Bones of the Hand and Wrist Wrist Injuries

Olecranon Head of radius Neck of radius Styloid Process Neck of radius Head of radius Olecranon Radial notch Tuberosity of radius Styloid Process Ulna Radius Interosseous Membrane Styloid Process Anterior View Posterior View

Metacarpals May be palpated in orderMay be palpated in order Numbered 1 -5 starting at thumbNumbered 1 -5 starting at thumb Palpate the entire lengthPalpate the entire length 1st Metacarpal From Snuffbox to MCP JointFrom Snuffbox to MCP Joint Shorter and broader than other metacarpalsShorter and broader than other metacarpals Trapezium 1st Metacarpal

–Etiology Direct axial force orDirect axial force or Compressive forceCompressive force 5th metatarsal5th metatarsal –Boxing or martial arts –(boxer’s fracture) –Signs and Symptoms PainPain SwellingSwelling CrepitusCrepitus Possible deformityPossible deformity –angular –rotational Metacarpal Fracture –Fracture tests PalpationPalpation CompressionCompression Axial compressionAxial compression PercussionPercussion –Management RICERICE AnalgesicsAnalgesics X-ray examinationX-ray examination Deformity is reducedDeformity is reduced SplintingSplinting –30 degrees of flexion –4 weeks

Wrist Sprains –Most common wrist injury –Mechanism of injury Arises from any abnormal, forced movementArises from any abnormal, forced movement FOOSH (Fall on outstretched hand)FOOSH (Fall on outstretched hand) Falling on hyperextended wristFalling on hyperextended wrist Violent flexion or torsionViolent flexion or torsion

Stress Tests –Radial and Ulnar Deviation –Anterior Posterior Glides –Signs and Symptoms PainPain SwellingSwelling Loss of functionLoss of function Decreased ROMDecreased ROM InstabilityInstability

Wrist Sprains –Management Refer to physician for X-ray if severeRefer to physician for X-ray if severe RICERICE SplintSplint AnalgesicsAnalgesics StrengtheningStrengthening Tape for supportTape for support

Carpal Bones Radius Ulna Scaphoid Lunate Triquetrium PisiformTrapezium Trapezoid CapitateHamate Anterior View Right Wrist

Receives most force transmitted through radiusReceives most force transmitted through radius Frequently involved in fracturesFrequently involved in fractures Often fails to heal because of inadequate blood supplyOften fails to heal because of inadequate blood supply Proximal pole without blood supply 1/3 populationProximal pole without blood supply 1/3 population Subject to avascular necrosisSubject to avascular necrosis Scaphoid Anatomy Anterior View Right Wrist Distal Pole Waist Proximal Pole

Scaphoid Fracture –Mechanism of injury Caused by fall on outstretched handCaused by fall on outstretched hand Compresses scaphoid between radius and second distal row of carpal bones Compresses scaphoid between radius and second distal row of carpal bones

Scaphoid Fracture –Signs and Symptoms Swelling, severe pain in anatomical snuff boxSwelling, severe pain in anatomical snuff box –Hold thumb straight up –Snuffbox is between two most prominent tendons Signs and symptoms similar to wrist sprainSigns and symptoms similar to wrist sprain Pain w/ radial flexionPain w/ radial flexion

EtiologyEtiology –Occurs in lower end of radius or ulna –FOOSH – Radius and ulna forced into hyperextension Colles’ Fracture

–Signs and Symptoms Visible deformity (silver fork deformity)Visible deformity (silver fork deformity) When no deformity is present, injury can be passed off as bad sprainWhen no deformity is present, injury can be passed off as bad sprain Extensive bleeding and swellingExtensive bleeding and swelling Tendons may be torn/avulsed and there may be nerve damageTendons may be torn/avulsed and there may be nerve damage Colles’ Fracture

–Management Cold compress or iceCold compress or ice Splint wristSplint wrist Refer to physicianRefer to physician X-ray and immobilizationX-ray and immobilization Severe sprains should be treated as fracturesSevere sprains should be treated as fractures Without complications a Colles’ fracture athlete will be out for 1-2 mo.Without complications a Colles’ fracture athlete will be out for 1-2 mo. In children, injury may cause growth plate injuryIn children, injury may cause growth plate injury Colles’ Fracture

Figure 8 Anchor

Straight Strip and “X”

Closing Anchors