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
Metacarpals-5 Phalanges - 5
1-5 1=Thumb 5=Pinky
Wrist/Hand Anatomy (2) Radiocarpal joints (between wrist and hand) Metacarpal joints Metacarpalphalangeal Joints Phalangeal joints-PIP and DIP
Normal resting position Proximal, Middle, Distal phalanx
Nerve supply Radial Medial Ulnar
Colles Fracture Most common type of forearm fracture HOPS:
fall on outstretched hand with extreme hyperextension, extreme pain obvious deformity, excessive swelling numbness along the median nerve distribution, extreme
pain Treatment: splint, refer http://orthopedics.about.com/library/xray/blxray-
fxapcolles.htm
Carpal tunnel syndrome (1) Carpal tunnel is located in the anterior of the
wrist. 8 finger flexor tendons, their synovial sheaths
and the median nerve lie in the tunnel Results from an inflammation of synovial
sheaths
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
Scaphoid Fracture (1) Most frequently fractured carpal bone Lies beneath the “anatomical snuff box” Does not have a good blood supply – often
does not heal – “non-union”
Scaphoid Fracture (2) HOPS
fall on the outstretched hand some swelling pain in anatomic snuff box
Tx: refer to physician, immobilization x 6 weeks, protection against impact for 3 months
Mallet finger “Baseball”, “basketball” finger Avulsion of the extensor tendon, to the Distal
phalange 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
Boutonneire Deformity Rupture of the extensor tendon dorsal to middle
phalanx HOPS:
forced flexion of the interphalangeal joint swelling, flexion deformity of PIP joint point tenderness over middle phalanx (dorsal side) inability to extend finger
Tx: refer, splint in extension
Jersey Finger Rupture of flexor digitorum profundus tendon at
insertion on distal phalanx Most often occurs in ring finger HOPS:
MOI: rapid ext. of the finger while actively flexed Swelling point tenderness over DIP joint inability to flex DIP joint
Tx: Refer to physician
Gamekeeper’s thumb Sprain of ulnar collateral ligament in thumb MOI: forcefull abduction of thumb while thumb is
extended HOPS:
Swelling over palmar aspect Instabilty in the joint Laxity in thumb flexion
Tx: refer to physician, tape, rest, surgery
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.
Boxer’s Fracture – (2) HOPS- Striking an immovable object-
wall, floor, etc Swelling/Discoloration in area Deformity Pain Pt tender at location of fracture MCP joint deformity – shorter, at an angle
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
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