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PED 2440
The Wrist
Exercises and Injuries
Wrist curls
Squeezing tennis
Scaphoid Fractures
Scaphoid fractures account for about
60 percent of all wrist (carpal)
They usually occur in men between
ages 20 and 40 years, and are less
common in children or in older adults.
The break usually occurs during a fall
on the outstretched wrist.
It’s a common injury in sports and
motor vehicle accidents.
The angle at which the wrist hits the ground determines the injury.
If the wrist is extended at a 90-degree angle or greater, the scaphoid bone will break; if
the angle is less than 90 degrees, the lower arm bone (radius) will break.
Scaphoid Fractures
Signs and symptoms
Pain and tenderness on the thumb
side of the wrist.
Motion (gripping) may be painful.
May be some swelling on back and
thumb side of wrist.
Pain may subside, then return as a
deep, dull aching.
Marked tenderness to pressure on the
"anatomical snuffbox," a triangularshaped area on the side of the hand
between two tendons that lead to the
Scaphoid Fractures
The scaphoid is more susceptible to injury
than any of the other carpal bones because of
its unique position bridging the proximal and
distal rows of the carpal bones.
This frequency is due to a tenuous blood
supply, with only one dorsoradial artery to the
proximal pole, which results in a nearly 100%
incidence of avascular necrosis in proximal
fractures and a 30% incidence in distal
Any tenderness in the anatomic snuffbox over
the dorsal scaphoid (figure 1b) should prompt
treatment as for a fracture.
Scaphoid Fractures
Arthritis of the Wrist
Osteoarthritis (OA) is a progressive condition that destroys the smooth
articular cartilage covering the ends of bones.
The bare bones rub against each other, resulting in pain, stiffness and
OA can develop due to normal "wear-and-tear" on the wrist or as a result of a
traumatic injury to the forearm, wrist or ligaments.
Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the
joint linings and destroys bones, tissues, and joints.
Rheumatoid arthritis often starts in smaller joints, like those found in the hand
and wrist, and is symmetrical, meaning that it usually affects the same joint
on both sides of the body.
Arthritis of the Wrist
Signs and symptoms
OA of the wrist joint manifests with swelling, pain, limited motion and
weakness. These symptoms are usually limited to the wrist joint itself.
RA of the wrist joint usually manifests will swelling, tenderness, limited motion
and decreased grip strength. In addition, hand function may be impaired and
there may be pain in the knuckle joints (metacarpophalangeal or MP joints).
Joint swelling may also put pressure on the nerves that travel through the
wrist. This can cause a lesion to develop (compression neuropathy) or lead to
carpal tunnel syndrome.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Osseofibirous canal
-osseo = bones
-fibro = ligament
One nerve
Nine tendons
1. Carpal Bones
3. Median Nerve
2. Transverse
4. Nine Flexor Tendons
- 4 flexor digitorum
- 4 flexor digitorum profundus
- 1 flexor pollicis
Carpal Tunnel Syndrome
1. Scaphoid
2. Lunate
3. Triquetrum
4. Pisiform
5. Trapezium
6. Trapezoid
7. Capitate
8. Hamate
Carpal Tunnel Syndrome
“Medial wall” –
Pisiform and Hamate
“Lateral wall” –
Scaphoid and
“Floor” – Lunate,
Triquetrum, Trapeziod
and Capitate
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Pain and numbness in 13 fingers and half of the
4th or ring finger
Symptoms do not include
palm or little finger
Carpal Tunnel Syndrome
“a compressive neuropathy of the median nerve with the
carpal tunnel”
Lifestyle (diabetes, gout, arthritis, pregnancy, and alcoholism are risk
Repetitive motion. Keyboard, rock climbing, tennis,
Pressure inside the tunnel can double with CTS
Carpal Tunnel Syndrome
on median
of flexor
Carpal Tunnel Syndrome
Modification in activities
Table height, wrist angle, elbow angle
10-15 minute breaks
Exercises and warm-up wrist flexor muscles
Flex fingers tightly then extend and abduct fingers for 5 seconds
With arms extended, flex and extend wrist several times followed by circumduction of the wrist
Removable wrist brace
Anti-inflammatory medicines
Surgery – carpal tunnel release
Scare tissue