The Forearm, Wrist, Hand, and Fingers
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Transcript The Forearm, Wrist, Hand, and Fingers
The Forearm, Wrist, Hand,
and Fingers
Chapter 24
Forearm Anatomy
Radius and Ulna: Elbow
Joints: radioulnar joint (superior, middle,
and distal)
Bone: proximal radial head, olecranon process,
radial shaft, ulnar shaft, distal radius, radial
styloid process, ulnar head, ulnar styloid
Musculature: flexors& pronators (lie anteriorly.
ulnar side), extensors & supinators (lie
posteriorly, medial side)
Nerve/Blood Supply: median and radial nerve
and brachial, radial, and ulnar artery
Forearm Assessment
History
Observation
Visually inspect, including wrsit and elbow
If no deformity present, observe while they
supinate and pronate
Palpation
Special Tests
Management of Forearm
Injuries
Contusion
Etiology:direct blow
Why more common to ulna?
Signs and Symptoms
Management
Forearm Splints
Etiology: repeated severe static contraction
Signs and Symptoms:dull ache between extensors,
interosseous membrane
Management: early season vs late in season?
Note: Acute / Chronic exertional compartment
syndrome: deep compartment most common and
associated with avulsions, distal radius fracture, or
crushing injuries; management same as in lower leg
Colles’ fracture
Etiology: FOA, forces radius and ulna back and up =
hyperextension
Signs and Symptoms (posterior displacement)
Management
Reverse Colles’ = fall on back of hand
Forearm Fractures
Etiology
Signs and Symptoms: more common for radius and ulna
to fracture simultaneously
Management
Wrist, Hand, and Finger
Anatomy
Bones: carpals and metacarpals
Joints: radiocarpal, carpal, metacarpal, and
phalangeal joints
Ligaments: “many at each joint in the hand”
TFCC (triangular fibrocartilage complex); b/t head of
ulna and triquetrial bone
Musculature: “many intrinsic and extrinsic
muscles”
Blood and Nerve Supply: ulnar, median, radial
nerve and radial and ulnar superficial and deep
palmar arch arteries.
Assessment of Wrist,
Hand, and Finger Injuries
History
Observation
Palpation
Special Tests: Finklestein’s test, Tinel’s
Sign, Phalen’s test, valgus and varus
stress test,
Circulatory and Neurological Evaluation
Allen test
Functional Evaluation
Special Tests
Finklesteins’ Test
De Quervains (tenosynovitis)
Thumb tucked inside fist with ulnar deviation
Tinel’s Sign
Tap over transverse carpal ligament
Pain numbness and tingling indicates median nerve disruption and
presence of carpal tunnel
Phalen’s Test
Carpal tunnel
Bilateral wrist flexion and press them together; pain is positive sign
Valgus/varus at wrist, MCP, and IP joints
Circulatory / neurological evaluations
Allen's test: test function of radial and ulnar arteries
Athlete makes fist 4-5 times; while holding final fist, evaluator pinches
off both arteries; hand should be blanched
Release arties individually
Recognition and Management
of Wrist, Hand, and Finger
Injuries
Wrist Sprain
Etiology
Signs and Symptoms
Management
Triangular Fibrocartilage Complex Injury
Etiology:forced hyperextension or
compression of radioulnar joint and proximal
row of carpals
Signs and Symptoms
Management
Tenosynovitis
Etiology: repeated wrist acceleration and
deceleration
Signs and Symptoms: pain w/ passive stretching
Management: may need splinting and
strengthening
Tendinitis
Etiology: repetitive pulling motions and pressure
on palm of hand
Signs and Symptoms:pain with AROM and passive
stretching
Management
Nerve Compression, Entrapment, Palsy
Etiology: median (carpal tunnel) and ulnar
(pisiform and hamate)
Signs and Symptoms:deformities(bishop’s, claw
and drop wrist)
Management: if chronic, may require surgical
Carpal Tunnel Syndrome
Tunnel = pink
Bones = white
Ligament = blue
Carpal tunnel syndrome
Etiology: repeated
flexion
Signs and Symptoms:
sensory and motor
impairment
Management
Recognition and Management
of Wrist, Hand, and Finger
Injuries
Dislocation of the Lunate
Bone
Etiology:forced
hyperextension of wrist
Signs and
Symptoms:difficulty
with wrist and finger
flexion; may have
impaired nerves
Management: referral
for reduction
Hamate Fracture
Etiology: contact while
holding
something(racket)
Signs and Symptoms
Management
Wrist Ganglion(synovial
cyst)
Etiology:herniation of
joint capsule or tendon
Signs and Symptoms
Management
De Quervain’s Disease
Etiology:
tenosynovitis of
thumb
Signs and
Symptoms
Management
Scaphoid Fracture
Etiology: compression of scaphoid
b/t radius and ulna
Concerns: portion of scaphoid has
decreased vascular supply; improper
healing can occur and result in aseptic
necrosis of the scaphoid bone
Signs and Symptoms
Anatomical snuffbox pain
Management
Finger anatomy
Bones
Ligaments
PIP and DIP have the same
design
Collateral ligaments,
palmar fibrocartilage, and
loose posterior capsule or
synovial membrane
(protected by extensor
expansion)
Finger anatomy
Musculature
PIP: Flex. Digitorium Superficialis
DIP: Flex. Digitorium Profundus
PIP & DIP: Exten. Digitorium Longus (becomes
extensor expansion after MCP)
Intrinsics:
Dorsal and palmar interosseei:
Lumbricals:volar surface; MCP flex., IP exten.
Thenar (4 that act on thumb) & hypothenar (4
that act on 5th)
Recognition and Management of
Wrist, Hand, and Finger Injuries
Contusion to hand and fingers
Etiology
Signs and Symptoms: fingernail?
Management
Bowler’s Thumb
Etiology: fibrosis of the ulnar digital nerve
form pressure
Signs and Symptoms:pain, numbness, tingling
Management: pad area, decrease activity;
surgery PRN
Jersey finger
Etiology:FDP rupture, grabbing jersey
Signs and Symptoms:DIP cannot flex
Management:SURGERY
Trigger finger or thumb
Etiology: stenosing tendon by repeated
movements
Signs and Symptoms: resistance to reextension after thumb and finger flexed
Management:possible injections; splinting
Dupuytren’s Contracture
Etiology: idiopathic development of nodules in
palmer aponeurosis
Signs and Symptoms:flexion deformity; cannot
extend
Management: surgical removal
Boutonniere deformity
Etiology:rupture of
extensor tendon
dorsal to middle
phalanx; trauma to tip
of finger causes DIP
extension and PIP
flexion
Signs and Symptoms:
cannot extend
Management:splint
PIP in extension 58wks.
Swan neck deformity
AKA
Pseudoboutonniere
Etiology:severe
hyperextension;
injury to volar plate
Signs and
Symptoms:
hyperextension of
PIP
Management:
splint 20-30
degrees flexion 3
wks
Mallet Finger
Etiology: strike to tip of
finger, jamming and
avulsing extensor
tendon
Signs and Symptoms:
unable to extend, may
palpate avulsed bone
Management:extension
splint 6-8 wks
Gamekeepers Thumb
Etiology:UCL of
thumb; forced
abductions, an
hyperextension
Signs and
Symptoms:inability
to pinch; pain with
stress
Management:splint
3 weeks; protect
with activity
Recognition and Management of
Wrist, Hand, and Finger Injuries
Sprains, Dislocations, and
Fractures
Etiology
Signs and Symptoms
Management
Sprains PIP and DIP joint
Etiology
Signs and Symptoms
Management
PIP Doral Dislocation
Etiology:twist while
semiflexed
Signs and Symptoms
Management:splint in
ext
PIP Dorsal dislocation
Etiology:hyperext.
Signs and
symptoms:deformity;
inability to move
Management:reduce
and splint 20-30
degrees flex
Recognition and Management of Wrist,
Hand, and Finger Injuries
MCP dislocation
Etiology:twist an shear force
Signs and Symptoms:prox. Phalanx dorsal 60-90
degrees
Management: reduce; splint; early ROM
Metacarpal fracture
Etiology:compressive axial force
Signs and Symptoms:appear angular or rotated
Management: reduce and splint
Bennett’s Fracture
Etiology:thumb CMC; axial and ABD force to thumb
Signs and Symptoms:base of thumb painful
Management:refer to surgeon due to unstable
nature
Distal/Middle/Proximal phalangeal fracture
Etiology:crushing force; direct trauma or twist
Signs and Symptoms: subungual hematoma subungual
hematoma
Management:drain and splint / buddy tape; control pain
Fingernail deformity
Occur for variety of reasons:
Scaling or ridging – psoriasis
Ridging or poor development – hyperthyroidism
Clubbing and cyanosis-chronic respiratory disease or heart disorder
Spooning or depression- chronic alcoholism and vitamin
deficiencies
Rehabilitation Principles for
the Forearm, Wrist, Hand, and
Fingers
General Body Conditioning
Joint Mobilization:traction and mobilization help
restore ROM
Flexibility: full ROM is measure of good rehab
Strength:equal
Neuromuscular Control:great dexterity required
Return to Activity: Goals: full dexterity, full
ROM, full strength