Chapter 17 Wrist Hand and Finger Pathologies Copyright

Clinical Anatomy § Bony anatomy § § Distal radius Ulnar notch Radial styloid process

Clinical Anatomy § Bony anatomy § Carpal bones § Metacarpals § Phalanx § Proximal

Clinical Anatomy § Articulations and ligamentous support § § § Distal radioulnar joint Radiocarpal

Clinical Anatomy Palmar (volar) ligaments of the wrist and hand Copyright © 2015. F.

The Triangular Fibrocartilage Complex (TFCC) Several ligaments and other fibrous structures attach to the

Clinical Anatomy Copyright © 2015. F. A. Davis Company

Clinical Anatomy § Nerves § § Ulnar nerve Median nerve Radial nerve The carpal

Clinical Anatomy Extensor compartment Copyright © 2015. F. A. Davis Company

Clinical Anatomy Hand intrinsic muscles Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers Past history § Previous

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Inspection § Functional

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Inspection § Wrist

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Inspection § Thumb

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Palpation of the

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Joint and muscle

Selective Tissue Test: Grip Dynamometry Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Joint stability tests

Ligaments Stressed During Wrist Passive Range of Motion Ligaments Stressed Passive Movement Primary Secondary

Radial Collateral and Ulnar Collateral Ligament Stress Tests of the Wrist Copyright © 2015.

Valgus and Varus Testing of the Interphalangeal Joints Copyright © 2015. F. A. Davis

Test for Laxity of the Thumb MCP Collateral Ligaments Copyright © 2015. F. A.

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Neurological testing §

Pathologies of the Wrist, Hand, and Fingers and Related Special Tests § Wrist pathology

On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries § Lacerations § Management

Selective Tissue Test: Watson Test for Scapholunate Instability Copyright © 2015. F. A. Davis

Selective Tissue Test: Phalen Test Copyright © 2015. F. A. Davis Company

Pathologies of the Wrist, Hand, and Fingers and Related Special Tests § Hand pathology

Pathologies of the Wrist, Hand, and Fingers and Related Special Tests § Finger pathology

Pathologies of the Wrist, Hand, and Fingers and Related Special Tests § Thumb pathology

Selective Tissue Test: Finkelstein’s Test for de Quervain’s Syndrome Copyright © 2015. F. A.

On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries § Interphalangeal joint dislocations

$On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries § Hand finger fractures$

Splinting of Common Finger Injuries Deformity Splinting Position Jersey finger DIP joint in flexion

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Clinical Anatomy § Articulations and ligamentous support § § § Distal radioulnar joint Radiocarpal joint Intercarpal joints Midcarpal joints Carpometacarpal joints Metacarpophalangeal and interphalangeal joints Copyright © 2015. F. A. Davis Company

The Triangular Fibrocartilage Complex (TFCC) Several ligaments and other fibrous structures attach to the fibrocartilage. As a unit, the TFCC provides support to the distal radioulnar joint. L = lunate; TQ = triquetrum. Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers Past history § Previous history § Loss of function from previous injury § General medical health § Rheumatoid arthritis § PVD (peripheral vascular disease) § Raynaud phenomenon Copyright © 2015. F. A. Davis Company History of the present condition § § § Location of pain MOI Relevant sounds or sensations Duration of symptoms Description of symptoms Changes in activity

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Inspection § Functional observation § General inspection § § Posturing of the wrist and hand Gross deformity Palmar creases Lacerations or scars Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Inspection § Wrist and hand § Continuity of the distal radius and ulna § Continuity of the carpals and metacarpals § Alignment of the MCP joints § Posture of the wrist and hand § Ganglion cyst Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Inspection § Thumb and fingers § Inspection of the skin and fingernails § Subungual hematoma § Felon § Paronychia § Alignment of fingernails § Muscle contour § Individual finger deformities Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Palpation of the palmar (anterior) wrist 1. 2. 3. 4. 5. 6. 7. 8. 9. Radius Flexor carpi radialis Palmaris longus Carpal tunnel Ulna Flexor carpi ulnaris TFCC Pisiform Hamate Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Palpation of the dorsal (posterior) wrist 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Ulnar head Ulnar styloid process Ulnar collateral ligament Extensor carpi ulnaris Lister tubercle Distal radius or styloid process Radial collateral ligament Scaphoid Lunate Triquetrum Trapezium Capitate Trapezoid Extensor carpi radialis brevis Extensor carpi radialis longus Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Palpation of the hand 1. 2. 3. 4. 5. Thenar eminence Central compartment Hypothenar compartment Metacarpals Collateral ligaments of the metacarpophalangeal joints 6. Phalanges 7. Collateral ligaments of the IP joints 8. Thenar webspace 9. Extensor digitorum 10 -12. Extensor digitorum 13. Extensor pollicis longus 14. Abductor pollicis longus and extensor pollicis brevis Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Joint and muscle function assessment § Wrist § Thumb § Finger § Active range of motion (AROM) § Manual muscle test (MMT) § Passive range of motion (PROM) Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Joint stability tests § Stress testing § Collateral support of the wrist ligaments § Collateral support of the IP joints § Support for the UCL § Joint play tests Copyright © 2015. F. A. Davis Company

Ligaments Stressed During Wrist Passive Range of Motion Ligaments Stressed Passive Movement Primary Secondary Extension Palmar ulnocarpal Radial collateral Palmar radiocarpal Ulnar collateral Flexion Dorsal radiocarpal Radial collateral Ulnar collateral Radial Deviation Ulnar collateral Palmar ulnocarpal Ulnar Deviation Radial collateral Palmar radiocarpal Copyright © 2015. F. A. Davis Company

Clinical Examination of Injuries to the Wrist, Hand, and Fingers § Neurological testing § Upper quarter screen § Pathologies § Carpal tunnel syndrome § Drop wrist syndrome Copyright © 2015. F. A. Davis Company

Pathologies of the Wrist, Hand, and Fingers and Related Special Tests § Wrist pathology § § § § Distal forearm fractures Scaphoid fractures Hamate fractures Perilunate and lunate dislocation Wrist sprains TFCC injury Carpal tunnel syndrome Copyright © 2015. F. A. Davis Company

On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries § Lacerations § Management § Use universal precautions § Take precautions against infection § Lacerations involving the fascia should be referred to determine if suturing is needed. Copyright © 2015. F. A. Davis Company

Pathologies of the Wrist, Hand, and Fingers and Related Special Tests § Finger pathology § Collateral ligament injuries § Boutonnière deformity § Finger fractures § Tendon ruptures and avulsion fractures § Mallet finger Copyright © 2015. F. A. Davis Company

Pathologies of the Wrist, Hand, and Fingers and Related Special Tests § Thumb pathology § § De Quervain’s syndrome Thumb sprain MCP joint dislocation Thumb fractures Copyright © 2015. F. A. Davis Company

On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries § Interphalangeal joint dislocations § Management § Reduction can be performed by trained personnel by applying traction § If unreduced, splint on the palmar aspect and apply ice pack § Splint § Refer for imaging Copyright © 2015. F. A. Davis Company

$On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries § Hand finger fractures$

On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries § Hand finger fractures § Management § Splint § If wrist and hand both injured, leave nailbeds exposed to check capillary refill Copyright © 2015. F. A. Davis Company

Splinting of Common Finger Injuries Deformity Splinting Position Jersey finger DIP joint in flexion Mallet finger DIP joint in extension Boutonnière deformity PIP and DIP joints in extension Phalanx fracture Position found Metacarpal fracture Palmar surface of wrist and hand Unreduced dislocations Position found DIP = distal interphalangeal; PIP = proximal interphalangeal Copyright © 2015. F. A. Davis Company