Transcript Chapter 17 - Wrist, Hand, and Finger Pathologiesx

Chapter 17
Wrist, Hand, and Finger
Pathologies
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Clinical Anatomy
 Bony anatomy
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Distal radius
Ulnar notch
Radial styloid process
Ulnar head
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Clinical Anatomy
 Bony anatomy
 Carpal bones
 Metacarpals
 Phalanx
 Proximal
 Middle (not in thumb)
 Distal
 Sesamoid bones
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Clinical Anatomy
 Articulations and ligamentous support
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Distal radioulnar joint
Radiocarpal joint
Intercarpal joints
Midcarpal joints
Carpometacarpal joints
Metacarpophalangeal and interphalangeal
joints
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Clinical Anatomy
Palmar (volar) ligaments of the
wrist and hand
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Dorsal ligaments of the wrist and
hand
The Triangular Fibrocartilage Complex
(TFCC)
Several ligaments and other fibrous structures attach to the
fibrocartilage. As a unit, the TFCC provides support to the distal
radioulnar joint. L = lunate; TQ = triquetrum.
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Clinical Anatomy
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Clinical Anatomy
 Nerves
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Ulnar nerve
Median nerve
Radial nerve
The carpal tunnel
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Clinical Anatomy
Extensor compartment
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Clinical Anatomy
Hand intrinsic muscles
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Clinical Anatomy
Hand intrinsic muscles
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Clinical Examination of Injuries to the
Wrist, Hand, and Fingers
Past history
 Previous history
 Loss of function from
previous injury
 General medical health
 Rheumatoid arthritis
 PVD (peripheral vascular
disease)
 Raynaud phenomenon
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History of the present
condition
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Location of pain
MOI
Relevant sounds or sensations
Duration of symptoms
Description of symptoms
Changes in activity
Clinical Examination of Injuries to
the Wrist, Hand, and Fingers
 Inspection
 Functional observation
 General inspection
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Posturing of the wrist and hand
Gross deformity
Palmar creases
Lacerations or scars
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Clinical Examination of Injuries to the
Wrist, Hand, and Fingers
 Inspection
 Wrist and hand
 Continuity of the distal
radius and ulna
 Continuity of the
carpals and
metacarpals
 Alignment of the MCP
joints
 Posture of the wrist and
hand
 Ganglion cyst
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Clinical Examination of Injuries to the
Wrist, Hand, and Fingers
 Inspection
 Thumb and fingers
 Inspection of the skin
and fingernails
 Subungual hematoma
 Felon
 Paronychia
 Alignment of fingernails
 Muscle contour
 Individual finger
deformities
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Clinical Examination of Injuries to
the Wrist, Hand, and Fingers
 Palpation of the palmar
(anterior) wrist
1.
2.
3.
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5.
6.
7.
8.
9.
Radius
Flexor carpi radialis
Palmaris longus
Carpal tunnel
Ulna
Flexor carpi ulnaris
TFCC
Pisiform
Hamate
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Clinical Examination of Injuries to
the Wrist, Hand, and Fingers
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Palpation of the dorsal
(posterior) wrist
1.
2.
3.
4.
5.
6.
7.
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10.
11.
12.
13.
14.
15.
16.
Ulna
Ulnar head
Ulnar styloid process
Ulnar collateral ligament
Extensor carpi ulnaris
Lister tubercle
Distal radius or styloid process
Radial collateral ligament
Scaphoid
Lunate
Triquetrum
Trapezium
Capitate
Trapezoid
Extensor carpi radialis brevis
Extensor carpi radialis longus
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Clinical Examination of Injuries to the Wrist,
Hand, and Fingers
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Palpation of the hand
1.
2.
3.
4.
5.
Thenar eminence
Central compartment
Hypothenar compartment
Metacarpals
Collateral ligaments of the
metacarpophalangeal joints
6. Phalanges
7. Collateral ligaments of the IP
joints
8. Thenar webspace
9. Extensor digitorum
10-12. Extensor digitorum
13. Extensor pollicis longus
14. Abductor pollicis longus and
extensor pollicis brevis
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Clinical Examination of Injuries to the
Wrist, Hand, and Fingers
 Joint and muscle function assessment
 Wrist
 Thumb
 Finger
 Active range of motion (AROM)
 Manual muscle test (MMT)
 Passive range of motion (PROM)
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Selective Tissue Test: Grip
Dynamometry
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Clinical Examination of Injuries to the
Wrist, Hand, and Fingers
 Joint stability tests
 Stress testing
 Collateral support of the wrist ligaments
 Collateral support of the IP joints
 Support for the UCL
 Joint play tests
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Ligaments Stressed During Wrist
Passive Range of Motion
Ligaments Stressed
Passive Movement
Primary
Secondary
Extension
Palmar ulnocarpal
Radial collateral
Palmar radiocarpal
Ulnar collateral
Flexion
Dorsal radiocarpal
Radial collateral
Ulnar collateral
Radial Deviation
Ulnar collateral
Palmar ulnocarpal
Ulnar Deviation
Radial collateral
Palmar radiocarpal
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Radial Collateral and Ulnar Collateral
Ligament Stress Tests of the Wrist
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Valgus and Varus Testing of the
Interphalangeal Joints
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Test for Laxity of the Thumb MCP
Collateral Ligaments
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Clinical Examination of Injuries to the
Wrist, Hand, and Fingers
 Neurological testing
 Upper quarter screen
 Pathologies
 Carpal tunnel syndrome
 Drop wrist syndrome
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Pathologies of the Wrist, Hand, and
Fingers and Related Special Tests
 Wrist pathology
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Distal forearm fractures
Scaphoid fractures
Hamate fractures
Perilunate and lunate dislocation
Wrist sprains
TFCC injury
Carpal tunnel syndrome
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On-Field Evaluation and Management of
Wrist, Hand, and Finger Injuries
 Lacerations
 Management
 Use universal precautions
 Take precautions against infection
 Lacerations involving the fascia should be referred
to determine if suturing is needed.
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Selective Tissue Test: Watson Test
for Scapholunate Instability
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Selective Tissue Test: Phalen Test
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Pathologies of the Wrist, Hand, and
Fingers and Related Special Tests
 Hand pathology
 Metacarpal fractures
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Pathologies of the Wrist, Hand, and
Fingers and Related Special Tests
 Finger pathology
 Collateral ligament injuries
 Boutonnière deformity
 Finger fractures
 Tendon ruptures and avulsion fractures
 Mallet finger
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Pathologies of the Wrist, Hand, and
Fingers and Related Special Tests
 Thumb pathology
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De Quervain’s syndrome
Thumb sprain
MCP joint dislocation
Thumb fractures
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Selective Tissue Test: Finkelstein’s
Test for de Quervain’s Syndrome
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On-Field Evaluation and Management of
Wrist, Hand, and Finger Injuries
 Interphalangeal joint dislocations
 Management
 Reduction can be performed by trained personnel
by applying traction
 If unreduced, splint on the palmar aspect and apply ice
pack
 Splint
 Refer for imaging
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On-Field Evaluation and Management of
Wrist, Hand, and Finger Injuries
 Hand and finger fractures
 Management
 Splint
 If wrist and hand both injured, leave nailbeds exposed to
check capillary refill
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Splinting of Common Finger Injuries
Deformity
Splinting Position
Jersey finger
DIP joint in flexion
Mallet finger
DIP joint in extension
Boutonnière deformity
PIP and DIP joints in extension
Phalanx fracture
Position found
Metacarpal fracture
Palmar surface of wrist and hand
Unreduced dislocations
Position found
DIP = distal interphalangeal; PIP = proximal interphalangeal
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