Lumbrical muscles of the hand
The lumbrical muscles (lumbricidae - Latin = earthworm) are four short hand muscles located in the metacarpus deep to the palmar fascia. These muscles are specially interesting because they do not attach to bone. Instead, they attach to the tendon sheats, originating from the tendons of flexor digitorum profundus and inserting to the extensor expansions.
These muscles flex the fingers at the metacarpophalangeal joints, and extend them at the interphalangeal joints. Note that lumbricals of the foot have the similar actions on the toes.
|Origin||Radial aspects of tendons of flexor digitorum profundus|
|Insertion||Dorsal aponeurosis of digits 2-5|
Lumbricals 1-2: Median nerve (C8, T1)
Lumbricals 3-4: Ulnar nerve (C8-T1)
Metacarpophalangeal joints 2-5: Finger flexion;
Interphalangeal joints 2-5: Finger extension
In this article, we're going to discuss the insertion, origin, innervation, and function of these muscles.
Anatomy and supply
One feature of these muscles is that they originate from tendons instead of bony structures, making their origin surfaces quite moveable. Usually, they arise from the radial side of the tendons of the flexor digitorum profundus. In addition, the third and fourth lumbrical muscles have a second head attached to the ulnar side of the adjacent tendon.
Distally, their insertion tendons attach to the dorsal aponeurosis of the respective finger.
Function & Action
The lumbricals fulfill movements of the second to the fifth finger. Their contraction leads to flexion in the metacarpophalangeal joints (MCP) and extension in both the proximal (PIP) and distal interphalangeal joints (DIP). The reason for the opposite actions is that the tendons cross the MCP on the palmar side but distally insert at the dorsal side of the finger. These combined movements support a strong hand grip (e.g. holding a pen).
When the tendons of the flexor digitorum profundus detach distal from the origin surfaces of the lumbricals an interesting phenomenon occurs: when trying to close the fist, the fingers strangely extend instead.
Pathophysiology and Mechanism
After detachment of the distal tendons, the lumbricals now serve as the new insertion surface of the flexor digitorum profundus. This means, even though the person consciously activates the flexor muscle, he/she actually moves the lumbricals instead. And since the flexor digitorum profundus and the lumbricals are antagonists in the PIP and DIP the intended fist closure paradoxically leads to an extension of the fingers. This oddity is clinically referred to as the lumbrical-plus finger and can occur after injuries or amputations.