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Wrist and Hand. Wrist Radiocarpal Mid-carpal (intercarpal) zmaintain length- tension relationship for hand musculature.

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Presentation on theme: "Wrist and Hand. Wrist Radiocarpal Mid-carpal (intercarpal) zmaintain length- tension relationship for hand musculature."— Presentation transcript:

1 Wrist and Hand

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

3 Distal Radius Facets zLateral (46%)  scaphoid zMedial (43%)  lunate zInferior 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  45 0 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  90 0 of PIP flexion   40%  in tension in restraining pulley

13 Tendon Excursion and Pulleys

14

15 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

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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 95 0  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  zthinning & lengthening of central tendon 

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

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

27 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

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

29 Thumb Injuries Gamekeeper’s/skier’s thumb  MCP ulnar collateral ligament  2 0 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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