Chapter 18 The Forearm Wrist Hand and Fingers

Chapter 18 The Forearm, Wrist, Hand, and Fingers 5/3/2016 Sports Medicine - Mr. Cronin 1

Objectives �When you finish with this chapter you should be able to: �Review the structural and functional anatomy of the forearm, wrist, hand fingers. �Outline the process of assessment for injuries to the forearm, wrist, hand fingers. �Incorporate management techniques for dealing with injuries to the forearm, wrist, hand, and fingers. �Implement the appropriate rehabilitation techniques for dealing with injuries to the forearm, wrist, hand, and fingers. 5/3/2016 Sports Medicine - Mr. Cronin 2

Anterior Radius and Ulna Parts to know: • Radius: • Head of the radius • Neck of the radius • Radial tuberosity • Shaft of the radius • Ulnar notch of the radius • Styloid process of the radius • Ulna • Trochlear notch of the ulna • Coronoid process of the ulna • Ulnar tuberosity • Radial notch of the ulna • Styloid process of the ulna • Olecranon process of the ulna • Head of the ulna • Shaft of the Ulna • Interosseous membrane • Distal radioulnar joint • Proximal radioulnar joint 5/3/2016 3 Sports Medicine - Mr. Cronin

Posterior Radius and Ulna Parts to know: • Radius: • Head of the radius • Neck of the radius • Shaft of the radius • Ulnar notch of the radius • Styloid process of the radius • Ulna • Radial notch of the ulna • Styloid process of the ulna • Olecranon process of the ulna • Head of the ulna • Shaft of the ulna • Interosseous membrane • Distal radioulnar joint • Proximal radioulnar joint 5/3/2016 4 Sports Medicine Mr. Cronin

Articulations of the Forearm �Proximal (Superior) Radioulnar Joint �Middle Radioulnar Joint �Distal (Inferior) Radioulnar Joint 5/3/2016 Sports Medicine - Mr. Cronin 5

Forearm Musculature �Flexor Carpi Radialis �Origin � Medial epicondyle of the humerus. �Insertion � Ventral surface (palm side) of the second and third metacarpals. �Action � Flexes the wrist and abducts the hand (radial deviation); aids in flexion of the elbow and pronation of the forearm. 5/3/2016 Sports Medicine - Mr. Cronin 6

Forearm Musculature �Palmaris Longus �Origin � Medial epicondyle of the humerus. �Insertion � Palmar aponeurosis (a sheet of pearly-white fibrous tissue that takes the place of a tendon in sheet-like muscles having a wide area of attachment). �Action � Flexes the wrist. 5/3/2016 Sports Medicine - Mr. Cronin 7

Forearm Musculature �Flexor Carpi Ulnaris �Origin � Medial epicondyle of the humerus, olecranon process, and the proximal two-thirds of the posterior surface of the ulna. �Insertion � Pisiform, hamate, and fifth metacarpal. �Action � Flexes the wrist and adducts the hand (ulnar deviation). 5/3/2016 Sports Medicine - Mr. Cronin 8

Forearm Musculature �Flexor Digitorum Superficialis � Origin � Medial epicondyle of the humerus, coronoid process of the ulna, and the anterior radius. � Insertion � Ventral surface (palm side) of the middle phalanges of the second through fifth fingers � Action � Flexes the wrist and phalanges. 5/3/2016 Sports Medicine - Mr. Cronin 9

Forearm Musculature � Flexor Digitorum Profundus � Origin � Medial epicondyle of the humerus, the coronoid process of the ulna, the interosseous membrane, and the ventral (anterior) side of the ulna. � Insertion � Ventral (palm side) of the base of the distal phalanges of the second through fifth fingers. � Action � 5/3/2016 Flexes the wrist and the phalanges. Sports Medicine - Mr. Cronin 10

Forearm Musculature �Flexor Pollicis Longus � Origin � Ventral surface of the radius (anterior) and the interosseous membrane. � Insertion � Ventral surface (palm side) of the base of the distal phalanx of the thumb. � Action � Flexes the thumb and aids in flexing the wrist. 5/3/2016 Sports Medicine - Mr. Cronin 11

Forearm Musculature �Pronator Quadratus �Origin � Distal ventral surface (anterior side) of the ulna. �Insertion � Distal ventral surface (anterior side) of the radius. �Action � Pronates the forearm and hand. 5/3/2016 Sports Medicine - Mr. Cronin 12

Forearm Musculature �Extensor Carpi Radialis Longus �Origin � Lateral supracondylar ridge of the humerus. �Insertion � Dorsal surface (posterior) of the base of the second metacarpal. �Action � Extends the wrist and abducts (radial deviation) the hand. 5/3/2016 Sports Medicine - Mr. Cronin 13

Forearm Musculature �Extensor Carpi Radialis Brevis �Origin � Lateral epicondyle of the humerus. �Insertion � Dorsal surface (posterior) of the base of the third metacarpal. �Action � Extends the wrist and abducts (radial deviation) the hand. 5/3/2016 Sports Medicine - Mr. Cronin 14

Forearm Musculature �Extensor Digitorum (Communis) �Origin � Extends the wrist and abducts (radial deviation) the hand. �Insertion � Dorsal surface (posterior) of the phalanges of the second through fifth fingers. �Action � Extends the fingers and wrist. 5/3/2016 Sports Medicine - Mr. Cronin 15

Forearm Musculature �Extensor Digiti Minimi �Origin � Tendon of the extensor digitorum communis. �Insertion � Tendon of the extensor digitorum communis on the dorsum (posterior) of the little finger. �Action � Extends the little finger. 5/3/2016 Sports Medicine - Mr. Cronin 16

Forearm Musculature �Extensor Carpi Ulnaris �Origin � Lateral epicondyle of the humerus. �Insertion � Base of the fifth metacarpal. �Action � Extends the wrist and adducts (ulnar deviation) the hand. 5/3/2016 Sports Medicine - Mr. Cronin 17

Forearm Musculature �Abductor Pollicis Longus �Origin � Posterior surface of the middle of the radius and ulna and the interosseous membrane. �Insertion � Base of the first metacarpal. �Action � Abducts the thumb and hand (radial deviation). 5/3/2016 Sports Medicine - Mr. Cronin 18

Forearm Musculature �Extensor Pollicis Brevis �Origin � Posterior surface of the middle of the radius and the interosseous membrane. �Insertion � Base of the first phalanx of the thumb. �Action � Extends thumb and wrist, abducts the hand (radial deviation). 5/3/2016 Sports Medicine - Mr. Cronin 19

Forearm Musculature �Extensor Pollicis Longus �Origin • Posterior surface of the middle of the ulna and the interosseous membrane. �Insertion � Base of the distal phalanx of the thumb. �Action � Extends the thumb and abducts the hand (radial deviation). 5/3/2016 Sports Medicine - Mr. Cronin 20

Forearm Musculature �Extensor Indicis �Origin � Posterior surface of the distal end of the ulna and the interosseous membrane. �Insertion � Tendon of the extensor digitorum communis to the index finger. �Action � Extends the index finger. 5/3/2016 Sports Medicine - Mr. Cronin 21

Brachioradialis �Origin �Lateral supracondylar ridge of the humerus �Insertion �Styloid process of the ulna �Action �Elbow flexion 12/14/2021 Sports Medicine - Mr. Cronin 22

Supinator �Origin �Lateral epicondyle of the humerus �Insertion �Proximal end of the lateral surface of the shaft of the radius �Action �Elbow supination 12/14/2021 Sports Medicine - Mr. Cronin 23

Pronator Teres �Origin �Medial epicondyle of the humerus and the coronoid process of the ulna �Insertion �Middle of the lateral surface of the shaft of the radius �Action �Elbow pronation 12/14/2021 Sports Medicine - Mr. Cronin 24

Anconeus �Origin �Lateral epicondyle of the humerus �Insertion �Lateral surface of the olecranon process of the ulna �Action �Elbow extension 12/14/2021 Sports Medicine - Mr. Cronin 25

Muscle Groups of the Forearm �Extensors �(Posterolateral) �Extensor Carpi Radialis Longus �Extensor Carpi Radialis Brevis �Extensor Carpi Ulnaris �Brachioradialis �Extensor Pollicis Longus �Extensor Pollicis Brevis �Abductor Pollicis Longus �Extensor Indicis �Supinator 5/3/2016 Sports Medicine - Mr. Cronin �Flexors �(Anteromedial) �Flexor Carpi Radialis �Flexor Carpi Ulnaris �Palmaris Longus �Flexor Digitorum Superficialis �Flexor Digitorum Profundus �Flexor Pollicis Longus �Pronator Quadratus �Pronator Teres 26

Common Forearm Injuries �Forearm Splints �Forearm Fractures �Colles’ Fracture 5/3/2016 Sports Medicine - Mr. Cronin 27

Forearm Splints �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 28

Forearm Fractures �Etiology gymnastics injury �Signs/Symptoms �Management �Colles’ Fracture 5/3/2016 Sports Medicine - Mr. Cronin 29

Anatomy of the Wrist, Hand, and Fingers � Bones of the Wrist � Carpals (8) � � � � Scaphoid Lunate Triquetral Pisiform Hamate Capitate Trapezoid Trapezium � Metacarpals (5) � � � 1 st 2 nd 3 rd 4 th 5 th � Phalanges (14) � � � Proximal Intermediate Distal 5/3/2016 Sports Medicine - Mr. Cronin 30

Articulations �Radiocarpal Joint �(Inter)Carpal Joints �Metacarpal Phalangeal Joints (MCP) �(Inter)Phalangeal Joints �Proximal Interphalangeal Joint (PIP) �Distal Interphalangeal Joint (DIP) 5/3/2016 Sports Medicine - Mr. Cronin 31

Musculature of the Wrist, Hand, and Fingers �Palmar Muscles �Lumbricales (4) �Dorsal Interossei (4) �Palmar Interossei (3) �Thenar Muscles �Abductor Pollicis Brevis �Opponens Pollicis �Flexor Pollicis Brevis �Adductor Pollicis 5/3/2016 Sports Medicine - Mr. Cronin �Hypothenar Muscles �Palmaris Brevis �Abductor Digiti Minimi �Flexor Digiti Minimi Brevis �Opponens Digiti Minimi 32

Musculature of the Wrist, Hand, and Fingers �Lumbricals �Origin – Tendons of the flexor digitorum profundus. �Insertion – Tendons of the extensor digitorum communis. �Action – Flexes the metacarpophalangeal joints. 5/3/2016 Sports Medicine - Mr. Cronin 33

Musculature of the Wrist, Hand, and Fingers �Dorsal Interossei (4) �Origin – Adjacent sides of all of the metacarpals. �Insertion – Proximal phalanx of the second, third, and fourth fingers. �Action – Abducts the fingers from the middle finger. 5/3/2016 Sports Medicine - Mr. Cronin 34

Musculature of the Wrist, Hand, and Fingers �Palmar Interossei (3) �Origin – Medial side of the second metacarpal and lateral side of the fourth and fifth metacarpals. �Insertion – Proximal phalanx of the same finger. �Action – Adducts the fingers toward the middle finger. 5/3/2016 Sports Medicine - Mr. Cronin 35

Musculature of the Wrist, Hand, and Fingers �Abductor Pollicis Brevis �Origin – Flexor Retinaculum, scaphoid, and trapezium. �Insertion – Proximal phalanx of the thumb. �Action – Abduct the thumb. �Abductor pollicis brevis video 5/3/2016 Sports Medicine - Mr. Cronin 36

Musculature of the Wrist, Hand, and Fingers �Opponens Pollicis �Origin – Flexor retinaculum, and trapezium. �Insertion – Lateral border of the metacarpal of the thumb. �Action – Pulls the thumb in front of the palm to meet the little finger. 5/3/2016 Sports Medicine - Mr. Cronin 37

Musculature of the Wrist, Hand, and Fingers �Flexor Pollicis Brevis �Origin – Flexor retinaculum, trapezium, and first metacarpal. �Insertion – Base of the proximal phalanx of the thumb. �Action – Flexes and adducts the thumb. �Flexor Pollicis Brevis Video 5/3/2016 Sports Medicine - Mr. Cronin 38

Musculature of the Wrist, Hand, and Fingers �Adductor Pollicis �Origin – Capitate, and second and third metacarpals. �Insertion – Proximal phalanx of the thumb. �Action – Adducts the thumb. �Adductor Pollicis Video 5/3/2016 Sports Medicine - Mr. Cronin 39

Musculature of the Wrist, Hand, and Fingers �Palmaris Brevis �Origin – Flexor retinaculum. �Insertion – Skin on the ulnar border of the hand. �Action – Pulls the skin toward the middle of the palm. 5/3/2016 Sports Medicine - Mr. Cronin 40

Musculature of the Wrist, Hand, and Fingers �Abductor Digiti Minimi �Origin – Pisiform and the tendon of the flexor carpi ulnaris. �Insertion – Base of the proximal phalanx of the little finger. �Action – Abducts the little finger. 5/3/2016 Sports Medicine - Mr. Cronin 41

Musculature of the Wrist, Hand, and Fingers �Flexor Digiti Minimi Brevis �Origin – Flexor retinaculum and hamate. �Insertion – Base of the proximal phalanx of the little finger. �Action – Flexes the little finger. 5/3/2016 Sports Medicine - Mr. Cronin 42

Musculature of the Wrist, Hand, and Fingers �Opponens Digiti Minimi �Origin – Flexor retinaculum and hamate. �Insertion – Metacarpal of the little finger. �Action – Brings the little finger our to meet the thumb. 5/3/2016 Sports Medicine - Mr. Cronin 43

Joint Movements Fingers and Thumb �Finger Extension �Finger Flexion �Finger Abduction �Finger Adduction �Thumb Abduction �Thumb Adduction �Thumb Extension �Thumb Opposition 5/3/2016 Sports Medicine - Mr. Cronin 44

Nerve Supply �Two major nerves: (motor and sensory) �Ulnar Nerve �Median Nerve �Additional nerve (mostly sensory) �Radial Nerve 5/3/2016 Sports Medicine - Mr. Cronin 45

Blood Supply �Radial Artery �Ulnar Artery 5/3/2016 Sports Medicine - Mr. Cronin 46

Special Tests �Finkelstein’s Test �Tinel’s Sign �Phalen’s Test �Valgus/Varus and Glide Tests for the Wrist, MCP and IP Joints �Luntriquetral Ballotment Test �Allen’s Test 5/3/2016 Sports Medicine - Mr. Cronin �Circulatory and Neurological Evaluation �Dermatomes and Myotomes �Nailbed Pinch �Functional Evaluation 47

Common Injuries to the Wrist, Hand, and Fingers �Wrist Sprains �Tenosynovitis �Tendinitis �Nerve Compression, Entrapment, Palsy �Carpal Tunnel Syndrome �de. Quervain’s Syndrome �Dislocation of the Lunate �Scaphoid Fracture �Hamate Fracture �Wrist Ganglion �Trigger Finger or Thumb 5/3/2016 Sports Medicine - Mr. Cronin �Extensor Tendon Avulsion (Mallet Finger) �Boutonniere Deformity �Flexor Digitorum Profundus Rupture (Jersey Finger) �Gamekeeper’s Thumb �MCP Dislocation �Bennett’s Fracture �Metacarpal Fracture (Boxer’s Fracture) 48

Wrist Sprains �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 49

Wrist Tenosynovitis vs. Tendonitis �Etiology �Tenosynovitis = repetitive wrist accelerations and decelerations; repetitive use and overuse of the wrist tendons and their sheaths �Tendonitis = repetitive wrist flexion; overuse of the wrist �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 50

Carpal Tunnel Syndrome �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 51

de. Quervian’s Syndrome Aka Hoffman’s disease �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 52

Lunate Dislocation �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 53

Scaphoid Fracture �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 54

Hamate Fracture �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 55

Wrist Ganglion �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 56

Trigger Finger/Thumb �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 57

Mallet Finger �Etiology �Baseball finger/basketball finger �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 58

Boutonniere Deformity �Etiology �Buttonhole deformity �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 59

Jersey Finger �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 60

Gamekeeper’s Thumb �Etiology �Skier's thumb �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 61

MCP Dislocation �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 62

Bennett’s Fracture �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 63

Metacarpal Fracture (Boxer’s Fracture) �Etiology �Signs/Symptoms �Management 5/3/2016 Sports Medicine - Mr. Cronin 64