The Wrist, Hand and Fingers

BONES FOREARM Radius – lateral and thumb side Ulna – medial and pinky side

BONES Carpal bones - 8 SCAPHOID LUNATE TRIQUETRAL PISIFORM TRAPEZIUM In two rows of four Lots of little joints with ligaments SCAPHOID LUNATE TRIQUETRAL PISIFORM TRAPEZIUM TRAPEZOID CAPITATE HAMATE

BONES Metacarpals - 5 Phalanges - 14 Three in fingers (proximal, middle, and distal) Two in thumb (proximal and distal)

JOINTS True Wrist Joint Between the radius and the proximal row of the carpal bones

Joints Named for the bones they join Proximal Interphalangeal (PIP) Flexion and extension Distal Interphalangeal (DIP)

Joints Metacarpal phalangeal (MP) Flexion, extension, abduction and adduction Metacarpal phalangeal joint of the thumb (MCP) Flexion and extension Carpal metacarpal joint of the thumb (CMC) Flexion, extension, abduction, adduction, opposition

Muscles Extrinsic muscles Intrinsic muscles Start in the forearm and end in the hand Extensors and flexors of wrist and fingers Intrinsic muscles Start and end in the hand Abd and add of fingers and thumb

Wrist Motions Flexion Extension Ulnar flexion Radial flexion

INJURIES

Colles’ Fracture Fracture of the distal radius Cause S/S Care Falling on outstretched arm forcing hyperextension S/S Fracture raises up and is somewhat obvious (silver fork) Unable to use hand Significant swelling Care Check for feeling and blood supply Splint and transport to ER

Navicular Fracture Most common fracture of the carpal bones Navicular sits in anatomical snuff box Cause Falling on the outstretched arm S/S Generalized swelling in the wrist Tender snuff box Does not want to radial or ulnar flex Problem: densest bone in the body, hard to x-ray, slow healing due to poor blood supply Care RICE, Splint, and refer for x-ray

Wrist Sprain Cause S/S Care Falling on outstretched arm Hyperextension or hyperflexion of the wrist S/S Pain and swelling Limited range of motion Care RICE, refer to MD if pain is severe

Ganglion Cyst Cause S/S Care Sheath that surround the tendon fills with fluid and creates a bump Usually from repeated hyperextension S/S Bump usually on the dorsal (back) side of the hand Care If painful, may require surgical removal

Carpal Tunnel Syndrome Tunnel: on palmar side, transverse carpal ligament covers 8 tendons and a nerve Cause Repeated wrist flexion S/S Tingling/numbness into thumb, index & middle fingers Weakness with thumb movement Care Rest from activity, Anti-inflammatory medication Can be injected or may need surgery if severe enough

Finger injuries Dislocations/Sprains of fingers Cause S/S Care Collateral ligaments in PIP or DIP “Jammed finger” = sprain Cause Hit to the tip of finger S/S Swelling with sprain Deformity with dislocation Care Sprain – RICE, buddy tape Dislocation – Splint and refer to ER Do not try to reduce

Mallet finger (Basketball Finger) Tear of tendon that extends DIP Cause Tip of the finger is flexed & starting to extend when hit Pulls off the extensor tendon from phalange S/S Cannot extend the DIP Care Splint the finger in extension and refer to a specialist

Boutinnerre finger Injury at PIP joint Cause S/S Care Forced flexion while attempting to extend the finger at the same time S/S Pain Obvious deformity Care Ice and splint PIP while straight Needs to be referred to a hand specialist ASAP

Gamekeeper’s Thumb (Skier’s Thumb) Tear of the ulnar/medial collateral ligament of the thumb Cause Forced abduction of MCP joint of thumb Hyperextension of thumb S/S Pain over UCL in thumb Unable to grip or pinch with thumb May be unstable – feels like it slips out Care RICE, Splint, refer to MD

Metacarpal fracture (Boxer’s fracture) Fractures of 3rd, 4th, & 5th metacarpals are common Cause Hitting something (like a wall or person) with fist Fingers get bent back Stepped on S/S When making a fist a knuckle will drop Finger may turn when making a fist Pain on bone of hand Care RICE, Splint, Refer to MD for x-rays

Metacarpal Fracture A fracture/dislocation of the distal part of the 1st metacarpal (thumb) is a Bennett’s fracture

TEST Shoulder, Elbow, Wrist, Hand and Fingers