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Comprehensive Analysis of Wrist and Hand Anatomy, Injuries, and Treatment Approaches

This detailed overview covers the anatomy of the wrist and hand, focusing on the joints, nerves, and blood supply involved in hand function. It discusses common injuries such as wrist sprains, fractures, carpal tunnel syndrome, and nerve palsies, along with their clinical evaluations, signs, and symptoms. Treatment options range from rest and rehabilitation techniques to surgical interventions like carpal tunnel release. Additional insights into specific conditions like ganglion cysts and triangular fibrocartilage complex tears are also included, providing a thorough understanding of wrist and hand health.

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Comprehensive Analysis of Wrist and Hand Anatomy, Injuries, and Treatment Approaches

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  1. Wrist and Hand Connie S. Hayes, DC, MS, CCSP Laney Nelson DC, DACBSP

  2. Joints of the Wrist • Distal Radioulnar • Supination & Pronation • Radiocarpal • Radius, Radioulnar disk, scaphoid, lunate & triquetrum • Flexion & Extension • Ulnocarpal • Ulna & Triquetrum • Flexion & Extension Held together by strength of its ligaments

  3. Midcarpal Joints

  4. Distal Row Moves with You

  5. Wrist Adduction & Abduction

  6. Wrist Flexion & Extension

  7. Functional Anatomy • Final Link in Kinematic Chain • End point of all directed Forces & Velocities • Built for Mobility • Lacks Stability

  8. Nerve Supply • Ulnar Nerve: • Passes between Pisiform and Hook of the Hamate

  9. Nerve Supply • Median Nerve • Enters the hand through the Carpal Tunnel

  10. Blood Supply • Radial and Ulnar Artery • Deep and Superficial Palmar Arch • Radial and Ulnar Veins • Palmar and Dorsal Venous Arch

  11. Examination • Visual Inspection • Deformity • Swelling • OPPQRST • Dermatomes • Myotomes • Grip & DTRs • Allen’s Test • Radial/Ulnar Arteries • Finkelstein’s Test • de Quervain’s • Tinel’s Sign • Carpal Tunnel • Phalen’s Test • Carpal Tunnel • Lunotriquetral Ballotment • Lunate Dislocation

  12. Wrist Sprains • Most Common Wrist Injury • Fall on Hyperextended wrist • Pain, Swelling and Limited ROM • X-ray, DX US • RICE, Kinesiotaping, restore pain-free ROM

  13. Dislocations & Fractures • 2 Pillars Control Major Hand Function • Lunate Pillar • 3rd Metacarpal-Capitate-Lunate • Scaphoid Pillar • 1st Metacarpal-Trapezium-Scaphoid • FOOSH • Lunate Dislocate • Scaphoid & Distal Radius Fracture • Pain in anatomical snuffbox • Extension with Ulnar Deviation • Scaphoid & Lunate are Dorsal • Wrist in Closed Pack Position

  14. Stenosing Tenosynovitis • Finkelstein’s Test • Extensor Pollicis Brevis & Abductor Pollicis Longus • Pain & Weakness in Thumb Extension & Abduction • Rest, ice, adjust wrist and hand

  15. Carpal Tunnel • Formed by Carpal Bones as the Floor & Transverse Carpal Ligament as the Roof • Compression of the Median Nerve • Tingling • Numbness • Weakness in Thumb movements Treatment – soft tissue and ext manipulation, Carpal Tunnel Release surgery

  16. Nerve Palsy • Direct Trauma to Radial, Median or Ulnar • Drop Wrist • Ape or Claw • Benediction Deformity • Treatments • Soft tissue and extremity manipulation • Surgical decompression

  17. Triangular Fibrocartilage Complex • Ulnar Side • Stabilizes Radius & Ulna during hand grasp • Two Types of Tears • Type 1 – Traumatic • Racquets & Bats • Type 2 – Degenerative • Over 50

  18. TFCC Tear • Signs & Symptoms • Wrist Pain on Ulna Side • Loss of Grip Strength • Swelling Treatment Laser, Ultrasound, Tape Surgery

  19. Ganglion Cyst • Most Common soft tissue swelling in the hand and wrist • Dorsal side of wrist 70% of the time • Treatment Options • Digital Pressure • Aspiration with Injection • Surgical Excision

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