1. Wrist and Hand
Wrist is the most complex joints of the body due to the numerous joints combined to create one.

2. Wrist and Hand Anatomy
Carpal bones- Create a Mnemonic for them. S-L-T-P-T-T-C-H

3. Wrist and Hand Anatomy Two rows of bones starting on the thumb side.
Scaphoid, lunate, triquetrum, pisiform

4. Palpate the Scaphoid
You would palpate the scaphoid in the anatomical snuff box.

5. Wrist and Hand Anatomy Second row of carpals bones, is more proximal
Trapezium, trapezoid, capitate, Hamate.

6. Wrist and Hand Anatomy
Medial and Lateral epicondyle are where many of the wrist and hand muscles originate.

7. Wrist and Hand Anatomy
Styloid process- projection at distal end of radius and ulna where the collateral ligaments attach.

8. Wrist and Hand Joints
Radiocarpal Joint- distal end of the radius and scaphoid, lunate, and triquetrum. There is a radioulnar disk in between the radius and other bones. It is a condyloid joint.

9. Wrist and Hand Joints
Midcarpal joint- between the two rows of carpal bones. Plane joints that allow gliding motion, but assist with wrist motions.

10. Wrist and Hand Joints
Carpometacarpal joint- between the distal row of carpal bones and proximal end of the metacarpal bones. Provide more stability than mobility.

11. Ligaments of hand
Palmar radiocarpal ligament-broad band attaches anterior surface of distal radius and ulna to anterior surface of the proximal carpal bones and the capitate. Limits wrist extension. So repeated falls in extension would injur it.

12. Wrist and Hand Injuries
Fractures of the Wrist and Hand
Finger Fractures
Boxer’s Fracture- fracture of 5th metacarpal. Hitting something with fisted hand.

13. Wrist and Hand Injuries
Fractures of the Wrist and Hand
Finger Fractures
Scaphoid Fracture- fracture of scaphoid which you call palpate in anatomical snuffbox. Occurs with fall on hand in extension.

14. Wrist and Hand Injuries
Wrist Fractures
Colles’s fracture- fracture of the radius just above the wrist. A result of a fall with wrist extended.

15. Tendon Injuries
Mallet Finger- hitting something with the tip of a finger and causing the extensor tendon to tear.
Jersey Finger- grabbing something and tearing the flexor tendon.

16. Tendon Injuries Boutonniere deformity-
extensor tendon injury affecting
two joints of the finger. It is
an injury to the central tendon
on top of the finger.
It may appear as a “jammed finger” that cannot be extended from the PIP joint.
Treatment should be in an extended position so the tendon can heal.

17. Dislocations/Subluxations
Dislocations occur in the fingers and wrist bones.
Point tenderness and swelling, possible deformity.
Physician
intervention
may be
necessary.

18. Wrist and Hand Muscles
Extensor Carpi Ulnaris- superficial muscle that arises from the common extensor tendon on the lateral epicondyle. It runs the medial side of the posterior arm and attaches to the fifth metcarpal. What does it do?

19. Wrist and Hand Muscles
Flexor carpi radialis- superficial muscle running from the medial epicondyle diagonaly across the anterior forearm to attach to lateral base of second and third metacarpal. What is the motions?

20. Wrist and Hand Muscles
Palmaris Longus- superficial muscle running down the anterior surface of the forearm from common flexor attachment of medial epicondyle to the midline of the palmar fascia.
Missing in 21%
of people.
Flexor

21. Wrist and Hand Muscles
Flexor Digitorum superficialis- deep to the wrist flexors and palmaris longus muscle. Starts at the common flexor tendon of medial epicondyle and coranoid process, inserts to the sides of digits 2-5.

22. Wrist and Hand Muscles
Abductor pollicis brevis- proximal attachment is the scaphoid, trapezium and inserts to the base of the proximal phalange of the thumb.

23. Hand Grips
Grasps
Power grip is when an object needs to be held forcefully and then moved by more proximal muscles.
Precision Grip is when an object is manipulated with fingers

24. Hand Grips
Power grips
Cylindrical grip is fingers flexed around an object. Thumb on one side fingers on other, like gripping a hammer or racquet.
Spherical grip is fingers and thumb are together around an
object. Like grabbing
an apple or doorknob.

25. Hand Grips
Power Grip
Hook grip involves the second through fifth fingers flexed around an object in a hooklike manner. Thumb is extended and not involved at all. Only possible grip for
someone with no thumb or
median nerve ability.

26. Hand Grips Precision Grips- Pad to pad
Pinch grip is the thumb and one finger gripping
Three jaw chuck is holding a pencil, three fingers and thumb.

27. Hand Grips Precision Grips Tip to Tip grip
Pincer grip is tip of thumb against tip of a finger, like to pick up a coin. Difficult with long fingernails

28. Hand Grips Precision Grips
Lumbrical grip or plate grip has the MCP and PIP joint flexed and the DIP extended. The thumb opposes and this grip is used to hold something horizontal like a plate. Lumbricals is used they flex the MCP joint.

29. Wrist Strengthening Flexion Extension Ulnar Deviation Radial Deviation
Pronation
Supination