Bones

Carpal Bones 8 small bones in wrist 2 rows of 4 bones each Row 1: Scaphoid, Lunate, triquetrum, pisiform Row 2(from thumb to 5th): Trapezium, Trapezoid, Capitate, Hamate

Something special @ carpals Hamate has hook for retinaculum (forms top of carpal tunnel Capitate- biggest, center of wrist Lunate- commonly dislocated Scaphoid Navicular- Commonly FX and not easily diagnosed

Anterior Forearm Muscles

Posterior Forearm muscles

Muscles Finger Flexors- Flexor Digitorum Profundus Flexor Digitorum Superficialis Finger Extensors- Extensor Digitorum

Muscles of the Hand

Flexor Digitorum Profoundus

Extensor Digitorum

Thumb Muscles ~ Pollicis Flexor Pollicis Longus (there is a Brevis) Extensor Pollicis Longus and Brevis Abductor Pollicis Adductor Pollicis Opponens Pollicis

Ligaments

https://loptonline.com/patient-education/injuries-conditions/hand-anatomy/

II. Injuries 1) Carpal Tunnel Def- very narrow tunnel created by retinaculum/bones- contains tendons, vessels, and nerves: median, radial, ulna Mech- compression of nerve(median) from excessive use/wrist flexion Symp-Paresthesia to digits 1-3/palm and, burning, tingling

Treatment Tx- rest- avoid activity that causes discomfort, immobilize, NSAIDS, possible surgery Corticosteroid shots TX- surgery- cut retinaculum http://www.mayoclinic.com/health/carpal-tunnel-syndrome-surgery/MM00572

Immobilizing joint allows the tendons to rest and reduces inflammation

Median nerve

2) Fractures Scaphoid Navicular- most frequently fx carpal bone- often mistaken for wrist sprain Mech- Fall on outstretched hand Symptoms- pain, swelling, pt in anatomical snuff box TX- immobilization, doesn’t heal if not found right away due to poor blood supply

Screw Fixation

2) Fractures cont. B) Bennett’s FX- fx to base of 1st metacarpal Mech- fall on thumb or direct blow (punch) Symptoms- pain, swelling at base of thumb, limited movement (see next slide) TX- If aligned- cast, if not-surgery with a pin to hold in place

If after injuring your hand you have the following symptoms then you may have this fracture severe pain in the base of the thumb swelling over base of the thumb inability to touch the base of the little finger with the tip of your thumb your thumb appears shorter than its counterpart                                                                                                You can not do this movement if you have Bennett Fracture

Bennett fracture

2) Fractures cont. C) Boxers FX- fx to base of 5th Mech- punch with closed fist Symptoms- PT, swelling, def, etc. base of 5th TX- cast (or surgery)

3) Finger Injuries Mallet Finger- tear to extensor tendon at DIP joint Mech- hit on tip of finger Symp- can’t ext distal phalanx Tx- splinting (in hyper ext)- ASAP.

3) Finger Injuries Cont. B) Boutonniere Deformity- tear of Extensor tendon at PIP joint. Finger hyper ext at DIP and flexes at PIP causes “buttonhole” deformity Mech- “jammed” finger Symp- obv deformity TX- Splint ASAP, (possible surgery)

3) Finger Injuries C) Gamekeeper’s Thumb (also called skiiers thumb)- tear in ulna collateral lig at base of thumb Mech- (Killing game), forceful abduction Symp- p.t., swelling, pain with movement, valgus movement causes pain or increased ROM TX- splint, thumb spica taping, check xray for fx

Gamekeeper’s thumb

3) Finger Injuries Cont. D) Interphalangeal Collateral Ligament- Mech-“jammed finger” tear ulna or radial collateral lig of fingers. Symp- TX- PRICE- splint, buddy tape Check for FX

III Assessment Always complete HOP first Special Tests- 1) Carpal Tunnel- Phalen’s Test 2) Scaphoid Fracture – press in Anatomical Snuff Box 3) FX or Ligament Strain?? A) FX- FX symptoms (pt, deformity, bother at night, etc) and FX test B) pt on joint line, positive valgus/varus test

FX Tests: (black AT textbook p. 490) Percussion Compression Distraction Tuning Fork ** If any doubt- send for Xray Ligamentous Stress Test (Valgus/Varus test) Looking for pain and/or movement

You Try! Break into groups of TWO Complete the following Special Tests: 1) Phalen’s Test 2) Fracture test to Second Middle Phalanx 3) Ligamentous Stress Test a)(Valgus/Varus) to Radial Collateral Ligment of Second Middle Phalange b) valgus/varus to elbow UCL 4) RROM for epicondylitis 5)Rule out FX, so Buddy tape

Phase II Phase I Ice bags, Ice bucket, Paraffin wax, Hydrocullator Increase ROM in elbow, wrist, hand and fingers

Thumb active range of motion: 1) With your palm flat on a table or other surface, move your thumb away from your hand as far you can. Hold this position for 5 seconds and bring it back to the starting position. 2) Rest your hand on the table in a handshake position. Move your thumb out to the side away from your palm as far as possible. Hold for 5 seconds. Return to the starting position. 3) Next, bring your thumb across your palm toward your little finger. Hold this position for 5 seconds. Return to the starting position. Repeat this entire sequence 10 times. Do 3 sets. Wrist Range of Motion 1) Flexion: Gently bend your wrist forward. Hold for 5 seconds. Do 3 sets of 10. 2)Extension: Gently bend your wrist backward. Hold this position 5 seconds. Do 3 sets of 10. 3) Side to side: Gently move your wrist from side to side (a handshake motion). Hold for 5 seconds at each end. Do 3 sets of 10.

Phase 3 Strengthen elbow, wrist, hand, fingers, grip strength Overload principal Start with fine motor and go to gross motor

Playing jacks

Name 5 thumb muscles