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Wrist and Hand
Wrist Radiocarpal Mid-carpal (intercarpal) zmaintain length- tension relationship for hand musculature
Distal Radius Facets zLateral (46%) scaphoid zMedial (43%) lunate zInferior disk (11%) triquetrum
Radiocarpal Radius and Radioulnar disk (concave) Scaphoid (navicular), lunate, and triquetrum (proximal wrist bones)
Ligaments volar - thick, strong dorsal - thinner, fewer unique function extrinsic intrinsic
Ligaments Radiocarpal superficial deep
Ligaments Ulnocarpal complex meniscus homologue - radiotriquetral ligament triangular fibrocartilage - articular disk
Kinematics Extension distal carpals on fixed proximal carpals neutral (scaphoid-capitate close-packed)
Kinematics Extension scaphoid travels w/ distal carpals 45 0 ext. scaphoid & lunate close-packed scaphoid travels w/ proximal carpals
Kinematics Flexion opposite extension
Hand Flexor Tendons surrounded by synovial sheaths reinforced by pulleys (5/3) minimize force/pressure prevent bowstringing
Flexor Tendons 60 90 0 of PIP flexion 40% in tension in restraining pulley
Tendon Excursion and Pulleys
Sliding of flexor/extensor tendons proximal jts. > distal joints FS > FP Flexors > extensors Extrinsics > intrinsics
Pulley Disruption Bowstringing excursion at a joint weakness at other joints
Balance of Power Extrinsic vs. Intrinsics Intrinsic - clawing counteract extrinsics stabilize proximal phalanx tendons volar to AOR lumbricales critical for timing
Hand/Wrist Injuries CTD/RSI CTS inflammation in CT compressive neuropathy
Hand/Wrist Injuries Etiology of CTS forceful exertions repetitive*/prolonged activities awkward postures localized contact stresses vibration cold temp.
Carpal Fractures 80:20% load distribution between radius:ulna scaphoid (60-70%) hyperextension beyond 95 0 lunate
Finger Injuries Mallet Finger distal terminal tendon/slip rupture flexion of DIP
Finger Injuries Boutonniere (Button-Hole) Deformity dorsal synovitis /capsular distension zthinning & lengthening of central tendon
Finger Injuries Boutonniere (Button-Hole) Deformity zdorsal subluxation of proximal phalanx (PIP) zpalmar displacement (dislocation) of lateral bands of long extensors zMCP / PIP DIP /
Finger Injuries Swan-Neck Deformity zFlexor synovitis flexor forces on MCP zstretching of collateral ligaments and palmar plate at PIP
Finger Injuries Swan-Neck Deformity zdorsal displacement of lateral bands of extensors zintrinsic tightening with MCP flexion zposition of lateral bands pull of extensor tendon z reciprocal DIP flexion
Finger Injuries Swan-Neck Deformity zMCP PIP / DIP
Thumb Injuries Gamekeeper’s/skier’s thumb MCP ulnar collateral ligament 2 0 to tensile loading (chronic or acute) excessive abduction/hyperextension
Thumb Injuries Bennett’s Fx fx subluxation of trapeziometacarpal joint intraarticular fx of 1st MET axial compression
Fractures from Hand to Elbow. Concave articular surface MC PP MP DP Biconcave with a median ridge Sesamoid bone, found on the palmar surface. Found within.
Injuries to the Elbow, Forearm, Wrist & Hand. Bones and Joints of the Elbow Bones Humerus Radius Ulna Joints Humeroulna = humerus & ulna Humeroradial.
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Principles of Tendon Transfers What is a tendon transfer? The tendon of a functioning muscle is detached from its insertion and reattached to another.
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UPPER EXTREMITY INJURIES Objective 2: Recognize common injuries to the upper extremity…
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Principles of External Fixation Roman Hayda, MD Original Authors: Alvin Ong, MD & Roman Hayda, MD; March 2004; New Author: Roman Hayda, MD; Revised November,
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Environmental Health and Safety 1 Construction Ergonomics This material was developed for a companys use based on its needs and requirements. It may not.
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