FOREARM, WRIST, AND HAND EVALUATION

Overview Applied anatomy Common wrist and hand injuries History Observation Examination

AROM/PROMSpecial testsNeurological examCirculatory exam

Bony Anatomy 29 total bones (27

not counting radius and ulna)8 carpals5 metacarpals14 phalangesRadiusUlna

Bony Anatomy Carpals

Navicular Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate

Bony Anatomy Handy memory

tricks “Never Lie To a

Preacher, The Truth Comes Home”

“New Lovers Try Positions That They Can’t Handle”

Bony Anatomy Metacarpals

1-5○ Thumb is 1, “pinky”

is 5 Phalanges

Proximal, intermediate, & distal

Bony Anatomy Radius & ulna

Styloid processes

Bony Articulations DRUJ Radiocarpal (wrist)

Condyloid-type○ Flexion, extension,

abduction, adduction

Bony Articulations Thumb

Ginglymus Saddle joint of CMC

Digits 2-5 3 condyloid joints

Interphalangeal (IP); Proximal interphalangeal (PIP); Distal interphalangeal (DIP)

Articulations Joints

MCP (metacarpophalangeal)PIP (proximal interphalangeal)DIP (distal interphalangeal)

Articulations The thumb is different!! Joints

MCP (metacarpophalangeal)IP (interphalangeal)

Muscular Anatomy Flexor group (anterior)

Flexor carpi radialisFlexor carpi ulnarisPalmaris longusFlexor digitorum superficialisFlexor digitorum profundusFlexor pollicis longus

Muscular Anatomy Extensor group (posterior)

Extensor carpi radialisExtensor carpi ulnarisExtensor digitorumExtensor pollicis longus & brevisAbductor pollicis longus

Muscular Anatomy Flexor group (anterior)

Flexor carpi radialisFlexor carpi ulnarisPalmaris longusFlexor digitorum superficialisFlexor digitorum profundusFlexor pollicis longus

Flexor Group Flexor Carpi

Radialis (FCR)O: medial

epicondyleI: palmar handA: flexion, abductionN: median

Flexor Group Flexor Carpi

Ulnaris (FCU)O: medial

epicondyleI: palmar handA: flexion, adductionN: ulnar

Flexor Group Palmaris Longus

O: Medial epicondyle

I: palmar handA: flexionN: Median

Flexor GroupFlexor Digitorum

Superficialis◦O: medial epicondyle,

proximal radius & ulna◦ I: middle phalanx of

digits 2-5 (palmar surface)

◦A: finger & wrist flexion

◦N: median

Flexor Group Flexor Digitorum

ProfundusO: proximal ulnaI: distal phalanx of

digits 2-5 (palmar surface)

A: finger & wrist flexion

N: median

Finger Flexors

Flexor GroupFlexor Pollicis Longus

◦O: proximal radius & ulna

◦I: distal phalanx of digit 1 (thumb) (palmar surface)

◦A: thumb & wrist flexion

◦N: Median

Extensor Group Extensor Carpi

Radialis (ECR)O: lateral

epicondyleI: dorsal handA: ext & abdN: radial

Extensor Group Extensor Carpi

Ulnaris (ECU)O: lateral

epicondyleI: dorsal handA: ext & addN: radial

Extensor GroupExtensor Digitorum

◦O: lateral epicondyle

◦I: middle & distal phalanges of digits 2-5 (dorsal hand)

◦A: finger & wrist ext◦N: radial

Extensor GroupExtensor Pollicis

Longus & Brevis◦O: posterior distal

radius & ulna◦I: proximal & distal

phalange of digit 1 (thumb)(dorsal hand)

◦A: thumb & wrist ext

◦N: radial

Extensor Group Abductor Pollicis

O: posterior distal radius & ulna

I: first metacarpal (dorsal hand)

A: thumb & wrist abd

N: radial

Carpal Tunnel Transverse carpal

ligament Median nerve Flexor digitorum

profundus (4) Flexor digitorum

superficialis (4) Flexor pollicis longus

Common Forearm, Wrist & Hand Injuries Contusions Forearm splints Colles’ fracture

Distal radius & ulna fracture

Common Forearm, Wrist & Hand Injuries

Wrist sprain Carpal tunnel syndrome Tenosynovitis Tendinitis

Common Forearm, Wrist & Hand Injuries De Quervain’s disease Scaphoid fracture

Pain in the “anatomical snuffbox”Early diagnosis essential in proper

treatment Wrist ganglion

Common Forearm, Wrist & Hand Injuries

Contusion to hand and fingers Mallet finger

Torn extensor tendon (ED) at DIPSplint in extension 6-8 weeks

Boutonniere deformityTorn extensor tendon (EDS) at PIPSplint entire finger 6-8 weeks

Common Forearm, Wrist & Hand Injuries

Jersey fingerUsually a rupture of

the flexor digitorum profundus

Gamekeeper’s thumbSprain of the UCL of

thumb

History MOI

1. What was the mechanism of injury? 2. What were you doing when the injury occurred? 3. Did you hear or feel anything at the time of the

injury? 4. Did you receive a direct blow? 5. What was the angle of impact? 6. What was the position of arm or wrist at impact? 7. Was the wrist forced beyond its normal ROM? 8. Did you have a violent muscular contraction? 9. Were you throwing or swinging?

History S & S

10.Describe the symptoms. 11.Did the pain come on gradually or suddenly? 12.Describe the pain. 13.Is it sharp or dull? 14.Localized or diffuse? 15.Any numbness, tingling, or burning? 16.Is the pain radiating down your arm? 17.Is the pain severe? Does it keep you awake at night? 18.Demonstrate what causes pain. 19.Does the arm feel tight or locked? 20.Do you feel any weakness?

History Previous injury

21. Have you had a previous injury? 22.Did you rehab? If so, what exercises?