The Wrist & Hand. Bony Anatomy The Wrist - Made up of 8 bones, called carpals - Transverse 2 rows...
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Transcript of The Wrist & Hand. Bony Anatomy The Wrist - Made up of 8 bones, called carpals - Transverse 2 rows...
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