Wrist & Hand

Scaphoid Fracture

Most frequently fractured carpal bone. Lies beneath the anatomical snuff box. Does not have good blood supply- often doesn't heal: "non-union". Fall on outstretched hand, which compresses scaphoid bone b/w radius & 2nd row of carpal bones.

Mallet finger observation/symptoms

Pain @ distal interphalangeal joint. Bent DIP joint(bout 30 degrees). Unable to extend DIP joint Tenderness.

The thenar eminence

Palm of hand. Ball of thumb. Thumb motion is facilitated through the coordination of these intrinsic muscles.

Carpal Tunnel Syndrom Special Tests

positive Tinel Sign

Scaphoid fracture treatment

-refer to physician -immobilization 6 wks -protection against impact for 3 months

Identify the importance of the fracture to the hook of the hamate* and how it commonly occurs.

Can occur from a fall but more commonly occurs from contact when a holding a sports implement such as a bat, racket, lacrosse stick. Ulnar nerve may be compromised due to its close proximity to the hamate

Carpal Tunnel located and anatomical features

Carpal Tunnel is located on anterior side of wrist. Floor of CT formed by Carpal bones Roof= transverse carpal ligament. Includes 8 finger flexor tendons, their synovial sheaths, & median nerve lies in CT.

Carpal Tunnel Syndrom symptoms/observations

Compression of median nerve= sensory&motor deficits. numbness, tingling. median nerve area parathesia of thumb, index, middle fingers, palm of hand Muscle atrophy(advanced cases) Decreased/weakened RROM in thumb movement.

Identify the function of the Extensor digitorum profundus and know how to manually test for it.

Extends medial four fingers. have the patient actively extend each finger and hold it extended against resistance. Significant pain or weakness may indicate a partial laceration of the tendon.

Scaphoid Fracture MOI

Fall on outstretched hand, which compresses scaphoid bone b/w radius & 2nd row of carpal bones.

Location of Anatomic Snuffbox and it's importance

Falling w wrist hyperextended causes Scaphoid fracture, a fracture of scaphoid results in point tenderness in the anatomic snuffbox.

Define boxer's fracture and know how it commonly occurs.

Fracture to the 4th and/or 5th metacarpal. Caused by punching something harder than the hand aka wall, person's head.

Jersey Finger Treatment

Refer to physician, must be surgically treated w/in 7 days.

Jersey Finger

Rupture of flexor digitorum profundus at insertion on distal phalanx. Most often occurs in ring finger. Tendon no longer attached to Distal Phalanx = DIP joint cannot flex.

Boutonniere Deformity & MOI

Rupture of the extensor tendon dorsal to middle phalanx. Forced flexion of the interphalangeal joint. Trauma @ tip of finger, which forces DIP joint into extension & PIP joint into flexion

Define the gamekeeper's thumb

Sprain of UCL of MCP joint of the thumb is common among skiers, tackle football. MOI: forceful abduction of thumb while thumb is extended.

Boutonniere Deformity observation/symptoms

Swelling Flexion deformity of PIP joint Point tenderness over middle phalanx(dorsal side) Inability to extend finger.

Jersey Finger observation/ symptoms

Swelling Point tenderness over DIP joint. Inability to flex DIP joint

Scaphoid fracture Observation/symptoms

Swelling & tenderness over the scaphoid bone in the anatomic snuff box.

Be able to label the ligamentous anatomy of the wrist and hand

Ulnar Collateral Ligament Radial Collateral Ligament Flexor Retinaculum - cross anterior side of carpal bones. -Median Nerve

Be able to label the bony anatomy of the wrist and hand

Wrist formed by distal radius and the ulna w a proximal row of 4 carpal bones that articulates w 5 metacarpals. Metacarpal bones join the carpal bones above & phalanges below, forming metacarpophalangeal articulations. The four fingers each have proximal, middle, distal phalanx. Thumb=proximal & distal phalanx.

Mallet Finger "baseball finger" MOI

blow from a thrown ball that strikes the tip of finger, jamming/avulsing extensor tendon from it's insertion along w a piece of bone.

hypothenar eminence

control movement for little finger.

Be able to label the muscular anatomy of the wrist and hand

muscles on medial aspect and front of wrist/hand= flex wrist/fingers. Posterior&Lateral muscles =extend wrist fingers. Intrinsic muscles= abduct, adduct, & in thumb creates opposition of metacarpals.

Jersey Finger MOI

rapid extension of finger while actively flexed.

Mallet finger treatment

refer physician, PRICE splint in extension 6-8 wks.

Carpal Tunnel Sydrom treatment

rest, wrist splint, anti-inflammatory medication, severe-surgery.

Carpal Tunnel Syndrom MOI

results from an inflammation of synovial sheaths in this space, ultimately leads to compression of median nerve. Common in athletes who engage in repeated wrist flexion, also anterior direct trauma.

Tunnel of Guyon

semi-rigid longitudinal canal in the wrist that allows passage of the ulnar artery and ulnar nerve into the hand. Pinky & ring finger

Boutonniere Deformity Treatment

splint in extension, refer