Wrist and Hand Conditions

1. Wrist and Hand Conditions Chapter 13

2. Wrist Articulations • Radiocarpal: Radius with the Scaphoid, Lunate, Triquetrum. • Intercarpal • Distal Radioulnar • Triangular Fibro cartilage Complex stabilizes the Radioulnar joint.

3. Hand Articulations • Carpometacarpal (CM) • Intermetacarpal (IM) • Metacarpophalangeal (MP) • Interphalangeal (IP)

4. Carpometacarpal and Intermetacarpal Joints • CM of the thumb is a saddle joint • CM of the four fingers gliding joints • IM reinforced by joint capsules comprised of the dorsal, volar, and two interosseous CM ligaments

5. Metacarpophalangeal Joints • Rounded distal heads of the metacarpals articulate with the concave proximal ends of the phalanges • Reinforced by strong collateral ligaments

6. Interphalangeal Joints • The Proximal (PIP), Distal (DIP), and the IP joint of the thumb are all hinge joints • The articular capsule made up of volar and collateral ligaments surround each IP joint

7. Muscles • Retinacula of the Wrist: • The fascial tissue surrounding the wrist thickened into strong fibrous bands called retinacula that form protective passageways through which tendons, nerves, and blood vessels pass. • Tendon Sheaths: • Sealed at both ends containing synovial fluid, annular pulleys that prevent tendon bowstringing with flexion.

8. Kinematics • Flexion • Extension • Hyperextension • Radial deviation • Ulnar deviation

9. Flexion • Flexor carpi radialis • Flexor carpi ulnaris • Palmaris longus (sometimes absent) • Flexor digitorum superficialis • Flexor digitorum profundus

10. Extension and Hyperextension • Extensor carpi radialis longus • Extensor carpi radialis brevis • Extensor carpi ulnaris • Extensor pollicis longus • Extensor digiti minimi • Extensor digitorum

11. Radial and Ulnar Deviation • Radial Deviation • Flexor carpi radialis • Extensor carpi radialis • Ulnar Deviation • Flexor carpi ulnaris • Extensor carpi ulnaris

12. Kinetics of the Wrist • Extrinsic flexor muscles are twice as strong as the… • Extrinsic extensor muscles • Flexors used everyday for gripping, grasping, or pinching movements.

13. Strengthening • Strengthening should include general elbow flexion, extension, pronation, and supination, wrist flexion, extension, Radial and Ulnar deviation.

14. Contusions and Abrasions • Thoroughly clean, dress daily, inspect for infection daily. • Ice, compression, elevation for 2 – 3 days.

15. Sprains • Wrist sprains • Gamekeeper’s Thumb • Interphalangeal Collateral Ligament Sprains

16. Dislocations • Distal radioulnar joint (DRUJ) • Lunate dislocation • MP joint dislocation • PIP joint dislocation

17. Strains • Jersey Finger • Mallet Finger • Boutonniere Deformity

18. Tendinopathies • Trigger Finger • DeQuervain’s tenosynovitis • Intersection Syndrome

19. Ganglion Cysts

20. Fingertip Injuries • Subungual hematomas • Paronychia

21. Nerve Entrapment Syndromes • Median Nerve Entrapment • Anterior Interosseous Nerve Syndrome • Carpal Tunnel Syndrome • Ulnar Nerve Entrapment • Ulnar tunnel syndrome • Cyclist’s palsy • Bowler’s thumb • Chris Carlin, Dominique Rodriguez

22. Radial Nerve Entrapment • Distal Posterior Interosseous Nerve Syndrome • Superficial Radial Nerve Entrapment

23. Fractures • Distal Radial and Ulnar fractures • Monteggia’s fracture • Galeazzi’s fracture • Colle’s fracture • Smith’s fracture • Scaphoid fracture • Hamate fracture • Triquetrum fracture • Kienbock’s disease

24. Fractures cont. • Metacarpal fractures • Boxer’s fracture • Bennett’s fracture • Phalangeal fractures