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Laney Nelson DC, DACBSP

Wrist and Hand Connie S. Hayes, DC, MS, CCSP. Laney Nelson DC, DACBSP. Joints of the Wrist . Distal Radioulnar Supination & Pronation Radiocarpal Radius, Radioulnar disk, scaphoid, lunate & triquetrum Flexion & Extension Ulnocarpal Ulna & Triquetrum Flexion & Extension

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Laney Nelson DC, DACBSP

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  1. Wrist and Hand Connie S. Hayes, DC, MS, CCSP Laney Nelson DC, DACBSP

  2. Joints of the Wrist • Distal Radioulnar • Supination & Pronation • Radiocarpal • Radius, Radioulnar disk, scaphoid, lunate & triquetrum • Flexion & Extension • Ulnocarpal • Ulna & Triquetrum • Flexion & Extension Held together by strength of its ligaments

  3. Midcarpal Joints

  4. Distal Row Moves with You

  5. Wrist Adduction & Abduction

  6. Wrist Flexion & Extension

  7. Functional Anatomy • Final Link in Kinematic Chain • End point of all directed Forces & Velocities • Built for Mobility • Lacks Stability

  8. Nerve Supply • Ulnar Nerve: • Passes between Pisiform and Hook of the Hamate

  9. Nerve Supply • Median Nerve • Enters the hand through the Carpal Tunnel

  10. Blood Supply • Radial and Ulnar Artery • Deep and Superficial Palmar Arch • Radial and Ulnar Veins • Palmar and Dorsal Venous Arch

  11. Examination • Visual Inspection • Deformity • Swelling • OPPQRST • Dermatomes • Myotomes • Grip & DTRs • Allen’s Test • Radial/Ulnar Arteries • Finkelstein’s Test • de Quervain’s • Tinel’s Sign • Carpal Tunnel • Phalen’s Test • Carpal Tunnel • Lunotriquetral Ballotment • Lunate Dislocation

  12. Wrist Sprains • Most Common Wrist Injury • Fall on Hyperextended wrist • Pain, Swelling and Limited ROM • X-ray, DX US • RICE, Kinesiotaping, restore pain-free ROM

  13. Dislocations & Fractures • 2 Pillars Control Major Hand Function • Lunate Pillar • 3rd Metacarpal-Capitate-Lunate • Scaphoid Pillar • 1st Metacarpal-Trapezium-Scaphoid • FOOSH • Lunate Dislocate • Scaphoid & Distal Radius Fracture • Pain in anatomical snuffbox • Extension with Ulnar Deviation • Scaphoid & Lunate are Dorsal • Wrist in Closed Pack Position

  14. Stenosing Tenosynovitis • Finkelstein’s Test • Extensor Pollicis Brevis & Abductor Pollicis Longus • Pain & Weakness in Thumb Extension & Abduction • Rest, ice, adjust wrist and hand

  15. Carpal Tunnel • Formed by Carpal Bones as the Floor & Transverse Carpal Ligament as the Roof • Compression of the Median Nerve • Tingling • Numbness • Weakness in Thumb movements Treatment – soft tissue and ext manipulation, Carpal Tunnel Release surgery

  16. Nerve Palsy • Direct Trauma to Radial, Median or Ulnar • Drop Wrist • Ape or Claw • Benediction Deformity • Treatments • Soft tissue and extremity manipulation • Surgical decompression

  17. Triangular Fibrocartilage Complex • Ulnar Side • Stabilizes Radius & Ulna during hand grasp • Two Types of Tears • Type 1 – Traumatic • Racquets & Bats • Type 2 – Degenerative • Over 50

  18. TFCC Tear • Signs & Symptoms • Wrist Pain on Ulna Side • Loss of Grip Strength • Swelling Treatment Laser, Ultrasound, Tape Surgery

  19. Ganglion Cyst • Most Common soft tissue swelling in the hand and wrist • Dorsal side of wrist 70% of the time • Treatment Options • Digital Pressure • Aspiration with Injection • Surgical Excision

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