Carpal bones (from within the cartilage) and the ossific centers appear only after birth. The formation of these centers roughly follows a chronological spiral pattern starting in the capitate and hamate during the first year of life. The ulnar bones are then ossified before the radial bones, while the sesamoid pisiform arises in the tendon of the flexor carpi ulnaris after more than ten years. There are four groups of ligaments in the region of the wrist: The hand is said to be in straight position when the third finger runs over the capitate bone and is in a straight line with
Carpal bones proximal row (comprising scaphoid, lunate, and triquetrum) articulates with the surfaces of the radius and distal carpal row, and thus constantly adapts to these mobile surfaces. Within the proximal row, each carpal bone has slight independent mobility. For example, the scaphoid contributes to midcarpal stability by articulating distally with the trapezium and the trapezoid. In contrast, the distal row is more rigid as its transverse arch moves with the metacarpals. Biomechanically and clinically, the carpal bones are better conceptualized as three longitudinal columns: In this context the pisiform is regarded as a sesamoid bone embedded in the tendon of the