Unit 9: Forearm, wrist, and hand

Forearm and Wrist

Anatomy Forearm Wrist Radius Ulna Region that connects the forearm to the hand Radiocarpal joint Radius and ulna connects with proximal row of carpals

Muscles of the forearm Flexors and pronators  on anterior side Flexor carpi radialis Flexor carpi ulnaris Flexor digitorum superficialis Flexor pollicis longus Pronator quadratus Extensors and supinators  on posterior side Extensor carpi radialis longus and brevis Extensor digiti minimi Extensory digitorum communis Extensor carpi ulnaris Extensor pollicis longus and brevis Extensor indicis

Muscles of the forearm

Forearm Injuries Colles’ Fracture TFCC injury

Forearm injuries Colle’s Fracture Involve lower end of radius MOI: Fall on an outstretched hand Signs and symptoms: Visible deformity to the wrist Swelling Bleeding/bruising Tendons may be torn Treatment: Ice Splint X-ray and refer to doctor

Forearm injuries TFCC injury TFCC- cartilagnious structure separating the radiocarpal and inferior radioulnar joints of the wrist Major ligamentous stabilizer of the wrist Cushions forces through wrist MOI: swinging a bat or racquet creating twisting force on wrist Hyperextension of the wrist from falling on outstretched hand Signs and symptoms: Pain along ulnar side of wrist Wrist extension difficult and painful Clicking and catching in wrist Treatment: immobilization, rehab, ROM Refer to physician

Hand

Anatomy Bones 8 carpal bones Metacarpals Phalanges Scaphoid, lunate, triquetrium, pisiform Trapezium, Trapezoid, Capitate, Hamate Metacarpals Phalanges

Anatomy Muscles Thenar muscles Abductor pollicis brevis Opponens pollicis Flexor pollicis brevis Adductor pollicis Hypothenar muscles Palmaris brevis Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minmi

Muscles

Evaluation- History Location of the pain Mechanism of injury Where does it hurt in particular? Hand? Wrist? Forearm? Is it in a more bony location vs. muscular mass? Is it in the joint? Deep pain vs. superficial pain Mechanism of injury How did it happen? Fall on an outstretched hand? Hit? Overtime gradually? Duration of the pain Any past medical history Similar past injuries? Health problems?

Evaluation-Observation Posture of the hand Gross deformity Obvious broken bones Distal radius, ulna Carpal and metacarpals Phalanges Arches of the hand Discoloration Swelling

Evaluation- Palpation Bony Radius Ulna 1-5 metacarpals Phalanges Carpal bones: Scaphoid, Trapezium, Lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid Wrist joint Joints in the hand: Interphalangeal, MCP Muscles: Forearm (flexor and extensor muscle masses), hand (hypothenar and thenar eminenance)

Evaluation- Special tests Muscle testing Wrist flexion Wrist extension Thumb: Abductor pollicis longus Extensor pollicis longus Flexor pollicis longus Extensor digitorum communis Flexor digitorum profundus/superficialis

Evaluation- Special tests What it tests for… Video Valgus stress test Collateral ligament damage https://www.youtube.com/watch?v=KkHrm7nWUck Varus stress test https://www.youtube.com/watch?v=QO9hntCGsKE Anteroposterior glide Ligament Rotation Compression Fracture Murphy’s sign Dislocated lunate https://www.youtube.com/watch?v=rNzoE6UyDIk Tinel’s sign Carpal tunnel https://www.youtube.com/watch?v=U8cPjPeZgFw Finkelstein test Dequervian’s syndrome https://www.youtube.com/watch?v=eL2Uzfd26SA

Hand Injuries Carpal Tunnel Syndrome De Quervian’s disease Lunate dislocation Scaphoid fracture Other injuries… Wrist sprain Dislocated phalange Trigger finger Mallet finger UCL sprain

Hand activity Trace your hand Draw out the bony structures of the hand (refer back to your notes for help) Include… All the bones (radius, ulna, carpals- each one, metacarpals, and all phalanges) Joints Label and color code each bone/part (On the back) research a hand, forearm, and/or wrist injury and answer these questions… What is the injury? What anatomical structures are involved? (i.e. muscle, bone, ligaments, etc.) What causes the injury? Sign and symptoms of the injury How to treat the injury How to rehab the injury Recovery time

Hand injuries Carpal Tunnel Syndrome Inflammation of the tendons and synovial sheaths within the space compressing the median nerve MOI: repeated wrist flexion Signs and symptoms: Sensory and motor deficits Tingling, numbness, and paresthesia Weakness with thumb movements Treatment: Rest Immobilization Anti-inflammatory medication Surgery

Hand Injuries De Quervian’s disease Stenosing tenosynovitis in the thumb What does that mean? Tendons affected Extensor pollicis brevis Abductor pollicis longus Signs and symptoms: Aching pain (may radiate into hand or forearm) Movements of wrist increase pain Point tenderness and weakness during thumb extension and abduction Treatment: immobilization, rest, anti-inflammatories

Hand injuries Lunate dislocation MOI: forceful hyperextension of wrist, fall on an outstretched hand Signs and symptoms: Pain Swelling Difficulty with wrist and finger flexion Treatment: See physician to reduce dislocation

Hand injuries Scaphoid fracture MOI: force on an outstretched hand Commonly mistaken for severe sprain Signs and symptoms: Swelling in area of carpal bones Severe point tenderness at scaphoid bone (in snuff box) Treatment: Ice and splint Refer to doctor for x-ray and casting

Rehab Similar exercises to the shoulder and elbow Exercises specific to the wrist and hand: Band squeezes Resisted wrist extension, flexion, ulnar deviation, and radial deviation Rice bucket exercises Opposition exercises Wrist circles Putty exercises Web exercises