Transcript The Wrist, Hand and Fingers

The Wrist, Hand and
Fingers
BONES

FOREARM
• Radius – lateral
and thumb side
• Ulna – medial
and pinky side
BONES

Carpal bones - 8
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• In two rows of four
• Lots of little joints with ligaments
SCAPHOID
LUNATE
TRIQUETRAL
PISIFORM
TRAPEZIUM
TRAPEZOID
CAPITATE
HAMATE
BONES
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Metacarpals - 5
Phalanges - 14
• Three in fingers (proximal, middle,
and distal)
• Two in thumb (proximal and distal)
JOINTS

True Wrist
Joint
• Between the
radius and the
proximal row
of the carpal
bones
Joints

Named for the
bones they join
• Proximal
Interphalangeal
(PIP)
• Flexion and extension
• Distal
Interphalangeal
(DIP)
• Flexion and extension
Joints
• Metacarpal phalangeal (MP)
• Flexion, extension, abduction and
adduction
• Metacarpal phalangeal joint of the
thumb (MCP)
• Flexion and extension
• Carpal metacarpal joint of the
thumb (CMC)
• Flexion, extension, abduction,
adduction, opposition
Muscles

Extrinsic muscles
• Start in the forearm and end in the
hand
• Extensors and flexors of wrist and
fingers
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Intrinsic muscles
• Start and end in the hand
• Abd and add of fingers and thumb
Wrist Motions
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Flexion
Extension
Ulnar flexion
Radial flexion
INJURIES
Colles’ Fracture
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Fracture of the distal radius
Cause
• Falling on outstretched arm forcing hyperextension

S/S
• Fracture raises up and is somewhat obvious (silver fork)
• Unable to use hand
• Significant swelling

Care
• Check for feeling and blood supply
• Splint and transport to ER
Navicular Fracture

Most common fracture of the carpal bones
Navicular sits in anatomical snuff box
Cause
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S/S
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• Falling on the outstretched arm
• Generalized swelling in the wrist
• Tender snuff box
• Does not want to radial or ulnar flex
Problem: densest bone in the body, hard to xray, slow healing due to poor blood supply
Care
• RICE, Splint, and refer for x-ray
Wrist Sprain

Cause
• Falling on outstretched arm
• Hyperextension or hyperflexion of the wrist

S/S
• Pain and swelling
• Limited range of motion

Care
• RICE, refer to MD if pain is severe
Ganglion Cyst
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Cause
• Sheath that surround the tendon fills with
fluid and creates a bump
• Usually from repeated hyperextension

S/S
• Bump usually on the dorsal (back) side of the
hand

Care
• If painful, may require surgical removal
Carpal Tunnel Syndrome
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Tunnel: on palmar side, transverse carpal
ligament covers 8 tendons and a nerve
Cause
• Repeated wrist flexion

S/S
• Tingling/numbness into thumb, index & middle fingers
• Weakness with thumb movement

Care
• Rest from activity, Anti-inflammatory medication
• Can be injected or may need surgery if severe enough
Finger injuries

Dislocations/Sprains of fingers
• Collateral ligaments in PIP or DIP
• “Jammed finger” = sprain

Cause
• Hit to the tip of finger
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S/S
• Swelling with sprain
• Deformity with dislocation
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Care
• Sprain – RICE, buddy tape
• Dislocation – Splint and refer to ER
• Do not try to reduce
Mallet finger
(Basketball Finger)
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Tear of tendon that extends DIP
Cause
• Tip of the finger is flexed & starting to extend when hit
• Pulls off the extensor tendon from phalange
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S/S
• Cannot extend the DIP
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Care
• Splint the finger in extension and refer to a specialist
Boutinnerre finger
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Injury at PIP joint
Cause
• Forced flexion while attempting to extend the finger at
the same time
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S/S
• Pain
• Obvious deformity
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Care
• Ice and splint PIP while straight
• Needs to be referred to a hand specialist ASAP
Gamekeeper’s Thumb
(Skier’s Thumb)
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Tear of the ulnar/medial collateral ligament of
the thumb
Cause
• Forced abduction of MCP joint of thumb
• Hyperextension of thumb
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S/S
• Pain over UCL in thumb
• Unable to grip or pinch with thumb
• May be unstable – feels like it slips out
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Care
• RICE, Splint, refer to MD
Metacarpal fracture
(Boxer’s fracture)
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Fractures of 3rd, 4th, & 5th metacarpals are common
Cause
• Hitting something (like a wall or person) with fist
• Fingers get bent back
• Stepped on

S/S
• When making a fist a knuckle will drop
• Finger may turn when making a fist
• Pain on bone of hand
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Care
• RICE, Splint, Refer to MD for x-rays
Metacarpal Fracture

A fracture/dislocation of the
distal part of the 1st metacarpal
(thumb) is a Bennett’s fracture
TEST
Shoulder, Elbow, Wrist,
Hand and Fingers