EXAMINATION OF THE WRIST BEYOND THE BASICS OMA SPORT MED Janice Harvey MD CCFP CFFP Dip. Sp Med.

Size: px
Start display at page:

Download "EXAMINATION OF THE WRIST BEYOND THE BASICS OMA SPORT MED Janice Harvey MD CCFP CFFP Dip. Sp Med."

Transcription

1 EXAMINATION OF THE WRIST BEYOND THE BASICS OMA SPORT MED 2019 Janice Harvey MD CCFP CFFP Dip. Sp Med.

2 CFPC CoI Templates: Slide 1 used in Faculty presentation only. FACULTY/PRESENTER DISCLOSURE Faculty: Janice Harvey Relationships with financial sponsors: Receive speaker honoraria from OCFP

3 CFPC CoI Templates: Slide 2 DISCLOSURE OF FINANCIAL SUPPORT This program has received NO financial support This program has received NO in-kind support Potential for conflict(s) of interest: Paid employee of the CFPC

4 1ST THE BASICS 1ST THE BASICS

5 WRIST STABILITY Dependent on 3 factors Skeletal alignment Passive restraint from ligaments Muscular compressive forces require sensorimotor input from mechanoreceptors

6 WRIST STABILITY Ligaments of the radial column constrain and guide the wrist, while richly innervated dorsal intercarpal and volar triquetral ligaments provide sensory feedback to muscles for actions like throwing Injury results in disruption of the sensory input and disrupts transmission of proprioceptive input functional impairment and a feeling that the wrist doesn t feel like their own

7 LIGAMENTS

8 INSPECTION Both wrists surfaces (swelling, incisions, erythema etc.) Alignment of hand with the wrist ulnar styloid Ulnar variance difficult to assess in inspection need an x-ray to determine Malunited distal radial # - whole hand drops off on the radial side when radial inclination is lost Carpal Boss (? Ganglion) Base of 2 nd + 3 rd metacarpals Articulate with the trapezoid on the index finger and the capitate on the long finger Extensor tendons of 4 th compartment can ride over this and cause a tendonitis Plastics can do a cheilectomy

9 ROM + RESISTED ROM Grip Strength Flexion radial deviation deg ulnar deviation deg Ulnar Deviation Extension Radial Deviation Supination Pronation

10 PALPATION Start at one side + move circumferentially Dorsal Radial side Proximal Carpal Row 1 st compartment Radial styloid Snuff box best with thumb extended scaphoid body Lister s tubercle just distal to snuff box on radius (extend thumb, follow EPL tendon as it wraps around the bony prominence Scapholunate interval distal to Lister s tubercle Base of Long finger lunate just radial to this is the SL interval Ulnar styloid process volar aspect is the FOVEAL Region tender in TFCC injuries

11 VOLAR ASPECT Ulnar Side Pisiform can do Pisiform translation on the triquetrum to look for instability/pain Hook of Hamate distal and radial to Pisiform lay crease of 1 st MP jt on Pisiform, pad will be on Hook of Hamate Distal Ulnar nerve compression in Guyan s canal will be felt in same region Carpal Tunnel Tinels tap test, modified Phalens (compress and flex the wrist with one hand may also elevate wrist above the pt s shoulder to look for median nerve paresthesias Scaphoid tuberosity 1 st extensor compartment

12 THE SNUFFBOX Palpation snuff box Palpation of volar aspect Ulnar deviation while palpating radiocarpal jt space to feel the waist of the scaphoid Axial load of 1 st mcp jt Resisted supination

13 BEYOND THE BASICS -SPECIAL TESTS- Ligament Instability Tests + Impaction Tests

14 WATSON S Scapholunate Instability Test SL ligament tear or scaphoid # Place examining thumb on volar scaphoid tuberosity and press dorsally while passively deviating ulnar and radial As the wrist extends, there is a tendency for the scaphoid to supinate and the lunate to pronate, which effectively separates the palmar surfaces of the 2 bones With a full tear ulnar deviation can sublux the proximal pole of the scaphoid off the radius, radial deviation will let the scaphoid reduce back in place - clunk

15 MID CARPAL INSTABILITY Mid carpal shift test (Lichtman) Just distal to capitate at 3 rd cmc jt. Is the midcarpal jt area (between the distal and proximal carpal rows) 2 Types: Non dissociative instability between carpal rows - (usually volar; dorsal is rare) Dissociative instability within a carpal row between 2 carpals (SL, lig LT lig) Maneuver: R wrist grasp pronated mid forearm with L hand and distally grip metacarpals with R hand Translate mid carpals volar-dorsally (volar slight twist due to more natural laxity on ulnar aspect of the metacarpals vs radial side which is more rigid (palmar mid carpal instability) Radioulnar deviation ulnar direction will accentuate the translation but radial deviation puts tension through the ulnar capsule Tx Midcarpal instability - if conservative Tx fails (splint in extension to rest the capsule, PT, proprioception 4-6 wks) End stage - dorsoulnar capsular plication

16 DISSOCIATIVE INSTABILITY LT Shuck Test For LT ligament instability: Base of long finger lunate grasp with right thumb and fingers, L hand grasp the Pisiform and triquetrum - translate dorsal/volar Compare to the other wrist for degree of mov t. Reverse Watson s Push on the Pisiform while deviating ulnar radial

17 DRUJ INSTABILITY Distal Radioulnar Joint Testing DRUJ located just radial to TFCC (distal to dorsal ulnar head) Line up forearm with elbow resting on the desk and hand in pronation - grasp the radius with the R hand and ulna with the L - translate the ulna on the radius dorsal/volar Repeat in Neutral rotation and in Supination Check for asymmetry between wrists If instability unidirectional (volar or dorsal ) usually equates to bidirectional instability due to the anatomy of the TFCC Superficial and Deep Ulnar ligaments: one attachment of the TFCC superficially onto the ulnar styloid and a deeper attachment on to the fovea ( at the base of volar ulnar styloid)

18 ULNOCARPAL IMPACTION Ulnar Grind Test - Ulnar head - Lunate impaction Maneuver: Place arm in pronation - this puts the ulna in a position of dynamic positive variance (ulna longer) allowing the ulnar head to impact on the carpals most commonly the lunate Elbow on solid surface grasp forearm with L hand and metacarpals with R hand Put wrist into Ulnar deviation to see if there is pain in the dorsal ulnar region Then while grasping the metacarpals grind the hand passively in dorsal and volar (flexion/extension) directions while keeping middle finger of R examining hand over the dorsal ulnar aspect of the wrist to pick any click/clunk or grind Flap tear of the TFCC (not a bony grind), or head of ulna on lunate (bony grind) Tx injection of steroid into TFCC 2mm distal to ulnar head 22g needle 40 mg depo, 0.5cc of 0.25% bupivacaine

19 U L N A R S T Y L O I D T R I Q U E T RU M I M PAC T I O N USTI Similar orientation to UCI (ulnar to radial) but more ulnar in location Often a result of a longer ulna or ulnar hypertrophy from a distal radial # or ulnar styloid #s *** Radius pivots around the ulna in movement. In pronation the radius will be relatively shortened relative to the ulna. So this is why impaction can happen (ulnar styloid on triquetrum) Maneuver: Put elbow on solid surface, hand is in the Stop position (extension) Grasp the humerus just above the elbow with L hand + place R hand loading on the pt s palm Rotate the forearm into supination while loading

20 USTI Most pain of impaction will be experienced in the dorsal ulnar aspect of the last deg. X-rays: pronated PA, pronated PA Grip view (gripping compresses the carpals and that compresses the radius which shows a relative elongated ulna dynamic change into a positive 3mm variance from neutral ulnar variance in pronation) Tx: Conservative Tx (rest, physio, splinting) If pain on ADL persists MRA, scope Wafer from ulnar head or a shortening osteotomy

21 SOFT TISSUE TESTS De quervain's tenosynovitis Extensor pollicis brevis (EPB) and the abductor pollicis longus (ABL) tendons, which extend the joints of the thumb Intersection Syndrome Outcropper muscles of 1 st extensor compartment muscles Abductor Pollicis Longus, EPB, as they cross over the common extensors ECRL, ECRB

22 THANK YOU

Trapezium is by the thumb, Trapezoid is inside

Trapezium is by the thumb, Trapezoid is inside Trapezium is by the thumb, Trapezoid is inside Intercarpal Jt Radiocarpal Jt Distal Middle Proximal DIP PIP Interphalangeal Jts Metacarpalphalangeal (MCP) Jt Metacarpal Carpometacarpal (CMC) Jt Trapezium

More information

Acute Wrist Injuries OUCH!

Acute Wrist Injuries OUCH! Acute Wrist Injuries OUCH! Case the athlete FOOSH from sporting event 2 days ago C/O wrist swelling, pain, worse with movement Hmmm Wrist pain Exam of the wrist - basics Appearance Swelling, bruising,

More information

Physical therapy of the wrist and hand

Physical therapy of the wrist and hand Physical therapy of the wrist and hand Functional anatomy wrist and hand The wrist includes distal radius, scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate. The hand includes

More information

Wrist and Hand Anatomy/Biomechanics

Wrist and Hand Anatomy/Biomechanics Wrist and Hand Anatomy/Biomechanics Kristin Kelley, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 Orthopaedic Manual Physical Therapy Series 2017-2018 Anatomy -

More information

Anatomy - Hand. Wrist and Hand Anatomy/Biomechanics. Osteology. Carpal Arch. Property of VOMPTI, LLC

Anatomy - Hand. Wrist and Hand Anatomy/Biomechanics. Osteology. Carpal Arch. Property of VOMPTI, LLC Wrist and Hand Anatomy/Biomechanics Kristin Kelley, DPT, OCS, FAAOMPT The wrist The metacarpals The Phalanges Digit 1 thumb Digit 5 digiti minimi Anatomy - Hand Orthopaedic Manual Physical Therapy Series

More information

SPORTS INJURIES IN HAND

SPORTS INJURIES IN HAND Grundkurs SGSM-SSMS Sion 2015 SPORTS INJURIES IN HAND Dr S. KŠmpfen EPIDEMIOLOGY Incidence of hand, finger and wrist injuries in sports : 3% Ð 9 % RADIAL-SIDED WRIST PAIN 1)! Distal Radius Fractures 2)!

More information

Forearm and Wrist Regions Neumann Chapter 7

Forearm and Wrist Regions Neumann Chapter 7 Forearm and Wrist Regions Neumann Chapter 7 REVIEW AND HIGHLIGHTS OF OSTEOLOGY & ARTHROLOGY Radius dorsal radial tubercle radial styloid process Ulna ulnar styloid process ulnar head Carpals Proximal Row

More information

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute. The Stiff Hand: Manual Therapy Sylvia Dávila, PT, CHT San Antonio, Texas Orthopedic Manual Therapy Common Applications Passive stretch Tensile force to tissue to increase extensibility of length & ROM

More information

10/15/2014. Wrist. Clarification of Terms. Clarification of Terms cont

10/15/2014. Wrist. Clarification of Terms. Clarification of Terms cont Wrist Clarification of Terms Palmar is synonymous with anterior aspect of the wrist and hand Ventral is also synonymous with anterior aspect of the wrist and hand Dorsal refers to the posterior aspect

More information

Wrist & Hand Ultrasonography 대구가톨릭대학교병원재활의학과 권동락

Wrist & Hand Ultrasonography 대구가톨릭대학교병원재활의학과 권동락 Wrist & Hand Ultrasonography 대구가톨릭대학교병원재활의학과 권동락 Dorsal Wrist Evaluation (1 st Compartment) EPB APL Transverse View APL, abductor pollicis longus; EPB, extensor pollicis brevis Dorsal Wrist Evaluation

More information

Introduction. The wrist contains eight small carpal bones, which as a group act as a flexible spacer between the forearm and hand.

Introduction. The wrist contains eight small carpal bones, which as a group act as a flexible spacer between the forearm and hand. Wrist Introduction The wrist contains eight small carpal bones, which as a group act as a flexible spacer between the forearm and hand. Distal forearm Distal forearm 4 Distal end of the radius A. anterior

More information

Wrist & Hand Assessment and General View

Wrist & Hand Assessment and General View Wrist & Hand Assessment and General View Done by; Mshari S. Alghadier BSc Physical Therapy RHPT 366 m.alghadier@sau.edu.sa http://faculty.sau.edu.sa/m.alghadier/ Functional anatomy The hand can be divided

More information

Wrist and Hand Complaints

Wrist and Hand Complaints Wrist and Hand Complaints Charles S. Day, M.D., M.B.A. Chief, Hand & Upper Extremity Surgery St. Elizabeth s Medical Center Tufts University School of Medicine Primary Care Internal Medicine 2018 Outline

More information

3. Ulno lunate, Ulno triquetral ligament. Poirier: Between RSC &LRL. 5. Dorsal intercarpal ligament

3. Ulno lunate, Ulno triquetral ligament. Poirier: Between RSC &LRL. 5. Dorsal intercarpal ligament CARPAL INSTABILITY Ligaments Intrinsic Scapho lunate ligament: Dorsal component stronger than volar ligament Luno triquetral ligament: Volar component stronger than dorsal ligament Extrinsic Palmar 1 Radio

More information

Hand & Wrist Injuries. DR MA Manjra

Hand & Wrist Injuries. DR MA Manjra Hand & Wrist Injuries DR MA Manjra 1 Background Up to 25% of all athletic injuries General population Sport people Sport specific Position specific Multifaceted Time of season Level of athlete Parents

More information

Kinesiology of The Wrist and Hand. Cuneyt Mirzanli Istanbul Gelisim University

Kinesiology of The Wrist and Hand. Cuneyt Mirzanli Istanbul Gelisim University Kinesiology of The Wrist and Hand Cuneyt Mirzanli Istanbul Gelisim University Bones The wrist and hand contain 29 bones including the radius and ulna. There are eight carpal bones in two rows of four to

More information

Hand and wrist emergencies

Hand and wrist emergencies Chapter1 Hand and wrist emergencies Carl A. Germann Distal radius and ulnar injuries PEARL: Fractures of the distal radius and ulna are the most common type of fractures in patients younger than 75 years.

More information

Upper Limb- Sports Medicine II

Upper Limb- Sports Medicine II Upper Limb- Sports Medicine II I. Palpation A. With patient sitting, supine, & prone, palpate for pain, specific tenderness, swelling, effusion, local hyperthermia B. Bony Palpation 1. Carpal Bones (8)

More information

MCQWeek2. All arise from the common flexor origin. The posterior aspect of the medial epicondyle is the common flexor origin.

MCQWeek2. All arise from the common flexor origin. The posterior aspect of the medial epicondyle is the common flexor origin. MCQWeek2. 1. Regarding superficial muscles of anterior compartment of the forearm: All arise from the common flexor origin. The posterior aspect of the medial epicondyle is the common flexor origin. Flexor

More information

Wrist and Hand Anatomy

Wrist and Hand Anatomy Wrist and Hand Anatomy Bone Anatomy Scapoid Lunate Triquetrium Pisiform Trapeziod Trapezium Capitate Hamate Wrist Articulations Radiocarpal Joint Proximal portion Distal portion Most surface contact found

More information

Kristin Kelley, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville Trauma/Fractures

Kristin Kelley, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville Trauma/Fractures WRIST/HAND PATHOLOGY Kristin Kelley, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 Trauma/Fractures Hook of Hamate Fractures Triangular Fibrocartilage Complex (TFCC)

More information

Ligaments of Elbow hinge: sagittal plane so need lateral and medial ligaments

Ligaments of Elbow hinge: sagittal plane so need lateral and medial ligaments Ligaments of Elbow hinge: sagittal plane so need lateral and medial ligaments Ulnar Collateral ligament on medial side; arising from medial epicondyle and stops excess valgus movement (lateral movement)

More information

Trauma/Fractures WRIST/HAND PATHOLOGY. TFCC Injury. Hook of Hamate Fracture. Property of VOMPTI, LLC

Trauma/Fractures WRIST/HAND PATHOLOGY. TFCC Injury. Hook of Hamate Fracture. Property of VOMPTI, LLC WRIST/HAND PATHOLOGY Kristin Kelley, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 Trauma/Fractures Hook of Hamate Fractures Triangular Fibrocartilage Complex (TFCC)

More information

(i) Examination of the wrist surface anatomy of the carpal bones

(i) Examination of the wrist surface anatomy of the carpal bones Current Orthopaedics (2005) 19, 171 179 www.elsevier.com/locate/cuor MINI-SYMPOSIUM: THE WRIST (i) Examination of the wrist surface anatomy of the carpal bones R. Srinivas Reddy, J. Compson Upper Limb

More information

Elbow, Wrist & Hand Evaluation.

Elbow, Wrist & Hand Evaluation. Elbow, Wrist & Hand Evaluation www.fisiokinesiterapia.biz Common Injuries to the Elbow, Wrist, Hand & Fingers Lateral epicondylitis tennis elbow Medial epicondylitis golfer s s elbow, little league elbow

More information

8/25/2014. Radiocarpal Joint. Midcarpal Joint. Osteology of the Wrist

8/25/2014. Radiocarpal Joint. Midcarpal Joint. Osteology of the Wrist Structure and Function of the Wrist 2 joints and 10 different bones Combine to create wrist motion Anatomical Terms: Wrist/Hand Palmar = anterior aspect of the wrist and hand Dorsal = posterior aspect

More information

Wrist movements, apart from the distal radioulnar joint, take place in two planes:

Wrist movements, apart from the distal radioulnar joint, take place in two planes: The wrist consists of eight bones in two rows: the proximal and distal. The proximal row includes (starting from the radial bone): the scaphoid bone, the lunate bone, the triangular bone and the postulnar

More information

Main Menu. Wrist and Hand Joints click here. The Power is in Your Hands

Main Menu. Wrist and Hand Joints click here. The Power is in Your Hands 1 The Wrist and Hand Joints click here Main Menu K.5 http://www.handsonlineeducation.com/classes/k5/k5entry.htm[3/23/18, 1:40:40 PM] Bones 29 bones, including radius and ulna 8 carpal bones in 2 rows of

More information

Clinical Examination of the Hand and Wrist

Clinical Examination of the Hand and Wrist Clinical Examination of the Hand and Wrist OBJECTIVES Review the clinical anatomy and physical exam of the wrist and hand Formulate a pathoanatomic diagnosis in the clinical setting Discuss common clinical

More information

ARM Brachium Musculature

ARM Brachium Musculature ARM Brachium Musculature Coracobrachialis coracoid process of the scapula medial shaft of the humerus at about its middle 1. flexes the humerus 2. assists to adduct the humerus Blood: muscular branches

More information

MR IMAGING OF THE WRIST

MR IMAGING OF THE WRIST MR IMAGING OF THE WRIST Wrist Instability Dissociative Pattern apparent on routine radiographs Non-dissociative Stress / positional radiographs Dynamic fluoroscopy during stress Arthrography MRI / MR arthrography

More information

LECTURE 8 HANDS: BONES AND MUSCLES

LECTURE 8 HANDS: BONES AND MUSCLES LECTURE 8 HANDS: BONES AND MUSCLES WRIST AND HAND - Human hand can do power grip and precision grip - Thumb is 90 to the rest of the hand can do fine actions - Often able to do power actions o Take tools

More information

RADIOGRAPHY OF THE WRIST

RADIOGRAPHY OF THE WRIST RADIOGRAPHY OF THE WRIST Patient Position: WRIST PA Projection, elbow in same plane Part Position: Hand ; fingers centered to IR Central Ray: Structures Shown: NOTE: Optional AP projection best demonstrates

More information

10/10/2014. Structure and Function of the Hand. The Hand. Osteology of the Hand

10/10/2014. Structure and Function of the Hand. The Hand. Osteology of the Hand Structure and Function of the Hand 19 bones and 19 joints are necessary to produce all the motions of the hand The Hand Dorsal aspect Palmar aspect The digits are numbered 1-5 Thumb = #1 Little finger

More information

COMMON CARPAL INJURIES IN ATHLETES Nicholas A. Bontempo, MD Orthopedic Associates of Hartford I HAVE NO CONFLICTS OR DISCLOSURES TO REPORT OUTLINE

COMMON CARPAL INJURIES IN ATHLETES Nicholas A. Bontempo, MD Orthopedic Associates of Hartford I HAVE NO CONFLICTS OR DISCLOSURES TO REPORT OUTLINE COMMON CARPAL INJURIES IN ATHLETES Nicholas A. Bontempo, MD Orthopedic Associates of Hartford I HAVE NO CONFLICTS OR DISCLOSURES TO REPORT OUTLINE The carpus Scaphoid fracture Scapholunate ligament tear

More information

Hand Anatomy A Patient's Guide to Hand Anatomy

Hand Anatomy A Patient's Guide to Hand Anatomy Hand Anatomy A Patient's Guide to Hand Anatomy Introduction Few structures of the human anatomy are as unique as the hand. The hand needs to be mobile in order to position the fingers and thumb. Adequate

More information

Hand & Wrist Casey G. Batten MD Assistant Clinical Professor UCSF Sports Medicine

Hand & Wrist Casey G. Batten MD Assistant Clinical Professor UCSF Sports Medicine Hand & Wrist Casey G. Batten MD Assistant Clinical Professor UCSF Sports Medicine Topics: Scaphoid Fracture Scapholunate Separation TFCC Injury Thumb Ulnar Collateral Lig (UCL) Injury Extensor Injury /

More information

CHAPTER 6: THE UPPER EXTREMITY: THE ELBOW, FOREARM, WRIST, AND HAND

CHAPTER 6: THE UPPER EXTREMITY: THE ELBOW, FOREARM, WRIST, AND HAND CHAPTER 6: THE UPPER EXTREMITY: THE ELBOW, FOREARM, WRIST, AND HAND KINESIOLOGY Scientific Basis of Human Motion, 12 th edition Hamilton, Weimar & Luttgens Presentation Created by TK Koesterer, Ph.D.,

More information

PREVIEW ONLY 27/10/2014. Instabilities in the Wrist

PREVIEW ONLY 27/10/2014. Instabilities in the Wrist Be sure to convert to your own time zone at Andrew Ellis BSc (Ex. Sci), M. Phty Instabilities in the Wrist Presented by: Ben Cunningham Be sure to convert to your own time zone at Ben Cunningham Member

More information

WEEKEND 2 Elbow. Elbow Range of Motion Assessment

WEEKEND 2 Elbow. Elbow Range of Motion Assessment Virginia Orthopedic Manual Physical Therapy Institute - 2016 Technique Manual WEEKEND 2 Elbow Elbow Range of Motion Assessment - Patient Positioning: Sitting or supine towards the edge of the bed - Indications:

More information

Anatomy and Physiology II. Review Shoulder Girdle New Material Upper Extremities - Bones

Anatomy and Physiology II. Review Shoulder Girdle New Material Upper Extremities - Bones Anatomy and Physiology II Review Shoulder Girdle New Material Upper Extremities - Bones Anatomy and Physiology II Shoulder Girdle Review Questions From Last Lecture Can you identify the following muscles?

More information

Sean Walsh Orthopaedic Surgeon Dorset County Hospital

Sean Walsh Orthopaedic Surgeon Dorset County Hospital Sean Walsh Orthopaedic Surgeon Dorset County Hospital Shapes and orientation of articular surfaces Ligaments Oblique positioning of scaphoid Tendons surrounding the joints Other soft tissues Peripheral

More information

Management of Wrist and Hand Injuries

Management of Wrist and Hand Injuries Sunday General Session Management of Wrist and Hand Injuries Shaun Garff, DO Sports Medicine Physician Methodist Health System Dallas, Texas Educational Objectives By the end of this educational activity,

More information

Biceps Brachii. Muscles of the Arm and Hand 4/4/2017 MR. S. KELLY

Biceps Brachii. Muscles of the Arm and Hand 4/4/2017 MR. S. KELLY Muscles of the Arm and Hand PSK 4U MR. S. KELLY NORTH GRENVILLE DHS Biceps Brachii Origin: scapula Insertion: radius, fascia of forearm (bicipital aponeurosis) Action: supination and elbow flexion Innervation:

More information

Shaun P. Garff, DO Physician of Sports Medicine

Shaun P. Garff, DO Physician of Sports Medicine Shaun P. Garff, DO Physician of Sports Medicine Speaker Disclosure I have no actual or potential conflicts of interest to disclose as it relates to this presentation. A little about me Born and raised

More information

Clinical examination of the wrist, thumb and hand

Clinical examination of the wrist, thumb and hand Clinical examination of the wrist, thumb and hand 20 CHAPTER CONTENTS Referred pain 319 History 319 Inspection 320 Functional examination 320 The distal radioulnar joint.............. 320 The wrist.......................

More information

Lecture 9: Forearm bones and muscles

Lecture 9: Forearm bones and muscles Lecture 9: Forearm bones and muscles Remember, the region between the shoulder and the elbow = brachium/arm, between elbow and wrist = antebrachium/forearm. Forearm bones : Humerus (distal ends) Radius

More information

Ultrasonography of the wrist - a step-by-step approach to study protocols and normal findings

Ultrasonography of the wrist - a step-by-step approach to study protocols and normal findings Ultrasonography of the wrist - a step-by-step approach to study protocols and normal findings Poster No.: C-1779 Congress: ECR 2016 Type: Educational Exhibit Authors: R. R. Domingues Madaleno, A. P. Pissarra,

More information

Joint Mobilization: Elbow, Wrist, and Hand

Joint Mobilization: Elbow, Wrist, and Hand Joint Mobilization: Elbow, Wrist, and Hand Small Joints of the Hand: MCP, PIP, and DIP: distraction and glides (A/P or P/A) Philadelphia Hand Meeting Monday, March 26, 2018 Jane Fedorczyk, PT, PhD, CHT

More information

The Forearm, Wrist, Hand and Fingers. Contusion Injuries to the Forearm. Forearm Fractures 12/11/2017. Oak Ridge High School Conroe, Texas

The Forearm, Wrist, Hand and Fingers. Contusion Injuries to the Forearm. Forearm Fractures 12/11/2017. Oak Ridge High School Conroe, Texas The Forearm, Wrist, Hand and Fingers Oak Ridge High School Conroe, Texas Contusion Injuries to the Forearm The forearm is constantly exposed to bruising and contusions in contact sports. The ulna receives

More information

TFCC Tears and Repair. Jeffrey Yao, M.D. Associate Professor Department of Orthopaedic Surgery Stanford University Medical Center

TFCC Tears and Repair. Jeffrey Yao, M.D. Associate Professor Department of Orthopaedic Surgery Stanford University Medical Center TFCC Tears and Repair Jeffrey Yao, M.D. Associate Professor Department of Orthopaedic Surgery Stanford University Medical Center Disclosures The following relationships exist: 1. Grants American Foundation

More information

Sick Call Screener Course

Sick Call Screener Course Sick Call Screener Course Musculoskeletal System Upper Extremities (2.7) 2.7-2-1 Enabling Objectives 1.46 Utilize the knowledge of musculoskeletal system anatomy while assessing a patient with a musculoskeletal

More information

Introduction to Ultrasound Examination of the Hand and upper

Introduction to Ultrasound Examination of the Hand and upper Introduction to Ultrasound Examination of the Hand and upper Emil Dionysian, M.D. Ultrasound of upper ext. Upside Convenient Opens another exam dimension Can be like a stethoscope Helps 3-D D visualization

More information

Client centered approach to distal radius fracture management. Jared Rasmussen OTR

Client centered approach to distal radius fracture management. Jared Rasmussen OTR Client centered approach to distal radius fracture management Jared Rasmussen OTR Disclosures Sadly, no financial disclosures Objectives Review of anatomy, common fractures of the distal radius, fixation

More information

Supplied in part by the musculocutaneous nerve. Forms the axis of rotation in movements of pronation and supination

Supplied in part by the musculocutaneous nerve. Forms the axis of rotation in movements of pronation and supination Anatomy: Upper limb (15 questions) 1. Latissimus Dorsi: Is innervated by the dorsal scapular nerve Lies above feres major muscle Medially rotates the humerus All of the above 2. Supinator muscle is: Deep

More information

The Forearm 2. Extensor & lateral Compartments of the Forearm

The Forearm 2. Extensor & lateral Compartments of the Forearm The Forearm 2 Extensor & lateral Compartments of the Forearm 1-Lateral Fascial Compartment (at the lateral side of the forearm ) *Some books mention the lateral compartment contain just the Brachioradialis

More information

Hand / wrist Injections. MATS. June Condition Symptoms Conservative Treatments Location of injection CBA for surgery

Hand / wrist Injections. MATS. June Condition Symptoms Conservative Treatments Location of injection CBA for surgery Hand / wrist Injections. MATS. June 2018. Condition Symptoms Conservative Treatments Location of injection CBA for surgery Carpal Tunnel Tingling / numbness in median nerve distribution (lateral 3 fingers)

More information

The Muscular System. Chapter 10 Part C. PowerPoint Lecture Slides prepared by Karen Dunbar Kareiva Ivy Tech Community College

The Muscular System. Chapter 10 Part C. PowerPoint Lecture Slides prepared by Karen Dunbar Kareiva Ivy Tech Community College Chapter 10 Part C The Muscular System Annie Leibovitz/Contact Press Images PowerPoint Lecture Slides prepared by Karen Dunbar Kareiva Ivy Tech Community College Table 10.9: Muscles Crossing the Shoulder

More information

Difference Between Angle You Can Bend Your Left Wrist Back vs Your Right Wrist Jenna Priest Science Department Altoona High School January 25, 2017

Difference Between Angle You Can Bend Your Left Wrist Back vs Your Right Wrist Jenna Priest Science Department Altoona High School January 25, 2017 Difference Between Angle You Can Bend Your Left Wrist Back vs Your Right Wrist Jenna Priest Science Department Altoona High School January 25, 2017 Background 1- The wrist joint (also known as the radiocarpal

More information

[[Sally Leaning Towards Peter To Take Cold Hand]]

[[Sally Leaning Towards Peter To Take Cold Hand]] In this lecture we will talk about the bones of the hand, and the muscles and contents of the forearm. *The hand bones are: - Carpal bones. -Metacarpals. -Phalanges. *The carpal bones (wrist bones): They

More information

The Painful Elbow, Wrist, and Hand. Jennifer R Marks, MD

The Painful Elbow, Wrist, and Hand. Jennifer R Marks, MD The Painful Elbow, Wrist, and Hand Jennifer R Marks, MD The Painful Elbow A 44 yo M presents to clinic complaining of a sore elbow What further questions do you have for this patient? What is on your differential

More information

Netter's Anatomy Flash Cards Section 6 List 4 th Edition

Netter's Anatomy Flash Cards Section 6 List 4 th Edition Netter's Anatomy Flash Cards Section 6 List 4 th Edition https://www.memrise.com/course/1577581/ Section 6 Upper Limb (66 cards) Plate 6-1 Humerus and Scapula: Anterior View 1.1 Acromion 1.2 Greater tubercle

More information

Anatomy Workshop Upper Extremity David Ebaugh, PT, PhD Workshop Leader. Lab Leaders: STATION I BRACHIAL PLEXUS

Anatomy Workshop Upper Extremity David Ebaugh, PT, PhD Workshop Leader. Lab Leaders: STATION I BRACHIAL PLEXUS Anatomy Workshop Upper Extremity David Ebaugh, PT, PhD Workshop Leader Lab Leaders: STATION I BRACHIAL PLEXUS A. Posterior cervical triangle and axilla B. Formation of plexus 1. Ventral rami C5-T1 2. Trunks

More information

Manual therapy approach to the Patient with Carpal Tunnel Syndrome.

Manual therapy approach to the Patient with Carpal Tunnel Syndrome. Manual therapy approach to the Patient with Carpal Tunnel Syndrome www.fisiokinesiterapia.biz Symptoms and Signs Thumb, index, middle, and radial aspect of ring finger Hand Pain Paresthesia Numbness Pins

More information

The skeleton consists of: Bones: special connective tissue, hard. Cartilage: special connective tissue, less hard than bones. Joints: joint is the

The skeleton consists of: Bones: special connective tissue, hard. Cartilage: special connective tissue, less hard than bones. Joints: joint is the The skeleton consists of: Bones: special connective tissue, hard. Cartilage: special connective tissue, less hard than bones. Joints: joint is the location at witch two bones make contact, whereas ligaments

More information

Kristin Kelley, PT, DPT, OCS, FAAOMPT Dhinu Jayaseelan, PT, DPT, OCS, FAAOMPT

Kristin Kelley, PT, DPT, OCS, FAAOMPT Dhinu Jayaseelan, PT, DPT, OCS, FAAOMPT WRIST CASE STUDY Kristin Kelley, PT, DPT, OCS, FAAOMPT Dhinu Jayaseelan, PT, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 CTS C6-C7 Radiculopathy TOS 1 st CMC

More information

WRIST CASESTUDY. Property of VOMPTI, LLC. For Use of Participants Only. No Use or Reproduction Without Consent 1

WRIST CASESTUDY. Property of VOMPTI, LLC. For Use of Participants Only. No Use or Reproduction Without Consent 1 WRIST CASESTUDY Kristin Kelley, PT, DPT, OCS, FAAOMPT Dhinu Jayaseelan, PT, DPT, OCS, FAAOMPT CTS C6-C7 Radiculopathy TOS 1 st CMC OA DM neuropathy Pronator Teres Syndrome Orthopaedic Manual Physical Therapy

More information

divided by the bones ( redius and ulna ) and interosseous membrane into :

divided by the bones ( redius and ulna ) and interosseous membrane into : fossa Cubital Has: * floor. * roof : - Skin - superficial fasica - deep fascia ( include bicipital aponeurosis ) Structures within the roof : -cephalic and basilic veins -and between them median cubital

More information

Interesting Case Series. Perilunate Dislocation

Interesting Case Series. Perilunate Dislocation Interesting Case Series Perilunate Dislocation Tom Reisler, BSc (Hons), MB ChB, MRCS (Ed), Paul J. Therattil, MD, and Edward S. Lee, MD Division of Plastic and Reconstructive Surgery, Department of Surgery,

More information

Exam of the Injured Hand and Wrist. Christina M. Ward, MD Regions Hospital TRIA Woodbury

Exam of the Injured Hand and Wrist. Christina M. Ward, MD Regions Hospital TRIA Woodbury Exam of the Injured Hand and Wrist Christina M. Ward, MD Regions Hospital TRIA Woodbury Disclosures We have no disclosures that are pertinent to this presentation Terminology Ring Long Index Small Thumb

More information

Conservative management of palmer mid-carpal instability

Conservative management of palmer mid-carpal instability Conservative management of palmer mid-carpal instability Peter Belward Physiotherapist UHS NHSFT Key messages Restore patient confidence Regain strength and control in a position of stability Reduce dependency

More information

Chapter 12 Distal Ulnar Resection

Chapter 12 Distal Ulnar Resection Chapter 12 Distal Ulnar Resection Introduction Ulnar impaction syndrome is a common but often unrecognized cause of pain on the ulnar side of the wrist. Although it can be congenital (due to a long ulna),

More information

Lab Activity 11: Group II

Lab Activity 11: Group II Lab Activity 11: Group II Muscles Martini Chapter 11 Portland Community College BI 231 Origin and Insertion Origin: The place where the fixed end attaches to a bone, cartilage, or connective tissue. Insertion:

More information

Figure 1: Bones of the upper limb

Figure 1: Bones of the upper limb BONES OF THE APPENDICULAR SKELETON The appendicular skeleton is composed of the 126 bones of the appendages and the pectoral and pelvic girdles, which attach the limbs to the axial skeleton. Although the

More information

Cover Page. The handle holds various files of this Leiden University dissertation

Cover Page. The handle   holds various files of this Leiden University dissertation Cover Page The handle http://hdl.handle.net/1887/36343 holds various files of this Leiden University dissertation Author: Jong, Staas de Title: Computed fingertip touch for the instrumental control of

More information

FOOSH It sounded like a fun thing at the time!

FOOSH It sounded like a fun thing at the time! FOOSH It sounded like a fun thing at the time! Evaluating acute hand and wrist injuries Larry Collins, MPAS, PA-C, ATC, DFAAPA Assistant Professor, Physician Assistant Program Assistant Professor, Department

More information

Common Upper Extremity Neuropathies (Not Carpal Tunnel Syndrome)

Common Upper Extremity Neuropathies (Not Carpal Tunnel Syndrome) Common Upper Extremity Neuropathies (Not Carpal Tunnel Syndrome) Nerve Compressions Common in adults, rare in children Frequently cause missed days of work and sleepless nights CDC 2001 26,794 cases of

More information

Intrinsic muscles palsies of the hand Management of Thumb Opposition with BURKHALTER s Procedure

Intrinsic muscles palsies of the hand Management of Thumb Opposition with BURKHALTER s Procedure Intrinsic muscles palsies of the hand Management of Thumb Opposition with BURKHALTER s Procedure TRUONG LE DAO, MD, IFAAD 1 Burkhalter W.E, Cristhensen R.C, Brown P.W, Extensor Indicis Proprius opponensplasty

More information

A Patient s Guide to Adult Distal Radius (Wrist) Fractures

A Patient s Guide to Adult Distal Radius (Wrist) Fractures A Patient s Guide to Adult Distal Radius (Wrist) Fractures Suite 11-13/14/15 Mount Elizabeth Medical Center 3 Mount Elizabeth Singapore, 228510 Phone: (65) 6738 2628 Fax: (65) 6738 2629 1 DISCLAIMER: The

More information

Modular Ulnar Head surgical technique. Transforming Extremities

Modular Ulnar Head surgical technique. Transforming Extremities First Choice Modular Ulnar Head surgical technique Transforming Extremities instrumentation Head and Collar Trials Assembly Pad Starter Awl Trial Extractor Osteotomy Guide Stem Trials Implant Impactor

More information

STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 5. September 30, 2011

STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 5. September 30, 2011 STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 5 September 30, 2011 PART l. Answer in the space provided. (12 pts) 1. Identify the structures. (2 pts) EXAM NUMBER A. Suprascapular nerve B. Axillary nerve

More information

The Elbow and Radioulnar Joints Kinesiology. Dr Cüneyt Mirzanli Istanbul Gelisim University

The Elbow and Radioulnar Joints Kinesiology. Dr Cüneyt Mirzanli Istanbul Gelisim University The Elbow and Radioulnar Joints Kinesiology Dr Cüneyt Mirzanli Istanbul Gelisim University 1 The Elbow & Radioulnar Joints Most upper extremity movements involve the elbow & radioulnar joints. Usually

More information

JOINT MOBILITY Joint Mobility of Upper Extremity

JOINT MOBILITY Joint Mobility of Upper Extremity Kinesiology 2017#5: JOINT MOBILITY Joint Mobility of Upper Extremity Huei-Ming Chai, Ph.D., PT School of Physical Therapy National Taiwan University Functions of Synovial Joints Joint Mobility Osteokinematic

More information

Elbow Anatomy, Growth and Physical Exam. Donna M. Pacicca, MD Section of Sports Medicine Division of Orthopaedic Surgery Children s Mercy Hospital

Elbow Anatomy, Growth and Physical Exam. Donna M. Pacicca, MD Section of Sports Medicine Division of Orthopaedic Surgery Children s Mercy Hospital Elbow Anatomy, Growth and Physical Exam Donna M. Pacicca, MD Section of Sports Medicine Division of Orthopaedic Surgery Children s Mercy Hospital Contributing Factors to Elbow Injury The elbow is affected

More information

The Elbow and the cubital fossa. Prof Oluwadiya Kehinde

The Elbow and the cubital fossa. Prof Oluwadiya Kehinde The Elbow and the cubital fossa Prof Oluwadiya Kehinde www.oluwadiya.com Elbow and Forearm Anatomy The elbow joint is formed by the humerus, radius, and the ulna Bony anatomy of the elbow Distal Humerus

More information

FOOSH It sounded like a fun thing at the time!

FOOSH It sounded like a fun thing at the time! FOOSH It sounded like a fun thing at the time! Evaluating acute hand and wrist injuries Larry Collins, MPAS, PA-C, ATC, DFAAPA Assistant Professor, Physician Assistant Program Assistant Professor, Department

More information

Chapter 51 Wrist and Forearm Episode Overview

Chapter 51 Wrist and Forearm Episode Overview Chapter 51 Wrist and Forearm Episode Overview 1) Describe normal radiographic relationships: a. Radial length measurement b. Radial inclination c. Volar Tilt d. Scapholunate angle e. Capitolunate angle

More information

Nerves of Upper limb. Dr. Brijendra Singh Professor & Head Department of Anatomy AIIMS Rishikesh

Nerves of Upper limb. Dr. Brijendra Singh Professor & Head Department of Anatomy AIIMS Rishikesh Nerves of Upper limb Dr. Brijendra Singh Professor & Head Department of Anatomy AIIMS Rishikesh 1 Objectives Origin, course & relation of median & ulnar nerves. Motor & sensory distribution Carpal tunnel

More information

Muscular Nomenclature and Kinesiology - One

Muscular Nomenclature and Kinesiology - One Chapter 16 Muscular Nomenclature and Kinesiology - One Lessons 1-3 (with lesson 4) 1 Introduction 122 major muscles covered in this chapter Chapter divided into nine lessons Kinesiology study of human

More information

Joints of the upper limb II

Joints of the upper limb II Joints of the upper limb II Prof. Abdulameer Al-Nuaimi E-mail: a.al-nuaimi@sheffield.ac.uk E. mail: abdulameerh@yahoo.com Elbow joint The elbow joint is connecting the upper arm to the forearm. It is classed

More information

ORTHOPAEDIC INJECTION AND ASPIRATION TECHNIQUES

ORTHOPAEDIC INJECTION AND ASPIRATION TECHNIQUES ORTHOPAEDIC INJECTION AND ASPIRATION TECHNIQUES OAAPN October 20, 2016 David H. Sohn, JD MD Chief, Shoulder and Sports Medicine University of Toledo Medical Center When to aspirate? To rule out infection

More information

Muscles of the hand Prof. Abdulameer Al-Nuaimi

Muscles of the hand Prof. Abdulameer Al-Nuaimi Muscles of the hand Prof. Abdulameer Al-Nuaimi a.alnuaimi@sheffield.ac.uk abdulameerh@yahoo.com Thenar Muscles Thenar muscles are three short muscles located at base of the thumb. All are innervated by

More information

Wrist Arthroscopy. Outline. This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.

Wrist Arthroscopy. Outline. This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute. Wrist Arthroscopy Background: Why Do Wrist Arthroscopy? Ramesh C. Srinivasan Hand & Upper Extremity Surgeon Director of Research The Hand Center of San Antonio Associate Master Instructor, AANA Wrist and

More information

forearm posterior compartment

forearm posterior compartment Quick revision: The anterior compartment of the forearm contains of 8 muscles... -4 superficial -1 intermediate -3 deep *All supplied by median nerve except 1 and 1/2 muscle (by ulnar N.) forearm posterior

More information

Chapter 8. The Pectoral Girdle & Upper Limb

Chapter 8. The Pectoral Girdle & Upper Limb Chapter 8 The Pectoral Girdle & Upper Limb Pectoral Girdle pectoral girdle (shoulder girdle) supports the arm consists of two on each side of the body // clavicle (collarbone) and scapula (shoulder blade)

More information

1/13/2013. Anatomy Guy Dissection Sheet Extensor Forearm and Hand. Eastern Virginia Medical School

1/13/2013. Anatomy Guy Dissection Sheet Extensor Forearm and Hand. Eastern Virginia Medical School Dr. Craig Goodmurphy Anatomy Guy Superficial Extensor Muscles Complete skin removal if necessary then remove the antebrachial fascia starting at the extensor retinaculum and working proximally. Define

More information

Functional Anatomy of the Elbow

Functional Anatomy of the Elbow Functional Anatomy of the Elbow Orthopedic Institute Daryl C. Osbahr, M.D. Chief of Sports Medicine, Orlando Health Chief Medical Officer, Orlando City Soccer Club Orthopedic Consultant, Washington Nationals

More information

Hands PA; Obl. Lat.; Norgaard s Thumb AP; Lat. PA. PA; Lat.: Obls.; Elongated PA with ulnar deviation

Hands PA; Obl. Lat.; Norgaard s Thumb AP; Lat. PA. PA; Lat.: Obls.; Elongated PA with ulnar deviation Projections Region Basic projections Additional / Modified projections Upper Limbs Hands PA; Obl. Lat.; Norgaard s Thumb ; Lat. PA Fingers PA; Lat. Wrist PA; Lat. Obls. Scaphoid Lunate Trapezium Triquetral

More information

Arhtroscopy of the wrist joint: Setup, instrumentation, anatomy & indications

Arhtroscopy of the wrist joint: Setup, instrumentation, anatomy & indications Arhtroscopy of the wrist joint: Setup, instrumentation, anatomy & indications Andreas Panagopoulos, MD, PhD Upper Limb and Sports Medicine Surgeon Assistant Professor in Orthopaedics Patras University

More information

Elbow. Chapter 2 LISTEN. Mechanism of Injury (If Applicable) Pain

Elbow. Chapter 2 LISTEN. Mechanism of Injury (If Applicable) Pain Chapter 2 Elbow LISTEN Mechanism of Injury (If Applicable) Patient usually remembers their position at the time of injury Certain mechanisms of injury result in characteristic patterns Fall on outstretched

More information