Wrist/Hand Anatomy

Carpals-8 Scaphoid Trapezium Trapezoid Capitate Hamate Pisiform Triquetral Lunate www.eatonhand.com

http://www.gwc.maricopa.edu/class/bio201/hand/anhand.htm

Metacarpals-5 Phalanges - 5

1-5 1=Thumb 5=Pinky

Wrist/Hand Anatomy (2)

Radiocarpal joints (beween wrist and hand) Metacarpal joints Metacarpalphalangeal Joints Phalangeal joints-PIP and DIP

Normal resting position Proximal, Middle, Distal phalanx

Blood Supply -______________________ Nerve supply

Radial Medial Ulnar

Colles Fracture

______________________________________ HOPS:

______________________________________ extreme pain __________________________________ numbness along the median nerve distribution,

extreme pain Treatment: splint, refer http://orthopedics.about.com/library/xray/blxray-

fxapcolles.htm

http://sfghed.ucsf.edu/ClinicImages/Colle's fracture.jpg

http://www.eatonhand.com/hw/colles1.gif

Carpal tunnel syndrome (1)

Carpal tunnel is located in the anterior of the wrist.

____________________, their synovial sheaths and the median nerve lie in the tunnel

_____________________________________________________________

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

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

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

Scaphoid Fracture (1)

________________________________ Lies beneath the “anatomical snuff box” Does not have a good blood supply –

often does not heal – “non-union”

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

                   

     

Scaphoid Fracture (2)

HOPS fall on the outstretched handsome swellingpain in anatomic snuff box

Tx: refer to physician, immobilization x 6 weeks, protection against impact for 3 months

Mallet finger

“Baseball”, “basketball” finger ______________________________________

____________________________ 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

Mallet Finger

http://www.utahmountainbiking.com/firstaid/pics/fing-mal.jpg

www.eatonhand.com

Boutonneire Deformity

____________________________________________________________

HOPS: forced flexion of the interphalangeal joint swelling, flexion deformity of PIP joint point tenderness over middle phalanx (dorsal side) ____________________________

Tx: refer, splint in extension

Boutonneire Deformity

www.eatonhand.com

Jersey Finger

_________________________________________________________________

________________________________ HOPS:

MOI: rapid ext. of the finger while actively flexed Swelling point tenderness over DIP joint ____________________________

Tx: Refer to physician

Jersey Finger

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

Gamekeeper’s thumb

Sprain of ulnar collateral ligament in thumb MOI: ________________________________

___________________ HOPS:

Swelling over palmar aspect Instabilty in the joint Laxity in thumb flexion

Tx: refer to physician, tape, rest, surgery

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

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. 

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

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

Boxer’s Fracture – (2)

HOPS- _________________________ ____________________________ Swelling/Discoloration in areaDeformityPain Pt tender at location of fracture___________________________________

Treatment- Splint, refer for x-rays, possible surgery

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

Test Valgus Stress Test - Ulna Collateral

Ligament - +sign laxity Varus Stress Test - Radial Collateral

Ligament - +sign laxity Phalen’s- Median Nerve - +sign

numbness/tingling Tinel’s – Ulna and Median Nerve - +sign

numbness/tingling Fracture Testing- Compression, Distraction,

Flick