1. Wrist and Hand Conditions
Chapter 13

2. Wrist Articulations
Radiocarpal: Radius with the Scaphoid, Lunate, Triquetrum.
Intercarpal
Distal Radioulnar
Triangular Fibro cartilage Complex stabilizes the Radioulnar joint.

3. Hand Articulations Carpometacarpal (CM) Intermetacarpal (IM)
Metacarpophalangeal (MP)
Interphalangeal (IP)

4. Carpometacarpal and Intermetacarpal Joints
CM of the thumb is a saddle joint
CM of the four fingers gliding joints
IM reinforced by joint capsules comprised of the dorsal, volar, and two interosseous CM ligaments

5. Metacarpophalangeal Joints
Rounded distal heads of the metacarpals articulate with the concave proximal ends of the phalanges
Reinforced by strong collateral ligaments

6. Interphalangeal Joints
The Proximal (PIP), Distal (DIP), and the IP joint of the thumb are all hinge joints
The articular capsule made up of volar and collateral ligaments surround each IP joint

7. Muscles Retinacula of the Wrist: Tendon Sheaths:
The fascial tissue surrounding the wrist thickened into strong fibrous bands called retinacula that form protective passageways through which tendons, nerves, and blood vessels pass.
Tendon Sheaths:
Sealed at both ends containing synovial fluid, annular pulleys that prevent tendon bowstringing with flexion.

8. Kinematics Flexion Extension Hyperextension Radial deviation
Ulnar deviation

9. Flexion Flexor carpi radialis Flexor carpi ulnaris
Palmaris longus (sometimes absent)
Flexor digitorum superficialis
Flexor digitorum profundus

10. Extension and Hyperextension
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor pollicis longus
Extensor digiti minimi
Extensor digitorum

11. Radial and Ulnar Deviation
Radial Deviation
Flexor carpi radialis
Extensor carpi radialis
Ulnar Deviation
Flexor carpi ulnaris
Extensor carpi ulnaris

12. Kinetics of the Wrist
Extrinsic flexor muscles are twice as strong as the…
Extrinsic extensor muscles
Flexors used everyday for gripping, grasping, or pinching movements.

13. Strengthening
Strengthening should include general elbow flexion, extension, pronation, and supination, wrist flexion, extension, Radial and Ulnar deviation.

14. Contusions and Abrasions
Thoroughly clean, dress daily, inspect for infection daily.
Ice, compression, elevation for 2 – 3 days.

15. Sprains Wrist sprains Gamekeeper’s Thumb
Interphalangeal Collateral Ligament Sprains

16. Dislocations Distal radioulnar joint (DRUJ) Lunate dislocation
MP joint dislocation
PIP joint dislocation

17. Strains
Jersey Finger
Mallet Finger
Boutonniere Deformity

18. Tendinopathies Trigger Finger DeQuervain’s tenosynovitis
Intersection Syndrome

19. Ganglion Cysts

20. Fingertip Injuries
Subungual hematomas
Paronychia

21. Nerve Entrapment Syndromes
Median Nerve Entrapment
Anterior Interosseous Nerve Syndrome
Carpal Tunnel Syndrome
Ulnar Nerve Entrapment
Ulnar tunnel syndrome
Cyclist’s palsy
Bowler’s thumb
Chris Carlin, Dominique Rodriguez

22. Radial Nerve Entrapment
Distal Posterior Interosseous Nerve Syndrome
Superficial Radial Nerve Entrapment

23. Fractures Distal Radial and Ulnar fractures Scaphoid fracture
Monteggia’s fracture
Galeazzi’s fracture
Colle’s fracture
Smith’s fracture
Scaphoid fracture
Hamate fracture
Triquetrum fracture
Kienbock’s disease

24. Fractures cont. Metacarpal fractures Bennett’s fracture
Boxer’s fracture
Bennett’s fracture
Phalangeal fractures