KinesiologyKinesiologyKinesiologyKinesiology

PED 2440PED 2440

The WristThe Wrist

Exercises and InjuriesExercises and Injuries

ExercisesExercises

• Wrist curls

Squeezing tennis balls

• Wrist curls

Squeezing tennis balls

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• Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures.

• They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults.

• The break usually occurs during a fall on the outstretched wrist.

It’s a common injury in sports and motor vehicle accidents.

• Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures.

• They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults.

• The break usually occurs during a fall on the outstretched wrist.

It’s a common injury in sports and motor vehicle accidents.

• The angle at which the wrist hits the ground determines the injury. • If the wrist is extended at a 90-degree angle or greater, the scaphoid bone

will break; if the angle is less than 90 degrees, the lower arm bone (radius) will break.

Scaphoid Fractures

• Signs and symptoms

• Pain and tenderness on the thumb side of the wrist.

• Motion (gripping) may be painful.

• May be some swelling on back and thumb side of wrist.

• Pain may subside, then return as a deep, dull aching.

Marked tenderness to pressure on the "anatomical snuffbox," a triangular-shaped area on the side of the hand between two tendons that lead to the thumb.

• Signs and symptoms

• Pain and tenderness on the thumb side of the wrist.

• Motion (gripping) may be painful.

• May be some swelling on back and thumb side of wrist.

• Pain may subside, then return as a deep, dull aching.

Marked tenderness to pressure on the "anatomical snuffbox," a triangular-shaped area on the side of the hand between two tendons that lead to the thumb.

Scaphoid Fractures Scaphoid Fractures

• The scaphoid is more susceptible to injury than any of the other carpal bones because of its unique position bridging the proximal and distal rows of the carpal bones.

• This frequency is due to a tenuous blood supply, with only one dorsoradial artery to the proximal pole, which results in a nearly 100% incidence of avascular necrosis in proximal fractures and a 30% incidence in distal fractures.

Any tenderness in the anatomic snuffbox over the dorsal scaphoid (figure 1b) should prompt treatment as for a fracture.

• The scaphoid is more susceptible to injury than any of the other carpal bones because of its unique position bridging the proximal and distal rows of the carpal bones.

• This frequency is due to a tenuous blood supply, with only one dorsoradial artery to the proximal pole, which results in a nearly 100% incidence of avascular necrosis in proximal fractures and a 30% incidence in distal fractures.

Any tenderness in the anatomic snuffbox over the dorsal scaphoid (figure 1b) should prompt treatment as for a fracture.

Scaphoid Fractures Scaphoid Fractures

Scaphoid Fractures Scaphoid Fractures

• Osteoarthritis (OA) is a progressive condition that destroys the smooth articular cartilage covering the ends of bones.

• The bare bones rub against each other, resulting in pain, stiffness and weakness.

• OA can develop due to normal "wear-and-tear" on the wrist or as a result of a traumatic injury to the forearm, wrist or ligaments.

• Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the joint linings and destroys bones, tissues, and joints.

Rheumatoid arthritis often starts in smaller joints, like those found in the hand and wrist, and is symmetrical, meaning that it usually affects the same joint on both sides of the body.

• Osteoarthritis (OA) is a progressive condition that destroys the smooth articular cartilage covering the ends of bones.

• The bare bones rub against each other, resulting in pain, stiffness and weakness.

• OA can develop due to normal "wear-and-tear" on the wrist or as a result of a traumatic injury to the forearm, wrist or ligaments.

• Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the joint linings and destroys bones, tissues, and joints.

Rheumatoid arthritis often starts in smaller joints, like those found in the hand and wrist, and is symmetrical, meaning that it usually affects the same joint on both sides of the body.

Arthritis of the Wrist Arthritis of the Wrist

• Signs and symptoms

• OA of the wrist joint manifests with swelling, pain, limited motion and weakness. These symptoms are usually limited to the wrist joint itself.

• RA of the wrist joint usually manifests will swelling, tenderness, limited motion and decreased grip strength. In addition, hand function may be impaired and there may be pain in the knuckle joints (metacarpophalangeal or MP joints).

Joint swelling may also put pressure on the nerves that travel through the wrist. This can cause a lesion to develop (compression neuropathy) or lead to carpal tunnel syndrome.

• Signs and symptoms

• OA of the wrist joint manifests with swelling, pain, limited motion and weakness. These symptoms are usually limited to the wrist joint itself.

• RA of the wrist joint usually manifests will swelling, tenderness, limited motion and decreased grip strength. In addition, hand function may be impaired and there may be pain in the knuckle joints (metacarpophalangeal or MP joints).

Joint swelling may also put pressure on the nerves that travel through the wrist. This can cause a lesion to develop (compression neuropathy) or lead to carpal tunnel syndrome.

Arthritis of the Wrist Arthritis of the Wrist

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

• Osseofibirous canal

• -osseo = bones

• -fibro = ligament

• One nerve

Nine tendons

• Osseofibirous canal

• -osseo = bones

• -fibro = ligament

• One nerve

Nine tendons

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

1. Carpal Bones1. Carpal Bones2. 2.

Transverse Transverse Carpal Carpal

LigamentLigament

3. Median Nerve3. Median Nerve 4. Nine Flexor Tendons4. Nine Flexor Tendons-- 4 flexor digitorum 4 flexor digitorum

superficialissuperficialis-- 4 flexor digitorum 4 flexor digitorum

profundusprofundus-- 1 flexor pollicis 1 flexor pollicis

• Scaphoid

• Lunate

• Triquetrum

• Pisiform

• Trapezium

• Trapezoid

• Capitate

8.Hamate

• Scaphoid

• Lunate

• Triquetrum

• Pisiform

• Trapezium

• Trapezoid

• Capitate

8.Hamate

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

• “Medial wall” – Pisiform and Hamate

• “Lateral wall” – Scaphoid and Trapezium

“Floor” – Lunate, Triquetrum, Trapeziod and Capitate

• “Medial wall” – Pisiform and Hamate

• “Lateral wall” – Scaphoid and Trapezium

“Floor” – Lunate, Triquetrum, Trapeziod and Capitate

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

TrapeziumTrapezium

HamateHamate

Transverse Transverse Carpal Carpal

LigamentLigament

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

• Symptoms

• Pain and numbness in 1-3 fingers and half of the 4th or ring finger

Symptoms do not include palm or little finger

• Symptoms

• Pain and numbness in 1-3 fingers and half of the 4th or ring finger

Symptoms do not include palm or little finger

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

• Pathology

• “a compressive neuropathy of the median nerve with the carpal tunnel”

• Causes

• Genetics

• Lifestyle (diabetes, gout, arthritis, pregnancy, and alcoholism are risk factors)

• Repetitive motion. Keyboard, rock climbing, tennis,

• Trauma

Pressure inside the tunnel can double with CTS

• Pathology

• “a compressive neuropathy of the median nerve with the carpal tunnel”

• Causes

• Genetics

• Lifestyle (diabetes, gout, arthritis, pregnancy, and alcoholism are risk factors)

• Repetitive motion. Keyboard, rock climbing, tennis,

• Trauma

Pressure inside the tunnel can double with CTS

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

Overuse Overuse of flexor of flexor musclesmuscles

Pressure Pressure on on

median median nervenerve

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

• Modification in activities

• Table height, wrist angle, elbow angle

• 10-15 minute breaks

• Exercises and warm-up wrist flexor muscles

• Flex fingers tightly then extend and abduct fingers for 5 seconds

• With arms extended, flex and extend wrist several times followed by circumduction of the wrist

• Removable wrist brace

• Anti-inflammatory medicines

• NSAID

• Cortisone

Surgery – carpal tunnel release

• Modification in activities

• Table height, wrist angle, elbow angle

• 10-15 minute breaks

• Exercises and warm-up wrist flexor muscles

• Flex fingers tightly then extend and abduct fingers for 5 seconds

• With arms extended, flex and extend wrist several times followed by circumduction of the wrist

• Removable wrist brace

• Anti-inflammatory medicines

• NSAID

• Cortisone

Surgery – carpal tunnel release

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

Scare tissueScare tissue

Questions?Questions?