Bones Carpal Bones 8 small bones in wrist

Bones

Carpal Bones • 8 small bones in wrist • 2 rows of 4 bones each • Row 1: Scaphoid, Lunate, triquetrum, pisiform • Row 2(from thumb to 5 th): Trapezium, Trapezoid, Capitate, Hamate

Something special @ carpals • Hamate has hook for retinaculum (forms top of carpal tunnel • Capitate- biggest, center of wrist • Lunate- commonly dislocated • Scaphoid Navicular- Commonly FX and not easily diagnosed

Anterior Forearm Muscles

Posterior Forearm muscles

Muscles • Finger Flexors • Flexor Digitorum Profundus • Flexor Digitorum Superficialis • Finger Extensors • Extensor Digitorum

Muscles of the Hand

Flexor Digitorum Profound

Extensor Digitorum

Thumb Muscles ~ Pollicis 1. 2. 3. 4. 5. Flexor Pollicis Longus (there is a Brevis) Extensor Pollicis Longus and Brevis Abductor Pollicis Adductor Pollicis Opponens Pollicis

Ligaments

https: //loptonline. com/patienteducation/injuries-conditions/handanatomy/

II. Injuries 1) Carpal Tunnel • Def- very narrow tunnel created by retinaculum/bones- contains tendons, vessels, and nerves: median, radial, ulna • Mech- compression of nerve(median) from excessive use/wrist flexion • Symp-Paresthesia to digits 1 -3/palm and, burning, tingling

Treatment Tx- rest- avoid activity that causes discomfort, immobilize, NSAIDS, possible surgery Corticosteroid shots TX- surgery- cut retinaculum http: //www. mayoclinic. com/health/carpal-tunnel-syndrome-surgery/MM 00572

Immobilizing joint allows the tendons to rest and reduces inflammation

MEDIAN NERVE

2) Fractures A) Scaphoid Navicular- most frequently fx carpal bone- often mistaken for wrist sprain Mech- Fall on outstretched hand Symptoms- pain, swelling, pt in anatomical snuff box TX- immobilization, doesn’t heal if not found right away due to poor blood supply

Screw Fixation

2) Fractures cont. B) Bennett’s FX- fx to base of 1 st metacarpal Mech- fall on thumb or direct blow (punch) Symptoms- pain, swelling at base of thumb, limited movement (see next slide) TX- If aligned- cast, if not-surgery with a pin to hold in place

If after injuring your hand you have the following symptoms then you may have this fracture • severe pain in the base of the thumb • swelling over base of the thumb • inability to touch the base of the little finger with the • tip of your thumb • your thumb appears shorter than its counterpart You can not do this movement if you have Bennett Fracture

Bennett fracture

2) Fractures cont. C) Boxers FX- fx to base of 5 th Mech- punch with closed fist Symptoms- PT, swelling, def, etc. base of 5 th TX- cast (or surgery)

3) Finger Injuries Mallet Finger- tear to extensor tendon at DIP joint Mech- hit on tip of finger A) Symp- can’t ext distal phalanx Tx- splinting (in hyper ext)- ASAP.

3) Finger Injuries Cont. B) Boutonniere Deformity- tear of Extensor tendon at PIP joint. Finger hyper ext at DIP and flexes at PIP causes “buttonhole” deformity Mech- “jammed” finger Symp- obv deformity TX- Splint ASAP, (possible surgery)

3) Finger Injuries C) Gamekeeper’s Thumb (also called skiiers thumb)- tear in ulna collateral lig at base of thumb Mech- (Killing game), forceful abduction Symp- p. t. , swelling, pain with movement, valgus movement causes pain or increased ROM TX- splint, thumb spica taping, check xray for fx

Gamekeeper’s thumb

3) Finger Injuries Cont. D) Interphalangeal Collateral Ligament. Mech-“jammed finger” tear ulna or radial collateral lig of fingers. Symp. TX- PRICE- splint, buddy tape Check for FX

III Assessment • Always complete HOP first • Special Tests- 1) Carpal Tunnel- Phalen’s Test 2) Scaphoid Fracture – press in Anatomical Snuff Box 3) FX or Ligament Strain? ? A) FX- FX symptoms (pt, deformity, bother at night, etc) and FX test B) pt on joint line, positive valgus/varus test

• FX Tests: (black AT textbook p. 490) • Percussion • Compression • Distraction • Tuning Fork ** If any doubt- send for Xray Ligamentous Stress Test (Valgus/Varus test) Looking for pain and/or movement •

You Try! • Break into groups of TWO • Complete the following Special Tests: 1) Phalen’s Test 2) Fracture test to Second Middle Phalanx 3) Ligamentous Stress Test a)(Valgus/Varus) to Radial Collateral Ligment of Second Middle Phalange b) valgus/varus to elbow UCL 4) RROM for epicondylitis 5)Rule out FX, so Buddy tape

Phase I Ice bags, Ice bucket, Paraffin wax, Hydrocullator Phase II Increase ROM in elbow, wrist, hand fingers

Thumb active range of motion: 1) With your palm flat on a table or other surface, move your thumb away from your hand as far you can. Hold this position for 5 seconds and bring it back to the starting position. 2) Rest your hand on the table in a handshake position. Move your thumb out to the side away from your palm as far as possible. Hold for 5 seconds. Return to the starting position. 3) Next, bring your thumb across your palm toward your little finger. Hold this position for 5 seconds. Return to the starting position. Repeat this entire sequence 10 times. Do 3 sets. Wrist Range of Motion 1) Flexion: Gently bend your wrist forward. Hold for 5 seconds. Do 3 sets of 10. 2)Extension: Gently bend your wrist backward. Hold this position 5 seconds. Do 3 sets of 10. 3) Side to side: Gently move your wrist from side to side (a handshake motion). Hold for 5 seconds at each end. Do 3 sets of 10.

Phase 3 Strengthen elbow, wrist, hand, fingers, grip strength Overload principal Start with fine motor and go to gross motor

Playing jacks

Name 5 thumb muscles