1. Bones

2. Carpal Bones 8 small bones in wrist 2 rows of 4 bones each
Row 1: Scaphoid, Lunate, triquetrum, pisiform
Row 2(from thumb to 5th): Trapezium, Trapezoid, Capitate, Hamate

4. Something special @ carpals
Hamate has hook for retinaculum (forms top of carpal tunnel
Capitate- biggest, center of wrist
Lunate- commonly dislocated
Scaphoid Navicular- Commonly FX and not easily diagnosed

9. Anterior Forearm Muscles

10. Posterior Forearm muscles

11. Muscles Finger Flexors- Flexor Digitorum Profundus
Flexor Digitorum Superficialis
Finger Extensors-
Extensor Digitorum

12. Muscles of the Hand

13. Flexor Digitorum Profoundus

14. Extensor Digitorum

16. Thumb Muscles ~ Pollicis
Flexor Pollicis Longus (there is a Brevis)
Extensor Pollicis Longus and Brevis
Abductor Pollicis
Adductor Pollicis
Opponens Pollicis

18. Ligaments

19. https://loptonline.com/patient-education/injuries-conditions/hand-anatomy/

20. II. Injuries 1) Carpal Tunnel
Def- very narrow tunnel created by retinaculum/bones- contains tendons, vessels, and nerves: median, radial, ulna
Mech- compression of nerve(median) from excessive use/wrist flexion
Symp-Paresthesia to digits 1-3/palm and, burning, tingling

23. Treatment Tx- rest- avoid activity that causes discomfort,
immobilize, NSAIDS, possible surgery
Corticosteroid shots
TX- surgery- cut retinaculum

25. Immobilizing joint allows the tendons to rest and
reduces inflammation

27. Median nerve

29. 2) Fractures
Scaphoid Navicular- most frequently fx carpal bone- often mistaken for wrist sprain
Mech- Fall on outstretched hand
Symptoms- pain, swelling, pt in anatomical snuff box
TX- immobilization, doesn’t heal if not found right away due to poor blood supply

31. Screw Fixation

32. 2) Fractures cont.
B) Bennett’s FX- fx to base of 1st metacarpal Mech- fall on thumb or direct blow (punch) Symptoms- pain, swelling at base of thumb, limited movement (see next slide) TX- If aligned- cast, if not-surgery with a pin to hold in place

33. If after injuring your hand you have the following
symptoms then you may have this fracture
severe pain in the base of the thumb
swelling over base of the thumb
inability to touch the base of the little finger with the
tip of your thumb
your thumb appears shorter than its counterpart
                                                                                              
You can not do this movement if you have Bennett Fracture

34. Bennett fracture

35. 2) Fractures cont.
C) Boxers FX- fx to base of 5th Mech- punch with closed fist Symptoms- PT, swelling, def, etc. base of 5th TX- cast (or surgery)

37. 3) Finger Injuries Mallet Finger- tear to extensor tendon at DIP joint
Mech- hit on tip of finger
Symp- can’t ext distal phalanx
Tx- splinting (in hyper ext)- ASAP.

40. 3) Finger Injuries Cont.
B) Boutonniere Deformity- tear of Extensor tendon at PIP joint. Finger hyper ext at DIP and flexes at PIP causes “buttonhole” deformity Mech- “jammed” finger Symp- obv deformity TX- Splint ASAP, (possible surgery)

42. 3) Finger Injuries
C) Gamekeeper’s Thumb (also called skiiers thumb)- tear in ulna collateral lig at base of thumb Mech- (Killing game), forceful abduction Symp- p.t., swelling, pain with movement, valgus movement causes pain or increased ROM TX- splint, thumb spica taping, check xray for fx

43. Gamekeeper’s thumb

45. 3) Finger Injuries Cont.
D) Interphalangeal Collateral Ligament- Mech-“jammed finger” tear ulna or radial collateral lig of fingers. Symp- TX- PRICE- splint, buddy tape Check for FX

46. III Assessment Always complete HOP first Special Tests-
1) Carpal Tunnel- Phalen’s Test
2) Scaphoid Fracture – press in Anatomical Snuff Box
3) FX or Ligament Strain??
A) FX- FX symptoms (pt, deformity, bother at night, etc) and FX test
B) pt on joint line, positive valgus/varus test

47. FX Tests: (black AT textbook p. 490)
Percussion
Compression
Distraction
Tuning Fork
** If any doubt- send for Xray
Ligamentous Stress Test (Valgus/Varus test) Looking for pain
and/or movement

48. You Try! Break into groups of TWO
Complete the following Special Tests:
1) Phalen’s Test
2) Fracture test to Second Middle Phalanx
3) Ligamentous Stress Test a)(Valgus/Varus) to Radial Collateral Ligment of Second Middle Phalange
b) valgus/varus to elbow UCL
4) RROM for epicondylitis
5)Rule out FX, so Buddy tape

49. Phase II Phase I Ice bags, Ice bucket, Paraffin wax, Hydrocullator
Increase ROM in elbow, wrist, hand and
fingers

50. Thumb active range of motion: 1) With your palm flat on a table or other surface, move your thumb away from your hand as far you can. Hold this position for 5 seconds and bring it back to the starting position.
2) Rest your hand on the table in a handshake position. Move your thumb out to the side away from your palm as far as possible. Hold for 5 seconds. Return to the starting position.
3) Next, bring your thumb across your palm toward your little finger. Hold this position for 5 seconds. Return to the starting position. Repeat this entire sequence 10 times. Do 3 sets.
Wrist Range of Motion
1) Flexion: Gently bend your wrist forward. Hold for 5 seconds. Do 3 sets of 10.
2)Extension: Gently bend your wrist backward. Hold this position 5 seconds. Do 3 sets of 10.
3) Side to side: Gently move your wrist from side to side (a handshake motion). Hold for 5 seconds at each end. Do 3 sets of 10.

51. Phase 3 Strengthen elbow, wrist, hand, fingers, grip strength
Overload principal
Start with fine motor and go to gross motor

52. Playing jacks

57. Name 5 thumb muscles