WristHand Anatomy

1
Wrist/Hand Anatomy

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

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

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-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.
• 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
• 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)

• 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/fi
ng-mal.jpg
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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
Gamekeepers 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
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. 

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http//www.eatonhand.com/hw/hw005.htm
22
http//ranney.com/mjr/Image_Library/20020516/0516
0005.JPG
23
Boxers 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

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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

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Test

• Valgus Stress Test - Ulna Collateral Ligament
• Varus Stress Test - Radial Collateral Ligament
• Phalens- Median Nerve
• Tinels Ulna and Median Nerve
• Fracture Testing- Compression, Distraction, Flick