Wrist and Hand Flashcards
Why is the wrist and hand vulnerable to injury?
very little muscle or fat padding to protect structures;
What are MOI for wrist and hand injuries?
Direct impact;
FOOSH
What structures of the wrist and hand can be injured?
carpals, metacarpals, phalanges, ligaments, tendons
How many carpal bones are there and what are they?
8: trapezoid, trapezium, hamate, capitate, triquetral, pisiform, lunate and scaphoid
What bones are in the proximal row of carpals?
scaphoid, lunate, triquetrum, pisiform
What carpal bones make up the distal row?
trapezium, trapezoid, capitate, hamate
What are the articulations of the wrist?
distal radioulnar joint: immediately adjacent to radiocarpal joint;
radiocarpal joint: radius with scaphoid, lunate, and triquetrum
intercarpal joints
midcarpal joints
What is the triangular fibrocartilage? (TFC)
cartilaginous disc that binds end of ulna and radius together
What does the TFC complex do?
stabilizer of the distal radioulnar joint. also provides an articular surface for the carpal condyle.
What are the gliding joints that have minimal contribution to wrist movement?
intercarpal joints
What joints are between the rows of proximal and distal carpals?
midcarpal joints
How many bones make up the hand?
19
What are the digits made up of?
carpometacarpal joints, metacarpophalangeal joints.
3 phalanges per finger & interphalangeal joints
2 in thumb & 1 IP joint
What are the hypothenar muscles?
opponens digiti minimi;
flexor digiti minimi brevis;
abductor digiti minimi
What are the thenar muscles?
adductor pollicis
flexor pollicis brevis
abductor pollicis brevis
opponens pollicis
What are the nerves of the wrist and hand?
median, radial and ulnar
how is blood supplied to the hand?
ulnar and radial arteries with two arterial arches that are superficial and deep to the palmar arches
What are common acute wrist and hand injuries?
contusions, sprains, strains (mallet finger, boutonniere deformity)
fractures (colle’s, scaphoid, metacarpals- boxers, bennett’s, phalanges)
dislocations- lunate, MCP, PIP, & DIP
What is a chronic wrist injury?
wrist ganglion
What are MOI for contusions?
direct impact via falling or being struck by and implement
S&S of contusions of the wrist or hand:
pain on palpation, obvious bruising or swelling
Management for contusions of wrist/hand:
PIER, protect with padding and follow up with physician if it does not resolve within couple of days
What are the most common and poorly managed injuries of the wrist?
sprains
MOI for wrist sprains? S&S of wrist sprains?
FOOSH,
pain over ligament & w AROM/PROM, generalized swelling, tenderness, inability to flex or deviate wrist.
Management for wrist sprains?
PIER, NSAIDs, protect with splinting, taping or bracing, referral to physician to rule out fractures.
What is gamekeepers thumb? What is the MOI?
a tear of the ulnarcollateral ligament of the MCP joint.
MCP in extension and forceful abduction
S&S of gamekeepers thumb:
palmar aspect of the joint- pain and swelling and positive abduction stress.
Management of a gamekeepers thumb sprain:
standard acute: instability: spica cast for 3-6 weeks.
severe: surgical repair
What is the MOI for phalange sprains?
direct blow to the tip of the finger may injure the DIP, PIP or MCP joint capsule and/or ligaments
S&S of phalange sprains:
swelling, pain, loss of ROM
- incapacitating to hand function in many cases
management of phalange sprains:
Ice, splint, refer to medical care if fracture is suspected
What are MOI for metacarpal fractures? What types of fractures are there?
direct trauma due to striking an object or being struck by implements. Boxers or Bennett’s fracture.
S&S of metacarpal fractures:
Pain, deformity, crepitus, swelling & abnormal mobility
Management for metacarpal fractures:
PIER, splint & refer to physician for x-ray and casting (~4-6 weeks)
What is a boxer’s fracture?
unstable distal metaphysis or neck of the fourth or fifth metacarpals.
What fracture has S&S of sudden pain, inability to grip, rapid swelling, and deformity. With point tenderness; crepitus and increased pain with axial compression and percussion
Boxer’s
what is the management for boxer’s fracture?
standard acute; splint and immediate physician referal.
What is a bennet fracture?
a fracture dislocation to the proximal end of the 1st metacarpal at the carpometacarpal joint
What are MOI for phalange fractures?
direct blow or FOOSH
S&S for phalange fractures:
possible deformity, severe pain, crepitus, swelling and loss of function (lack of AROM/PROM)
management for phalange fractures?
ice, splint, refer to physician
What is the MOI for a scaphoid fracture?
FOOSH
What are S&S of scaphoid fractures?
point tenderness in anatomical snuff box, pain with inward pressure along long axis, increased pain with wrist extension and radial deviation?
management for scaphoid fracture:
standard acute-splint with physician referral
what kind of concern is attached to a scaphoid fracture?
avascular necrosis
What are MOI for phalange dislocations?
direct blow to tip of finger
- what joints are involved?
DIP, PIP, MCP
possible tissue damange to capsule, ligaments, nerves, blood vessels and bone
What are S&S for phalange dislocations?
obvious deformity, severe pain, rapid swelling and loss of function. inability to flex or extend fingers
management for phalange dislocation:
splint, ice, refer to physician for reduction.
splint for 3 weeks max; longer will lead to severe tissue contracture
What is a wrist ganglion?
rupture of the tendon sheath or joint capsule
What are treatments for wrist ganglions? past and present?
breaking them without rupture of skin
as many as 50% may go away on own,
closed rupture with multiple needle punctures;
surgery to remove cyst.
