Transcript Athletic Therapy

Wrist and Forearm
Lecture 15
The Wrist and Hand
the wrist and hand are used extensively in
activities of daily living and in nearly all
sports
 The anatomy of the wrist is highly complex
 injuries to this region are often the result of
the natural tendency of the individual to
sustain the force of the fall on the hyperextended wrist
 Often seen in ball handling sports
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Bones and Articulations
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the wrist and hand are
composed of numerous
small bones and
articulations, which
enable the dexterous
movements performed
by the hand and wrist
both during sports and
daily living
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Distal radioulnar
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joint between the distal ulna and the radius
allows for pronation and supination of the forearm
triangular fibrocartilage (TFC) is the disc that makes
up a portion of the triangular fibrocartilage
complex(TFCC) which acts as a stabilizer of the joint
often injured , can lead to serious problems
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Radiocarpal joint
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is the major joint of the wrist
condyloid shape where the radius articulates with
the scaphoid, lunate and triquetrum allows
flex/ext, radial and ulnar deviations and
circumduction
volar, dorsal , radial and ulnar collateral
ligaments reinforce the radiocarpal joint
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Carpometacarpel (CM) joint
 joint between the carpels and the
metacarpels
 gliding joint
 dorsal , volar and interosseous ligaments
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l st CM (thumb)
 saddle joint
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Metacarpalphalangeal ( MP)
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allows flex/ext , add/ abd
condyloid joints
reinforced by strong collateral ligaments
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Interphalangeal (PIP, DIP)
hinge joints
flex/ext
volar, and collateral ligaments
Muscle & Tendons of the
Hand
given the highly controlled and precise
movements that the hand and fingers can
perform , there is no surprise that a large
number of muscles are responsible
 extrinsic muscles ( 9) , originate outside
the wrist – cross wrist and insert in hand
 intrinsic muscles (10) , originate in the
hand or wrist, and insert in hand or wrist
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Major Actions of the Wrist
and Hand
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wrist – flex/ext/radial deviation/ulnar deviation/
circumduction
thumb – flexion /extension/ adduction /abduction
and opposition
fingers – flex/ext/add/abd/
Common Injuries to Wrist
and Hand
Wrist Sprain
result of a single trauma – or repeated
stress
 usually result of axial loading on the palm
during a fall on the outstretched arm
 severity depends on
i) magnitude of the force
ii) position of the hand on impact
iii) strength of tissue
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point tenderness on dorsum of radiocarpal
joint , pain increases with passive or active
extension
 because of the need to perform daily
activity these injuries are often not given
the time to heal and can lead to chronic
instabilities
 Rx – PIER, NSAIDS, modalities ,
immobilization , rule out fractures
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Wrist Strains
usually the result of an overload or over
stretching
 pain and restricted motion
 often occur with a wrist sprain
 difficult to distinguish if both are present
 Rx – PIER, NSAIDS, modalities ,
immobilization , rule out fractures
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Triangular Fibrocartilage Complex
TFCC is located on the ulnar side of the
wrist between the ulna and the triquetrum
and pisiform
 TFCC is a stabilizer of the distal
radialulnar joint
 Injuries are common but often missed
diagnosed
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Often caused by falling on outstretched
hand , forced hyperextension of the wrist
s/s
 Pain and swelling on ulnar side of wrist
 Point tenderness ( TFCC)
 Decreased ROM and strength esp wrist
extension and ulnar deviation
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Scaphoid #
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most frequently fractured carpel ( 60 - 70%)
usually the result of hyperextension during a
fall on the outstretched arm
pain in anatomical snuff box , and pain with
wrist extension and radial deviation ,
possible loss of function
often misdiagnosed due to lack of evidence
on xray – re xay in 2 weeks or bone scan
CAUTION - scaphoid has poor blood
supply distal pole
 Rx - PIER – refer to doctor immediately
 Casting involves a long process for
healing - minimum six weeks and maybe
more if not healing properly
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First Aid
Immediately apply ice with some type of
splint that helps to immobilize the wrist
 Elevate with use of a sling
 Refer for medical attention
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Colles Fracture
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fracture to the distal
forearm involving one
or both bones (usually
the radius)
occurs with in 1 ½
inches of the wrist
results in a fork
deformity (distal
segment displaces in
dorsal and radial
direction)
First Aid
Immediately apply ice with some type of
splint that helps to immobilize the wrist
 Elevate with use of a sling
 Refer for medical attention
 Treat for shock
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Skier’s or Gamekeeper’s
Thumb
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thumb is exposed to
more force than
fingers due to its
position on the hand
integrity of the ulnar
collateral ligament of
the thumb is crucial
for normal hand
functions
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UCL of thumb stabilizes the joint as the thumb is
pushed against the index and middle fingers
while performing pinching and grasping motions
usually occurs when MP joint is near full
extension and thumb is forcibly abducted away
from the hand
palmer aspect of the hand is swollen, bruising
may be visible , point tenderness on UCL (
inside of the thumb) , instability and pain on
stressing of the ligament
Rx – PIER , refer to doctor - severe cases may
require surgical repair
Dislocations
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lunate is prone to dislocate during axial
loading
dorsum of hand tender with a thickened
area distal to radius on the palm, swelling
most common dislocation occurs at the
PIP or DIP joints, may be associated with
open wounds
usually the result of hyperextension and
axial compression , such as a ball hitting
the end of a finger
obvious deformity ,pain , loss of function
 immediate treatment – reduction of finger
by trained individual
 Rx- PIER - xray – protection may take
awhile to heal
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Carpal Tunnel Syndrome
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caused by direct trauma
or repetitive overuse
condition is three times
more common in
women , with right hand
usually more common
this is due to the more
repetitive tasks that
women’s occupation
usually involve
(keyboard)
the carpel tunnel runs between the floor of
the wrist and the transverse retinacular
ligament that runs from the hamate and
pisiform on the medial side to the
trapezium and scaphoid on the lateral side
 this tunnel accommodates the medial
nerve, the flexors of the fingers and flexor
pollicis longus
 swelling of these tendons puts pressure on
the median nerve
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pain that wakes them at night , numbness,
decreased grip strength
 symptoms reproduced with pressure over
the carpel tunnel
 Rx - PIER - immobilization refer to doctor
chronic conditions often end up with
surgery
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Mallet Finger
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occurs when an object
hits the end of a finger
while the extensor
tendon is taut
the resulting force
avulses the lateral
bands of the extensor
mechanism from its
distal attachment
obvious deformity , pain
- check for fractures
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Rx- PIER and
immobilize joint in
hyperextended
position
Jersey Finger
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This injury typically
occurs when an
individual grips an
opponent’s jersey while
the opponent is twists
to get away
This ruptures the flexor
digitorum profundus
tendon from its
attachment on the
distal phalanx
Ring finger is the most commonly injured
 Individual will be unable to flex the DIP
joint
 Rx- PIER and refer to doctor , surgery
most likely will need to be performed
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Boutonniere Deformity
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caused by a blunt
trauma to the dorsal
aspect of the PIP joint
the central slip extensor
tendon is ruptured at
the middle phalanx,
leaving the extensor
mechanism intact over
the PIP joint
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this results in
hyperextension at the
MCP joint , flexion at
the PIP joint and
hyperextension at the
DIP joint
Rx – PIER - needs to
be referred to a doctor
may need surgery
Ganglion Cysts
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are begin tumour
masses typically
seen on the dorsal
aspect of the wrist
associated with
tissue sheath
degeneration
contains fluid and is
palpable between
the extensors
Ganglion Cysts
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contains fluid and is
palpable between the
extensors tendons
localised tenderness
and some aggravation
with wrist flexion
Rx – symptomatic –
aspiration or injection ,
or surgical removal of
the cyst
Metacarpal Fractures
fractures usually result in sever pain,
dorsal swelling and deformity
 i) Bennets's # – articular fracture to the
proximal end of the first metacarpal
 usually occurs during axial compression
as in when a punch is thrown with a closed
fist
ii) Boxer's # - fracture of the 5th metacarpal
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Rx – PIER – refer to doctor , may need
closed or possibly open reduction
depending on alignment
Subungual Hematoma
direct trauma to the nail bed
 capillaries burst from trauma and blood
gets trapped under the finger nail
 pressure builds and pain results
 soak for 10 to 15 minutes in ice water
 Rx - may need to drain the hematoma to
reduce the pressure
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