Wrist and Hand Examination Student 2024 PDF

WRIST & HAND EXAMINATION https://www.the-broad-side.com/raise-your-hand STRUCTURE AND FUNCTION  Bones  Distal radius  Distal Ulna  Carpals (8)  Metacarpals (5)  Proximal phalanges (5)  Middle phalanges (4) ...

WRIST & HAND EXAMINATION https://www.the-broad-side.com/raise-your-hand STRUCTURE AND FUNCTION  Bones  Distal radius  Distal Ulna  Carpals (8)  Metacarpals (5)  Proximal phalanges (5)  Middle phalanges (4)  Distal phalanges (5) http://www.kidport.com/RefLib/Science/HumanBody/SkeletalSystem/ Wrist.htm STRUCTURE AND FUNCTION  Scaphoid  Lunate  Triquetrum  Pisiform  Hamate  Capitate  Trapezoid  Trapezium http://www.raddaily.com/whitepaperarticle.php? articleTitle=Dorsal+and+Volar+Intercalated+Segment+Instability+ STRUCTURE AND FUNCTION  Proximal carpal row (4)  Scaphoid  Lunate  Triquetrum  Pisiform  Distal carpal row (4)  Hamate  Capitate  Trapezoid  Trapezium http://teachmeanatomy.info/upper-limb/bones/bones-of-the- hand-carpals-metacarpals-and-phalanges /  STRUCTURE AND FUNCTION  Articulations 1. Radiocarpal joint 2. Midcarpal joint 3. Carpometacarpal (CMC) joints 4. Metacarpophalangeal (MCP) joints 5. Interphalangeal (IP) joints http://sketchymedicine.com/2011/12/bones-and-joints-of-the-hand-and-  STRUCTURE AND FUNCTION- WRIST Radiocarpal joint  Articulation of distal radius and TFCC/disc to scaphoid, lunate and triquetrum  Synovial joint http://www.braceaccess.com/wrist-anatomy-carpal-tunnel- syndrome/  STRUCTURE AND FUNCTION- WRIST Midcarpal joint:  Located between the proximal and distal carpal rows  Synovial joint- rows move as a unit http://myhand.com.au/index.php? option=com_content&view=article&id=117%3Amallet-finger- splint3&catid=62%3Asplints&Itemid=134&font-size=larger STRUCTURE AND FUNCTION- WRIST  Joint Classification and Osteokinematics Degrees Classificatio Joint of Motion(s) n Freedom Distal Pronation/ Pivot 1 radioulnar supination Flexion/ Condyloid extension, Radiocarpal 2 (biaxial) radial/ulnar deviation Flexion/ Condyloid extension, Midcarpal 2 (“functional”) radial/ulnar deviation  THUMB: 1ST CMC JOINT CMC joint of thumb  Trapezium & base of 1st metacarpal  Saddle-shaped trapezium  2 degrees of freedom (flexion/extension, abduction/adduction) Concave – sagittal plane  Slight axial rotation Convex – frontal plane  Opposition = abduction, flexion MOTIONS OF THE THUMB *Extensio n *note difference to Hislop & Montgomery, 10th ed.  METACARPOPHALANGEAL (MCP) JOINTS, PROXIMAL AND DISTAL INTERPHALANGEAL JOINTS (PIP, DIP) / https://clinicalgate.com/hand-3 http://www.assh.org/handconsult/Cases-A-Z/Condition-Inf ArticleID/50826/Finger-Laceration STRUCTURE AND FUNCTION- HAND  Joint Classification and Osteokinematics Degrees Classificatio Joint of Motion(s) n Freedom Flexion/ Condyloid extension, MCP 2 (biaxial) abduction/ adduction Flexion/ PIP and DIP Hinge 1 extension Carpometa- Flexion/ carpal extension, Saddle 2 (CMC) abduction/ thumb adduction CAPSULAR PATTERNS Wrist: equal limits of flex/ext, slight limit of RD and UD Fingers: equal flex/ext Thumb CMC: Abd and ext Thumb MCP: All, flex>ext Thumb IP: All: flex>ext EFFECTS OF AGE, GENDER AND OTHER FACTORS Gradual decrease in ROM with age Women with slightly more ROM vs. men R vs. L side: unclear Test position: UD > in supination, RD > in pronation http://www.radtechonduty.com/2011/12/pa-scaphoid-hand-elevated-and-ulnar.html FUNCTIONAL ROM ROM during personal care Most ADLs require wrist extension and UD Examples: Examples:  Hand to top of head  Eating with utensil  Hand to occiput  Using phone  Hand to front of chest  Pouring from pitcher  Hand to sacrum  Turning doorknob  Hand to foot  Rising from chair  Hand to mid back  Turning steering wheel  Drinking from cup MUSCLES  Anterior Muscle Compartment (flexors)  Muscles that flex the wrist & fingers (including thumb)  Primarily innervated by median nerve (w/few exceptions = ulnar nerve)  Posterior Muscle Compartment (extensors)  Muscles that extend the wrist & fingers (including thumb extension and abduction)  Innervated by radial nerve MUSCLES OF THE ANTERIOR FOREARM http://www.easynotecards.com/notecard_set/73738 FLEXORS OF WRIST AND HAND  Common flexor tendon  Flexor carpi radialis (FCR)  Palmaris longus  Flexor carpi ulnaris (FCU)  Flexor digitorum superficialis (FDS)  Other muscles:  Flexor pollicis longus (FPL),  Flexor digitorum profundus (FDP)  FLEXORS OF THE HAND  Flexor digitorum superficialis (FDS)  flexes PIP joints  Flexor digitorum profundus (FDP)  flexes DIP joints https://medium.com/@jamesleedpt/common-finger-injuries-from-rock- climbing-850b2ad1da28 http://radsource.us/flexor-tendon-injuries/ MUSCLES OF POSTERIOR FOREARM F G / http://teachmeanatomy.info/upper-limb/muscles/posterior-forearm EXTENSORS OF WRIST AND HAND  Common extensor tendon  Extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, extensor carpi radialis brevis  Common area of injury/overuse  Lateral epicondylitis (epicondylalgia) MUSCLES OF THE POSTERIOR FOREARM  Othermuscles of posterior forearm:  Extensor indicis  Extensors of thumb  Abductor pollicis longus (APL)  Extensor pollicis brevis (EPB)  Extensor pollicis longus (EPL) http://teachmeanatomy.info/upper-limb/muscles/posterior-forearm/ INTRINSIC MUSCLES OF THE HAND  Intrinsic: muscles that have O and I within hand  Thenar muscles  APB, opponens pollicis (OP), FPB, adductor pollicis  Hypothenar muscles  ADM, flexor digiti minimi (brevis), opponens digiti minimi  Other  Palmaris brevis, adductor pollicis  Short muscles  Interossei  Lumbricals INTRINSIC MUSCLES OF THE HAND Muscles of Thenar Eminence: - APB - OP - FPB http://teachmeanatomy.info/upper-limb/muscles/hand/ INTRINSIC MUSCLES OF THE HAND Muscles of Hypothenar Eminence:  - ADM  - FDMB  - ODM / http://teachmeanatomy.info/upper-limb/muscles/hand  OTHER MUSCLES OF PALM https://www.orthobullets.com/anatomy/10045/palmaris-brevis https://classes.kumc.edu/sah/resources/handkines/muscles/inaddpolli.htm INTRINSIC MUSCLES: INTEROSSEI Adduction of Digits II, IV & Abduction of Digits II, III, V & IV 2 2 3 1 3 1 4 ADM Palmar Interossei Dorsal Interossei (3) (4)  INTRINSIC MUSCLES: LUMBRICALS  4 on each hand, from FDP tendon to extensor hood  Flexes MCP, extends IP  Innervation:  lateral 2: median n.  / http://teachmeanatomy.info/upper-limb/muscles/hand Medial 2: ulnar n. https://www.easynotecards.com/notecard_set/75387?vote_down  LISTER’S TUBERCLE  Bony landmark on distal radius  Pulley for EPL tendon http://accessemergencymedicine.mhmedical.com/content.aspx? https://sites.google.com/site/3r03msklearningportfolio/?tmpl= sectionid=64415441&bookid=1132&jumpsectionID=64415568&R %2Fsystem%2Fapp%2Ftemplates%2Fprint esultclick=2&q=wrist+fractures%2C+hamate+bone MMT CONSIDERATIONS: FINGER MCP FLEXION https://www.slideshare.net/kasyan/hand-2009-2-questions-included-not-to- post