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Wrist and Hand Injuries

Wrist and Hand Injuries

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Wrist and Hand Injuries

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  1. Wrist and Hand Injuries Chapter 12

  2. Anatomy of the Wrist and Hand • Bones and Joints • Wrist • Joint between arm and hand • Carpal bones • 8 • Irregularly shaped • Articulate w/ ulna, radius, and metacarpals

  3. Anatomy of the Wrist and Hand

  4. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid • Blood supply on only one end • Difficulty healing when it is fractured • “Anatomical snuffbox” • Anatomical peculiarity • An interesting anatomical anomaly in the vascular supply to the scaphoid is the area to which the blood supply is first delivered. Blood enters the scaphoid distally. Consequently, in the event of a fracture the proximal segment of the scaphoid will be devoid of a vascular supply, and will - if action is not taken - avascularly necrose within a sufferer's snuffbox. Due to the small size of the scaphoid and its shape, it is difficult to determine, early on, whether or not the scaphoid is indeed fractured with an x-ray. Further complications include; carpal instability (ligament disruption) and fracture-dislocations. [http://www.statemaster.com/encyclopedia/Anatomical-snuff-box]

  5. Anatomical Snuffbox

  6. Anatomy of the Wrist and Hand

  7. Anatomy of Wrist and Hand • Carpal Bones cont’d • Scaphoid • Find scaphoid bone on Coloring Sheet page 43. Color it red

  8. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid bone • Lunate bone • Find the lunate bone and color it green

  9. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid bone • Lunate bone • Triquetal bone • Find the triquetal bone and color it yellow

  10. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid bone • Lunate bone • Triquetal bone • Pisiform bone • Find the pisiform bone and color it black

  11. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid bone • Lunate bone • Triquetal bone • Pisiform bone • Trapezium bone • Find the Trapezium bone and color it pink

  12. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid bone • Lunate bone • Triquetal bone • Pisiform bone • Trapezium bone • Trapezoid bone • Find the trapezoid bone and color it blue

  13. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid bone • Lunate bone • Triquetal bone • Pisiform bone • Trapezium bone • Trapezoid bone • Capitate bone • Find the Capitate bone and color it brown

  14. Anatomy of the Wrist and Hand • Carpal bones cont’d • Scaphoid bone • Lunate bone • Triquetal bone • Pisiform bone • Trapezium bone • Trapezoid bone • Capitate bone • Hamate bone • Find the hamate bone and color it grey

  15. Anatomy of the Wrist and Hand • Bones and Joints Cont’d • Metacarpals • 5 • From distal end of carpals and join with the proximal phalanx of one of the fingers • Numbered 1 through 5 beginning with thumb side

  16. Bones and Joints Cont’d • Metacarpals • On your coloring sheet, draw a black circle around the roman numerals that represent the respective metacarpals. • Then color the metacarpals light purple. • Notice D1, D2, and D3, these represent the different parts of the metacarpal. Cool the corresponding arrows in the following manner… • D1 – striped light purple • D2 – dotted light purple • D3 – zig zagged light purple

  17. Anatomy of the Wrist and Hand • Bones and Joints Cont’d • Fingers • 5 • Total of 14 phalanges (in each hand)

  18. Anatomy of the Wrist and Hand • Bones and Joints Cont’d • Fingers • Color the Arrow “E” that corresponds with the phalanges orange with lines • Color the proximal phalanx of each finger dark orange • Color the middle phalanx of each finger orange • Color the distal phalanx of each finger with light orange • Color arrows E4 (base) in light brown, E5 (Shaft) light brown stripes, E6 (head) light brown circles

  19. Anatomy of the Wrist and Hand • Bones and Joints Cont’d • How joints are named… • Bones that comprise them • Whether they are distal or proximal • Thumb • Two joints • Metacarpal phalangeal joint • Interphalangeal joint • Each finger 2 – 5 • Metacarpal phalangeal (MCP) joint • Proximal Interphalangeal (PIP) joint • Distal interphalangeal (DIP) joint

  20. Anatomy of the Wrist and Hand • Bones and Joints Cont’d • Distal Radioulnar Joint • Ulnar head articulates with ulnar notch of the radius • Pronation • Supination • Radiocarpal Joint • Distal radius articulates with scaphoid and lunate • Flexion • Extension • Radial deviation – Movement of the hand toward the radial (thumb) side • Ulnar deviation – Movement of the hand toward the ulnar side of the forearm

  21. Anatomy of the Wrist and Hand • Bones and Joints Cont’d • Intercarpal Joints • Carpal bone articulates with another carpal bone • Very little gliding allowed between bones due to ligamentous structure • Carpometacarpal Joints • Metacarpals 1 – 3 articulate with a single carpal • I articulates with trapezium • II articulates with trapezoid • III articulates with capitate • IV and V articulate w hammate

  22. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Find this M on your coloring sheet pg 87 and color it orange

  23. Abductor Pollicis longus* Actions: 1st CMC joint abduction 1st CMC joint extension Assists in radial deviation of the wrist

  24. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Color this M Red

  25. Extensor carpi radialis brevis* Actions: Wrist extension Radial deviation

  26. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Color this M green

  27. Extensor carpi radialis longus* Actions Wrist extension Radial deviation

  28. Extensor carpi radialis longus* Actions Wrist extension Radial deviation

  29. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Color this M yellow

  30. Extensor carpi ulnaris* Action: Wrist extension Ulnar deviation

  31. Extensor carpi ulnaris Action: Wrist extension Ulnar deviation

  32. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis

  33. Extensor digitorum communis Action: Wrist extension MCP extension IP extension Radial deviation of the wrist

  34. Extensor digitorum communis Action: Wrist extension MCP extension IP extension Radial deviation of the wrist

  35. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Color this M black

  36. Extensor pollicis brevis* Actions: 1st MCP joint Ext 1st CMC joint Ext 1st CMC joint ABD Assists in wrist radial deviation

  37. Extensor pollicis brevis Actions: 1st MCP joint Ext 1st CMC joint Ext 1st CMC joint ABD Assists in wrist radial deviation

  38. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Extensor pollicus longus* • Color this M pink

  39. Extensor pollicis longus* Actions: 1st IP joint Ext 1st MCP joint Ext 1st CMC joint extension Assists in wrist Ext Assists in wrist radial deviation

  40. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Extensor pollicus longus* • Flexor carpi radialis* • Color this M blue

  41. Flexor carpi radialis* Actions: Wrist Flex Forearm pronation Radial deviation

  42. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Extensor pollicus longus* • Flexor carpi radialis* • Flexor carpi ulnaris* • Color this M brown

  43. Flexor carpi ulnaris* Actions: Wrist Flex Ulnar deviation

  44. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Extensor pollicus longus* • Flexor carpi radialis* • Flexor carpi ulnaris* • Flexor digitorum profundus*

  45. Flexor digitorum profundus* Actions: DIP Flex PIP Flex Wrist Flex

  46. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Extensor pollicus longus* • Flexor carpi radialis* • Flexor carpi ulnaris* • Flexor digitorum profundus* • Flexor digitorum superficialis*

  47. Flexor digitorum superficialis* Actions: PIP Flex MCP Flex Wrist Flex

  48. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Extensor pollicus longus* • Flexor carpi radialis* • Flexor carpi ulnaris* • Flexor digitorum profundus* • Flexor digitorum superficialis* • Flexor pollicis longus

  49. Flexor pollicis longus Actions: 1st IP joint Flex 1st MCP joint Flex Assists in wrist Flex

  50. Extrinsic MM Acting on the Wrist and Hand • Abductor pollicus longus* • Extensor carpi radialis brevis* • Extensor carpi radialis longus* • Extensor carpi ulnaris* • Extensor digitorum communis • Extensor pollicis brevis* • Extensor pollicus longus* • Flexor carpi radialis* • Flexor carpi ulnaris* • Flexor digitorum profundus* • Flexor digitorum superficialis* • Flexor pollicis longus • Palmaris longus