1. Unit 9: Forearm, wrist, and hand

2. Forearm and Wrist

3. Anatomy Forearm Wrist Radius Ulna
Region that connects the forearm to the hand
Radiocarpal joint
Radius and ulna connects with proximal row of carpals

4. Muscles of the forearm Flexors and pronators  on anterior side
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor pollicis longus
Pronator quadratus
Extensors and supinators  on posterior side
Extensor carpi radialis longus and brevis
Extensor digiti minimi
Extensory digitorum communis
Extensor carpi ulnaris
Extensor pollicis longus and brevis
Extensor indicis

5. Muscles of the forearm

6. Forearm Injuries
Colles’ Fracture
TFCC injury

7. Forearm injuries Colle’s Fracture Involve lower end of radius
MOI: Fall on an outstretched hand
Signs and symptoms:
Visible deformity to the wrist
Swelling
Bleeding/bruising
Tendons may be torn
Treatment:
Ice
Splint
X-ray and refer to doctor

8. Forearm injuries TFCC injury
TFCC- cartilagnious structure separating the radiocarpal and inferior radioulnar joints of the wrist
Major ligamentous stabilizer of the wrist
Cushions forces through wrist
MOI: swinging a bat or racquet creating twisting force on wrist
Hyperextension of the wrist from falling on outstretched hand
Signs and symptoms:
Pain along ulnar side of wrist
Wrist extension difficult and painful
Clicking and catching in wrist
Treatment: immobilization, rehab, ROM
Refer to physician

9. Hand

10. Anatomy Bones 8 carpal bones Metacarpals Phalanges Scaphoid, lunate,
triquetrium, pisiform
Trapezium,
Trapezoid, Capitate,
Hamate
Metacarpals
Phalanges

11. Anatomy Muscles 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 minmi

12. Muscles

13. Evaluation- History Location of the pain Mechanism of injury
Where does it hurt in particular? Hand? Wrist? Forearm?
Is it in a more bony location vs. muscular mass?
Is it in the joint?
Deep pain vs. superficial pain
Mechanism of injury
How did it happen?
Fall on an outstretched hand? Hit? Overtime gradually?
Duration of the pain
Any past medical history
Similar past injuries? Health problems?

14. Evaluation-Observation
Posture of the hand
Gross deformity
Obvious broken bones
Distal radius, ulna
Carpal and metacarpals
Phalanges
Arches of the hand
Discoloration
Swelling

15. Evaluation- Palpation
Bony
Radius
Ulna
1-5 metacarpals
Phalanges
Carpal bones: Scaphoid, Trapezium, Lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid
Wrist joint
Joints in the hand: Interphalangeal, MCP
Muscles: Forearm (flexor and extensor muscle masses), hand (hypothenar and thenar eminenance)

16. Evaluation- Special tests
Muscle testing
Wrist flexion
Wrist extension
Thumb:
Abductor pollicis longus
Extensor pollicis longus
Flexor pollicis longus
Extensor digitorum communis
Flexor digitorum profundus/superficialis

17. Evaluation- Special tests
What it tests for…
Video
Valgus stress test
Collateral ligament damage
Varus stress test
Anteroposterior glide
Ligament
Rotation
Compression
Fracture
Murphy’s sign
Dislocated lunate
Tinel’s sign
Carpal tunnel
Finkelstein test
Dequervian’s syndrome

18. Hand Injuries Carpal Tunnel Syndrome De Quervian’s disease
Lunate dislocation
Scaphoid fracture
Other injuries…
Wrist sprain
Dislocated phalange
Trigger finger
Mallet finger
UCL sprain

19. Hand activity Trace your hand
Draw out the bony structures of the hand (refer back to your notes for help)
Include…
All the bones (radius, ulna, carpals- each one, metacarpals, and all phalanges)
Joints
Label and color code each bone/part
(On the back) research a hand, forearm, and/or wrist injury and answer these questions…
What is the injury?
What anatomical structures are involved? (i.e. muscle, bone, ligaments, etc.)
What causes the injury?
Sign and symptoms of the injury
How to treat the injury
How to rehab the injury
Recovery time

20. Hand injuries Carpal Tunnel Syndrome
Inflammation of the tendons and synovial sheaths within the space compressing the median nerve
MOI: repeated wrist flexion
Signs and symptoms:
Sensory and motor deficits
Tingling, numbness, and paresthesia
Weakness with thumb movements
Treatment:
Rest
Immobilization
Anti-inflammatory medication
Surgery

21. Hand Injuries De Quervian’s disease
Stenosing tenosynovitis in the thumb
What does that mean?
Tendons affected
Extensor pollicis brevis
Abductor pollicis longus
Signs and symptoms:
Aching pain (may radiate into hand or forearm)
Movements of wrist increase pain
Point tenderness and weakness during thumb extension and abduction
Treatment: immobilization, rest, anti-inflammatories

22. Hand injuries Lunate dislocation
MOI: forceful hyperextension of wrist, fall on an outstretched hand
Signs and symptoms:
Pain
Swelling
Difficulty with wrist and finger flexion
Treatment:
See physician to reduce dislocation

23. Hand injuries Scaphoid fracture MOI: force on an outstretched hand
Commonly mistaken for severe sprain
Signs and symptoms:
Swelling in area of carpal bones
Severe point tenderness at scaphoid bone (in snuff box)
Treatment:
Ice and splint
Refer to doctor for x-ray and casting

24. Rehab Similar exercises to the shoulder and elbow
Exercises specific to the wrist and hand:
Band squeezes
Resisted wrist extension, flexion,
ulnar deviation, and radial deviation
Rice bucket exercises
Opposition exercises
Wrist circles
Putty exercises
Web exercises