The Wrist & The Wrist & HandHand

Bony AnatomyBony Anatomy

The Wrist

- Made up of 8 bones, called carpals - Transverse 2 rows

The Hand

- Made up of 5 metacarpals and 5 digits - One digit has 3 phalanges, except the thumb

The Joint is condyloid

Posterior Muscles →

Anterior Muscles

ROM’s for the WristROM’s for the Wrist

Wrist ExtensionWrist Flexion

ROM’s for the WristROM’s for the Wrist

Ulnar Deviation Radial Deviation

ROM’s of the FingersROM’s of the FingersFinger Extension Finger Flexion

Finger Abduction Finger Adduction

Wrist FracturesWrist Fractures

MOI: Direct blows or MOI: Direct blows or falling on handfalling on hand– Colle’s FxColle’s Fx

S/S: Reduced S/S: Reduced function, crepitus, function, crepitus, edema, & pt.tenderedema, & pt.tender

Tx. Splint, RICE, Tx. Splint, RICE, Refer to MDRefer to MD

Tests: NoneTests: None

Wrist FracturesWrist Fractures

MOI: Falling on MOI: Falling on outstretched handoutstretched hand– Scaphoid FxScaphoid Fx

S/S: Pt. Tender over S/S: Pt. Tender over anatomical snuffbox, anatomical snuffbox, edema, Pn with edema, Pn with extensionextension

Tx. Splint, RICE, Tx. Splint, RICE, Check pulse, Refer to Check pulse, Refer to MDMD

Tests: Spider TestTests: Spider Test

Dislocations/SubluxationsDislocations/Subluxations

MOI: Direct blowsMOI: Direct blows

S/S: LOF, edema, S/S: LOF, edema, deformitydeformity

Tx: Splint, RICE, Tx: Splint, RICE, Check pulseCheck pulse

Tests: Murphy’s SignTests: Murphy’s Sign

Sprains: Gamekeeper’s ThumbSprains: Gamekeeper’s Thumb

MOI: Overstretching of thumb, AB or ADDMOI: Overstretching of thumb, AB or ADD– LCL or MCLLCL or MCL

S/S: Edema, Pn with movement, Pt. S/S: Edema, Pn with movement, Pt. TenderTender

Tx: RICE, Thumb SpicaTx: RICE, Thumb Spica

Tests: Gamekeeper’s Test, Varus/Valgus Tests: Gamekeeper’s Test, Varus/Valgus

ImpingementImpingement

MOI: Repeated StressMOI: Repeated Stress

S/S: Pt. Tender, Pn, Numbness, Tingling, S/S: Pt. Tender, Pn, Numbness, Tingling, loss of strengthloss of strength

Tx: Rest & Ice, BracingTx: Rest & Ice, Bracing

Tests: Phalen’s, Pinch GripTests: Phalen’s, Pinch Grip

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

MOI: Overuse or prolonged flexion of the MOI: Overuse or prolonged flexion of the wristwrist

S/S: Tingling in thumb & middle fingers, S/S: Tingling in thumb & middle fingers,

↓ ↓ Grip strength, Grip strength,

Tx: Braces for days/months , Cortisone Tx: Braces for days/months , Cortisone shots or other meds, surgery, shots or other meds, surgery, strengthening exercisesstrengthening exercises

Tests:Phalen’sTests:Phalen’s

TendonitisTendonitis

MOI: Overuse of the handMOI: Overuse of the hand

S/S: Edema and Point TenderS/S: Edema and Point Tender

Tx: RICETx: RICE

Tests: Finkelstein’s TestTests: Finkelstein’s Test

Ganglion CystGanglion Cyst

Fluid-filled sac in the synovial membrane, Fluid-filled sac in the synovial membrane, or a herniation of the sheathor a herniation of the sheath

MOI: Degeneration of the sheathMOI: Degeneration of the sheath

S/S: Pn, S/S: Pn, ↓ ROM, Small lump (usually on ↓ ROM, Small lump (usually on posterior wrist)posterior wrist)

Tx: Donut pad, Ice, Refer to MD if does Tx: Donut pad, Ice, Refer to MD if does not heal after 1 wk.not heal after 1 wk.

Mallet FingerMallet FingerMOI: direct blow to MOI: direct blow to outstretched finger or outstretched finger or caught in jersey, tearing caught in jersey, tearing the extensor tendonthe extensor tendon– Jersey finger is a sprainJersey finger is a sprain

S/S: Pt. Tender, Flexed S/S: Pt. Tender, Flexed DIP JointDIP Joint

Tx: Splint, ICE, Refer to Tx: Splint, ICE, Refer to MDMD

Tests: NoneTests: None