Copyright © F.A. Davis Company Chapter 17 Wrist, Hand, and Finger Pathologies
Copyright © F.A. Davis Company Clinical Anatomy Bony anatomy Distal radius Ulnar notch Radial styloid process Ulnar head
Copyright © F.A. Davis Company Clinical Anatomy Bony anatomy Carpal bones Metacarpals Phalanx Proximal Middle (not in thumb) Distal Sesamoid bones
Copyright © F.A. Davis Company Clinical Anatomy Articulations and ligamentous support Distal radioulnar joint Radiocarpal joint Intercarpal joints Midcarpal joints Carpometacarpal joints Metacarpophalangeal and interphalangeal joints
Copyright © F.A. Davis Company Clinical Anatomy Palmar (volar) ligaments of the wrist and hand Dorsal ligaments of the wrist and hand
Copyright © F.A. Davis Company The Triangular Fibrocartilage Complex (TFCC) Several ligaments and other fibrous structures attach to the fibrocartilage. As a unit, the TFCC provides support to the distal radioulnar joint. L = lunate; TQ = triquetrum.
Copyright © F.A. Davis Company Clinical Anatomy
Copyright © F.A. Davis Company Clinical Anatomy Nerves Ulnar nerve Median nerve Radial nerve The carpal tunnel
Copyright © F.A. Davis Company Clinical Anatomy Extensor compartment
Copyright © F.A. Davis Company Clinical Anatomy Hand intrinsic muscles
Copyright © F.A. Davis Company Clinical Anatomy Hand intrinsic muscles
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Past history Previous history Loss of function from previous injury General medical health Rheumatoid arthritis PVD (peripheral vascular disease) Raynaud phenomenon History of the present condition Location of pain MOI Relevant sounds or sensations Duration of symptoms Description of symptoms Changes in activity
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Inspection Functional observation General inspection Posturing of the wrist and hand Gross deformity Palmar creases Lacerations or scars
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Inspection Wrist and hand Continuity of the distal radius and ulna Continuity of the carpals and metacarpals Alignment of the MCP joints Posture of the wrist and hand Ganglion cyst
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Inspection Thumb and fingers Inspection of the skin and fingernails Subungual hematoma Felon Paronychia Alignment of fingernails Muscle contour Individual finger deformities
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Palpation of the palmar (anterior) wrist 1.Radius 2.Flexor carpi radialis 3.Palmaris longus 4.Carpal tunnel 5.Ulna 6.Flexor carpi ulnaris 7.TFCC 8.Pisiform 9.Hamate
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Palpation of the dorsal (posterior) wrist 1. Ulna 2. Ulnar head 3. Ulnar styloid process 4. Ulnar collateral ligament 5. Extensor carpi ulnaris 6. Lister tubercle 7. Distal radius or styloid process 8. Radial collateral ligament 9. Scaphoid 10. Lunate 11. Triquetrum 12. Trapezium 13. Capitate 14. Trapezoid 15. Extensor carpi radialis brevis 16. Extensor carpi radialis longus
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Palpation of the hand 1. Thenar eminence 2. Central compartment 3. Hypothenar compartment 4. Metacarpals 5. Collateral ligaments of the metacarpophalangeal joints 6. Phalanges 7. Collateral ligaments of the IP joints 8. Thenar webspace 9. Extensor digitorum Extensor digitorum 13. Extensor pollicis longus 14. Abductor pollicis longus and extensor pollicis brevis
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Joint and muscle function assessment Wrist Thumb Finger Active range of motion (AROM) Manual muscle test (MMT) Passive range of motion (PROM)
Copyright © F.A. Davis Company Selective Tissue Test: Grip Dynamometry
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Joint stability tests Stress testing Collateral support of the wrist ligaments Collateral support of the IP joints Support for the UCL Joint play tests
Copyright © F.A. Davis Company Ligaments Stressed During Wrist Passive Range of Motion Ligaments Stressed Passive MovementPrimarySecondary ExtensionPalmar ulnocarpal Radial collateral Palmar radiocarpal Ulnar collateral FlexionDorsal radiocarpalRadial collateral Ulnar collateral Radial DeviationUlnar collateralPalmar ulnocarpal Ulnar DeviationRadial collateralPalmar radiocarpal
Copyright © F.A. Davis Company Radial Collateral and Ulnar Collateral Ligament Stress Tests of the Wrist
Copyright © F.A. Davis Company Valgus and Varus Testing of the Interphalangeal Joints
Copyright © F.A. Davis Company Test for Laxity of the Thumb MCP Collateral Ligaments
Copyright © F.A. Davis Company Clinical Examination of Injuries to the Wrist, Hand, and Fingers Neurological testing Upper quarter screen Pathologies Carpal tunnel syndrome Drop wrist syndrome
Copyright © F.A. Davis Company Pathologies of the Wrist, Hand, and Fingers and Related Special Tests Wrist pathology Distal forearm fractures Scaphoid fractures Hamate fractures Perilunate and lunate dislocation Wrist sprains TFCC injury Carpal tunnel syndrome
Copyright © F.A. Davis Company
On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries Lacerations Management Use universal precautions Take precautions against infection Lacerations involving the fascia should be referred to determine if suturing is needed.
Copyright © F.A. Davis Company Selective Tissue Test: Watson Test for Scapholunate Instability
Copyright © F.A. Davis Company
Selective Tissue Test: Phalen Test
Copyright © F.A. Davis Company Pathologies of the Wrist, Hand, and Fingers and Related Special Tests Hand pathology Metacarpal fractures
Copyright © F.A. Davis Company
Pathologies of the Wrist, Hand, and Fingers and Related Special Tests Finger pathology Collateral ligament injuries Boutonnière deformity Finger fractures Tendon ruptures and avulsion fractures Mallet finger
Copyright © F.A. Davis Company Pathologies of the Wrist, Hand, and Fingers and Related Special Tests Thumb pathology De Quervain’s syndrome Thumb sprain MCP joint dislocation Thumb fractures
Copyright © F.A. Davis Company
Selective Tissue Test: Finkelstein’s Test for de Quervain’s Syndrome
Copyright © F.A. Davis Company
On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries Interphalangeal joint dislocations Management Reduction can be performed by trained personnel by applying traction If unreduced, splint on the palmar aspect and apply ice pack Splint Refer for imaging
Copyright © F.A. Davis Company On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries Hand and finger fractures Management Splint If wrist and hand both injured, leave nailbeds exposed to check capillary refill
Copyright © F.A. Davis Company Splinting of Common Finger Injuries DeformitySplinting Position Jersey fingerDIP joint in flexion Mallet fingerDIP joint in extension Boutonnière deformityPIP and DIP joints in extension Phalanx fracturePosition found Metacarpal fracturePalmar surface of wrist and hand Unreduced dislocationsPosition found DIP = distal interphalangeal; PIP = proximal interphalangeal