1. The Wrist, Hand and Fingers

2. BONES FOREARM Radius – lateral and thumb side
Ulna – medial and pinky side

3. BONES Carpal bones - 8 SCAPHOID LUNATE TRIQUETRAL PISIFORM TRAPEZIUM
In two rows of four
Lots of little joints with ligaments
SCAPHOID
LUNATE
TRIQUETRAL
PISIFORM
TRAPEZIUM
TRAPEZOID
CAPITATE
HAMATE

4. BONES Metacarpals - 5 Phalanges - 14
Three in fingers (proximal, middle, and distal)
Two in thumb (proximal and distal)

5. JOINTS True Wrist Joint
Between the radius and the proximal row of the carpal bones

6. Joints Named for the bones they join Proximal Interphalangeal (PIP)
Flexion and extension
Distal Interphalangeal (DIP)

7. Joints Metacarpal phalangeal (MP)
Flexion, extension, abduction and adduction
Metacarpal phalangeal joint of the thumb (MCP)
Flexion and extension
Carpal metacarpal joint of the thumb (CMC)
Flexion, extension, abduction, adduction, opposition

8. Muscles Extrinsic muscles Intrinsic muscles
Start in the forearm and end in the hand
Extensors and flexors of wrist and fingers
Intrinsic muscles
Start and end in the hand
Abd and add of fingers and thumb

9. Wrist Motions
Flexion
Extension
Ulnar flexion
Radial flexion

10. INJURIES

11. Colles’ Fracture Fracture of the distal radius Cause S/S Care
Falling on outstretched arm forcing hyperextension
S/S
Fracture raises up and is somewhat obvious (silver fork)
Unable to use hand
Significant swelling
Care
Check for feeling and blood supply
Splint and transport to ER

12. Navicular Fracture Most common fracture of the carpal bones
Navicular sits in anatomical snuff box
Cause
Falling on the outstretched arm
S/S
Generalized swelling in the wrist
Tender snuff box
Does not want to radial or ulnar flex
Problem: densest bone in the body, hard to x-ray, slow healing due to poor blood supply
Care
RICE, Splint, and refer for x-ray

13. Wrist Sprain Cause S/S Care Falling on outstretched arm
Hyperextension or hyperflexion of the wrist
S/S
Pain and swelling
Limited range of motion
Care
RICE, refer to MD if pain is severe

14. Ganglion Cyst Cause S/S Care
Sheath that surround the tendon fills with fluid and creates a bump
Usually from repeated hyperextension
S/S
Bump usually on the dorsal (back) side of the hand
Care
If painful, may require surgical removal

15. Carpal Tunnel Syndrome
Tunnel: on palmar side, transverse carpal ligament covers 8 tendons and a nerve
Cause
Repeated wrist flexion
S/S
Tingling/numbness into thumb, index & middle fingers
Weakness with thumb movement
Care
Rest from activity, Anti-inflammatory medication
Can be injected or may need surgery if severe enough

16. Finger injuries Dislocations/Sprains of fingers Cause S/S Care
Collateral ligaments in PIP or DIP
“Jammed finger” = sprain
Cause
Hit to the tip of finger
S/S
Swelling with sprain
Deformity with dislocation
Care
Sprain – RICE, buddy tape
Dislocation – Splint and refer to ER
Do not try to reduce

17. Mallet finger (Basketball Finger)
Tear of tendon that extends DIP
Cause
Tip of the finger is flexed & starting to extend when hit
Pulls off the extensor tendon from phalange
S/S
Cannot extend the DIP
Care
Splint the finger in extension and refer to a specialist

18. Boutinnerre finger Injury at PIP joint Cause S/S Care
Forced flexion while attempting to extend the finger at the same time
S/S
Pain
Obvious deformity
Care
Ice and splint PIP while straight
Needs to be referred to a hand specialist ASAP

19. Gamekeeper’s Thumb (Skier’s Thumb)
Tear of the ulnar/medial collateral ligament of the thumb
Cause
Forced abduction of MCP joint of thumb
Hyperextension of thumb
S/S
Pain over UCL in thumb
Unable to grip or pinch with thumb
May be unstable – feels like it slips out
Care
RICE, Splint, refer to MD

20. Metacarpal fracture (Boxer’s fracture)
Fractures of 3rd, 4th, & 5th metacarpals are common
Cause
Hitting something (like a wall or person) with fist
Fingers get bent back
Stepped on
S/S
When making a fist a knuckle will drop
Finger may turn when making a fist
Pain on bone of hand
Care
RICE, Splint, Refer to MD for x-rays

21. Metacarpal Fracture
A fracture/dislocation of the distal part of the 1st metacarpal (thumb) is a Bennett’s fracture

22. TEST Shoulder, Elbow, Wrist, Hand and Fingers