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The Forearm, Wrist, Hand, and Fingers

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The Forearm, Wrist, Hand, and Fingers Chapter 24 Forearm Anatomy Radius and Ulna: Elbow Joints: radioulnar joint (superior, middle, and distal) Bone: proximal radial ... – PowerPoint PPT presentation

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Title: The Forearm, Wrist, Hand, and Fingers


1
The Forearm, Wrist, Hand, and Fingers
  • Chapter 24

2
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

3

4
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7
Forearm Assessment
  • History
  • Observation
  • Visually inspect, including wrsit and elbow
  • If no deformity present, observe while they
    supinate and pronate
  • Palpation
  • Special Tests

8
Recognition and Management of Forearm Injuries
  • Contusion
  • Etiologydirect blow
  • Why more common to ulna?
  • Signs and Symptoms
  • Management
  • Forearm Splints
  • Etiology repeated severe static contraction
  • Signs and Symptomsdull 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

9
  • 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

10
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12
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.

13
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14
Assessment of Wrist, Hand, and Finger Injuries
  • History
  • Observation
  • Palpation
  • Special Tests Finklesteins test, Tinels Sign,
    Phalens test, valgus and varus stress test,
  • Circulatory and Neurological Evaluation
  • Allen test
  • Functional Evaluation

15
Special Tests
  • Finklesteins Test
  • De Quervains (tenosynovitis)
  • Thumb tucked inside fist with ulnar deviation
  • Tinels Sign
  • Tap over transverse carpal ligament
  • Pain numbness and tingling indicates median nerve
    disruption and presence of carpal tunnel
  • Phalens 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

16
Recognition and Management of Wrist, Hand, and
Finger Injuries
  • Wrist Sprain
  • Etiology
  • Signs and Symptoms
  • Management
  • Triangular Fibrocartilage Complex Injury
  • Etiologyforced hyperextension or compression of
    radioulnar joint and proximal row of carpals
  • Signs and Symptoms
  • Management

17
  • 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 Symptomspain with AROM and passive
    stretching
  • Management
  • Nerve Compression, Entrapment, Palsy
  • Etiology median (carpal tunnel) and ulnar
    (pisiform and hamate)
  • Signs and Symptomsdeformities(bishops, claw and
    drop wrist)
  • Management if chronic, may require surgical
    decompression

18
  • Carpal Tunnel Syndrome
  • Tunnel pink
  • Bones white
  • Ligament blue
  • Carpal tunnel syndrome
  • Etiology repeated flexion
  • Signs and Symptoms sensory and motor impairment
  • Management

19
Recognition and Management of Wrist, Hand, and
Finger Injuries
  • Dislocation of the Lunate Bone
  • Etiologyforced hyperextension of wrist
  • Signs and Symptomsdifficulty 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)
  • Etiologyherniation of joint capsule or tendon
  • Signs and Symptoms
  • Management

20
  • De Quervains Disease
  • Etiology tenosynovitis of thumb
  • Signs and Symptoms
  • Management

21
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

22
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23
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)

24
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
  • Lumbricalsvolar surface MCP flex., IP exten.
  • Thenar (4 that act on thumb) hypothenar (4 that
    act on 5th)

25
Recognition and Management of Wrist, Hand, and
Finger Injuries
  • Contusion to hand and fingers
  • Etiology
  • Signs and Symptoms fingernail?
  • Management
  • Bowlers Thumb
  • Etiology fibrosis of the ulnar digital nerve
    form pressure
  • Signs and Symptomspain, numbness, tingling
  • Management pad area, decrease activity surgery
    PRN
  • Jersey finger
  • EtiologyFDP rupture, grabbing jersey
  • Signs and SymptomsDIP cannot flex
  • ManagementSURGERY

26
  • Trigger finger or thumb
  • Etiology stenosing tendon by repeated movements
  • Signs and Symptoms resistance to re-extension
    after thumb and finger flexed
  • Managementpossible injections splinting
  • Dupuytrens Contracture
  • Etiology idiopathic development of nodules in
    palmer aponeurosis
  • Signs and Symptomsflexion deformity cannot
    extend
  • Management surgical removal

27
Boutonniere deformity
  • Etiologyrupture of extensor tendon dorsal to
    middle phalanx trauma to tip of finger causes
    DIP extension and PIP flexion
  • Signs and Symptoms cannot extend
  • Managementsplint PIP in extension 5-8wks.

28
  • Swan neck deformity
  • AKA Pseudoboutonniere
  • Etiologysevere hyperextension injury to volar
    plate
  • Signs and Symptoms hyperextension of PIP
  • Management splint 20-30 degrees flexion 3 wks

29
Mallet Finger
  • Etiology strike to tip of finger, jamming and
    avulsing extensor tendon
  • Signs and Symptoms unable to extend, may palpate
    avulsed bone
  • Managementextension splint 6-8 wks

30
  • Gamekeepers Thumb
  • EtiologyUCL of thumb forced abductions, an
    hyperextension
  • Signs and Symptomsinability to pinch pain with
    stress
  • Managementsplint 3 weeks protect with activity

31
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
  • Etiologytwist while semiflexed
  • Signs and Symptoms
  • Managementsplint in ext
  • PIP Dorsal dislocation
  • Etiologyhyperext.
  • Signs and symptomsdeformity inability to move
  • Managementreduce and splint 20-30 degrees flex

32
Recognition and Management of Wrist, Hand, and
Finger Injuries
  • MCP dislocation
  • Etiologytwist an shear force
  • Signs and Symptomsprox. Phalanx dorsal 60-90
    degrees
  • Management reduce splint early ROM
  • Metacarpal fracture
  • Etiologycompressive axial force
  • Signs and Symptomsappear angular or rotated
  • Management reduce and splint
  • Bennetts Fracture
  • Etiologythumb CMC axial and ABD force to thumb
  • Signs and Symptomsbase of thumb painful
  • Managementrefer to surgeon due to unstable
    nature

33
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34
  • Distal/Middle/Proximal phalangeal fracture
  • Etiologycrushing force direct trauma or twist
  • Signs and Symptoms subungual hematoma subungual
    hematoma
  • Managementdrain 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

35
Rehabilitation Principles for the Forearm,
Wrist, Hand, and Fingers
  • General Body Conditioning
  • Joint Mobilizationtraction and mobilization help
    restore ROM
  • Flexibility full ROM is measure of good rehab
  • Strengthequal
  • Neuromuscular Controlgreat dexterity required
  • Return to Activity Goals full dexterity, full
    ROM, full strength
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