wrist/hand anatomy carpals-8 scaphoid trapezium trapezoid capitate hamate pisiform triquetral...
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Wrist/Hand Anatomy
Carpals-8 Scaphoid Trapezium Trapezoid Capitate Hamate Pisiform Triquetral Lunate www.eatonhand.com
http://www.gwc.maricopa.edu/class/bio201/hand/anhand.htm
Metacarpals-5 Phalanges - 5
1-5 1=Thumb 5=Pinky
Wrist/Hand Anatomy (2)
Radiocarpal joints (beween wrist and hand) Metacarpal joints Metacarpalphalangeal Joints Phalangeal joints-PIP and DIP
Normal resting position Proximal, Middle, Distal phalanx
Blood Supply -______________________ Nerve supply
Radial Medial Ulnar
Colles Fracture
______________________________________ HOPS:
______________________________________ extreme pain __________________________________ numbness along the median nerve distribution,
extreme pain Treatment: splint, refer http://orthopedics.about.com/library/xray/blxray-
fxapcolles.htm
http://sfghed.ucsf.edu/ClinicImages/Colle's fracture.jpg
http://www.eatonhand.com/hw/colles1.gif
Carpal tunnel syndrome (1)
Carpal tunnel is located in the anterior of the wrist.
____________________, their synovial sheaths and the median nerve lie in the tunnel
_____________________________________________________________
http://www.mayo.edu/mcj/hand/carpal.jpg
Carpal Tunnel (2)
Overuse condition caused by repeated wrist flexion, ulnar deviation
HOPS numbness, tingling, median nerve area muscle atrophy (in advanced cases) decreased RROM in thumb movement + Phalen’s test, pn w/ compression of carpal tunnel + Tinel Sign
Tx: rest, wrist splint, anti-inflammatory medication, if severe, surgery
http://www.ccohs.ca/images/office15.gif
Scaphoid Fracture (1)
________________________________ Lies beneath the “anatomical snuff box” Does not have a good blood supply –
often does not heal – “non-union”
http://www.hughston.com/hha/b.wrstfx
Scaphoid Fracture (2)
HOPS fall on the outstretched handsome swellingpain in anatomic snuff box
Tx: refer to physician, immobilization x 6 weeks, protection against impact for 3 months
Mallet finger
“Baseball”, “basketball” finger ______________________________________
____________________________ HOPS:
MOI: blow to tip of finger, pain over the DIP joint bent DIP joint (about 30 degrees) inability to extend the DIP joint
TX: refer, splint in extension 6 – 8 weeks
Mallet Finger
http://www.utahmountainbiking.com/firstaid/pics/fing-mal.jpg
www.eatonhand.com
Boutonneire Deformity
____________________________________________________________
HOPS: forced flexion of the interphalangeal joint swelling, flexion deformity of PIP joint point tenderness over middle phalanx (dorsal side) ____________________________
Tx: refer, splint in extension
Boutonneire Deformity
www.eatonhand.com
Jersey Finger
_________________________________________________________________
________________________________ HOPS:
MOI: rapid ext. of the finger while actively flexed Swelling point tenderness over DIP joint ____________________________
Tx: Refer to physician
Jersey Finger
http://www.handlibrary.org/images/jnslide5-s.jpg
Gamekeeper’s thumb
Sprain of ulnar collateral ligament in thumb MOI: ________________________________
___________________ HOPS:
Swelling over palmar aspect Instabilty in the joint Laxity in thumb flexion
Tx: refer to physician, tape, rest, surgery
http://www.weissortho.com/images/body_parts/skiers_thumb.jpg
Boxer’s Fracture
Fracture to the 4th and/or 5th metacarpal(s). MOI - caused by punching something harder
than the hand, such as a wall or another person's head. The end of the metacarpal bone takes the brunt of the impact, which usually breaks through the narrowest area near the end (the "neck"), and bends down toward the palm.
http://www.eatonhand.com/hw/hw005.htm
http://ranney.com/~mjr/Image_Library/20020516/05160005.JPG
Boxer’s Fracture – (2)
HOPS- _________________________ ____________________________ Swelling/Discoloration in areaDeformityPain Pt tender at location of fracture___________________________________
Treatment- Splint, refer for x-rays, possible surgery
ROM/Strength Testing
Wrist Flexion-Palmaris Longus Wrist Extension-Extensor Digitorum Wrist Radial Deviation-Flexor/Extensor Carpi
Radialis Wrist Ulna Deviation-Flexor/Extensor Carpi Ulnaris Finger Flexion/Extension-Flexor Digitorum/
Extensor Digitorum Finger Abduction/Adduction Opposition
Test Valgus Stress Test - Ulna Collateral
Ligament - +sign laxity Varus Stress Test - Radial Collateral
Ligament - +sign laxity Phalen’s- Median Nerve - +sign
numbness/tingling Tinel’s – Ulna and Median Nerve - +sign
numbness/tingling Fracture Testing- Compression, Distraction,
Flick