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Forearm , Wrist, and Hand Evaluation

Forearm , Wrist, and Hand Evaluation. Overview. Applied anatomy Common wrist and hand injuries History Observation Examination AROM/PROM Special tests Neurological exam Circulatory exam. Bony Anatomy. 29 total bones (27 not counting radius and ulna) 8 carpals 5 metacarpals

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Forearm , Wrist, and Hand Evaluation

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  1. Forearm, Wrist, and Hand Evaluation

  2. Overview • Applied anatomy • Common wrist and hand injuries • History • Observation • Examination • AROM/PROM • Special tests • Neurological exam • Circulatory exam

  3. Bony Anatomy • 29 total bones (27 not counting radius and ulna) • 8 carpals • 5 metacarpals • 14 phalanges • Radius • Ulna

  4. Bony Anatomy • Carpals • Navicular • Lunate • Triquetrum • Pisiform • Trapezium • Trapezoid • Capitate • Hamate

  5. Bony Anatomy • Handy memory tricks • “Never Lie To a Preacher, The Truth Comes Home” • “New Lovers Try Positions That They Can’t Handle”

  6. Bony Anatomy • Metacarpals • 1-5 • Thumb is 1, “pinky” is 5 • Phalanges • Proximal, intermediate, & distal

  7. Bony Anatomy • Radius & ulna • Styloid processes

  8. Bony Articulations • DRUJ • Radiocarpal (wrist) • Condyloid-type • Flexion, extension, abduction, adduction

  9. Bony Articulations • Thumb • Ginglymus • Saddle joint of CMC • Digits 2-5 • 3 condyloid joints • Interphalangeal (IP); Proximal interphalangeal (PIP); Distal interphalangeal (DIP)

  10. Articulations • Joints • MCP (metacarpophalangeal) • PIP (proximal interphalangeal) • DIP (distal interphalangeal)

  11. Articulations • The thumb is different!! • Joints • MCP (metacarpophalangeal) • IP (interphalangeal)

  12. Muscular Anatomy • Flexor group (anterior) • Flexor carpi radialis • Flexor carpi ulnaris • Palmaris longus • Flexor digitorum superficialis • Flexor digitorum profundus • Flexor pollicis longus

  13. Muscular Anatomy • Extensor group (posterior) • Extensor carpi radialis • Extensor carpi ulnaris • Extensor digitorum • Extensor pollicis longus & brevis • Abductor pollicis longus

  14. Muscular Anatomy • Flexor group (anterior) • Flexor carpi radialis • Flexor carpi ulnaris • Palmaris longus • Flexor digitorum superficialis • Flexor digitorum profundus • Flexor pollicis longus

  15. Flexor Group • Flexor Carpi Radialis (FCR) • O: medial epicondyle • I: palmar hand • A: flexion, abduction • N: median

  16. Flexor Group • Flexor Carpi Ulnaris (FCU) • O: medial epicondyle • I: palmar hand • A: flexion, adduction • N: ulnar

  17. Flexor Group • Palmaris Longus • O: Medial epicondyle • I: palmar hand • A: flexion • N: Median

  18. Flexor Group • Flexor Digitorum Superficialis • O: medial epicondyle, proximal radius & ulna • I: middle phalanx of digits 2-5 (palmar surface) • A: finger & wrist flexion • N: median

  19. Flexor Group • Flexor Digitorum Profundus • O: proximal ulna • I: distal phalanx of digits 2-5 (palmar surface) • A: finger & wrist flexion • N: median

  20. Finger Flexors

  21. Flexor Group • Flexor Pollicis Longus • O: proximal radius & ulna • I: distal phalanx of digit 1 (thumb) (palmar surface) • A: thumb & wrist flexion • N: Median

  22. Extensor Group • Extensor Carpi Radialis (ECR) • O: lateral epicondyle • I: dorsal hand • A: ext & abd • N: radial

  23. Extensor Group • Extensor Carpi Ulnaris (ECU) • O: lateral epicondyle • I: dorsal hand • A: ext & add • N: radial

  24. Extensor Group • Extensor Digitorum • O: lateral epicondyle • I: middle & distal phalanges of digits 2-5 (dorsal hand) • A: finger & wrist ext • N: radial

  25. Extensor Group • Extensor Pollicis Longus & Brevis • O: posterior distal radius & ulna • I: proximal & distal phalange of digit 1 (thumb)(dorsal hand) • A: thumb & wrist ext • N: radial

  26. Extensor Group • Abductor Pollicis • O: posterior distal radius & ulna • I: first metacarpal (dorsal hand) • A: thumb & wrist abd • N: radial

  27. Carpal Tunnel • Transverse carpal ligament • Median nerve • Flexor digitorum profundus (4) • Flexor digitorum superficialis (4) • Flexor pollicis longus

  28. Common Forearm, Wrist & Hand Injuries • Contusions • Forearm splints • Colles’ fracture • Distal radius & ulna fracture

  29. Common Forearm, Wrist & Hand Injuries • Wrist sprain • Carpal tunnel syndrome • Tenosynovitis • Tendinitis

  30. Common Forearm, Wrist & Hand Injuries • De Quervain’s disease • Scaphoid fracture • Pain in the “anatomical snuffbox” • Early diagnosis essential in proper treatment • Wrist ganglion

  31. Common Forearm, Wrist & Hand Injuries • Contusion to hand and fingers • Mallet finger • Torn extensor tendon (ED) at DIP • Splint in extension 6-8 weeks • Boutonniere deformity • Torn extensor tendon (EDS) at PIP • Splint entire finger 6-8 weeks

  32. Common Forearm, Wrist & Hand Injuries • Jersey finger • Usually a rupture of the flexor digitorum profundus • Gamekeeper’s thumb • Sprain of the UCL of thumb

  33. History • MOI • What was the mechanism of injury? • What were you doing when the injury occurred? • Did you hear or feel anything at the time of the injury? • Did you receive a direct blow? • What was the angle of impact? • What was the position of arm or wrist at impact? • Was the wrist forced beyond its normal ROM? • Did you have a violent muscular contraction? • Were you throwing or swinging?

  34. History • S & S • Describe the symptoms. • Did the pain come on gradually or suddenly? • Describe the pain. • Is it sharp or dull? • Localized or diffuse? • Any numbness, tingling, or burning? • Is the pain radiating down your arm? • Is the pain severe? Does it keep you awake at night? • Demonstrate what causes pain. • Does the arm feel tight or locked? • Do you feel any weakness?

  35. History • Previous injury • Have you had a previous injury? • Did you rehab? If so, what exercises?

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