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The Wrist, Hand, Fingers

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... disk exists between the ulna and the associated carpal bones ... Carpal Tunnel. Floor formed by carpal bones. Roof formed by transverse carpal ligament ... – PowerPoint PPT presentation

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Title: The Wrist, Hand, Fingers


1
Chapter 15
  • The Wrist, Hand, Fingers

2
Carpals
  • Distal Row (Fig 15-2, pg 519)
  • Trapezium, Trapezoid, Capitate, Hamate
  • Proximal Row
  • Scaphoid( navicular), Lunate, Triquetrum,
    Pisiform
  • Special Function
  • Pisiform floats on triquetrum and acts as
    sesamoid for flexor carpi ulnaris
  • Commonalities
  • Scaphoid is most commonly fractured
  • Lunate most commonly dislocated

3
Distal Radioulnar Articulation
  • Allows for pronation and supination
  • Requires both proximal and distal RU joints
    working in unison

4
Radiocarpal Joint
  • Formed by distal radius, scaphoid and lunate
  • Allows for flexion, extension, radial/ulnar
    deviation.
  • Supported by radial collateral lig preventing
    ulnar deviation
  • Also becomes taut in extreme flexion/extension

5
Palmar (volar) radiocarpal ligament
  • Formed by radiocapitate lig, radiotriquetral lig,
    and radioscaphoid lig
  • Fig 15-3, pg 521
  • Limits wrist hyperextension

6
Dorsal Radiocarpal Ligament
  • Attaches to lunate and triquetrum and limits
    hyperflexion

7
Ulnar-carpal joint
  • No true joint due to lack of bony contact between
    ulna and carpal bones
  • Fibrocartilaginous disk exists between the ulna
    and the associated carpal bones

8
Ulnar collateral ligament
  • Runs from the ulna to the trequitrum (dorsally)
    and the pisiform (palmerly)
  • Checks radial deviation
  • Becomes taut during end ranges for flexion and
    extension

9
Carpometacarpal Joint
  • Trapezoid MC I
  • Trapezium MC II
  • Capitate MC III
  • Hamate MC IV and V
  • CMC I saddle joint with flex/ext, abd/add,
    opposition/reposition
  • CMC II IV flex/ext only
  • CMC V flex/ext, abd/add

10
MCP Joint
  • Palmar surface contains palmar ligament (volar
    plate)

11
Carpal Tunnel
  • Floor formed by carpal bones
  • Roof formed by transverse carpal ligament
  • Flexor digitorum superficialis
  • Flexor digitorum profundus
  • Flexor pollicus longus
  • Median nerve
  • 2nd 4th fingers are affected with decreased
    grip strength and paresthesia being present

12
History
  • Pain Fig 15-9, pg 528
  • Duration
  • Scaphoid fx
  • General Medical
  • Raynauds phenomenon

13
Inspection
  • Posturing Box 15-1, pg 531
  • Acute pathologies Box 15-2, pg 534
  • Palmar creases
  • May denote swelling
  • Cuts or scars
  • Russells sign callus formation from hitting
    teeth during purging
  • Ganglion cyst Fig 15-11, pg 532
  • Subungual hematoma
  • Paronychia
  • Felon
  • Tinea unguium

14
Palpation
  • Several figures in book are important
  • Figure 15-17, pg 535
  • Table 15-3, pg 537

15
Range of Motion
  • Pg 537-545, 547

16
Ligamentous Testing
  • Table 15-4, pg 545

17
Neurologic Testing
  • Fig 15-24
  • Upper Quarter Screening

18
Wrist Fractures
  • Colles Fracture
  • Dorsal displacement of radius approx 1.5 cm from
    radiocarpal joint
  • Appearance of upside down fork
  • Fig 15-26, pg 556
  • Fig 15-33, pg 565 (Wrist dislocation, but common
    appearance of Colles Fracture)
  • Mechanism Falling on outstretched hand
  • Smiths Fracture or Reverse Colles Fracture
  • Palmar displacement of radius approx 1.5 cm from
    radiocarpal joint

19
Scaphoid Fracture
  • Mechanism falling on outstretched arm
  • Early assessment important
  • Not always visible on X-ray Bone scans, CT
    scans, and/or MRI scans may be needed
  • Crepitation may be present
  • Poor blood supply commonly leads to nonunion and
    malunion secondary to avascular necrosis
  • Preisers disease
  • Aching pain in anatomical snuff box that worsens
    upon palpation
  • Pain with active and resisted wrist ext.

20
Lunate Dislocation
  • Mechanism forced hyperextension of wrist and
    hand
  • Complaint of pain along radial side of palmer or
    dorsal aspect of wrist that limits ROM
  • Repeated trauma could compromise vascular supply
  • Special tests Murphys sign
  • Note alignment of 3rd MC with 2nd and 4th
  • May result in Kienböcks disease

21
Metacarpal Fracture
  • Mechanism often secondary to compressive force
    along shaft of bone
  • Snap often heard
  • Point tender over sight of fracture
  • Boxers fracture fracture of 5th metacarpal
  • -Characterized by depressed 5th MCP joint

22
Acute Finger Pathologies
  • Jersey Finger
  • Mallet Finger
  • Boutonniere Deformity
  • Box 15-2

23
Jersey Finger
  • Avulsion of flexor digitorum profundus tendon
  • Inability to actively flex the DIP joint

24
Mallet Finger
  • Avulsion of the extensor digitorum longus tendon
  • Inability to actively extend distal phalanx

25
Boutonniere Deformity
  • Rupture of central extensor tendon
  • Resulting position is extension of DIP and MCP
    joint, with flexion of PIP joint

26
DeQuervains Syndrome
  • Tenosynovitis of extensor pollicis brevis and
    abductor pollicis longus tendons
  • Mechanism Repetitive motions
  • Pain with radial/ulnar deviation
  • Special test Finkelsteins test

27
Thumb Sprains
  • Skiers thumb/Gamekeepers thumb
  • Sprain of UCL of thumbs MCP joint
  • Mechanism Hyperabduction or hyperextension of
    the MCP joint
  • Pain along ulnar aspect of MCP joint
  • Valgus/Varus Ligamentous tests for instability at
    MCP joint

28
Bennetts Fracture
  • Fracture of 1st MC
  • Fig 15-32, pg 564

29
Interphalangeal Joint Dislocations
  • Obvious deformity with IP joint
  • Possibility of avulsion fracture
  • X-rays to rule of fracture
  • Can be reduced with traction under supervision of
    physician
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