532016 Sports Medicine Mr Cronin 1 Objectives When you finish with this chapter you should be able to Review the structural and functional anatomy of the forearm wrist hand and fingers ID: 908764
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Slide1
Chapter 18
The Forearm, Wrist, Hand, and Fingers
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Slide2Objectives
When you finish with this chapter you should be able to:Review the structural and functional anatomy of the forearm, wrist, hand and fingers.
Outline the process of assessment for injuries to the forearm, wrist, hand and fingers.Incorporate management techniques for dealing with injuries to the forearm, wrist, hand, and fingers.
Implement the appropriate rehabilitation techniques for dealing with injuries to the forearm, wrist, hand, and fingers.
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Anterior Radius and Ulna
Parts to know:
Radius:
Head of the radius
Neck of the radius
Radial tuberosity
Shaft of the radius
Ulnar notch of the radius
Styloid process of the radius
Ulna
Trochlear notch of the ulna
Coronoid process of the ulna
Ulnar tuberosityRadial notch of the ulnaStyloid process of the ulnaOlecranon process of the ulnaHead of the ulnaShaft of the UlnaInterosseous membraneDistal radioulnar jointProximal radioulnar joint
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Posterior Radius and Ulna
Parts to know:
Radius:
Head of the radius
Neck of the radius
Shaft
of the radius
Ulnar notch of the radius
Styloid process of the radius
Ulna
Radial
notch of the ulna
Styloid process of the ulnaOlecranon process of the ulnaHead of the ulnaShaft of the ulnaInterosseous membraneDistal radioulnar jointProximal radioulnar joint
Slide5Articulations of the Forearm
Proximal (Superior) Radioulnar JointMiddle Radioulnar Joint
Distal (Inferior) Radioulnar Joint
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Slide6Forearm Musculature
Flexor Carpi Radialis
OriginMedial epicondyle of the humerus.
InsertionVentral surface (palm side) of the second and third metacarpals.Action
Flexes the wrist and abducts the hand (radial deviation); aids in flexion of the elbow and pronation of the forearm.
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Slide7Forearm Musculature
Palmaris Longus
OriginMedial epicondyle of the humerus.Insertion
Palmar aponeurosis (a sheet of pearly-white fibrous tissue that takes the place of a tendon in sheet-like muscles having a wide area of attachment).
Action
Flexes the wrist
.
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Slide8Forearm Musculature
Flexor Carpi Ulnaris
OriginMedial epicondyle of the humerus, olecranon process, and the proximal two-thirds of the posterior surface of the ulna.
InsertionPisiform, hamate, and fifth metacarpal.Action
Flexes the wrist and adducts the hand (ulnar deviation).
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Slide9Forearm Musculature
Flexor Digitorum Superficialis
OriginMedial epicondyle of the humerus, coronoid process of the ulna, and the anterior radius.
InsertionVentral surface (palm side) of the middle phalanges of the second through fifth fingersAction
Flexes the wrist and phalanges.
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Slide10Forearm Musculature
Flexor Digitorum Profundus
OriginMedial epicondyle of the humerus, the coronoid process of the ulna, the interosseous membrane, and the ventral (anterior) side of the ulna.
InsertionVentral (palm side) of the base of the distal phalanges of the second through fifth fingers.
Action
Flexes the wrist and the phalanges.
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Slide11Forearm Musculature
Flexor Pollicis Longus
OriginVentral surface of the radius (anterior) and the interosseous membrane.
InsertionVentral surface (palm side) of the base of the distal phalanx of the thumb.Action
Flexes the thumb and aids in flexing the wrist
.
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Slide12Forearm Musculature
Pronator Quadratus
OriginDistal ventral surface (anterior side) of the ulna.Insertion
Distal ventral surface (anterior side) of the radius.ActionPronates the forearm and hand
.
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Slide13Forearm Musculature
Extensor Carpi Radialis Longus
OriginLateral supracondylar ridge of the humerus.
InsertionDorsal surface (posterior) of the base of the second metacarpal.
Action
Extends the wrist and abducts (radial deviation) the hand
.
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Slide14Forearm Musculature
Extensor Carpi Radialis Brevis
OriginLateral epicondyle of the humerus.
InsertionDorsal surface (posterior) of the base of the third metacarpal.Action
Extends the wrist and abducts (radial deviation) the hand.
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Slide15Forearm Musculature
Extensor Digitorum (Communis)
OriginExtends the wrist and abducts (radial deviation) the hand.Insertion
Dorsal surface (posterior) of the phalanges of the second through fifth fingers.Action
Extends the fingers and wrist
.
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Slide16Forearm Musculature
Extensor Digiti Minimi
OriginTendon of the extensor digitorum communis.Insertion
Tendon of the extensor digitorum communis on the dorsum (posterior) of the little finger.Action
Extends the little finger
.
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Slide17Forearm Musculature
Extensor Carpi Ulnaris
OriginLateral epicondyle of the humerus.Insertion
Base of the fifth metacarpal.ActionExtends the wrist and adducts (ulnar deviation) the hand
.
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Slide18Forearm Musculature
Abductor Pollicis Longus
OriginPosterior surface of the middle of the radius and ulna and the interosseous membrane.
InsertionBase of the first metacarpal.Action
Abducts the thumb and hand (radial deviation
).
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Slide19Forearm Musculature
Extensor Pollicis Brevis
OriginPosterior surface of the middle of the radius and the interosseous membrane.
InsertionBase of the first phalanx of the thumb.
Action
Extends thumb and wrist, abducts the hand (radial deviation
).
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Slide20Forearm Musculature
Extensor Pollicis Longus
OriginPosterior surface of the middle of the ulna and the interosseous membrane.
InsertionBase of the distal phalanx of the thumb.
Action
Extends the thumb and abducts the hand (radial deviation
).
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Slide21Forearm Musculature
Extensor Indicis
OriginPosterior surface of the distal end of the ulna and the interosseous membrane.
InsertionTendon of the extensor digitorum communis to the index finger.
Action
Extends the index finger
.
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Slide22Brachioradialis
Origin
Lateral supracondylar ridge of the humerus
Insertion
Styloid process of the ulna
Action
Elbow flexion
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Slide23Supinator
Origin
Lateral epicondyle of the humerus
Insertion
Proximal end of the lateral surface of the shaft of the radius
Action
Elbow supination
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Slide24Pronator Teres
Origin
Medial epicondyle of the humerus and the coronoid process of the ulna
Insertion
Middle of the lateral surface of the shaft of the radius
Action
Elbow pronation
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Slide25Anconeus
Origin
Lateral epicondyle of the humerusInsertion
Lateral surface of the olecranon process of the ulnaActionElbow extension
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Slide26Muscle Groups of the Forearm
Extensors (Posterolateral)
Extensor Carpi Radialis LongusExtensor Carpi Radialis BrevisExtensor Carpi Ulnaris
BrachioradialisExtensor Pollicis LongusExtensor Pollicis Brevis
Abductor Pollicis Longus
Extensor Indicis
Supinator
Flexors
(Anteromedial)
Flexor Carpi Radialis
Flexor Carpi Ulnaris
Palmaris Longus
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Flexor Pollicis Longus
Pronator QuadratusPronator Teres5/3/2016Sports Medicine - Mr. Cronin26
Slide27Common Forearm Injuries
Forearm SplintsForearm FracturesColles’ Fracture
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Slide28Forearm Splints
EtiologySigns/Symptoms
Management
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Slide29Forearm Fractures
Etiologygymnastics injury
Signs/SymptomsManagement
Colles’ Fracture
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Slide30Anatomy of the Wrist, Hand, and Fingers
Bones of the Wrist
Carpals (8)ScaphoidLunate
TriquetralPisiformHamateCapitate
Trapezoid
Trapezium
Metacarpals (5)
1
st2
nd
3
rd
4
th
5
thPhalanges (14)ProximalIntermediateDistal5/3/2016Sports Medicine - Mr. Cronin30
Slide31Articulations
Radiocarpal Joint(Inter)Carpal JointsMetacarpal Phalangeal Joints (MCP)
(Inter)Phalangeal JointsProximal Interphalangeal Joint (PIP)Distal Interphalangeal Joint (DIP)
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Slide32Musculature of the Wrist, Hand, and Fingers
Palmar MusclesLumbricales (4)
Dorsal Interossei (4)Palmar Interossei (3)Thenar Muscles
Abductor Pollicis BrevisOpponens PollicisFlexor Pollicis Brevis
Adductor Pollicis
Hypothenar Muscles
Palmaris Brevis
Abductor Digiti Minimi
Flexor Digiti Minimi Brevis
Opponens Digiti Minimi
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Slide33Musculature of the Wrist, Hand, and Fingers
LumbricalsOrigin – Tendons of the flexor digitorum profundus.
Insertion – Tendons of the extensor digitorum communis.
Action – Flexes the metacarpophalangeal joints.
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Slide34Musculature of the Wrist, Hand, and Fingers
Dorsal Interossei (4)
Origin – Adjacent sides of all of the metacarpals.Insertion – Proximal phalanx of the second, third, and fourth fingers.
Action – Abducts the fingers from the middle finger.
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Slide35Musculature of the Wrist, Hand, and Fingers
Palmar Interossei (3)
Origin – Medial side of the second metacarpal and lateral side of the fourth and fifth metacarpals.Insertion – Proximal phalanx of the same finger.
Action – Adducts the fingers toward the middle finger.
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Slide36Musculature of the Wrist, Hand, and Fingers
Abductor Pollicis Brevis
Origin – Flexor Retinaculum, scaphoid, and trapezium.Insertion – Proximal phalanx of the thumb.
Action – Abduct the thumb.
Abductor pollicis brevis
video
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Slide37Musculature of the Wrist, Hand, and Fingers
Opponens Pollicis
Origin – Flexor retinaculum, and trapezium.Insertion – Lateral border of the metacarpal of the thumb.
Action – Pulls the thumb in front of the palm to meet the little finger.
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Slide38Musculature of the Wrist, Hand, and Fingers
Flexor Pollicis Brevis
Origin – Flexor retinaculum, trapezium, and first metacarpal.Insertion – Base of the proximal phalanx of the thumb.
Action – Flexes and adducts the thumb.
Flexor Pollicis Brevis Video
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Slide39Musculature of the Wrist, Hand, and Fingers
Adductor Pollicis
Origin – Capitate, and second and third metacarpals.Insertion – Proximal phalanx of the thumb.
Action – Adducts the thumb.Adductor Pollicis Video
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Slide40Musculature of the Wrist, Hand, and Fingers
Palmaris BrevisOrigin – Flexor retinaculum.
Insertion – Skin on the ulnar border of the hand.Action – Pulls the skin toward the middle of the palm.
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Slide41Musculature of the Wrist, Hand, and Fingers
Abductor Digiti MinimiOrigin – Pisiform and the tendon of the flexor carpi ulnaris.
Insertion – Base of the proximal phalanx of the little finger.
Action – Abducts the little finger.
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Slide42Musculature of the Wrist, Hand, and Fingers
Flexor Digiti Minimi BrevisOrigin – Flexor retinaculum and hamate.
Insertion – Base of the proximal phalanx of the little finger.
Action – Flexes the little finger.
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Slide43Musculature of the Wrist, Hand, and Fingers
Opponens Digiti Minimi
Origin – Flexor retinaculum and hamate.Insertion – Metacarpal of the little finger.
Action – Brings the little finger our to meet the thumb.
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Slide44Joint Movements Fingers and Thumb
Finger ExtensionFinger FlexionFinger Abduction
Finger AdductionThumb AbductionThumb Adduction
Thumb ExtensionThumb Opposition
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Slide45Nerve Supply
Two major nerves: (motor and sensory)Ulnar Nerve
Median NerveAdditional nerve (mostly sensory)Radial Nerve
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Slide46Blood Supply
Radial ArteryUlnar Artery
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Slide47Special Tests
Finkelstein’s Test
Tinel’s SignPhalen’s Test
Valgus/Varus and Glide Tests for the Wrist, MCP and IP JointsLuntriquetral Ballotment Test
Allen’s Test
Circulatory and Neurological Evaluation
Dermatomes
and
Myotomes
Nailbed Pinch
Functional Evaluation
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Slide48Common Injuries to the Wrist, Hand, and Fingers
Wrist Sprains
TenosynovitisTendinitisNerve Compression, Entrapment, Palsy
Carpal Tunnel SyndromedeQuervain’s SyndromeDislocation of the LunateScaphoid
Fracture
Hamate Fracture
Wrist
Ganglion
Trigger Finger or Thumb
Extensor Tendon Avulsion (Mallet Finger)
Boutonniere Deformity
Flexor Digitorum Profundus Rupture (Jersey Finger)
Gamekeeper’s Thumb
MCP Dislocation
Bennett’s Fracture
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Slide49Wrist Sprains
EtiologySigns/Symptoms
Management
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Slide50Wrist Tenosynovitis vs. Tendonitis
EtiologyTenosynovitis = repetitive wrist accelerations and decelerations; repetitive use and overuse of the wrist tendons and their sheaths
Tendonitis = repetitive wrist flexion; overuse of the wrist
Signs/SymptomsManagement
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Slide51Carpal Tunnel Syndrome
EtiologySigns/Symptoms
Management
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Slide52deQuervian’s Syndrome
Aka Hoffman’s diseaseEtiology
Signs/SymptomsManagement
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Slide53Lunate Dislocation
Etiology
Signs/Symptoms
Management
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Slide54Scaphoid Fracture
EtiologySigns/Symptoms
Management
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Slide55Hamate Fracture
EtiologySigns/Symptoms
Management
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Slide56Wrist Ganglion
EtiologySigns/Symptoms
Management
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Slide57Trigger Finger/Thumb
EtiologySigns/Symptoms
Management
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Slide58Mallet Finger
EtiologyBaseball finger/basketball finger
Signs/SymptomsManagement
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Slide59Boutonniere Deformity
EtiologyButtonhole deformity
Signs/SymptomsManagement
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Slide60Jersey Finger
EtiologySigns/Symptoms
Management
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Slide61Gamekeeper’s Thumb
EtiologySkier's thumb
Signs/SymptomsManagement
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Slide62MCP Dislocation
EtiologySigns/Symptoms
Management
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Slide63Bennett’s Fracture
EtiologySigns/Symptoms
Management
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Slide64Metacarpal Fracture (Boxer’s Fracture)
Etiology
Signs/SymptomsManagement
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