The wrist and the hand

Wrist anatomy Radius forms wrist joint with scaphoid, lunate & triquetrum

Innervations

Wrist fracture  A broken wrist is among the most common broken bones in patients under 65 years of age (after that (65) hip fractures become the most common broken bone).  Many type of wrist fracture (the most common):  Colle’s fracture  Smith’s Fracture

Colle’s fracture  It is Fracture of the distal radius bone and/or styloid process of ulna.  Result of falling on extended hands (outstretched hand).  May ends with deformity (the fragment is displaced dorsally)  May cause damage to the tendons, nerves and blood supply of the hand

causes  This injury is usually the result of trauma from a fall in which the person attempts to break the fall using the hands and arms.

Smith’s Fracture  Also known as a reverse Colle’s fracture.  is a fracture of the distal radius.  Result of falling on flexed hands.  Smith's fractures are less common than Colles' fractures.  May cause the same damage to the soft tissue as in the colle's fracture.  the fragment is displaced ventrally

Ganglion  It is Painful sac, like Swelling at the extensors tendon and the carpal area. Appears as nodules.  Ganglia can form around any joint, but they are most frequently found in the wrist and ankles.  It is not fully understood how they occur  May cause pressure on the ulnar or median nerve

De Quervain’s Disease  It is also known as tenosynovitis  it remains idiopathic.  It is an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb (involving abductor pollicis longus and extensor policis brevis tendons).

Finkelstein's test

Carpal tunnel syndrome  Carpal tunnel syndrome the most common peripheral neuropathy results from compression of the median nerve at the carpal tunnel.

 The syndrome affects an estimated 3 percent of adult.  Is three times more in women than in men.  The number of incidence is increasing world wide every year

Causes  Since the carpal tunnel runs between the transverse carpal ligament and the carpal bones, damage to this region can result from a number of compression lesion include: ◦ Local trauma. ◦ Over use of the hand and wrist. ◦ Prolonged improper positioning. ◦ Keyboard workers.

symptoms  The symptoms of carpal tunnel syndrome are: ◦ Sever pain. ◦ Numbness. ◦ Sensory loss. ◦ weak thump abduction. Note: As a result of the nerve supply, the symptoms are experienced along the median nerve pathway.

Severity of symptoms  We have three classifications for the severity of symptoms: ◦ Mild: short history of episodes of paraesthesia. ◦ Moderate: cases of frequent episodes paraesthesia and numbness. ◦ Sever: persistent paraesthesia, numbness and wasting of the abductor pollicis braves.

1. Tinel's test positive: percussion of the median nerve at the wrist create tingling in the median innervated fingers. 2. Phalen's test positive: flexion of the wrist at 90 degree for one minute and holding the position lead to tingling in median innervated fingers. 3. Abnormal nerve conduction studies. Tests

Tinel's test Phalen's test

Ulnar tunnel syndrome  Ulnar tunnel syndrome (UTS) is a painful syndrome which involves the arm and fingers.  It is seen more often in women than men.  usually occurs between years of age

Ulnar tunnel syndrome  The ulnar nerve compressed as it passes through the ulnar carpal canal between the pisiform and the hook of hamate. The common cause is a ganglion compression on the nerve tunnel. Both sensory and motor division of the nerve may be affected  The symptom may include small muscle wasting and paraesthesia along the ulnar nerve pathway.

Carpal Instability  It is a condition in which there is a loss of normal carpal alignment after injury.  10% of all carpal injuries result in instability.  Example for this injury is the scaphoid fracture and dislocation.

Mallet finger  Deformity of the distal IP joint in permanent flexion position as a result of extensor tendon rupture or avulsion.  Rupture or avulsion of the extensor policies longus

Vibration syndrome  A syndrome caused by prolonged exposure to a fast vibration (Jack hammers), may affect bones, nerves, and blood vessels, causing a disturbance of blood supply and sensation which end with hand weakness and disturbance of the proprioceptive sensation of the fingers.