Transcript Wrist and Hand Conditions - College of the Siskiyous

Wrist and Hand Conditions
Chapter 13
Wrist Articulations
Radiocarpal: Radius with the Scaphoid,
Lunate, Triquetrum.
Intercarpal
Distal Radioulnar

Triangular Fibro cartilage Complex
stabilizes the Radioulnar joint.
Hand Articulations
Carpometacarpal (CM)
Intermetacarpal (IM)
Metacarpophalangeal (MP)
Interphalangeal (IP)
Carpometacarpal and
Intermetacarpal Joints
CM of the thumb is a saddle joint
CM of the four fingers gliding joints
IM reinforced by joint capsules
comprised of the dorsal, volar, and two
interosseous CM ligaments
Metacarpophalangeal Joints
Rounded distal heads of the
metacarpals articulate with the concave
proximal ends of the phalanges
Reinforced by strong collateral
ligaments
Interphalangeal Joints
The Proximal (PIP), Distal (DIP), and
the IP joint of the thumb are all hinge
joints
The articular capsule made up of volar
and collateral ligaments surround each
IP joint
Muscles
Retinacula of the Wrist:

The fascial tissue surrounding the wrist thickened
into strong fibrous bands called retinacula that
form protective passageways through which
tendons, nerves, and blood vessels pass.
Tendon Sheaths:

Sealed at both ends containing synovial fluid,
annular pulleys that prevent tendon bowstringing
with flexion.
Kinematics
Flexion
Extension
Hyperextension
Radial deviation
Ulnar deviation
Flexion
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus (sometimes absent)
Flexor digitorum superficialis
Flexor digitorum profundus
Extension and Hyperextension
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor pollicis longus
Extensor digiti minimi
Extensor digitorum
Radial and Ulnar Deviation
Radial Deviation
Flexor carpi radialis
 Extensor carpi radialis

Ulnar Deviation
Flexor carpi ulnaris
 Extensor carpi ulnaris

Kinetics of the Wrist
Extrinsic flexor muscles are twice as
strong as the…
Extrinsic extensor muscles
Flexors used everyday for gripping,
grasping, or pinching movements.
Strengthening
Strengthening should include general
elbow flexion, extension, pronation, and
supination, wrist flexion, extension,
Radial and Ulnar deviation.
Contusions and Abrasions
Thoroughly clean, dress daily, inspect
for infection daily.
Ice, compression, elevation for 2 – 3
days.
Sprains
Wrist sprains
Gamekeeper’s Thumb
Interphalangeal Collateral Ligament
Sprains
Dislocations
Distal radioulnar joint (DRUJ)
Lunate dislocation
MP joint dislocation
PIP joint dislocation
Strains
Jersey Finger
Mallet Finger
Boutonniere Deformity
Tendinopathies
Trigger Finger
DeQuervain’s tenosynovitis
Intersection Syndrome
Ganglion Cysts
Fingertip Injuries
Subungual hematomas
Paronychia
Nerve Entrapment Syndromes
Median Nerve Entrapment
Anterior Interosseous Nerve Syndrome
 Carpal Tunnel Syndrome

Ulnar Nerve Entrapment
Ulnar tunnel syndrome
 Cyclist’s palsy
 Bowler’s thumb

Chris Carlin, Dominique Rodriguez
Radial Nerve Entrapment
Distal Posterior Interosseous Nerve
Syndrome
Superficial Radial Nerve Entrapment
Fractures
Distal Radial and Ulnar fractures




Monteggia’s fracture
Galeazzi’s fracture
Colle’s fracture
Smith’s fracture
Scaphoid fracture
Hamate fracture
Triquetrum fracture
Kienbock’s disease
Fractures cont.
Metacarpal fractures

Boxer’s fracture
Bennett’s fracture
Phalangeal fractures