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Wrist and Hand Conditions. Chapter 13. Wrist Articulations. Radiocarpal: Radius with the Scaphoid, Lunate, Triquetrum. Intercarpal Distal Radioulnar Triangular Fibro cartilage Complex stabilizes the Radioulnar joint. Hand Articulations. Carpometacarpal (CM) Intermetacarpal (IM)

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Presentation Transcript
wrist articulations
Wrist Articulations
  • Radiocarpal: Radius with the Scaphoid, Lunate, Triquetrum.
  • Intercarpal
  • Distal Radioulnar
    • Triangular Fibro cartilage Complex stabilizes the Radioulnar joint.
hand articulations
Hand Articulations
  • Carpometacarpal (CM)
  • Intermetacarpal (IM)
  • Metacarpophalangeal (MP)
  • Interphalangeal (IP)
carpometacarpal and intermetacarpal joints
Carpometacarpal and Intermetacarpal Joints
  • CM of the thumb is a saddle joint
  • CM of the four fingers gliding joints
  • IM reinforced by joint capsules comprised of the dorsal, volar, and two interosseous CM ligaments
metacarpophalangeal joints
Metacarpophalangeal Joints
  • Rounded distal heads of the metacarpals articulate with the concave proximal ends of the phalanges
  • Reinforced by strong collateral ligaments
interphalangeal joints
Interphalangeal Joints
  • The Proximal (PIP), Distal (DIP), and the IP joint of the thumb are all hinge joints
  • The articular capsule made up of volar and collateral ligaments surround each IP joint
muscles
Muscles
  • Retinacula of the Wrist:
    • The fascial tissue surrounding the wrist thickened into strong fibrous bands called retinacula that form protective passageways through which tendons, nerves, and blood vessels pass.
  • Tendon Sheaths:
    • Sealed at both ends containing synovial fluid, annular pulleys that prevent tendon bowstringing with flexion.
kinematics
Kinematics
  • Flexion
  • Extension
  • Hyperextension
  • Radial deviation
  • Ulnar deviation
flexion
Flexion
  • Flexor carpi radialis
  • Flexor carpi ulnaris
  • Palmaris longus (sometimes absent)
  • Flexor digitorum superficialis
  • Flexor digitorum profundus
extension and hyperextension
Extension and Hyperextension
  • Extensor carpi radialis longus
  • Extensor carpi radialis brevis
  • Extensor carpi ulnaris
  • Extensor pollicis longus
  • Extensor digiti minimi
  • Extensor digitorum
radial and ulnar deviation
Radial and Ulnar Deviation
  • Radial Deviation
    • Flexor carpi radialis
    • Extensor carpi radialis
  • Ulnar Deviation
    • Flexor carpi ulnaris
    • Extensor carpi ulnaris
kinetics of the wrist
Kinetics of the Wrist
  • Extrinsic flexor muscles are twice as strong as the…
  • Extrinsic extensor muscles
  • Flexors used everyday for gripping, grasping, or pinching movements.
strengthening
Strengthening
  • Strengthening should include general elbow flexion, extension, pronation, and supination, wrist flexion, extension, Radial and Ulnar deviation.
contusions and abrasions
Contusions and Abrasions
  • Thoroughly clean, dress daily, inspect for infection daily.
  • Ice, compression, elevation for 2 – 3 days.
sprains
Sprains
  • Wrist sprains
  • Gamekeeper’s Thumb
  • Interphalangeal Collateral Ligament Sprains
dislocations
Dislocations
  • Distal radioulnar joint (DRUJ)
  • Lunate dislocation
  • MP joint dislocation
  • PIP joint dislocation
strains
Strains
  • Jersey Finger
  • Mallet Finger
  • Boutonniere Deformity
tendinopathies
Tendinopathies
  • Trigger Finger
  • DeQuervain’s tenosynovitis
  • Intersection Syndrome
fingertip injuries
Fingertip Injuries
  • Subungual hematomas
  • Paronychia
nerve entrapment syndromes
Nerve Entrapment Syndromes
  • Median Nerve Entrapment
    • Anterior Interosseous Nerve Syndrome
    • Carpal Tunnel Syndrome
  • Ulnar Nerve Entrapment
    • Ulnar tunnel syndrome
    • Cyclist’s palsy
    • Bowler’s thumb
  • Chris Carlin, Dominique Rodriguez
radial nerve entrapment
Radial Nerve Entrapment
  • Distal Posterior Interosseous Nerve Syndrome
  • Superficial Radial Nerve Entrapment
fractures
Fractures
  • Distal Radial and Ulnar fractures
    • Monteggia’s fracture
    • Galeazzi’s fracture
    • Colle’s fracture
    • Smith’s fracture
  • Scaphoid fracture
  • Hamate fracture
  • Triquetrum fracture
  • Kienbock’s disease
fractures cont
Fractures cont.
  • Metacarpal fractures
    • Boxer’s fracture
  • Bennett’s fracture
  • Phalangeal fractures