The Forearm, Wrist, Hand, and Fingers - PowerPoint PPT Presentation


PPT – The Forearm, Wrist, Hand, and Fingers PowerPoint presentation | free to download - id: 3bdaff-YWZkM


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

The Forearm, Wrist, Hand, and Fingers


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

Number of Views:261
Avg rating:3.0/5.0
Slides: 36
Provided by: atUwaEdu
Learn more at:
Tags: fingers | forearm | hand | wrist


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: The Forearm, Wrist, Hand, and Fingers

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

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


(No Transcript)
(No Transcript)

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

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

  • Colles fracture
  • Etiology FOA, forces radius and ulna back and up
  • 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

(No Transcript)
(No Transcript)
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
  • Blood and Nerve Supply ulnar, median, radial
    nerve and radial and ulnar superficial and deep
    palmar arch arteries.

(No Transcript)
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

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
  • Athlete makes fist 4-5 times while holding final
    fist, evaluator pinches off both arteries hand
    should be blanched
  • Release arties individually

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

  • Tenosynovitis
  • Etiology repeated wrist acceleration and
  • 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
  • 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

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

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

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

Scaphoid Fracture
  • Etiology compression of scaphoid b/t radius and
  • 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

(No Transcript)
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)

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)

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
  • Jersey finger
  • EtiologyFDP rupture, grabbing jersey
  • Signs and SymptomsDIP cannot flex
  • ManagementSURGERY

  • 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
  • Management surgical removal

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.

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

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

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

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

Recognition and Management of Wrist, Hand, and
Finger Injuries
  • MCP dislocation
  • Etiologytwist an shear force
  • Signs and Symptomsprox. Phalanx dorsal 60-90
  • 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

(No Transcript)
  • Distal/Middle/Proximal phalangeal fracture
  • Etiologycrushing force direct trauma or twist
  • Signs and Symptoms subungual hematoma subungual
  • Managementdrain and splint / buddy tape control
  • 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

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