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Wrist and Hand

Wrist and Hand. Wrist. Radiocarpal Mid-carpal (intercarpal) maintain length-tension relationship for hand musculature. Distal Radius. Facets Lateral (46%)  scaphoid Medial (43%)  lunate Inferior disk (11%)  triquetrum. Radiocarpal. Radius and Radioulnar disk (concave)

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Wrist and Hand

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  1. Wrist and Hand

  2. Wrist Radiocarpal Mid-carpal (intercarpal) • maintain length-tension relationship for hand musculature

  3. Distal Radius Facets • Lateral (46%) scaphoid • Medial (43%) lunate • Inferior disk (11%) triquetrum

  4. Radiocarpal • Radius and Radioulnar disk (concave) • Scaphoid (navicular), lunate, and triquetrum (proximal wrist bones)

  5. Ligaments • volar - thick, strong • dorsal - thinner, fewer • unique function • extrinsic • intrinsic

  6. Ligaments Radiocarpal • superficial • deep

  7. Ligaments Ulnocarpal complex • meniscus homologue - radiotriquetral ligament • triangular fibrocartilage - articular disk

  8. Kinematics Extension • distal carpals on fixed proximal carpals • neutral (scaphoid-capitate close-packed)

  9. Kinematics Extension • scaphoid travels w/ distal carpals  450 ext. • scaphoid & lunate close-packed  scaphoid travels w/ proximal carpals

  10. Kinematics Flexion • opposite extension

  11. Hand Flexor Tendons • surrounded by synovial sheaths • reinforced by pulleys (5/3) • minimize force/pressure • prevent bowstringing

  12. Flexor Tendons • 60  900 of PIP flexion  • 40%  in tension in restraining pulley

  13. Tendon Excursion and Pulleys

  14. Tendon Excursion and Pulleys

  15. Tendon Excursion and Pulleys Sliding of flexor/extensor tendons • proximal jts. > distal joints • FS > FP • Flexors > extensors • Extrinsics > intrinsics

  16. Pulley Disruption • Bowstringing •  excursion at a joint  weakness at other joints

  17. Pulley Disruption

  18. Pulley Disruption

  19. Balance of Power Extrinsic vs. Intrinsics Intrinsic -  clawing • counteract extrinsics • stabilize proximal phalanx • tendons volar to AOR • lumbricales critical for timing

  20. Hand/Wrist Injuries CTD/RSI CTS • inflammation in CT • compressive neuropathy

  21. Hand/Wrist Injuries Etiology of CTS • forceful exertions • repetitive*/prolonged activities • awkward postures • localized contact stresses • vibration • cold temp.

  22. Carpal Fractures • 80:20% load distribution between radius:ulna • scaphoid (60-70%) • hyperextension beyond 950 • lunate

  23. Finger Injuries Mallet Finger • distal terminal tendon/slip rupture  flexion of DIP

  24. Finger Injuries Boutonniere (Button-Hole) Deformity • dorsal synovitis /capsular distension  • thinning & lengthening of central tendon

  25. Finger Injuries Boutonniere (Button-Hole) Deformity • dorsal subluxation of proximal phalanx (PIP)  • palmar displacement (dislocation) of lateral bands of long extensors  • MCP /  PIP  DIP /

  26. Finger Injuries Swan-Neck Deformity • Flexor synovitis  flexor forces on MCP • stretching of collateral ligaments and palmar plate at PIP

  27. Finger Injuries Swan-Neck Deformity • dorsal displacement of lateral bands of extensors  • intrinsic tightening with MCP flexion  • position of lateral bands  pull of extensor tendon  • reciprocal DIP flexion

  28. Finger Injuries Swan-Neck Deformity • MCP   PIP /  DIP 

  29. Thumb Injuries Gamekeeper’s/skier’s thumb • MCP ulnar collateral ligament • 20 to tensile loading (chronic or acute) • excessive abduction/hyperextension

  30. Thumb Injuries Bennett’s Fx • fx subluxation of trapeziometacarpal joint • intraarticular fx of 1st MET • axial compression

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