Consultant Hand Surgeon Hillingdon NHS Foundation Trust Acknowledgements Mr H Belcher Hand Surgeon QVH East Grinstead Aids to the examination of the PNS Advanced Examination Techniques in Orthopaedics ID: 1048545
Download Presentation The PPT/PDF document "Clinical Hand Anatomy David Ahearne FRCS..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Clinical Hand AnatomyDavid Ahearne FRCS (Tr and Orth)Consultant Hand SurgeonHillingdon NHS Foundation Trust
2. AcknowledgementsMr H Belcher Hand Surgeon, QVH, East Grinstead.Aids to the examination of the PNSAdvanced Examination Techniques in OrthopaedicsNetters Concise Atlas of Orthopaedic Anatomy.
3. Referrals to Hand SurgeonsTraumaInfectionDegenerativeInflammatoryIdiopathicTumour
4. HistoryAgeDominanceOccupationHistory of ComplaintLength of timePrimary symptom eg Pain, stiffness, instability.Level of Dysfunction
5. Trauma HistorySharpKnifeBluntHammerBlastIndustrial accidents.Indirect
6. Types of Trauma
7. Flexor Tendon InjuriesFlexor ZonesHelp determine Tendons Injured.
8. Trauma AssesmentMechanism of InjuryPosition of fingers at time of injuryTime of injuryDysfunctionExaminationVascular assessmentNeurological assessmentIndividual Tendons.
9. Aim of treatmentRestoration of functionDepends on needs of PatientsConcert Pianist (Dexterity)Labourer (Pain Free and Stable)
10. Examination of the HandSystematic approachDetermine cause of reduced function.NeurologicalMuscularTendonJointFunctional Position
11. Hand functional positions
12. Abnormal Functional Position
13. Neurological ExaminationNerve supplySensationMotorStrength
14. Median NerveSensation
15. Median NerveMotorAbductor Pollicis BrevisOpponens Pollicis
16. Median NerveFlexor Digitorum Superficialis
17. Ulnar NerveSensation
18. Ulnar nerveMotorAbductor Digiti MinimiFirst Dorsal Interosseous Muscle
19. Radial NerveSensation
20. Radial NerveMotorNo Muscle Supplied in handPosterior Interosseous Nerve main branch
21. JointRange of movementMCPJ0-90 degreesPIPJ0-110 degreesDIPJ0-90 degreesActivePassivePain on movementStabilityStatic Bony ContourLigamentsDynamicMuscular Contractions
22. TendonsAre all workingAre they StiffStiffness intrinsic extrinsic
23. Flexor TendonsFlexor Digitorum Profundus
24. Flexor TendonsFlexor Digitorum SuperficialisImmobilise other fingers to isolate FDSBottom picture shows decrease PIPJ movement due to Hypoplastic FDS
25. Tenodesis Effect,
26. Extensor Communis (Left)Extensor Proprius (Right)
27. MuscleAre they contractingLevel of PowerMRC Grading
28.
29. Hand incisions
30. Friday Night Boxers Fracture
31. Thenar WastingConsequence of Chronic Carpal Tunnel Syndrome
32. Ulnar nerve Lesion
33. Boutonniere Deformity (Central Slip Rupture)
34. Paronychia
35. Extensor tendon laceration
36. Repair of extensor tendom
37. Spiral fracture Metacarpals
38. FDP Tendon Injury
39. Rheumatoid Hand (Ulnar deviation)
40. Osteoarthritis of Base of Thumb
41. PIN Injury
42. Flexor Tendon Laceration
43. Multiple Extensor Tendons
44. PIPJ Dislocation
45. OA Base of Thumb
46.
47. Swan Neck Deformity
48. AIN Injury
49. Tip Avulsion Injury
50. Ulnar Collateral Ligament Rupture
51. Bony Avulsion of Above
52. Fixation of above
53. Ring Avulsion Injury
54. Operative repair of above
55. Severe Tip avulsion
56. Local Skin Flap to Repair
57. Volar Plate Injury
58. Peri-lunate Dislocation
59. Degloving Injury