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Wrist and Hand
Wrist Radiocarpal Mid-carpal (intercarpal)maintain length-tension relationship for hand musculature
Distal Radius Facets Lateral (46%) scaphoid Medial (43%) lunateInferior disk (11%) triquetrum
Radiocarpal Radius and Radioulnar disk (concave)Scaphoid (navicular), lunate, and triquetrum (proximal wrist bones)
Ligaments volar - thick, strong dorsal - thinner, fewerunique function extrinsic intrinsic
Ligaments Radiocarpal superficial deep
Ligaments Ulnocarpal complexmeniscus homologue - radiotriquetral ligament triangular fibrocartilage - articular disk
Kinematics Extension distal carpals on fixed proximal carpalsneutral (scaphoid-capitate close-packed)
Kinematics Extension scaphoid travels w/ distal carpals 450 ext.scaphoid & lunate close-packed scaphoid travels w/ proximal carpals
Kinematics Flexion opposite extension
Hand Flexor Tendons surrounded by synovial sheathsreinforced by pulleys (5/3) minimize force/pressure prevent bowstringing
Flexor Tendons 60 900 of PIP flexion 40% in tension in restraining pulley
Tendon Excursion and Pulleys
Tendon Excursion and Pulleys
Tendon Excursion and PulleysSliding 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 - clawingcounteract extrinsics stabilize proximal phalanx tendons volar to AOR lumbricales critical for timing
Hand/Wrist Injuries CTD/RSI CTS inflammation in CTcompressive neuropathy
Hand/Wrist Injuries Etiology of CTS forceful exertionsrepetitive*/prolonged activities awkward postures localized contact stresses vibration cold temp.
Carpal Fractures 80:20% load distribution between radius:ulnascaphoid (60-70%) hyperextension beyond 950 lunate
Finger Injuries Mallet Fingerdistal terminal tendon/slip rupture flexion of DIP
Finger Injuries Boutonniere (Button-Hole) Deformitydorsal synovitis /capsular distension thinning & lengthening of central tendon
Finger Injuries Boutonniere (Button-Hole) Deformitydorsal subluxation of proximal phalanx (PIP) palmar displacement (dislocation) of lateral bands of long extensors MCP / PIP DIP /
Finger Injuries Swan-Neck DeformityFlexor synovitis flexor forces on MCP stretching of collateral ligaments and palmar plate at PIP
Finger Injuries Swan-Neck Deformitydorsal displacement of lateral bands of extensors intrinsic tightening with MCP flexion position of lateral bands pull of extensor tendon reciprocal DIP flexion
Finger Injuries Swan-Neck Deformity MCP PIP / DIP
Thumb Injuries Gamekeeper’s/skier’s thumbMCP ulnar collateral ligament 20 to tensile loading (chronic or acute) excessive abduction/hyperextension
Thumb Injuries Bennett’s Fx fx subluxation of trapeziometacarpal jointintraarticular fx of 1st MET axial compression
Wrist and Hand Conditions
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Clinical Examination of the Hand and Wrist. OBJECTIVES Review the clinical anatomy and physical exam of the wrist and hand Formulate a pathoanatomic.
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