1. The Forearm, Wrist, Hand, and Fingers 5/3/2016Sports Medicine - Mr. Cronin1

2. Objectives When you finish with this chapter you should be able to: Review the structural and functional anatomy of the forearm, wrist, hand and fingers. Outline the process of assessment for injuries to the forearm, wrist, hand and fingers. Incorporate management techniques for dealing with injuries to the forearm, wrist, hand, and fingers. Implement the appropriate rehabilitation techniques for dealing with injuries to the forearm, wrist, hand, and fingers. 5/3/2016Sports Medicine - Mr. Cronin2

3. 5/3/20163 Sports Medicine - Mr. Cronin Anterior Radius and Ulna Parts to know: Radius: Head of the radius Neck of the radius Radial tuberosity Shaft of the radius Ulnar notch of the radius Styloid process of the radius Ulna Trochlear notch of the ulna Coronoid process of the ulna Ulnar tuberosity Radial notch of the ulna Styloid process of the ulna Olecranon process of the ulna Head of the ulna Shaft of the Ulna Interosseous membrane Distal radioulnar joint Proximal radioulnar joint

4. 5/3/20164 Sports Medicine - Mr. Cronin Posterior Radius and Ulna Parts to know: Radius: Head of the radius Neck of the radius Shaft of the radius Ulnar notch of the radius Styloid process of the radius Ulna Radial notch of the ulna Styloid process of the ulna Olecranon process of the ulna Head of the ulna Shaft of the ulna Interosseous membrane Distal radioulnar joint Proximal radioulnar joint

5. Articulations of the Forearm Proximal (Superior) Radioulnar Joint Middle Radioulnar Joint Distal (Inferior) Radioulnar Joint 5/3/2016Sports Medicine - Mr. Cronin5

6. Forearm Musculature Flexor Carpi Radialis Origin Medial epicondyle of the humerus. Insertion Ventral surface (palm side) of the second and third metacarpals. Action Flexes the wrist and abducts the hand (radial deviation); aids in flexion of the elbow and pronation of the forearm. 5/3/2016Sports Medicine - Mr. Cronin6

7. Forearm Musculature Palmaris Longus Origin Medial epicondyle of the humerus. Insertion Palmar aponeurosis (a sheet of pearly-white fibrous tissue that takes the place of a tendon in sheet-like muscles having a wide area of attachment). Action Flexes the wrist. 5/3/2016Sports Medicine - Mr. Cronin7

8. Forearm Musculature Flexor Carpi Ulnaris Origin Medial epicondyle of the humerus, olecranon process, and the proximal two-thirds of the posterior surface of the ulna. Insertion Pisiform, hamate, and fifth metacarpal. Action Flexes the wrist and adducts the hand (ulnar deviation). 5/3/2016Sports Medicine - Mr. Cronin8

9. Forearm Musculature Flexor Digitorum Superficialis Origin Medial epicondyle of the humerus, coronoid process of the ulna, and the anterior radius. Insertion Ventral surface (palm side) of the middle phalanges of the second through fifth fingers Action Flexes the wrist and phalanges. 5/3/2016Sports Medicine - Mr. Cronin9

10. Forearm Musculature Flexor Digitorum Profundus Origin Medial epicondyle of the humerus, the coronoid process of the ulna, the interosseous membrane, and the ventral (anterior) side of the ulna. Insertion Ventral (palm side) of the base of the distal phalanges of the second through fifth fingers. Action Flexes the wrist and the phalanges. 5/3/2016Sports Medicine - Mr. Cronin10

11. Forearm Musculature Flexor Pollicis Longus Origin Ventral surface of the radius (anterior) and the interosseous membrane. Insertion Ventral surface (palm side) of the base of the distal phalanx of the thumb. Action Flexes the thumb and aids in flexing the wrist. 5/3/2016Sports Medicine - Mr. Cronin11

12. Forearm Musculature Pronator Quadratus Origin Distal ventral surface (anterior side) of the ulna. Insertion Distal ventral surface (anterior side) of the radius. Action Pronates the forearm and hand. 5/3/2016Sports Medicine - Mr. Cronin12

13. Forearm Musculature Extensor Carpi Radialis Longus Origin Lateral supracondylar ridge of the humerus. Insertion Dorsal surface (posterior) of the base of the second metacarpal. Action Extends the wrist and abducts (radial deviation) the hand. 5/3/2016Sports Medicine - Mr. Cronin13

14. Forearm Musculature Extensor Carpi Radialis Brevis Origin Lateral epicondyle of the humerus. Insertion Dorsal surface (posterior) of the base of the third metacarpal. Action Extends the wrist and abducts (radial deviation) the hand. 5/3/2016Sports Medicine - Mr. Cronin14

15. Forearm Musculature Extensor Digitorum (Communis) Origin Extends the wrist and abducts (radial deviation) the hand. Insertion Dorsal surface (posterior) of the phalanges of the second through fifth fingers. Action Extends the fingers and wrist. 5/3/2016Sports Medicine - Mr. Cronin15

16. Forearm Musculature Extensor Digiti Minimi Origin Tendon of the extensor digitorum communis. Insertion Tendon of the extensor digitorum communis on the dorsum (posterior) of the little finger. Action Extends the little finger. 5/3/2016Sports Medicine - Mr. Cronin16

17. Forearm Musculature Extensor Carpi Ulnaris Origin Lateral epicondyle of the humerus. Insertion Base of the fifth metacarpal. Action Extends the wrist and adducts (ulnar deviation) the hand. 5/3/2016Sports Medicine - Mr. Cronin17

18. Forearm Musculature Abductor Pollicis Longus Origin Posterior surface of the middle of the radius and ulna and the interosseous membrane. Insertion Base of the first metacarpal. Action Abducts the thumb and hand (radial deviation). 5/3/2016Sports Medicine - Mr. Cronin18

19. Forearm Musculature Extensor Pollicis Brevis Origin Posterior surface of the middle of the radius and the interosseous membrane. Insertion Base of the first phalanx of the thumb. Action Extends thumb and wrist, abducts the hand (radial deviation). 5/3/2016Sports Medicine - Mr. Cronin19

20. Forearm Musculature Extensor Pollicis Longus Origin Posterior surface of the middle of the ulna and the interosseous membrane. Insertion Base of the distal phalanx of the thumb. Action Extends the thumb and abducts the hand (radial deviation). 5/3/2016Sports Medicine - Mr. Cronin20

21. Forearm Musculature Extensor Indicis Origin Posterior surface of the distal end of the ulna and the interosseous membrane. Insertion Tendon of the extensor digitorum communis to the index finger. Action Extends the index finger. 5/3/2016Sports Medicine - Mr. Cronin21

22. Muscle Groups of the Forearm Extensors (Posterolateral) Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Carpi Ulnaris Brachioradialis Extensor Pollicis Longus Extensor Pollicis Brevis Abductor Pollicis Longus Extensor Indicis Supinator Flexors (Anteromedial) Flexor Carpi Radialis Flexor Carpi Ulnaris Palmaris Longus Flexor Digitorum Superficialis Flexor Digitorum Profundus Flexor Pollicis Longus Pronator Quadratus Pronator Teres 5/3/2016Sports Medicine - Mr. Cronin22

23. Common Forearm Injuries Forearm Splints Forearm Fractures Colles’ Fracture 5/3/2016Sports Medicine - Mr. Cronin23

24. Forearm Splints Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin24

25. Forearm Fractures Etiology gymnastics injury Signs/Symptoms Management Colles’ Fracture 5/3/2016Sports Medicine - Mr. Cronin25

26. Anatomy of the Wrist, Hand, and Fingers Bones of the Wrist Carpals (8) Scaphoid Lunate Triquetral Pisiform Hamate Capitate Trapezoid Trapezium Metacarpals (5) 1 st 2 nd 3 rd 4 th 5 th Phalanges (14) Proximal Intermediate Distal 5/3/2016Sports Medicine - Mr. Cronin26

27. Articulations Radiocarpal Joint (Inter)Carpal Joints Metacarpal Phalangeal Joints (MCP) (Inter)Phalangeal Joints Proximal Interphalangeal Joint (PIP) Distal Interphalangeal Joint (DIP) 5/3/2016Sports Medicine - Mr. Cronin27

28. Musculature of the Wrist, Hand, and Fingers Palmar Muscles Lumbricales (4) Dorsal Interossei (4) Palmar Interossei (3) Thenar Muscles Abductor Pollicis Brevis Opponens Pollicis Flexor Pollicis Brevis Adductor Pollicis Hypothenar Muscles Palmaris Brevis Abductor Digiti Minimi Flexor Digiti Minimi Brevis Opponens Digiti Minimi 5/3/2016Sports Medicine - Mr. Cronin28

29. Musculature of the Wrist, Hand, and Fingers Lumbricals Origin – Tendons of the flexor digitorum profundus. Insertion – Tendons of the extensor digitorum communis. Action – Flexes the metacarpophalangeal joints. 5/3/2016Sports Medicine - Mr. Cronin29

30. Musculature of the Wrist, Hand, and Fingers Dorsal Interossei (4) Origin – Adjacent sides of all of the metacarpals. Insertion – Proximal phalanx of the second, third, and fourth fingers. Action – Abducts the fingers from the middle finger. 5/3/2016Sports Medicine - Mr. Cronin30

31. Musculature of the Wrist, Hand, and Fingers Palmar Interossei (3) Origin – Medial side of the second metacarpal and lateral side of the fourth and fifth metacarpals. Insertion – Proximal phalanx of the same finger. Action – Adducts the fingers toward the middle finger. 5/3/2016Sports Medicine - Mr. Cronin31

32. Musculature of the Wrist, Hand, and Fingers Abductor Pollicis Brevis Origin – Flexor Retinaculum, scaphoid, and trapezium. Insertion – Proximal phalanx of the thumb. Action – Abduct the thumb. Abductor pollicis brevis video Abductor pollicis brevis video 5/3/2016Sports Medicine - Mr. Cronin32

33. Musculature of the Wrist, Hand, and Fingers Opponens Pollicis Origin – Flexor retinaculum, and trapezium. Insertion – Lateral border of the metacarpal of the thumb. Action – Pulls the thumb in front of the palm to meet the little finger. 5/3/2016Sports Medicine - Mr. Cronin33

34. Musculature of the Wrist, Hand, and Fingers Flexor Pollicis Brevis Origin – Flexor retinaculum, trapezium, and first metacarpal. Insertion – Base of the proximal phalanx of the thumb. Action – Flexes and adducts the thumb. Flexor Pollicis Brevis Video Flexor Pollicis Brevis Video 5/3/2016Sports Medicine - Mr. Cronin34

35. Musculature of the Wrist, Hand, and Fingers Adductor Pollicis Origin – Capitate, and second and third metacarpals. Insertion – Proximal phalanx of the thumb. Action – Adducts the thumb. Adductor Pollicis Video 5/3/2016Sports Medicine - Mr. Cronin35

36. Musculature of the Wrist, Hand, and Fingers Palmaris Brevis Origin – Flexor retinaculum. Insertion – Skin on the ulnar border of the hand. Action – Pulls the skin toward the middle of the palm. 5/3/2016Sports Medicine - Mr. Cronin36

37. Musculature of the Wrist, Hand, and Fingers Abductor Digiti Minimi Origin – Pisiform and the tendon of the flexor carpi ulnaris. Insertion – Base of the proximal phalanx of the little finger. Action – Abducts the little finger. 5/3/2016Sports Medicine - Mr. Cronin37

38. Musculature of the Wrist, Hand, and Fingers Flexor Digiti Minimi Brevis Origin – Flexor retinaculum and hamate. Insertion – Base of the proximal phalanx of the little finger. Action – Flexes the little finger. 5/3/2016Sports Medicine - Mr. Cronin38

39. Musculature of the Wrist, Hand, and Fingers Opponens Digiti Minimi Origin – Flexor retinaculum and hamate. Insertion – Metacarpal of the little finger. Action – Brings the little finger our to meet the thumb. 5/3/2016Sports Medicine - Mr. Cronin39

40. Joint Movements Fingers and Thumb Finger Extension Finger Flexion Finger Abduction Finger Adduction Thumb Abduction Thumb Adduction Thumb Extension Thumb Opposition 5/3/2016Sports Medicine - Mr. Cronin40

41. Nerve Supply Two major nerves: (motor and sensory) Ulnar Nerve Median Nerve Additional nerve (mostly sensory) Radial Nerve 5/3/2016Sports Medicine - Mr. Cronin41

42. Blood Supply Radial Artery Ulnar Artery 5/3/2016Sports Medicine - Mr. Cronin42

43. Special Tests Finkelstein’s Test Tinel’s Sign Phalen’s Test Valgus/Varus and Glide Tests for the Wrist, MCP and IP Joints Luntriquetral Ballotment Test Allen’s Test Circulatory and Neurological Evaluation Dermatomes and Myotomes Nailbed Pinch Functional Evaluation 5/3/2016Sports Medicine - Mr. Cronin43

44. Common Injuries to the Wrist, Hand, and Fingers Wrist Sprains Tenosynovitis Tendinitis Nerve Compression, Entrapment, Palsy Carpal Tunnel Syndrome deQuervain’s Syndrome Dislocation of the Lunate Scaphoid Fracture Hamate Fracture Wrist Ganglion Trigger Finger or Thumb Extensor Tendon Avulsion (Mallet Finger) Boutonniere Deformity Flexor Digitorum Profundus Rupture (Jersey Finger) Gamekeeper’s Thumb MCP Dislocation Bennett’s Fracture Metacarpal Fracture (Boxer’s Fracture) 5/3/2016Sports Medicine - Mr. Cronin44

45. Wrist Sprains Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin45

46. Wrist Tenosynovitis vs. Tendonitis Etiology Tenosynovitis = repetitive wrist accelerations and decelerations; repetitive use and overuse of the wrist tendons and their sheaths Tendonitis = repetitive wrist flexion; overuse of the wrist Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin46

47. Carpal Tunnel Syndrome Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin47

48. deQuervian’s Syndrome Aka Hoffman’s disease Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin48

49. Lunate Dislocation Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin49

50. Scaphoid Fracture Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin50

51. Hamate Fracture Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin51

52. Wrist Ganglion Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin52

53. Trigger Finger/Thumb Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin53

54. Mallet Finger Etiology Baseball finger/basketball finger Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin54

55. Boutonniere Deformity Etiology Buttonhole deformity Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin55

56. Jersey Finger Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin56

57. Gamekeeper’s Thumb Etiology Skier's thumb Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin57

58. MCP Dislocation Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin58

59. Bennett’s Fracture Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin59

60. Metacarpal Fracture (Boxer’s Fracture) Etiology Signs/Symptoms Management 5/3/2016Sports Medicine - Mr. Cronin60