations. A 2020 radiological study on Saudi children highlighted population-specific variability, noting earlier of most relative to Indian cohorts, underscoring the role of genetic and environmental factors in these discrepancies. The Greulich-Pyle atlas, developed from radiographic standards of hand and wrist development, serves as a key tool for assessing in clinical and forensic contexts, comparing patient radiographs to reference images to evaluate maturation against chronological age. This method is widely used in to diagnose growth disorders and in forensics for age estimation, providing a baseline for identifying deviations influenced by factors such as , which recent research indicates can accelerate or delay timing by altering metabolic processes. For example, nutritional deficiencies may retard carpal , while adequate intake supports adherence to standard timelines.

Clinical significance

Injuries

The wrist is susceptible to a variety of traumatic injuries, primarily due to its role in and impact absorption during falls. Among these, fractures of the distal radius are the most common, accounting for approximately 20% of all skeletal fractures. These fractures exhibit an overall incidence of 207.8 per 100,000 persons per year, with females experiencing a higher rate of 323.4 per 100,000 per year. Colles' fractures, characterized by dorsal angulation and displacement of the distal fragment, typically result from a fall on an outstretched hand (FOOSH) with the wrist in dorsiflexion, leading to tension on the volar aspect and compression dorsally. In contrast, Smith's fractures involve volar displacement and angulation, often from a fall on a flexed wrist or direct volar impact, representing the reverse mechanism of Colles' fractures. These injuries are particularly prevalent in postmenopausal women due to accelerated bone loss at the distal radius associated with . Scaphoid fractures, which comprise about 60-70% of carpal bone injuries, often occur from FOOSH or axial loading with wrist hyperextension and radial deviation, with an incidence of approximately 1.47 fractures per 100,000 persons . A major concern with these fractures is the risk of (AVN), stemming from the scaphoid's retrograde blood supply, which is particularly vulnerable in proximal pole fractures (up to 100% risk) and waist fractures (around 33% risk), with overall AVN rates of 5-10% following immobilization and higher for proximal lesions. Ligamentous injuries frequently accompany high-energy trauma to the wrist. Scapholunate dissociation arises from axial loading and extension, such as in FOOSH, disrupting the scapholunate interosseous and leading to carpal if untreated. complex (TFCC) tears commonly result from falls on the outstretched or ulnarly deviated wrist, or rotational twists, causing ulnar-sided pain and potential . Soft tissue traumas include tendon ruptures and contusions. The extensor pollicis longus (EPL) tendon is prone to rupture near , often as a delayed complication of distal fractures due to sharp bony edges or ischemia, though spontaneous cases can occur from severe sprains with formation. Contusions to wrist soft tissues, such as from direct blows, result in localized swelling and ecchymosis, potentially impairing mobility without structural disruption. Acute management of wrist injuries emphasizes prompt stabilization to prevent further damage. Immobilization with splints or casts is standard for fractures and sprains to maintain alignment, while initial imaging via X-rays assesses bony integrity in multiple views; MRI is indicated for suspected or ligamentous involvement to evaluate tears or occult fractures. Complications such as , marked by disproportionate pain worsening with passive stretch, require urgent to avert irreversible muscle and nerve damage, occurring in up to 10% of severe traumas.

Disorders

The wrist is susceptible to various non-traumatic pathological conditions that can impair function and cause . Compressive neuropathies, such as , involve entrapment of the within the , leading to symptoms including numbness, tingling, and weakness in , index, middle, and part of . This condition arises from increased pressure on the nerve, often due to repetitive wrist motions, anatomical variations, or systemic factors like and . Risk factors include female sex, women are three times more likely than men to develop the condition, and occupations involving prolonged hand use. Another compressive neuropathy, Guyon's canal syndrome, results from ulnar nerve compression in the ulnar tunnel at the wrist, causing pain, , and motor deficits in the ring and little fingers, as well as intrinsic hand . Common etiologies include space-occupying lesions like ganglia or repetitive pressure, with symptoms varying by the zone of compression within the canal. Degenerative disorders frequently affect the wrist's joints, leading to cartilage breakdown and inflammation. Osteoarthritis of the wrist primarily involves the radiocarpal , manifesting as pain, stiffness, and reduced , and can develop as a primary condition or secondary to prior joint stress. In primary forms, it results from age-related wear, while post-traumatic variants accelerate degeneration through altered joint mechanics. , an autoimmune inflammatory disease, commonly involves the wrist, affecting approximately 75% of patients, causing , joint erosion, and deformities such as radial deviation or ulnar translocation of the carpus. Early wrist involvement occurs in about 50% of cases within two years of diagnosis, contributing to functional impairment through capsular stretching and . Other non-degenerative pathologies include cysts, which are benign, fluid-filled sacs arising from mucoid degeneration of the or , most commonly on the dorsal wrist. These cysts, comprising 60-70% of hand tumors, often present as painless masses but can cause discomfort or nerve compression if large. De Quervain's involves inflammation and thickening of the tendon sheaths enclosing the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment, resulting in radial wrist pain exacerbated by motion. This condition stems from repetitive and wrist use, leading to stenosing and potential myxoid degeneration. represents of the lunate bone, progressing through stages of sclerosis, fragmentation, and collapse, which causes dorsal wrist pain and limited extension. The involves disrupted blood supply to the lunate, often linked to negative ulnar variance, with the disease typically affecting young adults aged 20-40. Congenital disorders like arise from abnormal development of the distal radial growth plate, leading to volar and ulnar tilting of the distal , prominence of the distal , and carpal malalignment. This condition, often associated with Leri-Weill dyschondrosteosis due to SHOX gene mutations, results in progressive wrist deformity and pain during , with females more commonly affected. The partial premature closure of the volar-ulnar physis disrupts normal radial growth, causing a characteristic "V-shaped" carpal arch and potential limitation in rotation.

Diagnosis and treatment

Diagnosis of wrist conditions typically begins with a thorough to assess tenderness, swelling, , , and specific provocative tests tailored to suspected issues. For instance, Phalen's test, which involves flexing the wrist for 60 seconds to reproduce symptoms of compression, is commonly used to evaluate . Additional nerve conduction studies and (EMG) may measure electrical activity in muscles and nerve impulses to confirm nerve involvement. Imaging plays a central role in visualizing structural abnormalities. X-rays are the initial modality to detect fractures, dislocations, or signs of , providing quick assessment of alignment. For more detailed evaluation of soft tissues, (MRI) uses radio waves and magnets to image ligaments, tendons, and , while offers a noninvasive view of tendons, cysts, and dynamic structures. Computed (CT) scans provide high-resolution detail, particularly useful for complex fractures missed on X-rays. In cases of persistent unexplained pain, wrist serves as a diagnostic tool, inserting a fiber-optic camera through small incisions to directly inspect the interior and potentially perform therapeutic interventions. Treatment strategies for wrist conditions emphasize conservative measures initially, progressing to surgical options if symptoms persist or severity warrants. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen reduce pain and swelling, while splinting or casting immobilizes the wrist to promote healing in sprains or fractures. incorporates ergonomic adjustments and modalities like ice application or injections for targeted relief. For overuse injuries, rest and activity modification are foundational, often combined with ultrasound-guided therapies. Surgical interventions address structural damage when conservative approaches fail. Open reduction and internal fixation (ORIF) uses plates and screws to stabilize distal fractures, ensuring proper alignment for healing. release involves cutting the transverse carpal to decompress the , available via open or endoscopic techniques to minimize recovery time. reconstruction or arthroscopic repairs tears in the triangular fibrocartilage complex (TFCC) or removes loose bodies. Rehabilitation focuses on restoring function post-injury or through supervised exercises. Range-of-motion activities, such as wrist flexion and extension stretches held for five seconds, prevent , while progressive strengthening with therapy putty or resistance bands builds grip and endurance. These are typically initiated after immobilization, emphasizing gradual return to activities under professional guidance. Recovery outcomes vary by condition severity and treatment modality, with most patients achieving significant improvement within weeks to months. For distal radius fractures, cast immobilization lasts about six weeks, followed by , allowing light activities in 1-2 months and full recovery up to one year. Mild sprains often resolve in 2-4 weeks with conservative care, though surgical cases like release may yield relief within days but require 4-6 weeks for full hand use. Persistent stiffness or ache can linger for months, underscoring the importance of adherence to rehabilitation protocols.

History

Etymology

The English word "wrist" derives from Old English wrist, referring to the joint connecting the hand to the forearm, which itself stems from Proto-Germanic *wristiz, a term denoting the back of the hand or instep. This Proto-Germanic root traces back to the Proto-Indo-European *wris- or *wr̥stís, meaning "to turn" or "twist," an etymology that aptly reflects the wrist's rotational capabilities in human anatomy. Cognates appear in related languages, such as Old Norse rist for instep and modern German Rist for wrist or ankle, illustrating the term's evolution within the Germanic family. In medical and anatomical contexts, the term "carpus" has been influential, borrowed into Latin from Ancient Greek karpós (καρπός), originally meaning "wrist" and later extended metaphorically to "fruit" or "crop" due to its plucking action. The Greek karpós for wrist likely shares a conceptual link with turning or twisting motions, paralleling the Indo-European roots of "wrist" through possible connections to verbs of rotation in Germanic languages. This term entered English via Modern Latin carpus around the 1670s, becoming the standard for the wrist's bony structure in scientific nomenclature, as seen in "carpal bones." Historically, the adoption of "carpus" in anatomical texts began prominently with Andreas Vesalius's De Humani Corporis Fabrica (1543), where he employed it to describe the wrist joint and its ossa carpi, marking a shift toward precise Greco-Latin in . Prior to this, English usage of "wrist" in medical writing was more vernacular, but Vesalius's work standardized "carpus" across Europe, influencing subsequent treatises on the .

Anatomical discoveries

The earliest known descriptions of wrist date to , where (c. 460–370 BCE) identified the wrist as comprising eight small bones, termed the , and documented patterns of carpal dislocations resembling modern classifications, such as those involving the lunate or scaphoid. In the CE, of advanced understanding of wrist ligaments through dissections, primarily of animals, describing their role in stabilizing the joint and distinguishing between flexor and extensor tendons crossing the wrist, though his human applications were limited by reliance on non-human models. During the , revolutionized wrist anatomy with his 1543 publication De Humani Corporis Fabrica, which included detailed illustrations of the eight in multiple views, correcting over 200 errors in Galen's work, such as the precise arrangement of the proximal and distal rows and their articulations with the and . ab Aquapendente, Vesalius's successor, contributed in the early 1600s through surgical texts like Operationes Chirurgicae (), where he detailed the synovial sheaths enclosing flexor and extensor tendons at the wrist, emphasizing their role in reducing friction during motion. In the , Abraham Colles provided a seminal description of distal radius fractures extending to the carpal in his 1814 paper "On the Fracture of the Carpal Extremity of the Radius," noting the characteristic dorsal displacement and its implications for wrist alignment, based on clinical observations without imaging. Wilhelm Roux's developmental mechanics framework in the late 1800s influenced studies of carpal , proposing that form adapts to functional stresses, which informed early analyses of wrist motion patterns like radial-ulnar deviation. The 20th century saw recognition of the scapholunate ligament's critical role in wrist stability, with Linscheid et al. (1972) classifying scapholunate dissociation as a primary cause of carpal instability, leading to dorsal intercalated segment instability (DISI) patterns observable on radiographs. In the , advances in 3D computed tomography (CT) imaging have enhanced visualization of wrist ; for instance, a 2024 cadaveric study used dynamic 3D CT to quantify carpal bone translations post-scapholunate transection, revealing up to 2 mm proximal migration of the scaphoid under load. Recent research post-2020, such as a 2021 radiographic analysis, has refined timelines for carpal bone maturation, confirming capitate and hamate as the earliest to ossify (around 1–3 months postnatally) and linking accessory ossicles to 15–20% incidence in adults, aiding forensic and clinical assessments.

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