Wrist/Hand Anatomy

1
Wrist/Hand Anatomy

• Carpals-8
• Scaphoid
• Trapezium
• Trapezoid
• Capitate
• Hamate
• Pisiform
• Triquetral
• Lunate
• www.eatonhand.com http//www.gwc.maricopa.edu/cl
  ass/bio201/hand/anhand.htm

• Metacarpals-5
• Phalanges - 5
• 1-5
• 1Thumb
• 5Pinky

2
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

3
Colles Fracture

• ______________________________________
• HOPS
• ______________________________________
• extreme pain
• __________________________________
• numbness along the median nerve distribution,
  extreme pain
• Treatment splint, refer
• http//orthopedics.about.com/library/xray/blxray-f
  xapcolles.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.
• ____________________, their synovial sheaths and
  the median nerve lie in the tunnel
• __________________________________________________
  ___________

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
• Phalens 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)

• ________________________________
• 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
• __________________________________________________
  ________________
• 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/fi
ng-mal.jpg
14
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

15
Boutonneire Deformity
www.eatonhand.com
16
Jersey Finger

• __________________________________________________
  _______________
• ________________________________
• HOPS
• MOI rapid ext. of the finger while actively
  flexed
• Swelling
• point tenderness over DIP joint
• ____________________________
• Tx Refer to physician

17
Jersey Finger
http//www.handlibrary.org/images/jnslide5-s.jpg
18
Gamekeepers 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

19
http//www.weissortho.com/images/body_parts/skiers
_thumb.jpg
20
Boxers 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/20020516/0516
0005.JPG
23
Boxers Fracture (2)

• HOPS- _________________________
  ____________________________
• Swelling/Discoloration in area
• Deformity
• Pain Pt tender at location of fracture
• ___________________________________
• 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 -
  sign laxity
• Varus Stress Test - Radial Collateral Ligament -
  sign laxity
• Phalens- Median Nerve - sign numbness/tingling
• Tinels Ulna and Median Nerve - sign
  numbness/tingling
• Fracture Testing- Compression, Distraction, Flick