• WRIST & HAND FACTS
• THE WRIST INCLUDES THE FOLLOWING:
• RADIOCARPAL ,ULNOCARPAL JOINTS
• 8 CARPAL BONES IN 2 PARALLEL ROWS
• OVERLYING TENDONS.
• THE RADIOCARPAL/ULNOCARPAL JOINT IS WHERE THE   DISTAL RADIUS AND ULNA ARTICULATE WITH THE   NAVICULAR, LUNATE AND TRIANGULUM
• THE NAVICULAR IS THE MOST COMMONLY FX CARPAL BONE.
• THE RADIOULNAR JOINT IS A PIVOT JOINT OF THE RADIUS  AROUND A FIXED ULNA.
• THE 2ND MOST COMMON FX IN THE WRIST IS A SMITH   OR COLLE’S FRACTURE
• ULNAR NERVE: SUPPLIES THE FLEXOR CARPI ULNARIS, THE ULNAR 1/2 OF THE FLEXOR DIGITORUM PROFUNDUS,THE FINGER INTRINSICS.
• SENSATION IS TO THE  LITTLE FINGER AND ULNAR 1/2 OF THE RING FINGER
• TO TEST ULNAR FUNCTION: PATIENT IS TO SPREAD AND APPROXIMATE THEIR FINGERS.
• MEDIAN NERVE: SUPPLIES THE REST OF THE FLEXOR MUSCLES AND THE PRONATORS AS WELL
• SENSATION IS TO THE THE PALMAR ASPECT OF THE  THUMB,INDEX FINGER,MIDDLE  FINGER AND RADIAL 1/2 OF THE  RING FINGER.
• TO TEST MEDIAN NERVE FUNCTION TEST FINGER OPPOSITION
• RADIAL NERVE SUPPLIES THE EXTENSORS OF THE WRIST  AND HAND AS WELL AS THE SUPINATOR MUSCLES.
• SENSATION IS TO THE LATERAL 2/3 OF THE DORSUM OF THE HAND AND SOME OF THE THENAR EMINENCE AS WELL.
• TO TEST RADIAL NERVE FUNCTION HAVE THE PATIENT EXTEND THE WRIST AGAINST RESISTANCE.

• ULNAR NERVE  PALSY CAN RESULT INA CLAW HAND
• RADIAL NERVE  PALSY CAN RESULT  IN WRIST DROP
• MEDIAN NERVE  PALSY CAN RESUT IN APE/SIMIAN HAND

PURE PATCH SENSATION:

• THIS IS AN AREA OF PURE CUTANEOUS INNERVATION FOR A SPECIFIC PERIPHERAL NERVE.
• RADIAL: LOCATED ON THE DORSAL WEB OF  THE HAND.
• MEDIAN: LOCATED ON THE RADIAL DISTAL  ASPECT OF THE 2ND DIGIT.
• ULNAR: LOCATED ON THE DISTAL ULNA   ASPECT OF THE 5TH DIGIT.
• WRIST & HAND CONDITIONS
• STRAIN/SPRAIN INJURIES:
• EXTENSOR
• FLEXOR
• RADIAL
• ULNAR
• NERVE LESIONS AFFECTING THE WRIST AND   HAND:
• ULNAR
• MEDIAN
• RADIAL
• WRIST & HAND CONDITIONS:
• ARTHRITIDES:
• OA
• RA
• PA
• TENOSYNOVITIS:
• ACTUE NONSUPPERATIVE
• CHRONIC STENOSING TENOSYNOVITIS
• GANGLION:
• WRIST & HAND CONDITIONS:
• FRACTURES:
• SMITH’S
• COLLE’S
• MADELUNG DEFORMITY
• CARPAL TUNNEL SYNDROME
• DUPUYTRIN CONTRACTURE
• MALINGERER
• EVALUATION
• PHYSICAL CONSIDERATIONS
• PATIENT MOTIVE
• AGE OF PATIENT
• OCCUPATIONAL ERGONOMICS
• SPORTS HABITS
• PATIENT HISTORY:
• O.P.Q.R.S.T. APPROACH
• O= ONSET
• P=PAIN AND PROVICATION
• Q= QUALITY
• R= RADIATION
• S= SITE AND SEVERITY
• T= TIME
• INSPECTION
• LOOK FOR THE FOLLOWING ITEMS:
• SWELLING & COLOR CHANGES
• TENDERNESS
• VISABLE DEFORMITY:NODES & DRIFT
• DIFFERENCES OF CIRUMFERENCE IN   THE FOREARM.
• VISABLE MUSCLE WASTING AND ATROPHY IN THE FOREARM, WRIST  AND HAND.
• PALPATION
• PALPATE THE WRIST AND HAND FOR THE FOLLOWING:
• CREPITUS
• JOINT PLAY
• THE TENDONOUS SHEATHS ON THE ALL  SURFACES
• EXAMINATION
 
• RANGES OF MOTION
• ACTIVE VS PASSIVE
• ACTIVE AGAINST RESISTANCE
• NEUROLOGICAL EXAMINATION
• MYOTOME AND ISOLATED MUSCLE TESTING
• ORTHOPAEDIC EXAMINATION
• RADIOGRAPHIC EXAMINATION
• WRIST AND HAND RANGES OF MOTION:
• WRIST:
• FLEXION=
• EXTENSION=
• RADIAL DEVIATION=
• ULNA DEVIATION=

• HAND:
• METACARPOPHALANGEAL:
• FLEXION=
• EXTENSION=
• ABDUCTION=
• ADDUCTION=
• WRIST AND HAND RANGES OF MOTION:CONT..
• PROXIMAL INTERPHALANGEAL JOINT
• FLEXION=
• EXTENSION=
• DISTAL INTERPHALANGEAL JOINT
• FLEXION=
• EXTENSION=
• THUMB METACARPOPHALANGEAL JT.
• FLEXION=
• EXTENSION=         .
• THUMB INTERPHALANGEAL JOINT:
• FLEXION=
• EXTENSION=
• PALMAR ABDUCTION:
• PALMAR ADDUCTION:
• RANGE OF MOTION CLINICAL PEARL:
• REMEMBER, PASSIVE RANGES OF MOTION WILL ALWAYS BE GREATER THAN OR EQUAL TO THAT OF ACTIVE RANGE OF MOTION!!!
• IF YOU DON’T FIND THIS TO BE THE CASE, SUSPECT A MALINGERER
• WRIST TUNNELS:
• START ON THE RADIAL SIDE MOVE TO ULNAR.EXTENSORS:
• TUNNEL1= IMPORTANT DUE TO DeQUERVAIN’S DISEASE.  TENDONS OF THE ANATOMICAL SNUFF BOX. EXT. POLLICUS BREVIS AND ABD. POLLICUS LONGUS.
• TUNNEL 2= CONTAINS EXT. CARP. RAD. BREVIS AND LONGUS TENDONS
• TUNNEL 3= EXT. POLLICUS LONGUS TENDON.    IMPORTANT IN COLLE’S FRACTURE. CAN   DISRUPT THE TENDON.  R.A. CAN CAUSE   TENDON RUPTURE HERE.
• TUNNEL 4= EXTENSOR DIGITORUM COMMUNIS   AND EXTENSOR INDICIES TENDONS.  ALL   THE TENDONS HERE CAN BE AFFECTED BY   R.A. GANGLIONS USUALLY DEVELOP HERE.
• TUNNEL 5 = EXT. DIGIT. MINIMI TENDON.    DISRUPTION CAN OCCUR WITH A COLLE’S   FX WITH AN ASSOCIATED ULNA STYLOID FX  OR WITH R.A..
• TUNNEL 6= LOCATED IN THE GROOVE BETWEEN  THE APEX OF THE ULNA STYLOID PROCESS   AND THE ULNAHEAD.  CONTAINS THE   EXT.CARPI ULNARIS TENDON.  IN A COLLE’S  FX WITH FX OF THE ULN STYLOID YOU MAY  HAVE A TEAR OF THIS TENDON.
• FLEXORS
• TUNNEL OF GUYON: LOCATED IN THE    DEPRESSION BETWEEN THE PISIFORM AND   THE HOOK OF THE HAMATE.  CAN DEVELOP  ULNAR NERVE INJURY HERE.
• CARPAL TUNNEL: LOCATED PROXIMALLY BY 4 BONY PROMINENCES: PROXIMALLY    PISIFORM AND NAVICULAR AND DISTALLY  BY HOOK OF THE HAMATE AND THE  TUBERCLE OF THE TRAPIZIUM. COMPRESSION OF THE MEDIAN NERVE CAN  HAPPEN HERE.
• MYOTOME TESTING:
• REMEMBER THAT MYOTOME TESTING IS AN ISOMETRIC MUSCLE TEST.
• C6 NERVE ROOT :
• C7 NERVE ROOT
• C8 NERVE ROOT
• T1 NERVE ROOT

• MUSCLE GRADING SCALE
• 5/5 =
• 4/5 =
• 3/5 =
• 2/5 =
• 1/5 =
• 0/5 =
• ORTHOPAEDIC TESTING
• REMEMBER THAT ORTHOPAEDIC TESTING IS DESIGNED TO BE PROVOCATIVE IN NATURE.
• PATIENT’S SHOULD BE ADVISED  THAT THEY MAY FEEL WORSE   POST EXAMINATION.
• ORTHOPAEDIC TESTING IS DESIGNED TO LOCATE THE  INJURED TISSUE
• TYPES OF PAIN
• MUSCULAR STRAIN
• LIGAMENTOUS SPRAIN
• DEGENERATIVE BONE(ARTHRITIDES.)
• FRACTURE PAIN
• CARPAL TUNNEL PAIN

• PAIN DESCRIPTION
• MUSCULAR:
• LIGAMENTOUS:
• DEGENERATIVE BONE:
• FRACTURE: SHARP
• CARPAL TUNNEL: 

• RADIOGRAPHIC VIEWS:
• P-A WRIST: =
• P-A WRIST WITH ULNAR FLEXION
• LATERAL WRIST:
• P-A HAND:
• OBLIQUE HAND:
• P-A FINGERS: INTERPHALANGEAL JOINTS.
• A-P AND LATERAL THUMB:
• WRIST SPRAINS:

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• NERVE LESIONS:

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• WRIST AND HAND ARTHRITIDES:

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• TENOSYNOVITIS

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• GANGLION:

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• WRIST AND HAND FRACTURE:

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• MADELUNG DEFORMITY

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• CARPAL TUNNEL SYNDROME:

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:
 
• DUPUYTRIN CONTRACTURE

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT:

• WRIST AND HAND MALINGERING:

• DEFINITION:

• FACTS/CLINICAL PEARLS:

• SIGNS:

• ORTHOPEDIC TESTING:

• RADIOGRAPHS:

TREATMENT: