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Flashcards in Wrist & Hand Region Deck (12):
0

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

Flexion/extension

Abduction/adduction

Wrist (radiocarpal) joint

1

Between metacarpals & proximal phalanx

Flexion: flexor digitorum superficialis & profundus; lumbricals muscles

Adduction: palmar interosseous muscles (PAD)

Abduction: dorsal interosseous muscle (DAB)

Metacarpopharyngeal (MP) joint

2

Between proximal & middle phalanges

Flexion: flexor digitorum superficialis

Proximal interphalangeal (PIP) joint

3

Between middle & distal phalanges

Flexion: flexor digitorum profundus

Distal interphalangeal (DIP) joint

4

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

SSX:
- 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)

5

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

6

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

7

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

8

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

9

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

10

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)

11

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)