Chapter 16 (pp.416-425)

The Wrist, Hand,& Fingers

skeletal anatomy

complicated…

the radius

• “Thumb Side”• Shorter than the

Ulna• Larger at wrist,

smaller at elbow• Head is proximal

– at the elbow

the radius

Landmarks:• Carpal surface

–Articulates with carpal bones

• Styloid process

the ulna

• “Pinky Side”• Thicker proximally,

smaller distally• Head is distal – at

the wrist

the ulna

Landmarks:• Head• Styloid process

the wrist

• Common term for the carpal bones–Eight carpal

bones in each wrist

carpal bones

Proximal Row

(Lateral to Medial)

• Scaphoid (Navicular)

• Lunate• Triquetrum• Pisiform

Distal Row

(Lateral to Medial)

• Trapezium• Trapezoid• Capitate• Hamate

carpal bones

carpal trick

• Some = scaphoid• Lefties = lunate• Try = triquetrium• Plays = pisiform• That = trapezium• They = trapezoid• Can’t = capitate• Handle = hamate

metacarpals

• Knuckles - 5 per hand– Base is proximal– Head is distal

• Numbered 1-5 from thumb to pinky– ex: Thumb =1– ex: Pinky = 5

metacarpal landmarks

Landmarks:• Proximal to Distal:

– Base– Shaft– Head– Condyles

phalanges

• “Fingers”• 14 bones

– 3 per finger (12)– 2 per thumb (2)

• Landmarks:– Proximal– Middle– Distal

articulations

radiocarpal joint

• “Wrist joint”– Radius, scaphoid, &

lunate• Flex/Ext & Ulnar/Radial

Deviation• Stabilized by Radial

Collateral Ligament

ulnocarpal joint

• “False joint”• Separated & stabilized

by cartilaginous disc (meniscus-like)– TFCC

• Stabilized by Ulnar Collateral Ligament

triangular fibrocartilage complex (TFCC)

• Articular disc – the “meniscus” of the wrist

• Increases stability in the distal radioulnar joint, extends the ulnocarpal joint

radioulnar joint

• Formed by ulnar head and ulnar notch of the radius–Allows for

supination & pronation

intercarpal joints

• Supported by interosseous membrane and capsular ligaments– Too numerous to list (every bone is

connected)

carpometacarpal joints

• MC 1 trapezium• MC 2 trapezoid• MC 3 capitate• MC 4 & 5 hamate

(single joint)

metacarpophalangeal & interphalangeal joints

MCP joints:• “Knuckles”• Numbered 1-5 thumb

to pinky

IP joints:• Proximal & distal in

each finger• Just IP in thumb

DIP

PIP

IP

Soft tissue anatomyligaments & muscles

ligaments

• Dorsal & palmar (volar) radiocarpal ligaments

• Ulnar & radial collateral ligaments• TFCC• Intercarpal ligaments• UCL & RCL for each MCP & IP joint

wrist joint ligaments

radiocarpal ligaments

• Palmar (volar) RCL:– 3 individual ligaments– Capitate, triquetrum,

scaphoid– Limits wrist

hyperextension

• Dorsal RCL:– Posterior surface of

radius (styloid process) lunate & triquetrum

– Limits wrist flexion

radiocarpal ligaments

Palmar (Volar) Ligaments Dorsal Ligaments

collateral ligaments

• Ulnar Collateral Ligament

• Styloid process of ulna TFCC triquetrum & pisiform

• Limits radial deviation

• Radial Collateral Ligament

• Styloid process of radius scaphoid & trapezium

• Limits ulnar deviation

collateral ligaments

MCP & IP ligaments

• Ulnar collateral & radial collateral ligament at each MCP & IP joint

• Stabilizes the joint through flexion & extension

• Named according to anatomical position (i.e. backwards when looking at dorsal aspect of hand)

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muscles• Natural Position of hand/fingers is slightly

flexed– Passively extend wrist & watch fingers???

muscles• Wrist extensors & wrist flexors• Extrinsic muscles of the hand

– Muscles of the forearm that provide strength and crude control of the hand and fingers

• Intrinsic muscles of the hand– Muscles originate in the hand and wrist that

provide fine control of the hand

wrist flexors

• Flexor carpi radialis

• Flexor carpi ulnaris

• Palmaris longus

wrist extensors

• Extensor carpi radialis longus

• Extensor carpi radialis brevis

• Extensor carpi ulnaris

extrinsic muscles of the hand

• Muscles that move the hand/fingers– Extensor digitorum– Extensor indicis– Extensor digiti minimi– Flexor digitorum

superficialis– Flexor digitorum

profundus

extrinsic muscles of the hand

• Muscles that move the thumb– Abductor pollicis longus– Extensor pollicis brevis– Extensor pollicis longus– Flexor pollicis longus

*Easier to remember movements if you “rotate” thumb to correspond to fingers

intrinsic muscles of the hand

• Thenar eminence (thumb side)– Adductor pollicis– Opponens pollicis– Abductor pollicis

brevis– Flexor pollicis brevis

• Hypothenar eminence (pinky side)– Abductor digiti minimi– Flexor digiti minimi

brevis (no longus)– Opponens digiti minimi– Palmaris brevis

intrinsic muscles of the hand

• Lumbricles (4)• Dorsal Interossei / Interossei Dorsales (4)• Palmar Interossei / Interossei Palmares

(3 or 4)

Lumbricles PIs DIs

other structures

neurological anatomy

• Ulnar nerve (C8)– Passes above carpal tunnel– Sensory to 4th & 5th digits

neurological anatomy

• Median nerve (C7)– Passes through carpal

tunnel– Motor nerve for thenar

eminence– Sensory to 1st-3rd digits

neurological anatomy

• Radial nerve C6)– Separates in forearm– Sensory to dorsal hand

& 1st digit

carpal tunnel

• Floor: Scaphoid, Trapezium/Pisiform, Hamate

• Roof: Transverse carpal ligament (Flexor Retinaculum)

• Medial Pillars– Pisiform– Hook of Hamate

• Lateral Pillars– Scaphoid Tubercle – Trapezium Tubercle

carpal tunnel

• 10 structures pass through– Four Flexor Digitorum Superficialis tendons– Four Flexor Digitorum Profundus tendons– Flexor Pollicus Longus tendon– Median Nerve

anatomical snuff box• Term for area on radial aspect of wrist, proximal

to thumb• Borders

– Anterior: Abductor Pollicis Longus and Extensor Pollicis Brevis tendons

– Posterior: Extensor Pollicis Longus tendon• Contents: Radial artery • Floor: Scaphoid, Trapezium

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objectives

Identify…• Pertinent information to gather during a wrist

& hand evaluation• Important observations to make during a wrist

& hand evaluation

???

the evaluation process

• Must understand differential diagnosis (DDx)– Options that a specific injury could be– Pathologies often have similar S&S

• Rule out emergency situations quickly– If unsure, err on side of caution

history

general history

• Chief complaint• Age• Occupation/sport/position etc.• Hand dominance—why?• General health condition• Activity level• Medications & allergies

previous medical history

• What happened?• Who did you see?• What did they tell you?• How long were you out?• Has it fully resolved?

Anything else??

current history

• Mechanism of injury– How did it happen?

• Tension = sprain; strain• Torsion = sprain; fracture• Compression = contusion;

dislocation; fracture• Shear = fracture; sprain• Bending = fracture

current history

• Ask these questions regarding PAIN• P-rovocation – what causes it? what makes it better?• Q-uality – what does it feel like? neurological

symptoms?• R-egion – where does it hurt? can you point w/one

finger?• S-everity – how bad does it hurt? (1-10)• T-iming – when does it hurt? how long?

current history

Type of Pain Structure

Cramping, dull, aching Muscle

Dull, aching Ligament, joint capsule

Sharp, bright, lightning-like, burning

Nerve

Deep, nagging, dull Bone

Sharp, severe, intolerable

Fracture

Throbbing, diffuse Vasculature

current history

• Sounds & sensations–Did you hear any

sounds? Did you hear any pops, crackles, snaps, clicking?• What could this

indicate???–Did you feel

anything unusual?

specific to the wrist, hand, & fingers

• Must rule out radiating symptoms from other upper extremity injury

• Hand & finger postures– Chronic Injuries– Insidious Onset

specific to the wrist, hand, & fingers

• Length of symptoms– Scaphoid fractures or TFCC may “linger”

before diagnosis• General Health

– Arthritis– Carpal Tunnel

observation

observation

• When does this begin?• Compare each side bilaterally

to identify what is normal forthat person

• We look for:– Deformity, asymmetry,

edema, ecchymosis

general observation

• Hand posture– How are they carrying their hand?

• General position of hand/fingers– Are they flexed or extended?

• Willingness to use functionally– Will they use their hand for normal tasks?

further inspection

• Carrying position of hand• Calluses, creases, scars, etc.• Landmark alignments

– Knuckles, joints, etc.• Size of hands

observable deformities

• Boutonniere deformity

• Swan-neck deformity

• Mallet finger• Claw fingers

• Drop wrist• Nail deformities• Ganglion cysts• Russell’s sign

boutonniere deformityMCP extPIP flexDIP ext

swan-neck deformity

MCP flexPIP extDIP flex

mallet finger

DIP flex

claw fingers

MCP extPIP flexDIP flex

drop wrist deformity

Loss of wrist & finger extension

nail deformities

Multiple variations

ganglion cyst

Russell’s sign

critical thinking

A shot putter comes in complaining of sever pain in his throwing wrist that has been happening for about 2-3 weeks at practice.

1. List 10 relevant questions you would ask this athlete.

2. List 10 relevant landmarks you would observe & palpate for further information.

critical thinking

The catcher of the softball team has come in after catching an intense bullpen session. She says the palm of her hand is hurting.

1. List 10 relevant questions you would ask this athlete.

2. List 10 relevant landmarks you would observe & palpate for further information.

critical thinking

The captain of the tennis team asks you to evaluate his wrist after practice. He feels his grip strength declining after each practice.

1. List 10 relevant questions you would ask this athlete.

2. List 10 relevant landmarks you would observe & palpate for further information.

The wrist, hand, & fingers

Range of Motion

range of motion

For the wrist…• ROM around all

three axis of rotation

• Occurs at the radiocarpal & radioulnar joints

range of motion

For the wrist…• Flexion (Flex) &

extension (Ext)• Radial deviation (RD) &

ulnar deviation (UD)• Pronation (Pro) &

supination (Sup)radiocarpal | radioulnar

wrist movements

• Flexion – decreasing the joint angle between the hand and forearm

• Aka: bend your wrist• Normal: 80-90o

wrist movements

• Extension – increasing the joint angle between the hand and forearm

• Aka: bend your wrist backwards

• Normal: 75-90o

wrist movements

• Radial Deviation– decreasing the joint angle between the thumb and radius

• Aka: thumb out• Normal:

15-25o

wrist movements

• Ulnar Deviation – decreasing the joint angle between the pinky and ulna

• Aka: pinky in• Normal:

30-45o

wrist movements

• Pronation – rotation of the hand medially

• Aka: palm down• Normal: 85-90o

wrist movements

• Supination – rotation of the hand laterally

• Aka: palm up• Normal: 85-90o

range of motionFor the thumb…• ROM occurs at the CMC, MCP, IP joints• Assessed as groups, and individually

range of motion

Groups:• Flex/Ext of CMC,

MCP, IP jt• ABD/ADD of CMC jt• Combining

movements = opposition

thumb movements

• Flexion – decreasing the joint angle between the 1st MC & the Trapezium; 1st MC and prox. Phalange; prox & distal phalanges.

• AKA: bend your thumb

• Normal:60-70o

50-55o

80-85o

thumb movements

• Extension– increasing the joint angle between the 1st MC & the Trapezium; 1st MC and prox. Phalange; prox & distal phalanges.

• AKA: straigten your thumb

• Normal:0-5o

at all jts

thumb movements

• Abduction – increasing the joint angle between the 1st MC & the Trapezium.

• AKA: thumb away from index finger

• Normal:70-80o

thumb movements

• Adduction – decreasing the joint angle between the 1st MC & the Trapezium.

• AKA: thumb towards index finger

• Normal:limited by2nd MC.

range of motion

For the phalanges…• ROM occurs at the

MCP, PIP, & DIP joints

• Assessed as groups, and individually

range of motion

Groups:• Flex/Ext of MCP, PIP, & DIP jts• ABD of MCP jts

finger movements

• Flexion – decreasing the joint angle between the MC prox. phalange; prox & middle phalanges; middle & distal phalanges.

• AKA: bend your fingers

• Normal: 85-105o; 110-120o; 80-90o

finger movements

• Extension – increasing the joint angle between the MC prox. phalange; prox & middle phalanges; middle & distal phalanges.

• AKA: straighten your fingers

• Normal: 20-30o; trace; 20o

finger movements

• Abduction – increasing the joint angle between phalanges.

• AKA: splay / spread your fingers

• Normal: 20-25o

Range of motion

Definition:–Range of motion refers to the distance

and direction a joint can move between the flexed position and the extended position

In true clinical settings, we use a goniometer to measure ROM

Range of motion

• Types–Active range of motion (AROM)–Passive range of motion (PROM)–Resistive range of motion (RROM)

Range of motion

• AROM– The patient’s ability to move a joint under

their own strength• PROM

– The joint’s ability to be moved through a range of motion

• RROM– Measurement of the muscle strength of a

joint through the ROM

Range of motion

• Performed bilaterally on the uninjured side first– Why??

Allows us to get a look at what is normal for that athlete!

patient positioning

• Position the patient however you need to allow for the range of motion to be tested– Flexion is best tested in supination– Extension is best tested in pronation

• RD/UD and Pro/Sup will need the patient to hang their wrist & hand off the edge of the treatment table.

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active range of motion

The patient will actively…• Flex/ext, RD/UD, Pro/Sup their wrist • Flex/ext, ABD/ADD their thumb• Flex/ext, ABD their fingers

…on your command

hand positions

passive range of motion

The examiner will actively…• Flex/ext, RD/UD, Pro/Sup the wrist • Flex/ext, ABD/ADD the thumb• Flex/ext, ABD the fingers

…at all joints (CMC, MCP, PIP, DIP, IP) for each digit.

passive range of motion

passive range of motion

resistive range of motion

The examiner will resist…• Flex/ext, RD/UD, Pro/Sup the wrist • Flex/ext, ABD/ADD the thumb• Flex/ext, ABD the fingers

…at all joints (CMC, MCP, PIP, DIP, IP) for each digit as the patient actively performs the motion.

resistive range of motion

items to note:

• When assessing, make note of:–differences in AROM–Pain during PROM–Decreased strength during RROM

But WHY??

grading ROM

• AROM & PROM are graded as within normal limits (WNL) or decreased/limited & why– AROM: R = WNL, L = decreased Pro due

to pn– PROM: R = WNL, L = pn with Sup

grading ROM

• RROM is graded on a 0-5 scale

0. Absent – no muscle contraction 1. Trace – contraction without movement 2. Poor – full ROM without gravity 3. Fair – full ROM against gravity 4. Good – 3 + some resistance 5. Normal – 3 + full resistance

documenting ROM

When documenting ROM, each movement must be listed & assessed.

AROM: R = WNL, L = WNL

PROM: R = WNL, L = WNL with Pn

RROM: R = 5/5Flex, 5/5Ext, 5/5UD, 5/5RD; 5/5Pro; 5/5Sup at the wrist; 5/5Flex, 5/5Ext, at the 1st CMC, MCP, IP; 5/5Flex, 5/5Ext at 2-5 MCP, PIP, DIP jts.

The Wrist, Hand, & Fingers

Special Tests

so far…

• Gathered clues by taking a history• Observed for signs of injury• Palpated the structures for

abnormalities• Tested ROM to find differences

differential diagnosis

• By now the choices of injury should be narrowed down to a handful of options…

rule them out

• In order to determine the injury, we must rule out the DDx

• To do this we usespecial tests

special tests

• Fractures• Ligamentous stress tests• Joint play (glides)• Provocation• Neurological• Vascular

fracturesspecial tests

long bone compression test

• Patient: Relaxed with joints in neutral• Examiner: Stabilize above structure being

tested • Action: Apply axial load

long bone compression test

long bone compression test

• Positive: Pain, crepitus• Pathology: Fracture• Notes: Can perform tap test for distal phalanx

fractures

ligamentous stress tests

special tests

remember…

• Tests the integrity of ligaments by recreating the injury mechanism

• Stabilize proximal, move distal• Hand placement should be as close to

joint being tested as possible• Graded as 1st, 2nd, 3rd degree with the

use of + and -

ligamentous stress tests

• Wrist joint– Valgus = UCL– Varus = RCL

• 1st MP joint– Valgus = UCL– Varus = RCL

• IP joints– Valgus = UCL– Varus = RCL

valgus/varus stress tests

Which one is which?

valgus/varus stress tests

Which one is which?

joint play (glides)special tests

glides

• Patient: Sitting; Elbow flexed to 90˚, forearm pronated, & fingers in relaxed position

• Examiner: Sitting or standing lateral to patient–One hand grasps distal radius–Other hand grasps proximal carpal row

• Action: Shear force applied gliding distal segment

glides

glides

• Positive: Pain or significant laxity compared bilaterally

• Pathology: Sprain of collateral or intercarpal ligaments–Trauma to TFCC

• Note: Decreased glide may indicate adhesions or capsular stiffness –May also perform carpal (intercarpal) glides

provocationspecial tests

watson test

• Patient: Seated w/elbow flexed & supported on table–Hand/forearm point up (arm wrestling

position)• Examiner: In font of patient• Action: Examiner’s thumb applies

dorsal pressure to the distal pole of the scaphoid & then moves wrist from ulnar to radial deviation

watson test

watson test

• Positive: Reproduction of pain & notable pop at scapholunate articulation

• Pathology: Scapholunate dislocation• Note: May be painful to “normal”

patient–May not be performable in an acute

situation

finkelstein’s test

• Patient: relaxed w/ neutral forearm• Examiner: not active• Action: flexes fingers around thumb (fist

with thumb inside), active hyper-ulnar deviation

finkelstein’s test

finkelstein’s test

• Positive: Pain over APL and EPB tendons

• Pathology: de Quervain’s • Can be painful in normal people, must

compare bilaterally

neurologicalspecial tests

tinel’s sign

• Patient: relaxed and comfortable w/forearm supination

• Examiner: lateral or anterior to patient–One hand supporting forearm, wrist and

hand–One hand free to administer test

• Action: firm tapping of carpal tunnel

tinel’s sign

tinel’s sign

• Positive: reproduction of S&S to the median nerve sensory distribution

• Pathology: carpal tunnel syndrome

phalen’s test

• Patient: relaxed and comfortable• Examiner: not active• Action: forced hyperflexion of wrists w/

dorsum of hands together for 1 minute

phalen’s test

phalen’s test

• Positive: reproduction of S&S to the median nerve sensory distribution

• Pathology: carpal tunnel syndrome (median nerve)

reverse phalen’s test

• Patient: relaxed and comfortable• Examiner: not active• Action: forced hyperextension of wrist for 1

minute

reverse phalen’s test

reverse phalen’s test

• Positive: reproduction of S&S to the median nerve sensory distribution

• Pathology: carpal tunnel syndrome (median nerve)– “Prayer Sign”

vascularspecial tests

allen test

• Patient: relaxed w/supinated forearms• Examiner: lateral to patient

–One thumb over radial artery–Other thumb over ulnar artery

allen test

allen test

• Actions:–Patient opens and closes hand rapidly–Examiner occludes radial and ulnar

arteries with thumbs–Patient opens hand–Examiner releases one artery watching

for immediate flush of hand–Repeat to test other artery

allen test

allen test

• Positive: slow circulatory refill (check bilaterally)

• Pathology: radial or ulnar artery insufficiency

The Wrist, Hand, & Fingers

Common Injuries

fractures

• Distal forearm fractures of the radius & ulna– Colle’s fracture– Smith’s fracture– Styloid process fracture– Epiphyseal fractures

distal forearm fractures

• Colles’ Fracture–Distal radius–True Colle’s Fx

• Dorsal displacementof radius

• 1.5” proximal toradiocarpal joint

–Typically from hyperextension

distal forearm fractures

• Smith’s Fracture– “Reverse Colle’s

Fracture”–Distal radius–Palmar displacement

of radius–Typically from

hyperflexion

styloid process fracture

• Typical avulsion fracture

• UCL or RCL stronger than styloid process

• Hyper-UD or RD

epiphyseal fracture

• Fracture through the distal growth plate

fractures

• Carpal fractures– Scaphoid fracture– Hamate fracture

scaphoid fracture

• Most common carpal fracture (~70%)– Especially in 15-30 year olds

• Pain in anatomical snuff box & Scaphoid Tubercle

• FOOSH• Avascular necrosis• Leads to non-union or

malunion healing– No universal treatment– Displaced may require surgery

hamate fracture• May fracture body or

hook– Body = Direct blow or

axial load to 4th & 5th metacarpals

– Hook = FOOSH or swinging bat/golf club

• Movement of 5th finger causes pain when hook is fractured

metacarpal fractures

• Compressive forces– Axial or direct trauma– Can have avulsions

• Sx & Sy:– “Snap,” crepitus, etc. – Depressed knuckle– May not be able to

make fist• Tx depends on

rotation• “Boxer’s fracture”

metacarpal fractures

• Bennett’s fracture– 1st metacarpal– Intra-articular (C-M

joint)– Typically needs fixation

phalanx fractures

• Most common fractures of hand• Thumb and middle finger are most common

sites• Distal phalanx is most common

– Often involves avulsion of flexor/extensor tendon

• Direct blow = transverse or comminuted fx• Rotational force = spiral fracture• Patient will often hear “snap”

spiral fracture

spiral fracture repair

Dislocations/subluxations

• Wrist dislocations – very rare• Carpal dislocations

– Lunate• MCP joint – most common in 1st MCP• PIP & DIP joints – most common

lunate dislocations

• MOI: forced hyperextension of wrist• May move palmar or dorsally • May reduce spontaneously

lunate dislocations

• Mechanism may also cause scaphoid fracture & carpal instability

• Sx & Sy:– 3rd knuckle may become level with other

knuckles– Pain at wrist & along radius– May suffer from parasthesia in middle

finger

lunate dislocations

• Often, patient presents with no significant findings except pain– Will often have pain with carpal glides– X-ray or MRI needed to confirm– Usually require surgery– Rule out scaphoid fracture

lunate dislocation

mcp joint dislocation

• More common in thumb than fingers– Often caused by extension and abduction

• Often occurs w/fracture

pip & dip joint dislocations

• Most common dislocation• May remain displaced or spontaneously

reduce• Often reduced on-site by player, coach, etc.• Often involve fractures• Should ALWAYS be referred for X-rays

pip & dip dislocations

sprains vs. strains

• Hard to distinguish the difference in the wrist– AROM vs. PROM will indicate

• Typically due to hyperflexion or hyperextension

• Strain is to the tendon crossing at the wrist

• Sprain is Dx by r/o all other injuries

TFCC injury

• Often results from trauma or repeated stress• “WB” activities (gymnastics) can cause

degenerative injuries• Sx & Sy:

– Forced hyperextension often causes pain– Pain with weight-bearing activities – i.e., push

ups– May have pain at ulnar styloid process

• Refer if suspected – often requires surgery

sprains

• IP joint sprains–Very common w/ variety of

mechanisms–Typically involve collateral ligaments–May result in dislocation–May wait to report injury

sprains• MP joint sprains (thumb)

–Most often ulnar (medial) collateral ligament

–MOI: hyperabduction/ extension

– “Gamekeeper’s thumb” or “skier’s thumb”

–Loss of grip strength in opposition

observable deformities

• Boutonniere deformity

• Swan-neck deformity

• Mallet finger• Claw fingers

• Drop wrist• Nail deformities• Ganglion cysts• Russell’s sign

boutonniere deformityMCP extPIP flexDIP ext

swan-neck deformity

MCP flexPIP extDIP flex

mallet finger

DIP flex

claw fingers

MCP extPIP flexDIP flex

drop wrist deformity

Loss of wrist & finger extension

nail deformities

Multiple variations

ganglion cyst

russell’s sign

de quervain’s syndrome

• Tenosynovitis• Structures Involved:

– Extensor Pollicis Brevis– Abductor Pollicis Longus

• Repeated RD and gripping• Wrist movement & pinching

increases symptoms• Special test?

carpal tunnel syndrome

• Compression of the median nerve– Symptoms often

occur at night & relieved by shaking

– Neurological symptoms, loss of grip strength, “ache”

carpal tunnel syndrome

• Etiology: repetitive microtrauma of flexor tendons– Most patients 40-60 years old; more common in

females– Often results from tenosynovitis or trauma

Volkmann’s ischemic contracture

• Begins with fracture in humerus, where total arm cast is applied

• Tight casting causes muscle spasm, swelling, or bone pressure on brachial artery, inhibiting circulation to forearm

Volkmann’s ischemic contracture

• Can become permanent

• May be loss of motor & sensory function

• Results from insufficient bloodflow & return to forearm and hand

Volkmann’s ischemic contracture

• Sx & Sy:– Pain in forearm - ↑ w/ passive extension

of fingers– Pain is followed by loss of brachial and

radial pulses, coldness in arm– ↓ motion

• Management– Remove elastic wraps or casts – Close monitoring must occur

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