Ch. 20 Wrist and Hand

Anatomy 27 bones in the hand and wrist Nerves Medial Ulnar Radial Flexor and extensor tendon for each finger

Anatomy

Carpals Scaphoid Lunate Triquetral Pisiform Trapezium Trapezoid Capitate Hamate

Carpals Scaphoid-Sally Lunate-Likes Triquetral-To Pisiform-Party Trapezium-Trooper Trapezoid-Taylor Capitate-Can Hamate-Hit

Muscles

Muscles Flexors Extensors Supinator Flexor Carpi Radialis Flexor Carpi Ulnaris Palmaris Longus Extensors Extensor Carpi Radialis Extensor Carpi Ulnaris Supinator Pronator Teres and Pronator Quadratus

Dislocations Displacement of any bone from normal position Subluxation: abnormal movement of one of the bones that constitutes a joint

Colles’ Fracture Fracture of the distal radius or ulna just above the wrist From falling on outstretched hand Splint and refer to doctor

Boxer’s Fracture Fracture to the 5th metacarpal Most commonly seen in someone who has punched something solid

Mallet Finger Occurs when a ball strikes the tip of the finger Also known as baseball finger Tearing of extensor tendon

Jersey Finger Occurs when grabbing a jersey Tearing of flexor tendon Treatment usually involves surgery

Boutonniere Deformity Caused by blow to bent finger or arthritis The proximal interphalangeal joint is in flexion and the distal interphalangeal joint is in hyperextension

Scaphoid Fracture Pain over anatomic snuffbox Common fracture in athletics Fall on outstretched hand Not well vascularized

Contusions Subungual hematoma- bleeding under the nail Pain is from the pressure created Puncture nail to relieve pressure

Gamekeeper’s Thumb Sprain of ulnar collateral ligament of the metacarpophalangeal joint Common in skiing Use special test to diagnose Tape and protect

deQuervain’s Tenosynovitis Inflammation of the extensor pollicus brevis and abductor pollicus longus Use signs and symptoms to diagnosis Special test Treat with RICE or cortisone shot Finkelstein’s

Carpal Tunnel Syndrome Carpal tunnel is a passageway that runs from the forearm through the wrist Median nerve runs through CTS occurs when linings of tendons are inflamed or ligaments thicken Transverse carpal ligament

Carpal Tunnel Syndrome S/S: pain, numbness, tingling in wrist, hand, and fingers May drop objects Usually caused by overuse Phalan’s Test Treat conservatively, surgery if needed

Ganglion Cyst Ganglion cyst is a small, usually hard lump around a tendon or in a joint capsule Common in bowlers, tennis players Usually on back of wrist Resolves on its own

Rehab Wrist Extension Wrist Flexion Wrist Supination Wrist Pronation Wrist Ulnar Deviation Wrist Radial Deviation

Rehab Elbow Flexion Elbow Extension Hand Intrinsic Muscles Grip Strength