Wrist and Hand Conditions

1
Wrist and Hand Conditions

• Chapter 13

2
Wrist Articulations

• Radiocarpal Radius with the Scaphoid, Lunate,
  Triquetrum.
• Intercarpal
• Distal Radioulnar
• Triangular Fibro cartilage Complex stabilizes the
  Radioulnar joint.

3
Hand Articulations

• Carpometacarpal (CM)
• Intermetacarpal (IM)
• Metacarpophalangeal (MP)
• Interphalangeal (IP)

4
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

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Metacarpophalangeal Joints

• Rounded distal heads of the metacarpals
  articulate with the concave proximal ends of the
  phalanges
• Reinforced by strong collateral ligaments

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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

7
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.

8
Kinematics

• Flexion
• Extension
• Hyperextension
• Radial deviation
• Ulnar deviation

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Flexion

• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris longus (sometimes absent)
• Flexor digitorum superficialis
• Flexor digitorum profundus

10
Extension and Hyperextension

• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor carpi ulnaris
• Extensor pollicis longus
• Extensor digiti minimi
• Extensor digitorum

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Radial and Ulnar Deviation

• Radial Deviation
• Flexor carpi radialis
• Extensor carpi radialis
• Ulnar Deviation
• Flexor carpi ulnaris
• Extensor carpi ulnaris

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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.

13
Strengthening

• Strengthening should include general elbow
  flexion, extension, pronation, and supination,
  wrist flexion, extension, Radial and Ulnar
  deviation.

14
Contusions and Abrasions

• Thoroughly clean, dress daily, inspect for
  infection daily.
• Ice, compression, elevation for 2 3 days.

15
Sprains

• Wrist sprains
• Gamekeepers Thumb
• Interphalangeal Collateral Ligament Sprains

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Dislocations

• Distal radioulnar joint (DRUJ)
• Lunate dislocation
• MP joint dislocation
• PIP joint dislocation

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Strains

• Jersey Finger
• Mallet Finger
• Boutonniere Deformity

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Tendinopathies

• Trigger Finger
• DeQuervains tenosynovitis
• Intersection Syndrome

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Ganglion Cysts
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Fingertip Injuries

• Subungual hematomas
• Paronychia

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Nerve Entrapment Syndromes

• Median Nerve Entrapment
• Anterior Interosseous Nerve Syndrome
• Carpal Tunnel Syndrome
• Ulnar Nerve Entrapment
• Ulnar tunnel syndrome
• Cyclists palsy
• Bowlers thumb
• Chris Carlin, Dominique Rodriguez

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Radial Nerve Entrapment

• Distal Posterior Interosseous Nerve Syndrome
• Superficial Radial Nerve Entrapment

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Fractures

• Distal Radial and Ulnar fractures
• Monteggias fracture
• Galeazzis fracture
• Colles fracture
• Smiths fracture
• Scaphoid fracture
• Hamate fracture
• Triquetrum fracture
• Kienbocks disease

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Fractures cont.

• Metacarpal fractures
• Boxers fracture
• Bennetts fracture
• Phalangeal fractures