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Wrist and Hand.

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Presentation on theme: "Wrist and Hand."— Presentation transcript:

1 Wrist and Hand

2 Wrist Radiocarpal Mid-carpal (intercarpal)
maintain length-tension relationship for hand musculature

3 Distal Radius Facets Lateral (46%) scaphoid Medial (43%) lunate
Inferior disk (11%) triquetrum

4 Radiocarpal Radius and Radioulnar disk (concave)
Scaphoid (navicular), lunate, and triquetrum (proximal wrist bones)

5 Ligaments volar - thick, strong dorsal - thinner, fewer
unique function extrinsic intrinsic

6 Ligaments Radiocarpal superficial deep

7 Ligaments Ulnocarpal complex
meniscus homologue - radiotriquetral ligament triangular fibrocartilage - articular disk

8 Kinematics Extension distal carpals on fixed proximal carpals
neutral (scaphoid-capitate close-packed)

9 Kinematics Extension scaphoid travels w/ distal carpals  450 ext.
scaphoid & lunate close-packed  scaphoid travels w/ proximal carpals

10 Kinematics Flexion opposite extension

11 Hand Flexor Tendons surrounded by synovial sheaths
reinforced by pulleys (5/3) minimize force/pressure prevent bowstringing

12 Flexor Tendons 60  900 of PIP flexion 
40%  in tension in restraining pulley

13 Tendon Excursion and Pulleys

14 Tendon Excursion and Pulleys

15 Tendon Excursion and Pulleys
Sliding of flexor/extensor tendons proximal jts. > distal joints FS > FP Flexors > extensors Extrinsics > intrinsics

16 Pulley Disruption Bowstringing
 excursion at a joint  weakness at other joints

17 Pulley Disruption

18 Pulley Disruption

19 Balance of Power Extrinsic vs. Intrinsics Intrinsic -  clawing
counteract extrinsics stabilize proximal phalanx tendons volar to AOR lumbricales critical for timing

20 Hand/Wrist Injuries CTD/RSI CTS inflammation in CT
compressive neuropathy

21 Hand/Wrist Injuries Etiology of CTS forceful exertions
repetitive*/prolonged activities awkward postures localized contact stresses vibration cold temp.

22 Carpal Fractures 80:20% load distribution between radius:ulna
scaphoid (60-70%) hyperextension beyond 950 lunate

23 Finger Injuries Mallet Finger
distal terminal tendon/slip rupture  flexion of DIP

24 Finger Injuries Boutonniere (Button-Hole) Deformity
dorsal synovitis /capsular distension  thinning & lengthening of central tendon

25 Finger Injuries Boutonniere (Button-Hole) Deformity
dorsal subluxation of proximal phalanx (PIP)  palmar displacement (dislocation) of lateral bands of long extensors  MCP /  PIP  DIP /

26 Finger Injuries Swan-Neck Deformity
Flexor synovitis   flexor forces on MCP stretching of collateral ligaments and palmar plate at PIP

27 Finger Injuries Swan-Neck Deformity
dorsal displacement of lateral bands of extensors  intrinsic tightening with MCP flexion  position of lateral bands  pull of extensor tendon  reciprocal DIP flexion

28 Finger Injuries Swan-Neck Deformity MCP   PIP /  DIP 

29 Thumb Injuries Gamekeeper’s/skier’s thumb
MCP ulnar collateral ligament 20 to tensile loading (chronic or acute) excessive abduction/hyperextension

30 Thumb Injuries Bennett’s Fx fx subluxation of trapeziometacarpal joint
intraarticular fx of 1st MET axial compression

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