Hand and Hand and WristWrist

Mrs. MarrMrs. Marr

Anterior View

Clavicle

HumerusSc apula

UlnaRadius

MedialEpic ondy le ofHumerus

LateralEpic ondy le of

Humerus

Metac arpalsCarpals

Proximal Phalanges

Middle PhalangesD istal Phalanges

Ac romionProc ess

Corac oidProc ess

AC J t.

SC J t.GH J t.

Upper Extremity

•Shoulder

•Gleniod Humeral joint

•Humerus

•Gleniod Fossa

•Scapula (Shoulder Blade)

•Clavicle (Collarbone)

•Upper Arm

•Humerus

•Forearm

•Radius (Thumb side)

•Ulna (Pinky side)

•Wrist

•Carpals!

•Hand and Fingers

Thumb Side vs. 5Thumb Side vs. 5thth PhalangePhalange

RADIUSRADIUS

UULNALNA

Anterior V iew

Bic epsBrac hii

ThenarMusc les

Hy pothenarMusc les

Brac hioradialis

PronatorTeres

Flex. CarpiRadialis

PalmarisLongus

Flexor CarpiUlnaris

Extensors

Retinac ulum/Aponeurosis

Corac obrac hialis

Tric eps

Brac hialis

Tric eps

Poster ior V iew

Medial:Flex ors

W rist~ F lex. C a rp i R ad ia lis

Pa lmaris Longus F lex. C a rp i U lna r is

D ig its~ F lex. D ig ito rum

S uperf ic ia lis & P rodundusT hum b ~

F lex. P ollic is Longus

Lateral:Ex tens ors

W rist~Ext.C a rp i R ad ia lis

Longus & Brevis Ext. C a rp i U lna r is D ig its~ Ext. D ig ito r ium Ext. D ig iti M in imi Ext. Ind ic isT humb~ Ext. Po llic is Longus&

BrevisAbd . Po llic is Longus

Olec ranon

Anc oneus

Anatomic alSnuffbox

Brac hioradialis

Articular cartilageArticular cartilage

RadiusUlna

8 Carpal Bones: Scaphoid (Navicular), Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate5 Metacarpal Bones14 Phalanges

Navicular

Lunate

Triquetrum

Pisiform

Trapezium

Trapezoid

Capitate Hamate

Head(Knuckles)

ProximalPhalanx

MiddlePhalanx

DistalPhalanx

Metacarpo-phalangeal

(MP)Jt

Radialcarpal(wrist) Jt

Metacarpals

Phalanges

Interphalangeal(IP) joint

Base

• Navicular Never Scaphoid

• Lunate Lower• Triquetrum Tilley's• Pisiform Pants

• Trapezium Trouble• Trapezoid Times• Capitate Can• Hamate Happen

Muscular Hand Anatomy

Finger Mechanism

EXTENSOR (FINGER) TENDON INJURY

Wrist Motion

MOTIONS

Boxer’s FractureBoxer’s Fracture

Skier’s Thumb (Gamekeeper’s)

• Acute instability of the Ulnar collateral ligament (UCL)

• The most common soft tissue injury of the thumb Metacarpophalangeal (MP) joint is UCL sprain

Mallet Finger (Dropped Finger)• Mallet finger refers to a condition in

which the end joint of a finger bends but will not straighten by itself.  – Caused by sudden flexion of the distal

interphalangeal (DIP) joint while the finger is in an extended position

– Often occurs from a blow to the tip of an extended finger

• In this situation, the joint can be pushed straight but will not hold that position on its own. – Traumatic avulsion of the DIP extensor

tendon of the finger – Most common extensor tendon injury

• Sometimes called baseball finger or drop finger – Tendon may be stretched, completely

torn, or associated with a bony avulsion

Boutonniere Deformity (Buttonhole)

• The boutonniere deformity refers to a finger which is bent in a particular way: bent down at the middle joint and bent back at the end joint

• When the finger is hit or bent forcefully in just the wrong way, the sheet on the top of the finger (the central slip of tendon) tears away from its attachment to the top of the middle finger bone.

Jersey Finger (FDP TENDON AVULSION)

• Traumatic avulsion of the flexor Digitorum profundis (FDP) tendon

• The ring finger is most commonly affected– DIP hyperextension

(i.e. “jammed finger”) • Similar to Mallet finger

injury – outcome dependant on whether flexion or hyperextension injury occurred

• Most commonly occurs in football when grabbing the jersey of an opponent who is pulling away

Bennett's FractureA Bennett's

Fracture is a fracture + dislocation of the Metacarpal bone at the base of the thumb.

UlnarNerve

RadialNerve

MedianNerve

Nerve Root Scheme

Carpal Tunnel

DE QUERVAINS SYNDROME

• A common condition of inflammation around the tendons on the thumb side of the wrist.

Ligamentous Laxity Ligamentous Laxity

Now for the

Injuries....

Forearm (Radius) Forearm (Radius) fracturefracture

Ulnar Ulnar FractureFracture

Colles FractureColles Fracture

Colles fracture

Metacarpal Fracture

Metacarpal Fractures

Scaphoid (Navicular) Fracture

Hook of the Hook of the Hamate FractureHamate Fracture

Finger Amputation(Complete avulsion)

Re- attachmentRe- attachment

Finger Avulsion (Justin)

Hand Laceration (Rachel's)

The Test may look like this....

33 32

30

29

36

37

2728

25

39

40

21

38

34

______26______

_________24_____

22

23

35

31

Anterior View

C

K

F

HI

GJ

A

E

B

DL

___

bone

sid

e

An te rio r Vie w Po ste r io r Vie w

_ __

_ __

_ __

_ __

_ ___ __

_ __

___

bone

sid

e

__B ones_ _Bon e s

_ _

_ _

_ _ _ _

_ _Jt

_ _Jt_ _Jt

_ _ _ _

_ _

_ _

__

_ _

_ __ _

__

_ _

_ _

_ ___ _

_ _

_ __

_ __

1. Scapula2. Humerus3. Clavicle4. Acromion5. Coracoid6. Radius7. Ulna8. Carpals9. Metacarpals10. Phalanges11. Spine of Scapula12. SC Joint13. AC Joint14. GH Joint15. MP Joint16. PIP Joint17. DIP Joint18. Medial Epicondyle19. Lateral Epicondyle20. Olecranon21. Radial Head22. Biceps Brachii23. Triceps Brachii24. Brachialis25. Brachioradialis26. Coracobrachialis27. Extensor Muscle Mass

25. Ext. Carpi Radialis26. Ext. Digitorim27. Ext. Pollicis

Longus/Brevis28. Flexor Muscle Mass

29. Flex. Carpi Ulnaris30. Flex. Carpi Radialis31. Palmaris

32. Ulnar Collateral Lig.33. Radial Collateral Lig.34. Anatomical Snuff Box35. Thenar Muscles36. Hypothenar Muscles

Anterior V iewA

ED

F

B

C

G

N

Posterior V iewH

K

I

J

L

QUESTIONS / COMMENTS?QUESTIONS / COMMENTS?

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