1. Wrist/Hand Anatomy Carpals-8 Metacarpals-5 Phalanges - 5 Scaphoid
Trapezium
Trapezoid
Capitate
Hamate
Pisiform
Triquetral
Lunate
Metacarpals-5
Phalanges - 5
1-5
1=Thumb
5=Pinky

2. Wrist/Hand Anatomy (2) Radiocarpal joints (between wrist and hand)
Metacarpal joints
Metacarpalphalangeal Joints
Phalangeal joints-PIP and DIP
Normal resting position
Proximal, Middle, Distal phalanx
Nerve supply
Radial
Medial
Ulnar

3. Colles Fracture Most common type of forearm fracture HOPS:
fall on outstretched hand with extreme hyperextension,
extreme pain
obvious deformity, excessive swelling
numbness along the median nerve distribution, extreme pain
Treatment: splint, refer

4.
fracture.jpg

5. Carpal tunnel syndrome (1)
Carpal tunnel is located in the anterior of the wrist.
8 finger flexor tendons, their synovial sheaths and the median nerve lie in the tunnel
Results from an inflammation of synovial sheaths

7. Carpal Tunnel (2)
Overuse condition caused by repeated wrist flexion, ulnar deviation,
HOPS
numbness, tingling, median nerve area
muscle atrophy (in advanced cases)
decreased RROM in thumb movement
+ Phalen’s test, pn w/ compression of carpal tunnel
+ Tinel Sign
Tx: rest, wrist splint, anti-inflammatory medication, if severe, surgery

9. Scaphoid Fracture (1) Most frequently fractured carpal bone
Lies beneath the “anatomical snuff box”
Does not have a good blood supply – often does not heal – “non-union”

11. Scaphoid Fracture (2) HOPS
fall on the outstretched hand
some swelling
pain in anatomic snuff box
Tx: refer to physician, immobilization x 6 weeks, protection against impact for 3 months

12. Mallet finger “Baseball”, “basketball” finger
Avulsion of the extensor tendon, to the Distal phalange
HOPS:
MOI: blow to tip of finger,
pain over the DIP joint
bent DIP joint (about 30 degrees)
inability to extend the DIP joint
TX: refer, splint in extension 6 – 8 weeks

13. Mallet Finger www.eatonhand.com

14. Boutonneire Deformity
Rupture of the extensor tendon dorsal to middle phalanx
HOPS:
forced flexion of the interphalangeal joint
swelling, flexion deformity of PIP joint
point tenderness over middle phalanx (dorsal side)
inability to extend finger
Tx: refer, splint in extension

15. Boutonneire Deformity

16. Jersey Finger
Rupture of flexor digitorum profundus tendon at insertion on distal phalanx
Most often occurs in ring finger
HOPS:
MOI: rapid ext. of the finger while actively flexed
Swelling
point tenderness over DIP joint
inability to flex DIP joint
Tx: Refer to physician

17. Jersey Finger

18. Gamekeeper’s thumb Sprain of ulnar collateral ligament in thumb
MOI: forcefull abduction of thumb while thumb is extended
HOPS:
Swelling over palmar aspect
Instabilty in the joint
Laxity in thumb flexion
Tx: refer to physician, tape, rest, surgery

20. Boxer’s Fracture Fracture to the 4th and/or 5th metacarpal(s).
MOI - caused by punching something harder than the hand, such as a wall or another person's head. The end of the metacarpal bone takes the brunt of the impact, which usually breaks through the narrowest area near the end (the "neck"), and bends down toward the palm. 

23. Boxer’s Fracture – (2)
HOPS- Striking an immovable object- wall, floor, etc
Swelling/Discoloration in area
Deformity
Pain Pt tender at location of fracture
MCP joint deformity – shorter, at an angle
Treatment- Splint, refer for x-rays, possible surgery

24. ROM/Strength Testing Wrist Flexion-Palmaris Longus
Wrist Extension-Extensor Digitorum
Wrist Radial Deviation-Flexor/Extensor Carpi Radialis
Wrist Ulna Deviation-Flexor/Extensor Carpi Ulnaris
Finger Flexion/Extension-Flexor Digitorum/ Extensor Digitorum
Finger Abduction/Adduction
Opposition

25. Test Valgus Stress Test - Ulna Collateral Ligament
Varus Stress Test - Radial Collateral Ligament
Phalen’s- Median Nerve
Tinel’s – Ulna and Median Nerve
Fracture Testing- Compression, Distraction, Flick