Wrist And Hand

DR. ZOBIA NASEEM

DPT,MS-SPT
 Introduction
A beauty of wrist examination is that almost all bony,
articular, tendinous or vascular structures may be
palpated through the overlying skin.
 WRIST
• Between the distal end of the radius and the
articular disc above and the scaphoid, lunate,
and triquetral bones below The proximal
articular surface forms an ellipsoid concave
surface, which is adapted to the distal ellipsoid
convex surface.
Anatomy Wrist
 Wrist ROM
• Uninjured side as baseline
• Flexion 80 degrees
• Extension 70 degrees
• Ulnar deviation 30-35 degrees
• Radial deviation 20 degrees
• Pronation 75 degrees
• Supination 80 degrees
 Movements
• The following movements are possible:
flexion, extension, abduction, adduction.
• The lack of rotation is compensated for by the
movements of pronation and supination of
the forearm.
 Possible causes of pain and
limitation of movement
Trauma
• Fracture of the radius, ulna (e.g. Colies'
or Smith fracture), carpal or metacarpal
bones or phalanges
• Dislocation of interphalangeal joints
 Colles’fracture
• The most common type of distal radial fracture is
the Colles’fracture, which is most often
associated with falling on an outstretched arm
with the wrist in extension.
• The force associated with this mechanism of
injury tends to displace fractured fragments
dorsally
 Cont….
S&S: deformity of wrist,
profuse swelling

Care: cold, splint wrist,

forearm in sling, x-ray,
immobilize for 1-2
months
 Smith’s fracture
• The mechanism of injury usually associated with a
Smith’s fracture is characterized by falling on an
outstretched arm with the wrist in flexion.
• A Smith’s fracture tends to be considerably unstable and
requires urgent referral to an orthopedic specialist for
consultation
Smith’s fracture
 Peripheral nerve injuries
• Carpal tunnel syndrome
Stages:
Stage 1: pain, morning stiffness, no localization
of median nerve.
Stage 2:tingling, numbness, pain, paraesthesia,
localized to area of median nerve.
Stage 3:clumsiness, impairment of digital
function
Stage 4:wasting of thenar eminence
 Special Tests

• Tinel’s
• Phalen’s
 cock up splint

carpal tunnel syndrome

To perform a median nerve block, insert the needle perpendicular to
the skin between the PL and FCR tendons, angled slightly to place
the needle tip directly beneath the PL (shown). Insert the needle 1 cm
proximal to the distal wrist flexion crease and angle distally and
slightly radially. Avoid injecting directly into the nerve. If paresthesias
are elicited, the needle should be withdrawn and repositioned. If no
paresthesias are elicited, slowly inject 5 mL of anesthetic. After
injection, wait at least 10 minutes for full anesthetic effect.
 Tendon and tendon sheath
injuries
• Tenosynovitis:
De Quervain's disease

• Finkelstein test
• Abductor pollicis longus
• Extensor pollicis brevis.
 Finkelstein's test for
DeQuervain's tenosynovitis
Extensor tendon injury-Mallet finger
• Tear or stretch of
extensor tendon prior
to insertion on distal
phalanx
• Exam: Soft tissue
swelling, lack of full
extension of DIPJ
 Mallet finger
• X-ray may show lack of full extension with or
without a fracture of proximal aspect of distal
phalanx
• Strict immobilization in full extension 6-8 weeks
Thank You!