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Wrist/Hand Anatomy

Carpals-8 Scaphoid Trapezium Trapezoid Capitate Hamate Pisiform Triquetral Lunate www.eatonhand.com. Metacarpals-5 Phalanges - 5 1-5 1=Thumb 5=Pinky. Wrist/Hand Anatomy. Wrist/Hand Anatomy (2). Radiocarpal joints (between wrist and hand) Metacarpal joints

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Wrist/Hand Anatomy

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  1. Carpals-8 Scaphoid Trapezium Trapezoid Capitate Hamate Pisiform Triquetral Lunate www.eatonhand.com Metacarpals-5 Phalanges - 5 1-5 1=Thumb 5=Pinky Wrist/Hand Anatomy

  2. Wrist/Hand Anatomy (2) • Radiocarpal joints (between wrist and hand) • Metacarpal joints • Metacarpalphalangeal Joints • Phalangeal joints-PIP and DIP • Normal resting position • Proximal, Middle, Distal phalanx • Nerve supply • Radial • Medial • Ulnar

  3. Colles Fracture • Most common type of forearm fracture • HOPS: • fall on outstretched hand with extreme hyperextension, • extreme pain • obvious deformity, excessive swelling • numbness along the median nerve distribution, extreme pain • Treatment: splint, refer • http://orthopedics.about.com/library/xray/blxray-fxapcolles.htm

  4. http://www.eatonhand.com/hw/colles1.gif http://sfghed.ucsf.edu/ClinicImages/Colle's fracture.jpg

  5. Carpal tunnel syndrome (1) • Carpal tunnel is located in the anterior of the wrist. • 8 finger flexor tendons, their synovial sheaths and the median nerve lie in the tunnel • Results from an inflammation of synovial sheaths

  6. http://www.mayo.edu/mcj/hand/carpal.jpg

  7. Carpal Tunnel (2) • Overuse condition caused by repeated wrist flexion, ulnar deviation, • HOPS • numbness, tingling, median nerve area • muscle atrophy (in advanced cases) • decreased RROM in thumb movement • + Phalen’s test, pn w/ compression of carpal tunnel • + Tinel Sign • Tx: rest, wrist splint, anti-inflammatory medication, if severe, surgery

  8. http://www.ccohs.ca/images/office15.gif

  9. Scaphoid Fracture (1) • Most frequently fractured carpal bone • Lies beneath the “anatomical snuff box” • Does not have a good blood supply – often does not heal – “non-union”

  10. http://www.hughston.com/hha/b.wrstfx

  11. Scaphoid Fracture (2) • HOPS • fall on the outstretched hand • some swelling • pain in anatomic snuff box • Tx: refer to physician, immobilization x 6 weeks, protection against impact for 3 months

  12. Mallet finger • “Baseball”, “basketball” finger • Avulsion of the extensor tendon, to the Distal phalange • HOPS: • MOI: blow to tip of finger, • pain over the DIP joint • bent DIP joint (about 30 degrees) • inability to extend the DIP joint • TX: refer, splint in extension 6 – 8 weeks

  13. Mallet Finger www.eatonhand.com http://www.utahmountainbiking.com/firstaid/pics/fing-mal.jpg

  14. Boutonneire Deformity • Rupture of the extensor tendon dorsal to middle phalanx • HOPS: • forced flexion of the interphalangeal joint • swelling, flexion deformity of PIP joint • point tenderness over middle phalanx (dorsal side) • inability to extend finger • Tx: refer, splint in extension

  15. Boutonneire Deformity www.eatonhand.com

  16. Jersey Finger • Rupture of flexor digitorum profundus tendon at insertion on distal phalanx • Most often occurs in ring finger • HOPS: • MOI: rapid ext. of the finger while actively flexed • Swelling • point tenderness over DIP joint • inability to flex DIP joint • Tx: Refer to physician

  17. Jersey Finger http://www.handlibrary.org/images/jnslide5-s.jpg

  18. Gamekeeper’s thumb • Sprain of ulnar collateral ligament in thumb • MOI: forcefull abduction of thumb while thumb is extended • HOPS: • Swelling over palmar aspect • Instabilty in the joint • Laxity in thumb flexion • Tx: refer to physician, tape, rest, surgery

  19. http://www.weissortho.com/images/body_parts/skiers_thumb.jpg

  20. Boxer’s Fracture • Fracture to the 4th and/or 5th metacarpal(s). • MOI - caused by punching something harder than the hand, such as a wall or another person's head. The end of the metacarpal bone takes the brunt of the impact, which usually breaks through the narrowest area near the end (the "neck"), and bends down toward the palm. 

  21. http://www.eatonhand.com/hw/hw005.htm

  22. http://ranney.com/~mjr/Image_Library/20020516/05160005.JPG

  23. Boxer’s Fracture – (2) • HOPS- Striking an immovable object- wall, floor, etc • Swelling/Discoloration in area • Deformity • Pain Pt tender at location of fracture • MCP joint deformity – shorter, at an angle • Treatment- Splint, refer for x-rays, possible surgery

  24. ROM/Strength Testing • Wrist Flexion-Palmaris Longus • Wrist Extension-Extensor Digitorum • Wrist Radial Deviation-Flexor/Extensor Carpi Radialis • Wrist Ulna Deviation-Flexor/Extensor Carpi Ulnaris • Finger Flexion/Extension-Flexor Digitorum/ Extensor Digitorum • Finger Abduction/Adduction • Opposition

  25. Test • Valgus Stress Test - Ulna Collateral Ligament • Varus Stress Test - Radial Collateral Ligament • Phalen’s- Median Nerve • Tinel’s – Ulna and Median Nerve • Fracture Testing- Compression, Distraction, Flick

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