Wrist and Hand Conditions

Chapter 13

Wrist Articulations

Radiocarpal: Radius with the Scaphoid, Lunate, Triquetrum.

Intercarpal

Distal RadioulnarTriangular Fibro cartilage Complex

stabilizes the Radioulnar joint.

Hand Articulations

Carpometacarpal (CM)

Intermetacarpal (IM)

Metacarpophalangeal (MP)

Interphalangeal (IP)

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

Metacarpophalangeal Joints

Rounded distal heads of the metacarpals articulate with the concave proximal ends of the phalanges

Reinforced by strong collateral ligaments

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

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.

Kinematics

Flexion

Extension

Hyperextension

Radial deviation

Ulnar deviation

Flexion

Flexor carpi radialis

Flexor carpi ulnaris

Palmaris longus (sometimes absent)

Flexor digitorum superficialis

Flexor digitorum profundus

Extension and Hyperextension

Extensor carpi radialis longus

Extensor carpi radialis brevis

Extensor carpi ulnaris

Extensor pollicis longus

Extensor digiti minimi

Extensor digitorum

Radial and Ulnar Deviation

Radial DeviationFlexor carpi radialisExtensor carpi radialis

Ulnar DeviationFlexor carpi ulnarisExtensor carpi ulnaris

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.

Strengthening

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

Contusions and Abrasions

Thoroughly clean, dress daily, inspect for infection daily.

Ice, compression, elevation for 2 – 3 days.

Sprains

Wrist sprains

Gamekeeper’s Thumb

Interphalangeal Collateral Ligament Sprains

Dislocations

Distal radioulnar joint (DRUJ)

Lunate dislocation

MP joint dislocation

PIP joint dislocation

Strains

Jersey Finger

Mallet Finger

Boutonniere Deformity

Tendinopathies

Trigger Finger

DeQuervain’s tenosynovitis

Intersection Syndrome

Ganglion Cysts

Fingertip Injuries

Subungual hematomas

Paronychia

Nerve Entrapment Syndromes

Median Nerve EntrapmentAnterior Interosseous Nerve SyndromeCarpal Tunnel Syndrome

Ulnar Nerve EntrapmentUlnar tunnel syndromeCyclist’s palsyBowler’s thumb

Chris Carlin, Dominique Rodriguez

Radial Nerve Entrapment

Distal Posterior Interosseous Nerve Syndrome

Superficial Radial Nerve Entrapment

Fractures

Distal Radial and Ulnar fractures Monteggia’s fracture Galeazzi’s fracture Colle’s fracture Smith’s fracture

Scaphoid fractureHamate fractureTriquetrum fractureKienbock’s disease

Fractures cont.

Metacarpal fracturesBoxer’s fracture

Bennett’s fracture

Phalangeal fractures