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Flashcards in Wrist & Hand Region Deck (12):

Articulation of concave distal end of radius with scaphoid & lunate carpal bones



Wrist (radiocarpal) joint


Between metacarpals & proximal phalanx

Flexion: flexor digitorum superficialis & profundus; lumbricals muscles

Adduction: palmar interosseous muscles (PAD)

Abduction: dorsal interosseous muscle (DAB)

Metacarpopharyngeal (MP) joint


Between proximal & middle phalanges

Flexion: flexor digitorum superficialis

Proximal interphalangeal (PIP) joint


Between middle & distal phalanges

Flexion: flexor digitorum profundus

Distal interphalangeal (DIP) joint


Carpal tunnel syndrome

Tendosynovitis caused by repetitive hand movements --> compresses the median nerve

Flexor retinaculum
- composed of volar carpal ligament & transverse carpal ligament
- forms the carpal tunnel

Structures that pass through the carpal tunnel:
- Flexor digitorum superficialis tendons
- Flexor digitorum profundus tendons
- Flexor pollicis longus tendon
- Median nerve
- no arteries pass through this tunnel

- sensory loss: palmar & dorsal aspects of index, middle, & half of ring finger & on palmar aspect of the thumb
- flattening of thenar eminence (ape hand)
- tingling sensation produced by tapping the Palmaris longus tendon (Tinel test)
- symptoms elicited by forced flexion of wrist & to alleviate them by wrist extension (Phalen test)


Slashing of the wrist ("suicide cuts")

Deep laceration on radial side of the wrist may injure the ff:
- radial artery
- median nerve
- flexor carpi radialis tendon
- palmaris longus tendon

Deep laceration on ulnar side of the wrist may injure the ff:
- ulnar artery
- ulnar nerve
- flexor carpi ulnaris tendon


Fracture of the scaphoid

Most commonly fractured carpal bone

Articulates with radius at the radiocarpal joint

Associated with osteonecrosis of scaphoid bone (proximal fragment)

SSX: tenderness in anatomic snuffbox (formed by extensor pollicis longus & brevis & abductor pollicis longus tendons) because the scaphoid lies in the floor of the snuffbox

X-ray may be normal for several weeks until bone resorption occurs


COLLE'S fracture

Posterior displacement of distal portion of radius (dinner fork deformity)

Fall on outstretched hand with wrist extended

Often with fracture of ulnar styloid process


Boxer fracture

Fracture at the head of 5th metacarpal (little finger)

Closed fist is used to hit a hard object

SSX: pain on ulnar side of the hand, depression of the head of the 5th metacarpal, +pain on flexion


Gamekeeper thumb

Disruption of the ulnar collateral ligament of the Mp joint of the thumb

Skier's thumb gets entangled with the ski pole during a fall

Associated with avulsion fracture at the base of proximal phalanx of the thumb


Volkmann ischemic contracture

Causes contraction of the forearm muscles

Associated with the ff:
- supracondylar fracture of humerus in which the brachial artery goes into spasm, reducing blood flow

Cast that is too high

Compartment syndrome (muscles are subjected to ⬆️ pressure due to edema or hemorrhage)


DUPUYTREN'S contracture

Thickening & contracture of palmar aponeurosis--> progressive flexion of fingers

More pronounced in the ring & little fingers

Highly correlated with coronary artery disease (due to vasospasm caused by sympathetic inner still of e vasculature within T1 component of ulnar nerve)