Lecture 10 - Wrist and Hand

Question 1

list all carpals of the hand

Answer 1

Some Lovers Try positions (4 prox) That They Can’t Handle (4 distal)
- scaphoid
- lunate
- triquetrum
- pisiform
- trapezium (with the thumb)
- trapezoid
- capitate
- hamate

Question 2

list the ligaments of the list (that we need to know)

Answer 2

• ulnar collateral ligaments (UCL of wrist)
• radial collateral ligaments (RCL of wrist)
• radiocarpal ligaments (palmar and dorsal)
• radioulnar ligaments
• ulnar carpal ligaments

Question 3

why do we have a retinaculum at the wrist

Answer 3

• serve as a pulley for the carpal flexor muscles
• acts as leverage so larger muscles that extend from elbow to hands don’t bulge out and web when they’re contracted

Question 4

movements possible at the wrist

Answer 4

• Flex/Extend
• ulnar/radial deviation
• supination/pronation

Question 5

possible thumb movement

Answer 5

remember it is offset by 90deg
- Flex/Extension
- abduction/adduction
- oposition

Question 6

epidemiology of wrist injuries

Answer 6

• wrist and hand injuries are very common
• fracture of the wrist and thumb is more common than muscle or ligament injury
• more common in males and adolescents
• common in rugby and football

Question 7

Steps in examining wrist and thumb

Answer 7

1. History
2. Observation
3. ROM
4. Manual muscle testing
5. Palpations
6. Special Tests
7. Functional Ax

Question 8

soft tissue injuries on the hand and wrist

Answer 8

• contusion
• tendinopathy
• ligamentous injury
• TFCC injury

Question 9

MOI and observations of a contusion to the hand/wrist

Answer 9

MOI: blunt object hits the area
Observation
- swelling, redness
- pain with movement

Question 10

MOI and observations of DeQuervain’s Tenosynovitis

Answer 10

MOI: repeated loading
Observations: swelling
Special Test: Finklestein’s test (wrap fingers around thumb and try and ulnar deviation)
- DeQ’s tenosynovitis is the inflammation of the thumb tendons extensor pollicis longus

Question 11

ligaments of the thumb

Answer 11

UCL and RCL of the thumb

Question 12

TFCC Injury

Answer 12

Triangular Fibrocartilage Complex
- connects ulna to carpals; connects wrist and forearm
MOI: forced extension and/or rotation of the wrist
Observations
- may have swelling
- pain with wrist extension, ulnar deviation, and compressive load
Special Test: fovea sign

Question 13

an example of how to check for wrist/thumb fracture without x-ray

Answer 13

tuning fork
- 75-92% sensitivity for fracture
check radial pulse and stabilize

Question 14

game keepers thumb

Answer 14

• tear in the ulnar collateral ligaments, when thumb is pulled back or to the side, away from your finger
• often occurs when skiers FOOSH while holding a ski pole

Question 15

characteristics of wrist fractures

Answer 15

MOI: FOOSH
- most common is a scaphoid fracture; palpate snuff box

Question 16

different types of wrist fractures

Answer 16

Colle’s fracture (hand is extended)
- FOOSH; hand like a pushup
Smiths fracture (hand is flexed)
- fall on gay limp wrist

Question 17

why is a scaphoid fracture bad?

Answer 17

scaphoid has retroactive blood supply, only one way in
- this is important because a fracture can disrupt blood flow
- without blood and nutrients, bone cannot heal and sometimes will die/go through AVN (avascular necrosis)

Question 18

female athlete triad

Answer 18

REDS: relative energy deficiency in sport
- low energy due to eating disorder/severe caloric deficit
- menstrual dysfunction
- low bone density (break down bone to try and get some nutrients