Bones of the Hand and WristBones of the Hand and Wrist

Wrist InjuriesWrist Injuries

OlecranonOlecranon

Head of radiusHead of radius

Neck of radiusNeck of radius

Styloid ProcessStyloid Process

Neck of radiusNeck of radiusHead of radiusHead of radius

OlecranonOlecranon

Radial notchRadial notch

Tuberosity of radiusTuberosity of radius

Styloid ProcessStyloid Process

UlnaUlnaRadiusRadius

Interosseous Interosseous MembraneMembrane

Styloid ProcessStyloid Process

Styloid ProcessStyloid Process

Anterior ViewAnterior View Posterior ViewPosterior View

MetacarpalsMetacarpals

• May be palpated in orderMay be palpated in order

• Numbered 1 -5 starting at thumbNumbered 1 -5 starting at thumb

• Palpate the entire lengthPalpate the entire length

1st Metacarpal1st Metacarpal• From Snuffbox to MCP JointFrom Snuffbox to MCP Joint• Shorter and broader than other metacarpalsShorter and broader than other metacarpals

Trapezium

1st Metacarpal

– EtiologyEtiology• Direct axial force or Direct axial force or • Compressive forceCompressive force• 5th metatarsal5th metatarsal

– Boxing or martial arts Boxing or martial arts – (boxer’s fracture)(boxer’s fracture)

– Signs and SymptomsSigns and Symptoms• Pain Pain • SwellingSwelling• CrepitusCrepitus• Possible deformityPossible deformity

– angular angular – rotationalrotational

Metacarpal FractureMetacarpal Fracture

– Fracture testsFracture tests• PalpationPalpation• CompressionCompression• Axial compressionAxial compression• PercussionPercussion

– ManagementManagement• RICERICE• Analgesics Analgesics • X-ray examinationX-ray examination• Deformity is reducedDeformity is reduced• SplintingSplinting

– 30 degrees of flexion 30 degrees of flexion – 4 weeks 4 weeks

Wrist SprainsWrist Sprains– Most common wrist injuryMost common wrist injury

– Mechanism of injuryMechanism of injury

• Arises from any abnormal, forced movementArises from any abnormal, forced movement

• FOOSH (Fall on outstretched hand)FOOSH (Fall on outstretched hand)

• Falling on hyperextended wristFalling on hyperextended wrist

• Violent flexion or torsionViolent flexion or torsion

Stress TestsStress Tests

– Radial and Ulnar DeviationRadial and Ulnar Deviation

– Anterior Posterior GlidesAnterior Posterior Glides

– Signs and SymptomsSigns and Symptoms

• PainPain

• Swelling Swelling

• Loss of functionLoss of function

• Decreased ROMDecreased ROM

• InstabilityInstability

Wrist SprainsWrist Sprains– ManagementManagement

• Refer to physician for X-ray if severeRefer to physician for X-ray if severe• RICERICE• Splint Splint • AnalgesicsAnalgesics• StrengtheningStrengthening• Tape for supportTape for support

Carpal BonesCarpal Bones

RadiusUlna

Scaphoid

Lunate

Triquetrium

Pisiform Trapezium

Trapezoid

CapitateHamate

Anterior View Right Wrist

• Receives most force transmitted Receives most force transmitted through radiusthrough radius

• Frequently involved in fracturesFrequently involved in fractures

• Often fails to heal because of Often fails to heal because of inadequate blood supplyinadequate blood supply

• Proximal pole without blood supply Proximal pole without blood supply 1/3 population1/3 population

• Subject to avascular necrosisSubject to avascular necrosis

Scaphoid AnatomyScaphoid Anatomy

Anterior View Right Wrist

Distal Pole

Waist

Proximal Pole

Scaphoid FractureScaphoid Fracture

– Mechanism of injuryMechanism of injury

• Caused by fall on outstretched handCaused by fall on outstretched hand

• Compresses scaphoid between radius and second distal row of carpal bonesCompresses scaphoid between radius and second distal row of carpal bones

Scaphoid FractureScaphoid Fracture

– Signs and SymptomsSigns and Symptoms

• Swelling, severe pain in anatomical snuff boxSwelling, severe pain in anatomical snuff box– Hold thumb straight upHold thumb straight up

– Snuffbox is between two most prominent tendonsSnuffbox is between two most prominent tendons

• Signs and symptoms similar to wrist sprainSigns and symptoms similar to wrist sprain

• Pain w/ radial flexionPain w/ radial flexion

• EtiologyEtiology

– Occurs in lower end of radius or ulnaOccurs in lower end of radius or ulna

– FOOSHFOOSH

– Radius and ulna forced into hyperextensionRadius and ulna forced into hyperextension

Colles’ FractureColles’ Fracture

– Signs and SymptomsSigns and Symptoms

• Visible deformity (silver fork deformity)Visible deformity (silver fork deformity)

• When no deformity is present, injury can be passed off as bad sprainWhen no deformity is present, injury can be passed off as bad sprain

• Extensive bleeding and swellingExtensive bleeding and swelling

• Tendons may be torn/avulsed and there may be nerve damageTendons may be torn/avulsed and there may be nerve damage

Colles’ FractureColles’ Fracture

– ManagementManagement

• Cold compress or iceCold compress or ice

• Splint wrist Splint wrist

• Refer to physicianRefer to physician

• X-ray and immobilizationX-ray and immobilization

• Severe sprains should be treated as fracturesSevere sprains should be treated as fractures

• Without complications a Colles’ fracture athlete will be out for 1-2 mo.Without complications a Colles’ fracture athlete will be out for 1-2 mo.

• In children, injury may cause growth plate injuryIn children, injury may cause growth plate injury

Colles’ FractureColles’ Fracture

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