Lab - Wrist and Hand Flashcards
Bones?
Radius, Ulna, Caprals (8)
Metacarpals (5)
Phalanges
Carpal Bones?
Proximal Row (Lateral to med)
Scaphoid (anatomical snuff box)
Lunate
Triquestrum
Pisiform
Distal Row (lateral to med)
Trapezium
Trapezoid
Capitate
Hamate
The Q is alone, the Z’s are together and the Trapezium is closer to the thumb
Joints?
Carpometacarpal (CMC)
Metacarpophalangeal (MCP) - knuckles
Proximal interphalangeal (PIP)
Distal interphalangeal (DIP)
Interphalangeal (IP) - thumb
Ligaments?
UCL in the wrist –> styloid process of ulna to triquestrum
UCL in the thumb (web space) –> 1st MC to proximal flange of thumb
RCL - styloid process of radius to scaphoid
Muscles?
Supinators –> supinator
Pronators –> pronator quadratura, pronator Teresa
Flexor Mscs?
Common Flexor Origin = medial epicondyle
Supplied by median and ulnar n.
Origin at wrist or fingers
FCR (flex wrist, insert at radius)
Palmaris Longus
FCU
FDS –> to PIPs
FDP (profundus = deep) –> to DIPs
FPL (thumb)
Extensor Mscs?
Common Extensor Origin = Lateral Epicondyle
Supplied by radial n.
ECRL
ECRB
ED (to DIPs)
EDM (pinky finger)
ECU
EI (index finger)
Radial Deviator mscs?
FCR
ECRL
ECRS
Ulnar Deviator mscs?
FCU
ECU
Thumb mscs?
APL
EPB
EPL
These 3 mscs make the anatomical snuff box
Hand Intrinsic Mscs?
3 Groups
Lumbricals & Interossei
- Dorsal (abd)
- Palmar (add)
Thenar Mscs (thenar eminence - base of thumb). Move the thumb - dont need to know mscs
Hypothenar mscs (make up hypothenar mscs)
move the pinky (5th metacarpal)
Arteries and Nerves?
Ulnar and radial arteries
Median n. - through carpal tunnel
Ulnar n. - Travels through Guyon’s tunnel (through the Hook of the Hamate)
Movements of wrist?
Flex/ ext
pronation and supination
radial and ulnar deviation
Mvms of Phalanges?
Flex/ ext
abd and add
Mvms of thumb?
flex (straight across palm) and ext (L possision)
abd and add (thumb down to palm)
Opposition (thumb to pinkie)
Carpal Tunnel?
Assessment?
FOOSH? (can be #)
immediate pain? Where located now?
Can they make a fist, splay fingers, pick up objects?
Swelling, redness, deformity?
Tinel’s Test?
tap carpal tunnel to check median n and CTS
Phalen’s Test?
Finkelstein’s Test?
Test for Dequervain’s (tendynitis of APB) Syndrome
Tuck thumb inside fist and ulnarly deviate
Pain and decreased mvm = positive test
?
Colle’s # = Common - distal end of radius
MOI = usually FOOSH
Causes dinner fork deformity
Scaphoid #
- Most commonly # carpal bone
- Often missed
- Has retrograde blood supply (not great supply)
- if missed, blood flow can be blocked and can = Avascular Necrosis
Metacarpal #
- Boxer’s injury
- most common in 5th MC (most mobile MC)
Phalangeal #?
Jammed or broken finger
Can do screws
Healing = immobilize and 4-6 weeks
CTS/ Guyon’s Syndrome?
Occurs when there is compromised space for the nerve to travel through tunnel
Can occur due to repetitive trauma
Can also be due to swelling post-injury, general health changes (diabetes, pregnancy, kidney problems, etc.), fracture, carpal bone fixation
If severe, can see wasting of thenar (CTS) or hypothenar (GTS) eminence due to reduced nerve supply
Early symptoms include numbness/tingling or burning into hand, and pain at night
Tx of CTS/ Guyon’s Syndrome?
POLICE
Try and correct the reason why it occurred
Dr. - further follow-up
Physio
Brace
Skiers thumb?
Also known as Gamekeeper’s thumb
A sprained ulnar collateral ligament (in thumb)
Taping to protect
Dequervain’s Syndrome?
Stenosing tenosynovitis in the thumb
Inflammation of the EPB & APL tendons within their sheath
Can sometimes feel crepitus/clicking as the tendon moves
Treatment:
POLICE
Dr.
Physio
Brace?
Carpal Bone Dislocation ?
Very commonly lunate, but can be any one of the carpals
MOI is FOOSH, then wrist is stuck or person can only move it in certain directions
Very painful, deformed initially, then swelling can fill in deformity
Treatment:
POLICE
ER/Dr., as person will likely need an x-ray
Check circulation & nerve function because if impaired, then immediate risk for permanent damage – get to ER right away
Wrist Sprain or Strain?
FOOSH injury can easily strain or sprain structures
Taping to protect
Rule out the serious injuries, then ok to tape
If a hyperflexion FOOSH, then tape slightly into extension
If a hyperextension FOOSH, then tape slightly into flexion
Finger Sprain?
Can sprain the collateral ligaments on either side of the DIP or PIP
Helpful to buddy tape the sprained finger to the one beside it for support
Thumb Hyperextension?
Any sport can cause this, and when it does, taping is an excellent way to still allow the athlete to play
Contact thumb tape job is very useful, but can also do a non-contact thumb tape for athletes who need more precise thumb movements
