Wrist/Hand Anatomy Carpals-8 Metacarpals-5 Phalanges - 5 Scaphoid Trapezium Trapezoid Capitate Hamate Pisiform Triquetral Lunate www.eatonhand.com Metacarpals-5 Phalanges - 5 1-5 1=Thumb 5=Pinky

Wrist/Hand Anatomy (2) Radiocarpal joints (between wrist and hand) Metacarpal joints Metacarpalphalangeal Joints Phalangeal joints-PIP and DIP Normal resting position Proximal, Middle, Distal phalanx Nerve supply Radial Medial Ulnar

Colles Fracture Most common type of forearm fracture HOPS: fall on outstretched hand with extreme hyperextension, extreme pain obvious deformity, excessive swelling numbness along the median nerve distribution, extreme pain Treatment: splint, refer http://orthopedics.about.com/library/xray/blxray-fxapcolles.htm

http://www.eatonhand.com/hw/colles1.gif http://sfghed.ucsf.edu/ClinicImages/Colle's fracture.jpg

Carpal tunnel syndrome (1) Carpal tunnel is located in the anterior of the wrist. 8 finger flexor tendons, their synovial sheaths and the median nerve lie in the tunnel Results from an inflammation of synovial sheaths

http://www.mayo.edu/mcj/hand/carpal.jpg

Carpal Tunnel (2) Overuse condition caused by repeated wrist flexion, ulnar deviation, HOPS numbness, tingling, median nerve area muscle atrophy (in advanced cases) decreased RROM in thumb movement + Phalen’s test, pn w/ compression of carpal tunnel + Tinel Sign Tx: rest, wrist splint, anti-inflammatory medication, if severe, surgery

http://www.ccohs.ca/images/office15.gif

Scaphoid Fracture (1) Most frequently fractured carpal bone Lies beneath the “anatomical snuff box” Does not have a good blood supply – often does not heal – “non-union”

                         http://www.hughston.com/hha/b.wrstfx

Scaphoid Fracture (2) HOPS fall on the outstretched hand some swelling pain in anatomic snuff box Tx: refer to physician, immobilization x 6 weeks, protection against impact for 3 months

Mallet finger “Baseball”, “basketball” finger Avulsion of the extensor tendon, to the Distal phalange HOPS: MOI: blow to tip of finger, pain over the DIP joint bent DIP joint (about 30 degrees) inability to extend the DIP joint TX: refer, splint in extension 6 – 8 weeks

Mallet Finger www.eatonhand.com http://www.utahmountainbiking.com/firstaid/pics/fing-mal.jpg

Boutonneire Deformity Rupture of the extensor tendon dorsal to middle phalanx HOPS: forced flexion of the interphalangeal joint swelling, flexion deformity of PIP joint point tenderness over middle phalanx (dorsal side) inability to extend finger Tx: refer, splint in extension

Boutonneire Deformity www.eatonhand.com

Jersey Finger Rupture of flexor digitorum profundus tendon at insertion on distal phalanx Most often occurs in ring finger HOPS: MOI: rapid ext. of the finger while actively flexed Swelling point tenderness over DIP joint inability to flex DIP joint Tx: Refer to physician

Jersey Finger http://www.handlibrary.org/images/jnslide5-s.jpg

Gamekeeper’s thumb Sprain of ulnar collateral ligament in thumb MOI: forcefull abduction of thumb while thumb is extended HOPS: Swelling over palmar aspect Instabilty in the joint Laxity in thumb flexion Tx: refer to physician, tape, rest, surgery

http://www.weissortho.com/images/body_parts/skiers_thumb.jpg

Boxer’s Fracture Fracture to the 4th and/or 5th metacarpal(s). MOI - caused by punching something harder than the hand, such as a wall or another person's head. The end of the metacarpal bone takes the brunt of the impact, which usually breaks through the narrowest area near the end (the "neck"), and bends down toward the palm. 

http://www.eatonhand.com/hw/hw005.htm

http://ranney.com/~mjr/Image_Library/20020516/05160005.JPG

Boxer’s Fracture – (2) HOPS- Striking an immovable object- wall, floor, etc Swelling/Discoloration in area Deformity Pain Pt tender at location of fracture MCP joint deformity – shorter, at an angle Treatment- Splint, refer for x-rays, possible surgery

ROM/Strength Testing Wrist Flexion-Palmaris Longus Wrist Extension-Extensor Digitorum Wrist Radial Deviation-Flexor/Extensor Carpi Radialis Wrist Ulna Deviation-Flexor/Extensor Carpi Ulnaris Finger Flexion/Extension-Flexor Digitorum/ Extensor Digitorum Finger Abduction/Adduction Opposition

Test Valgus Stress Test - Ulna Collateral Ligament Varus Stress Test - Radial Collateral Ligament Phalen’s- Median Nerve Tinel’s – Ulna and Median Nerve Fracture Testing- Compression, Distraction, Flick