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The Forearm, Wrist, Hand, and Fingers Chapter 24.

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Presentation on theme: "The Forearm, Wrist, Hand, and Fingers Chapter 24."— Presentation transcript:

1 The Forearm, Wrist, Hand, and Fingers Chapter 24

2 Forearm Anatomy zRadius and Ulna: Elbow zJoints: radioulnar joint zUlna: direct extension to the humerus zRadius: extension of the hand

3 Forearm Anatomy zBone: proximal radial head, olecranon process, radial shaft, ulnar shaft, distal radius, radial styloid process, ulnar head, ulnar styloid

4 Forearm Anatomy zMusculature: xConsist of xFlexors of the wrist and fingers are

5 Forearm Anatomy zNerve/Blood Supply: median and radial nerve and brachial, radial, and ulnar artery

6 Forearm Assessment zHistory: What? Where? How? When? (some asked questions to figure out what happened to the forearm) zObservation: forearm is first visually inspected for obvious deformities, swelling, and skin defects

7 Forearm Assessment zPalpation: can reveal tenderness, edema, fracture deformity, change in skin temperature, a false joint, bone fragments, or a lack of continuity between bones

8 Recognition and Management of Forearm Injuries zContusion yEtiology: ySigns and Symptoms: pain, swelling, and hematoma; yManagement:

9 Recognition and Management of Forearm Injuries zForearm Splints yEtiology: ySigns and Symptoms: yManagement: if problem occurs early in season, athlete should concentrate on increasing the strength of the forearm through resistance exercises, but if arises late in season, emphasis should be placed on rest and cryo therapy or heat and use of a supportive wrap during activity

10 Recognition and Management of Forearm Injuries z Colles’ fracture yEtiology: involve lower end of the radius or ulna; fall on outstretched hand, ySigns and Symptoms: forward displacement of radius, makes visible deformity to the wrist; yManagement:

11 Recognition and Management of Forearm Injuries z Forearm Splints yEtiology: severe static contraction; ySigns and Symptoms: dull ache between the extensor muscles, which cross the back of forearm; yManagement: rest, cryotherapy, heat and it also depends on when it occurs in the season, other actions should be taken depending on that

12 Wrist, Hand, and Finger Anatomy zBones: zJoints:

13 Wrist, Hand, and Finger Anatomy zLigaments: “many at each joint in the hand” zMusculature: “many intrinsic and extrinsic muscles”

14 Wrist, Hand, and Finger Anatomy zBlood and Nerve Supply: ulnar, median, radial nerve and radial and ulnar superficial and deep palmar arch arteries.

15 Assessment of Wrist, Hand, and Finger Injuries zHistory: asks about location & type of pain xWhat increases or decreases the pain? zObservation: hand usage as of writing or unbuttoning a shirt is observed. General attitude of the hand is observed. Opening and closing the hand xIs the wrist or hand swollen? xAre there any postural deviations?

16 Assessment of Wrist, Hand, and Finger Injuries zPalpation yBony palpation includes carpals, meta-, and phalanges ySoft tissue palpation includes ligament, fibro-cartilage x-

17 Assessment of Wrist, Hand, and Finger Injuries zSpecial Tests: -Finklestein’s test, Tinel’s Sign, Phalen’s test, valgus and varus stress test, Glide test, Lunotri- quetral Ballotment test, Allen’s test

18 Assessment of Wrist, Hand, and Finger Injuries zCirculatory and Neurological Evaluation yAllen test yRange of motion is noted in all move- ments, active and resistance movements Functional Evaluation

19 Recognition and Management of Wrist, Hand, and Finger Injuries zWrist Sprain yEtiology: can arise from any abnormal movement of the wrist; ySigns and Symptoms: complains of pain, swelling, & difficulty moving the wrist; yManagement:

20 Recognition and Management of Wrist, Hand, and Finger Injuries zTriangular Fibrocartilage Complex Injury yEtiology: caused by forced hyper-extension of the wrist; TFCC is also associated with sprain of the ulnar collateral ligament ySigns and Symptoms: its common for no immediate report on injury from athlete; pain along the ulnar side of the wrist; yManagement: physician for treatment;

21 Recognition and Management of Wrist, Hand, and Finger Injuries zCarpal tunnel syndrome yEtiology: anterior aspect of the wrist; ySigns and Symptoms: compression in the medial nerve will usually result in both sensory and motor deficits; yManagement: rest, immobilization, and nonsteroidal anti-inflammatory medication;

22 Recognition and Management of Wrist, Hand, and Finger Injuries z Tenosynovitis yEtiology: ySigns and Symptoms: pain with use or pain in passive stretching; yManagement:

23 Recognition and Management of Wrist, Hand, and Finger Injuries z Tendinitis yEtiology: sports that require repetitive pulling movements and sports that place prolonged pressure on the palms ySigns and Symptoms: yManagement: ice massage for 10 minutes 4x’s a day for the 1 st 48-72 hours, NSAIDs, and rest;

24 Recognition and Management of Wrist, Hand, and Finger Injuries z Nerve Compression, Entrapment, Palsy yEtiology: ySigns and Symptoms: *(see pictures on next slide)* THANK YOU yManagement:

25 Recognition and Management of Wrist, Hand, and Finger Injuries Nerve Compression, Entrapment, Palsy Claw hand Drop wrist Ape hand Bishop’s, or benediction, hand

26 Recognition and Management of Wrist, Hand, and Finger Injuries zDe Quervain’s Disease (aka) Hoffman’s Disease yEtiology: stenosing tenosynovitis in the thumb; ySigns and Symptoms: point tenderness, aching pain, weakness during thumb extension and abduction, and there may be a painful snapping and catching of the tendons during movement yManagement: involves immobilization, rest, cyrotherapy, and anti-inflammatory medication.

27 Recognition and Management of Wrist, Hand, and Finger Injuries zDislocation of the Lunate Bone yEtiology: hyperextension of the wrist; dislocation of the lunate; ySigns and Symptoms: pain, swelling, difficulty in executing wrist and finger flexion, numbness or even paralysis of the flexor muscles yManagement: (if not bone deterioration may occur)

28 Recognition and Management of Wrist, Hand, and Finger Injuries z Hamate Fracture yEtiology: may occur from fall but most likely from contact while the athlete is holding a sports implement such as a tennis racket, a baseball bat, etc. ySigns and Symptoms: wrist pain and weakness and point tenderness are experienced; yManagement: casting of the wrist;

29 Recognition and Management of Wrist, Hand, and Finger Injuries z Scaphoid Fracture yEtiology: force on the outstretched hand, which compresses the scaphoid bone between the radius and the 2 nd row of carpal bones ySigns and Symptoms: yManagement: cold should be applied, the area splinted, and the athlete referred to a physician for x-ray study and casting

30 Recognition and Management of Wrist, Hand, and Finger Injuries z Wrist Ganglion yEtiology: synovial cyst; ySigns and Symptoms: pain with a lump at the site; pain increases with use; yManagement: break down the swelling through digital pressure and then apply a felt pressure pad for a period of time

31 Recognition and Management of Wrist, Hand, and Finger Injuries zContusion to hand and fingers yEtiology: irregular bony structure combined with little protective fat and muscle padding, are prone to bruising in sports ySigns and Symptoms: this condition is easily identified from the history of trauma and the pain and swelling of soft tissues yManagement: cold and compression followed by gradual warming of the warming bath;

32 Recognition and Management of Wrist, Hand, and Finger Injuries zBowler’s Thumb yEtiology: a perineural fibrosis of the subcutaneous ulnar digital nerve of the thumb can occur from the pressure of a bowling ball thumbhole & cause the development of fibrotic tissue around the ulnar nerve ySigns and Symptoms: yManagement:

33 Recognition and Management of Wrist, Hand, and Finger Injuries zJersey finger yEtiology: ySigns and Symptoms: pain & point tenderness; b/c the tendon is no longer attached to the distal phalanx, the DIP joint can’t be flexed and the finger is in an extended position yManagement:

34 Recognition and Management of Wrist, Hand, and Finger Injuries z Trigger finger or thumb yEtiology: repeated movement can cause the tendons of the wrist and hand to sustain irritation that results in tenosynovitis ySigns and Symptoms: when finger of thumb is flexed, there is resistance to re-extension, producing a snapping that is both palpable & audible; yManagement:

35 Recognition and Management of Wrist, Hand, and Finger Injuries z Mallet finger yEtiology: ySigns and Symptoms: yManagement: RICE is given for pain & swelling, if there’s no fracture it should be immediately splinted

36 Recognition and Management of Wrist, Hand, and Finger Injuries zMallet finger

37 Recognition and Management of Wrist, Hand, and Finger Injuries z Boutonniere deformity (aka) button-hole yEtiology: a rupture of the extensor tendon dorsal to the middle phalanx, trauma occurs to the tip of the finger ySigns and Symptoms: severe pain and inability to extend the DIP joint; yManagement:

38 Recognition and Management of Wrist, Hand, and Finger Injuries zBoutonniere deformity (aka) button-hole

39 Recognition and Management of Wrist, Hand, and Finger Injuries zDupuytren’s Contracture yEtiology: (nodules develop in the palmer aponeurosis that limit finger extension and eventually cause a flexion deformity) ySigns and Symptoms: the little fingers moves into the palm of the hand and cannot be extended yManagement: (immediately removed)

40 Recognition and Management of Wrist, Hand, and Finger Injuries zSprains, Dislocations, and Fractures of Phalanges yEtiology: phalanges are prone to sprains cause by a blow delivered to the tip or by violent twisting, the sprain affects the capsular, ligamentous, and tendinous tissues ySigns and Symptoms: recognition is accomplished primarily through the history and the sprain symptoms:

41 Recognition and Management of Wrist, Hand, and Finger Injuries zGamekeepers Thumb yEtiology: a sprain of the ulnar collateral ligament of the MCP joint of the thumb; ySigns and Symptoms: yManagement: proper, immediate, & follow-up care must be performed, & a thumb splint should be taken care of for 3-4 weeks

42 Recognition and Management of Wrist, Hand, and Finger Injuries z PIP Dorsal dislocation yEtiology: seen in collisions or contact sports; ySigns and Symptoms: pain & swelling over the PIP; yManagement: RICE, splinting, & analgesics, & a physician; finger is splinted at 20-30 degrees for 3 weeks;

43 Recognition and Management of Wrist, Hand, and Finger Injuries PIP Dorsal Dislocation

44 Recognition and Management of Wrist, Hand, and Finger Injuries

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53 zMCP dislocation yEtiology: ySigns and Symptoms: pain, swelling, and stiffness at the MCP joint; the proximal phalanx is dorsally angulated at 60-90 degrees yManagement: RICE, splinting, and analgesics; reduced, buddy tape, and given early ROM

54 Recognition and Management of Wrist, Hand, and Finger Injuries zMetacarpal fracture yEtiology: ySigns and Symptoms: pain & swelling; yManagement: RICE & analgesics followed by X- ray ‘s;

55 Recognition and Management of Wrist, Hand, and Finger Injuries zBennett’s Fracture yEtiology: ySigns and Symptoms: pain & swelling over the base of the thumb; the thumb’s CMC appears deformed; yManagement: structure is unstable and must be referred to an orthopedic surgeon

56 Recognition and Management of Wrist, Hand, and Finger Injuries z Distal phalangeal fracture yEtiology: ySigns and Symptoms: pain and swelling of the distal phalanx; there may be deformity; yManagement: RICE and analgesics, a protective splint, and subungual hematoma is drained

57 Recognition and Management of Wrist, Hand, and Finger Injuries z Middle phalangeal fracture yEtiology: ySigns and Symptoms: pain and swelling with tenderness over the middle phalanx, there may be deformity, and X-ray show bone displacement yManagement: RICE and analgesics are given;

58 Recognition and Management of Wrist, Hand, and Finger Injuries z Proximal phalangeal fracture yEtiology: ySigns and Symptoms: yManagement:

59 Recognition and Management of Wrist, Hand, and Finger Injuries z Fingernail deformity yScaling or ridging- yRidging and poor development- yClubbing and cyanosis- ySpooning or depression-

60 Rehabilitation Principles for the Forearm, Wrist, Hand, and Fingers zGeneral Body Conditioning- cardio- respiratory fitness, strength, flexibility, and neuromuscular control. Many exercises such as walking, running, stair climbing, aerobics, cycling, and a variety of resistance and flexibility activities zJoint Mobilization-

61 Rehabilitation Principles for the Forearm, Wrist, Hand, and Fingers zFlexibility - a pain-free ROM is a major goal of rehab of the lower arm. It should include active assisted and active pain-free stretching exercises zStrength - restoring grip strength is essential; it can be regained by gripping a number of different devices

62 Rehabilitation Principles for the Forearm, Wrist, Hand, and Fingers zNeuromuscular Control : hand and finger rehab requires a restoration of dexterity, which includes pinching and other fine motor activities such as buttoning buttons, tying shoes, and picking up small objects zReturn to Activity : criteria for the return to a sport after wrist or hand injury are grip strength equal to the unaffected limb, full range of motion, and full dexterity; instituted by adduction, abduction, flexion, extension, opposition, and circumduction


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