Wrist and Hand

1
Wrist and Hand

• Wrist is the most complex joints of the body due
  to the numerous joints combined to create one.

2
Wrist and Hand Anatomy

• Carpal bones- Create a Mnemonic for them.
  S-L-T-P-T-T-C-H

3
Wrist and Hand Anatomy

• Two rows of bones starting on the thumb side.
• Scaphoid, lunate, triquetrum, pisiform

4
Palpate the Scaphoid

• You would palpate the scaphoid in the anatomical
  snuff box.

5
Wrist and Hand Anatomy

• Second row of carpals bones, is more proximal
• Trapezium, trapezoid, capitate, Hamate.

6
Wrist and Hand Anatomy

• Medial and Lateral epicondyle are where many of
  the wrist and hand muscles originate.

7
Wrist and Hand Anatomy

• Styloid process- projection at distal end of
  radius and ulna where the collateral ligaments
  attach.

8
Wrist and Hand Joints

• Radiocarpal Joint- distal end of the radius and
  scaphoid, lunate, and triquetrum. There is a
  radioulnar disk in between the radius and other
  bones. It is a condyloid joint.

9
Wrist and Hand Joints

• Midcarpal joint- between the two rows of carpal
  bones. Plane joints that allow gliding motion,
  but assist with wrist motions.

10
Wrist and Hand Joints

• Carpometacarpal joint- between the distal row of
  carpal bones and proximal end of the metacarpal
  bones. Provide more stability than mobility.

11
Ligaments of hand

• Palmar radiocarpal ligament-broad band attaches
  anterior surface of distal radius and ulna to
  anterior surface of the proximal carpal bones and
  the capitate. Limits wrist extension. So
  repeated falls in extension would injur it.

12
Wrist and Hand Injuries

• Fractures of the Wrist and Hand
• Finger Fractures
• Boxers Fracture- fracture of 5th metacarpal.
  Hitting something with fisted hand.

13
Wrist and Hand Injuries

• Fractures of the Wrist and Hand
• Finger Fractures
• Scaphoid Fracture- fracture of scaphoid which you
  call palpate in anatomical snuffbox. Occurs
  with fall on hand in extension.

14
Wrist and Hand Injuries

• Wrist Fractures
• Colless fracture- fracture of the radius just
  above the wrist. A result of a fall with wrist
  extended.

15
Tendon Injuries

• Mallet Finger- hitting something with the tip of
  a finger and causing the extensor tendon to tear.
  
• Jersey Finger- grabbing something and tearing the
  flexor tendon.

16
Tendon Injuries

• Boutonniere deformity-
• extensor tendon injury affecting
• two joints of the finger. It is
• an injury to the central tendon
• on top of the finger.
• It may appear as a jammed finger that cannot be
  extended from the PIP joint.
• Treatment should be in an extended position so
  the tendon can heal.

17
Dislocations/Subluxations

• Dislocations occur in the fingers and wrist
  bones.
• Point tenderness and swelling, possible
  deformity.
• Physician
• intervention
• may be
• necessary.

18
Wrist and Hand Muscles

• Extensor Carpi Ulnaris- superficial muscle that
  arises from the common extensor tendon on the
  lateral epicondyle. It runs the medial side of
  the posterior arm and attaches to the fifth
  metcarpal. What does it do?

19
Wrist and Hand Muscles

• Flexor carpi radialis- superficial muscle running
  from the medial epicondyle diagonaly across the
  anterior forearm to attach to lateral base of
  second and third metacarpal. What is the motions?

20
Wrist and Hand Muscles

• Palmaris Longus- superficial muscle running down
  the anterior surface of the forearm from common
  flexor attachment of medial epicondyle to the
  midline of the palmar fascia.
• Missing in 21
• of people.
• Flexor
  

21
Wrist and Hand Muscles

• Flexor Digitorum superficialis- deep to the wrist
  flexors and palmaris longus muscle. Starts at
  the common flexor tendon of medial epicondyle and
  coranoid process, inserts to the sides of digits
  2-5.

22
Wrist and Hand Muscles

• Abductor pollicis brevis- proximal attachment is
  the scaphoid, trapezium and inserts to the base
  of the proximal phalange of the thumb.

23
Hand Grips

• Grasps
• Power grip is when an object needs to be held
  forcefully and then moved by more proximal
  muscles.
• Precision Grip is when an object is manipulated
  with fingers

24
Hand Grips

• Power grips
• Cylindrical grip is fingers flexed around an
  object. Thumb on one side fingers on other, like
  gripping a hammer or racquet.
• Spherical grip is fingers and thumb are together
  around an
• object. Like grabbing
• an apple or doorknob.

25
Hand Grips

• Power Grip
• Hook grip involves the second through fifth
  fingers flexed around an object in a hooklike
  manner. Thumb is extended and not involved at
  all. Only possible grip for
• someone with no thumb or
• median nerve ability.

26
Hand Grips

• Precision Grips-
• Pad to pad
• Pinch grip is the thumb and one finger gripping
• Three jaw chuck is holding a pencil, three
  fingers and thumb.

27
Hand Grips

• Precision Grips
• Tip to Tip grip
• Pincer grip is tip of thumb against tip of a
  finger, like to pick up a coin. Difficult with
  long fingernails

28
Hand Grips

• Precision Grips
• Lumbrical grip or plate grip has the MCP and PIP
  joint flexed and the DIP extended. The thumb
  opposes and this grip is used to hold something
  horizontal like a plate. Lumbricals is used they
  flex the MCP joint.

29
Wrist Strengthening

• Flexion
• Extension
• Ulnar Deviation
• Radial Deviation
• Pronation
• Supination