1. Forearm

2. Bones of the Forearm Ulna Radius Medial Extension of the humerus
Lateral
Extension of the hand

4. 3 Joints of the Forearm Proximal Radioulnar Distal Radioulnar
Pivot joint: radial head held in place by annular ligament
Distal Radioulnar
Pivot joint
Head of ulna and ulnar notch on radius

5. Bones Carpal Metacarpals Phalanges 8 cube shaped bones
Proximal row of 4 bones & distal row of 4 bones
Metacarpals
5 bones
1st metacarpal – thumb side
5th metacarpal – little finger side
Phalanges
14 bones
Proximal, middle, distal
1st – thumb side; 5th little finger side

6. 8 Carpal Bones Proximal Row starting on radial side Distal Row
Scaphoid (navicular)
Lunate
Triquetral
Pisiform
Distal Row
Trapezium
Trapezoid
Capitate
Hamate

7. Some Linemen Try Positions That They Can’t Handle
Carpals
Some Linemen Try Positions That They Can’t Handle

8. Scaphoid (navicular) Lunate Inside “anatomical snuffbox”
Avascular; fx don’t heal well
Lunate
Most commonly dislocated carpal

9. Trianglular Fibrocartilage Complex (TFCC)
Triangular shaped disc that is between the ulna and the triquetrum and pisiform
Main stabilizer and shock absorber
Like the meniscus of the knee

10. Joints of the Wrist Radiocarpal Joint Carpal Joints
Condyloid joint
Radius and proximal row of carpal bones
Carpal Joints
Gliding joints
Between carpal bones
Metacarpalphalangeal (MCP) Joints
Condyloid joints
Metacarpal and phalanges
Phalangeal Joints
Hinge joints
Proximal interphalangeal (PIP) & Distal interphalangeal (DIP)

11. Bony Anatomy

12. Wrist Ligaments

13. Wrist Collaterals Radial Collateral Ligament (RCL)
Resists ulnar deviation
Ulnar Collateral Ligament (UCL)
Resists radial deviation

14. Wrist Nerves Median Nerve Ulnar Nerve Carpal Tunnel
Thumb, Index & Middle (1st, 2nd, 3rd phalanges)
Ulnar Nerve
Tunnel of Guyon
Ring & pinky (4th & 5th phalanges)

15. Terms Palmar = palm side/anterior side
Dorsal = back of the hand/posterior side
Pollicis= thumb (1st)
Digitorium = 2st – 4th phalanges
Digiti minimi = 5th phalange (little finger)

16. Muscles of the Forearm Anterior Posterior Flexors Pronators Extensors
Supinators

17. Wrist Flexor Group Anterior/ Medial Epicondyle

18. WRIST / HAND Muscles: Flexor Group anterior forearm
forearm & wrist muscles:
flexor carpi ulnaris
flexor carpi radialis
palmaris longus
finger muscles:
flexor digitorum superficialis
flexor digitorum profundus
flexor digiti minimi (pinky)
opponens digiti minimi (pinky)
abductor digiti minimi (pinky)

19. Flexors continued Flexor digitorum superficialis
Inserts on middle phalanx
Flexor digitorum profundus
Inserts on distal phalanx

20. Wrist Extensors Posterior/ Lateral Epicondyle

21. WRIST / HAND Muscles: Extensor Group posterior forearm
forearm & wrist muscles:
extensor carpi radials longus
extensor carpi radials brevis
extensor carpi ulnaris
finger muscles:
extensor digitorum
extensor digiti minimi (pinky)
extensor indicis (index)

22. WRIST / HAND Muscles: Thumb (Pollicis) anterior forearm
flexor pollicis longus
flexor pollicis brevis
abductor pollicis brevis
abductor pollicis
opponens pollicis
posterior forearm
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus

23. WRIST / HAND Muscles: Many muscles make up the wrist & hands movement.
Realize that the forearm flexor & extensor muscles insert into the hand.
these muscles are responsible for moving the wrist & fingers

24. WRIST / HAND Movements: Wrist Fingers & Thumb flexion & extension
radial deviation
towards radius
ulnar deviation
towards ulna
Fingers & Thumb
flexion
extension
ABD / ADD

25. WRIST / HAND Ligaments: Tendons: We’re not going to study these.
There are a lot of small ligaments that connect each carpal, metacarpal & each phalanx.
Tendons:
Each forearm muscle turns into a tendon as it enters the hand.
We’re not going to study these.

26. Wrist Tendons Flexors Extensors Flexor carpi ulnaris
Flexor Carpi radialis
Palmaris Longus
Extensors
Extensor carpi ulnaris
Extensor carpi radialis

28. Anatomical Snuffbox Extensor pollicus longus Extensor pollicus brevis
Abductor pollicus longus

29. Fall On Out-Stretched Hand FOOSH
Scaphoid fx
Avascular; slow healing
Forearm fx
Common children; greenstick
Colles ‘ fracture
Elbow dislocation
Assume fx
Tx: ice, splint, x-rays

30. Scaphoid Fracture Most frequent wrist fx Pn in anatomical snuffbox
Concern of avascular necrosis (poor blood supply)
Non-surgical: brace
Surgical: Pin and bone graft

31. Mallet Finger
MOI: force to end of finger, that caused extensor tendon injury
Avulsion of distal phalanx
S&S: pn at DIP joint, swollen, DIP in flexion & unable to be extended
TX: ice, splint, X-ray, must stay splinted for weeks

32. Mallet Finger MOI

33. Boutonniere Deformity aka Buttonhole deformity
MOI: blow to end of finger that forces PIP into flexion and DIP into extenstion
Split of central slip which allows the PIP to go through the hole
S&S: PIP in flexion, DIP hyperextension, pn along to of finger
Splint to allow healing of central slip

34. Gamekeeper’s Thumb MOI: Forceful abduction hyperextension of thumb
Soccer goalies
Linebackers/Lineman
Skiers
Sprain UCL of thumb
Possible avulsion fx

35. Gamekeeper’s Thumb
S&S: Pn, swelling, decreased ROM & strength, instability
Limit ability to pinch
Ice, splint, x-ray
Named because the game (rabbits, birds…) keepers back in the day often injured this ligament when killing the animals to cook them

36. X-Ray Gamekeeper’s Thumb
Rule out avulsion injury
Assess

37. Subungual Hematoma Contusion or crushing to distal phalanx
Accumulation of blood under fingernail
Confined space =
Increase of pressure
Extreme pain
Possible Nail Loss
Tx: ice, possibly drill through nail to release pressure

38. Subungual Hematoma Release pressure
Cauterized needle under sterile conditions
Monitor for signs of infection

39. Finger Dislocation Blow to the tip of the finger
Force directed upwards
Displacement of joint
Tearing of capsule
R/O rupture of tendons

40. Finger Dislocation DO NOT REDUCE! Check for pulse distal to injury
Capillary Refill
Neurological symp.
Tingling/Numbness
Splint as found
X-ray to r/o fracture

41. Volar Plate Injury MOI: Hyperextension injury
Ligament avulsion injury to palmar aspect of phalanx
R/O fx and splint