Download Hand,wrist,_and_elbow_notes

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anatomical snuffbox - Area formed by the extensor tendons of the thumb.
bennett's fracture - Fracture of the carpometacarpal joint.
boutonniere deformity - A deformity caused by a rupture of the extensor tendon dorsal to the middle phalanx.
bowler's thumb - Perineural fibrosis of the subcutaneous ulnar digital nerve.
carpal tunnel syndrome - Compression of the median nerve resulting from inflammation of the tendons and
synovial sheath.
carpus - Wrist.
Colles' fracture - Forearm fracture of the lower end of the radius or ulna.
gamekeeper's thumb - A sprain of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb.
de Quervain's disease - Stenosing tenosynovitis of the first tunnel of the wrist, causing pain on movement of the
extensor pollucis brevis and abductor pollucis longus.
interosseous membrane - A thin sheet of fibrous tissue that runs downward from the radius to the ulna and
transmits forces directly through the hand from the radius to the ulna.
mallet finger - Injury caused by a blow from a thrown ball that strikes the tip of the finger and avulses the
extensor tendon from its insertion along with a piece of the bone.
Anatomy of the Wrist, Hand and Fingers
1. Hand and Fingers
a. Phalanges make up the fingers. 2 in the thumb, 3 each in digits 2-5
b. 5 metacarpal bones in the hand
2. Wrist
a. Wrist formed by the distal radius and ulna with proximal row of four and
distal row of four carpal bones, that articulate with the metacarpals
b. Proximal row of carpals: scaphoid, lunate, triquetral, and pisiform
c. Distal row of carpals: trapezium, trapezoid, capitate and hamate
d. TFCC lies between the head of ulna and the triquetral bone
3. Articulations
a. Radiocarpal Joints: Condyloid Joints – permit flexion, extension and
circumduction
b. Carpal Joints: Arthrodial, or Gliding Joints
c. Metacarpal Joints: Condyloid Joints – permit flexion, extension, abduction,
adduction and circumduction, thumb is a saddle joint
d. InterPhalangeal Joints: Hinge joints – allow only flexion and extension
4. Ligaments
a. Ligaments of the Wrist: Ulnar Collateral, Radial Collateral and Transverse
Carpal Ligament
b. Ligaments of the Phalanges:
5. Musculature
a. Pollicis muscles move the thumbs
b. Digitorum muscles move digits 2-5
c. Carpi muscles move the wrist
6. Blood and Nerve Supply
a. Nerves of the hand are the ulnar, radial and median
b. Radial and Ulnar arteries supply the wrist and hand, creating two arterial
arches: superficial palmar arch and deep palmar arch
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III.
Assessment of the Wrist, Hand and Fingers
1. History
2. Observation
3. Palpation
4. Special Tests
a. Finklestein’s Test (De Quervain’s Syndrome)
b. Tinel’s Sign (Carpal Tunnel)
c. Phalen’s Test (Carpal Tunnel)
d. Valgus/Varus and Glide Stress Tests for Wrist, MCP, and IP joints
5. Functional Evaluation
a. Range of motion and resistive movements
Recognition and Management of Injuries to the Wrist, Hand and Fingers
1. Wrist Injuries
a. Wrist Sprains
b. Triangular Fibrocartilage Complex (TFCC) Injury
c. Tenosynovitis
d. Tendinitis
e. Nerve Compression, Entrapment, Palsy
f. Carpal Tunnel Syndrome
g. De Quervain’s Disease
h. Dislocation of the Lunate
i. Scaphoid Fracture
j. Hamate Fracture
k. Wrist Ganglion
2. Hand and Finger Injuries
a. Bowler’s Thumb
b. Mallet Finger
c. Boutonniere Deformity
d. Jersey Finger
e. Sprains, Dislocations, and Fractures
f. Gamekeeper’s Thumb
g. Sprains of IP Joints
h. Metacarpal Fracture
i. Bennett’s Fracture
j. Distal Phalangeal Fracture
k. Middle Phalangeal Fracture
l. Proximal Phalangeal Fracture
m. PIP Fracture and Dislocation
IV.
Anatomy of the Forearm
1. Bones
a. Forearm = the ulna and the radius
b. Ulna extension of the humerus, and the radius is an extension of the hand
2. Articulations
a. Superior Radioulnar Joint: Pivot joint
b. Middle Radioulnar Joint: Junction between the shafts of the ulna and radius
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c. Distal Radioulnar Joint: Pivot joint formed by the articulation of the head of
the ulna with a small notch on the radius
3. Forearm Musculature
a. Wrist extensors originate from the lateral epicondyle of the humerus
b. Wrist flexors originate from the medial epicondyle of the humerus
4. Nerve and Blood Supply
a. Median nerve innervates most of the flexors except flexor carpi ulnaris and
half of the flexor digitorum profundus
b. Radial nerve innervates most of the extensors
c. Brachial artery divides into the radial and ulnar arteries in the forearm
Assessment of the Forearm
1. History
2. Observation
3. Palpation
Recognition and Management of Injuries to the Forearm
1. Contusions
2. Forearm Splints
3. Forearm Fractures
4. Colles’ Fracture
Anatomy of the Elbow Joint
1. Bones
a. Elbow joint composed of the humerus, ulna and radius
b. Lateral condyle of the humerus is the capitulum and the medial condyle is the
trochlea
c. Capitulum articulates with radial head
d. Flexion and extension occur due to articulation of the trochlea with the
semilunar notch of ulna
e. Pronation/supination occur because head of radius rotates against the
capitulum freely
2. Articulations
a. Humeroulnar Joint
b. Humeroradial Joint
c. Proximal Radioulnar Joint
3. Ligaments and Capsule
a. Capsule is thin and covered by the brachialis muscle in front and triceps in
the back
b. Capsule reinforced by the ulnar and radial collateral ligaments
c. Medial elbow stability depends on the integrity of the ulnar collateral
ligament
d. Lateral elbow stability depends on the integrity of the radial collateral
ligament and stabilization of the annular ligament
4. Synovium and bursae
a. Most important bursae are the bicipital and olecranon bursae
5. Elbow Musculature
a. Elbow Flexors: Biceps Brachii, Brachialis, and Brachioradialis
b. Elbow Extensors: Triceps Brachii, and Anconeus
c. Pronation: Pronator Teres, and Pronator Quadratus
d. Supination: Biceps Brachii, and Supinator
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6. Nerve and Blood Supply
a. Nerves stemming from the brachial plexus innervate the muscles surrounding
the elbow joint
b. At cubital fossa the nerves become musculocutaneous, radial and median
Functional Anatomy
1. Elbow complex allows for flexion, extension, pronation and supination
2. Elbow ROM is approximately 145º of flexion and 90º for both supination and
pronation
3. Normal carrying angle in females is 10º-15º and in males 5º-10º.
Assessment of the Elbow
1. History
2. Observation Palpation
3. Special Tests
a. Circulatory and Neurological Evaluation
b. Tinel’s Sign
c. Valgus/Varus Stress Test
d. Medial and Lateral Epicondylitis Tests
e. Functional Evaluation
Recognition and Management of Injuries to the Elbow
1. Contusions
2. Olecranon Bursitis
3. Strains
4. Ulnar Collateral Ligament Injuries
5. Lateral Epicondylitis
6. Medial Epicondylitis
7. Elbow Osteochondritis Dissecans
8. Little League Elbow
a. An accelerated apophyseal growth region plus a delay in the medial
epicondylar growth plate
b. A traction apophysitis with a possible fragmentation of the medial
epicondylar apophysis
c. An avulsion of the medial epicondyle of the radial head
d. Osteochondrosis of the humeral capitellum
e. A non-union stress fracture of the olecranon epiphysis
9. Dislocation of the Elbow
10. Fractures of the Elbow