Wrist and Hand Conditions Chapter 13

Wrist Articulations Radiocarpal: Radius with the Scaphoid, Lunate, Triquetrum. Intercarpal Distal Radioulnar Triangular Fibro cartilage Complex stabilizes the Radioulnar joint.

Hand Articulations Carpometacarpal (CM) Intermetacarpal (IM) Metacarpophalangeal (MP) Interphalangeal (IP)

Carpometacarpal and Intermetacarpal Joints CM of the thumb is a saddle joint CM of the four fingers gliding joints IM reinforced by joint capsules comprised of the dorsal, volar, and two interosseous CM ligaments

Metacarpophalangeal Joints Rounded distal heads of the metacarpals articulate with the concave proximal ends of the phalanges Reinforced by strong collateral ligaments

Interphalangeal Joints The Proximal (PIP), Distal (DIP), and the IP joint of the thumb are all hinge joints The articular capsule made up of volar and collateral ligaments surround each IP joint

Muscles Retinacula of the Wrist: Tendon Sheaths: The fascial tissue surrounding the wrist thickened into strong fibrous bands called retinacula that form protective passageways through which tendons, nerves, and blood vessels pass. Tendon Sheaths: Sealed at both ends containing synovial fluid, annular pulleys that prevent tendon bowstringing with flexion.

Kinematics Flexion Extension Hyperextension Radial deviation Ulnar deviation

Flexion Flexor carpi radialis Flexor carpi ulnaris Palmaris longus (sometimes absent) Flexor digitorum superficialis Flexor digitorum profundus

Extension and Hyperextension Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Extensor pollicis longus Extensor digiti minimi Extensor digitorum

Radial and Ulnar Deviation Radial Deviation Flexor carpi radialis Extensor carpi radialis Ulnar Deviation Flexor carpi ulnaris Extensor carpi ulnaris

Kinetics of the Wrist Extrinsic flexor muscles are twice as strong as the… Extrinsic extensor muscles Flexors used everyday for gripping, grasping, or pinching movements.

Strengthening Strengthening should include general elbow flexion, extension, pronation, and supination, wrist flexion, extension, Radial and Ulnar deviation.

Contusions and Abrasions Thoroughly clean, dress daily, inspect for infection daily. Ice, compression, elevation for 2 – 3 days.

Sprains Wrist sprains Gamekeeper’s Thumb Interphalangeal Collateral Ligament Sprains

Dislocations Distal radioulnar joint (DRUJ) Lunate dislocation MP joint dislocation PIP joint dislocation

Strains Jersey Finger Mallet Finger Boutonniere Deformity

Tendinopathies Trigger Finger DeQuervain’s tenosynovitis Intersection Syndrome

Ganglion Cysts

Fingertip Injuries Subungual hematomas Paronychia

Nerve Entrapment Syndromes Median Nerve Entrapment Anterior Interosseous Nerve Syndrome Carpal Tunnel Syndrome Ulnar Nerve Entrapment Ulnar tunnel syndrome Cyclist’s palsy Bowler’s thumb Chris Carlin, Dominique Rodriguez

Radial Nerve Entrapment Distal Posterior Interosseous Nerve Syndrome Superficial Radial Nerve Entrapment

Fractures Distal Radial and Ulnar fractures Scaphoid fracture Monteggia’s fracture Galeazzi’s fracture Colle’s fracture Smith’s fracture Scaphoid fracture Hamate fracture Triquetrum fracture Kienbock’s disease

Fractures cont. Metacarpal fractures Bennett’s fracture Boxer’s fracture Bennett’s fracture Phalangeal fractures