Forearm , Wrist, and Hand Evaluation
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FOREARM, WRIST, AND HAND EVALUATION
description
Forearm , Wrist, and Hand Evaluation. Overview. Applied anatomy Common wrist and hand injuries History Observation Examination AROM/PROM Special tests Neurological exam Circulatory exam. Bony Anatomy. 29 total bones (27 not counting radius and ulna) 8 carpals 5 metacarpals - PowerPoint PPT Presentation
Transcript of Forearm , Wrist, and Hand Evaluation
FOREARM, WRIST, AND HAND EVALUATION
Overview Applied anatomy Common wrist and hand injuries History Observation Examination
AROM/PROMSpecial testsNeurological examCirculatory exam
Bony Anatomy 29 total bones (27
not counting radius and ulna)8 carpals5 metacarpals14 phalangesRadiusUlna
Bony Anatomy Carpals
Navicular Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
Bony Anatomy Handy memory
tricks “Never Lie To a
Preacher, The Truth Comes Home”
“New Lovers Try Positions That They Can’t Handle”
Bony Anatomy Metacarpals
1-5○ Thumb is 1, “pinky”
is 5 Phalanges
Proximal, intermediate, & distal
Bony Anatomy Radius & ulna
Styloid processes
Bony Articulations DRUJ Radiocarpal (wrist)
Condyloid-type○ Flexion, extension,
abduction, adduction
Bony Articulations Thumb
Ginglymus Saddle joint of CMC
Digits 2-5 3 condyloid joints
Interphalangeal (IP); Proximal interphalangeal (PIP); Distal interphalangeal (DIP)
Articulations Joints
MCP (metacarpophalangeal)PIP (proximal interphalangeal)DIP (distal interphalangeal)
Articulations The thumb is different!! Joints
MCP (metacarpophalangeal)IP (interphalangeal)
Muscular Anatomy Flexor group (anterior)
Flexor carpi radialisFlexor carpi ulnarisPalmaris longusFlexor digitorum superficialisFlexor digitorum profundusFlexor pollicis longus
Muscular Anatomy Extensor group (posterior)
Extensor carpi radialisExtensor carpi ulnarisExtensor digitorumExtensor pollicis longus & brevisAbductor pollicis longus
Muscular Anatomy Flexor group (anterior)
Flexor carpi radialisFlexor carpi ulnarisPalmaris longusFlexor digitorum superficialisFlexor digitorum profundusFlexor pollicis longus
Flexor Group Flexor Carpi
Radialis (FCR)O: medial
epicondyleI: palmar handA: flexion, abductionN: median
Flexor Group Flexor Carpi
Ulnaris (FCU)O: medial
epicondyleI: palmar handA: flexion, adductionN: ulnar
Flexor Group Palmaris Longus
O: Medial epicondyle
I: palmar handA: flexionN: Median
Flexor GroupFlexor Digitorum
Superficialis◦O: medial epicondyle,
proximal radius & ulna◦ I: middle phalanx of
digits 2-5 (palmar surface)
◦A: finger & wrist flexion
◦N: median
Flexor Group Flexor Digitorum
ProfundusO: proximal ulnaI: distal phalanx of
digits 2-5 (palmar surface)
A: finger & wrist flexion
N: median
Finger Flexors
Flexor GroupFlexor Pollicis Longus
◦O: proximal radius & ulna
◦I: distal phalanx of digit 1 (thumb) (palmar surface)
◦A: thumb & wrist flexion
◦N: Median
Extensor Group Extensor Carpi
Radialis (ECR)O: lateral
epicondyleI: dorsal handA: ext & abdN: radial
Extensor Group Extensor Carpi
Ulnaris (ECU)O: lateral
epicondyleI: dorsal handA: ext & addN: radial
Extensor GroupExtensor Digitorum
◦O: lateral epicondyle
◦I: middle & distal phalanges of digits 2-5 (dorsal hand)
◦A: finger & wrist ext◦N: radial
Extensor GroupExtensor Pollicis
Longus & Brevis◦O: posterior distal
radius & ulna◦I: proximal & distal
phalange of digit 1 (thumb)(dorsal hand)
◦A: thumb & wrist ext
◦N: radial
Extensor Group Abductor Pollicis
O: posterior distal radius & ulna
I: first metacarpal (dorsal hand)
A: thumb & wrist abd
N: radial
Carpal Tunnel Transverse carpal
ligament Median nerve Flexor digitorum
profundus (4) Flexor digitorum
superficialis (4) Flexor pollicis longus
Common Forearm, Wrist & Hand Injuries Contusions Forearm splints Colles’ fracture
Distal radius & ulna fracture
Common Forearm, Wrist & Hand Injuries
Wrist sprain Carpal tunnel syndrome Tenosynovitis Tendinitis
Common Forearm, Wrist & Hand Injuries De Quervain’s disease Scaphoid fracture
Pain in the “anatomical snuffbox”Early diagnosis essential in proper
treatment Wrist ganglion
Common Forearm, Wrist & Hand Injuries
Contusion to hand and fingers Mallet finger
Torn extensor tendon (ED) at DIPSplint in extension 6-8 weeks
Boutonniere deformityTorn extensor tendon (EDS) at PIPSplint entire finger 6-8 weeks
Common Forearm, Wrist & Hand Injuries
Jersey fingerUsually a rupture of
the flexor digitorum profundus
Gamekeeper’s thumbSprain of the UCL of
thumb
History MOI
1. What was the mechanism of injury? 2. What were you doing when the injury occurred? 3. Did you hear or feel anything at the time of the
injury? 4. Did you receive a direct blow? 5. What was the angle of impact? 6. What was the position of arm or wrist at impact? 7. Was the wrist forced beyond its normal ROM? 8. Did you have a violent muscular contraction? 9. Were you throwing or swinging?
History S & S
10.Describe the symptoms. 11.Did the pain come on gradually or suddenly? 12.Describe the pain. 13.Is it sharp or dull? 14.Localized or diffuse? 15.Any numbness, tingling, or burning? 16.Is the pain radiating down your arm? 17.Is the pain severe? Does it keep you awake at night? 18.Demonstrate what causes pain. 19.Does the arm feel tight or locked? 20.Do you feel any weakness?
History Previous injury
21. Have you had a previous injury? 22.Did you rehab? If so, what exercises?
