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Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
Kin 188  Wrist And Hand Evaluation And Injuries
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Kin 188 Wrist And Hand Evaluation And Injuries

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  • 1. KIN 188 – Prevention and Care of Athletic Injuries Wrist and Hand Evaluation and Injuries
  • 2. Anatomy
  • 3. Bony Anatomy
    • Distal radius/ulna
      • Styloid processes
    • Carpal bones
      • 8 total (2 rows of 4, proximal/distal)
    • Metacarpals
      • 1-5 (one = thumb, five = little finger)
    • Phalanges
      • 14 total (proximal/middle/distal at each finger and proximal/distal at thumb)
  • 4. Carpal Bones
    • Proximal row (lateral to medial)
      • Scaphoid
      • Lunate
      • Triquetrum
      • Pisiform
      • “ Some Lovers Try Positions”
    • Distal row (lateral to medial)
      • Trapezium
      • Trapezoid
      • Capitate
      • Hamate
        • hook
      • “ That They Can’t Handle”
  • 5. Bony Anatomy
  • 6. Bony Anatomy
  • 7. Joint Anatomy
    • Distal radioulnar joint
      • Forearm pronation/supination
    • Radiocarpal joint
      • Allows wrist flexion/extension and radial/ulnar deviation ROM
    • Intercarpal joints
      • Subtle glide movements only
    • Carpometacarpal joints
      • Limited flexion/extension ROM
    • Metacarpophalangeal (MP) joints – “knuckles”
      • Flexion/extension and abduction/adduction ROM
    • Proximal/distal (PIP/DIP/IP) interphalangeal joints
      • Flexion/extension ROM
  • 8. Joint Anatomy
  • 9. Muscular Anatomy
    • Extrinsic muscles
      • Flexor/pronator group from medial epicondyle of humerus
      • Extensor/supinator group from lateral epicondyle of humerus
    • Intrinsic muscles
      • Thenar eminence – thumb
      • Hypothenar eminence – little finger
  • 10. Carpal Tunnel
    • Floor – proximal row of carpal bones
    • Roof – transverse carpal ligament
    • Contents (10 structures)
      • Median nerve
      • Thumb flexor tendon
      • 8 finger flexor tendons
  • 11. Evaluation
  • 12. History
    • Mechanism of injury/etiology
      • Fall on outstretched hand
        • Scaphoid fracture, wrist dislocation, forearm fracture, wrist sprain
      • Striking object with closed fist
        • Metacarpal fracture
      • Forces applied to fingers/thumb
        • Bennet’s fracture, finger sprain/dislocation, mallet finger, gamekeeper’s thumb
      • Direct trauma
        • Contusions, fractures
      • Overuse/repetitive motion or activity
        • Tendonitis, carpal tunnel syndrome
  • 13. History
    • Unusual sounds/sensations at time of injury
    • History of previous injury/surgery
    • Change in activity
      • Intensity, duration, frequency, biomechanics/technique, equipment
    • Acute/gradual onset of symptoms
      • Macrotraumatic vs. microtruamatic
    • Characterize pain
      • Location (point with 1 finger)
      • Dull, sharp, burning, throbbing, etc.
      • Rate on scale (1-10)
      • What increases or decreases?
    • Treatment, medication, evaluation to date
  • 14. Inspection/Observation
    • ALWAYS compare bilaterally
    • Obvious deformity
      • Swan neck deformity – flexor tendon from middle phalanx
      • Boutonniere deformity – extensor tendon from middle phalanx
      • Mallet finger – extensor tendon from distal phalanx
    • Bleeding
    • Discoloration/ecchymosis
    • Swelling
      • Immediate vs. gradual, amount
    • Scars
  • 15. Palpation
    • Radial styloid process
    • Ulnar styloid process
    • Carpal bones
    • “ Anatomic snuffbox”
    • Metacarpals
      • Head/shaft/base
    • MP joints
    • Phalanges
      • Proximal/middle/distal
    • PIP joints
    • DIP joints
    • Flexor carpi ulnaris
    • Flexor carpi radialis
    • Palmaris longus tendon
    • Thenar eminence
    • Hypothenar eminence
  • 16. Special Tests
    • ROM
      • Active – patient/athlete moves joint
      • Passive – clinician moves joint, evaluates end feel
      • Resistive – proximal stabilization and distal application of resistance (“break” test vs. resistance through ROM)
    • Neurovascular
    • Special tests
  • 17. Range of Motion
    • Wrist flexion/extension
      • Flexion – 85-90 degrees, extension – 75-85 degrees
    • Wrist radial/ulnar deviation
      • Radial – 20 degrees, ulnar – 35 degrees
    • Finger flexion/extension
      • Flexion – MP 85-105 degrees, PIP 110-120 degrees, DIP 80-90 degrees
      • Extension – MP 20-30 degrees, PIP/DIP 0 degrees
    • Finger abduction/adduction
      • Midline is middle finger, motion at MP joints
      • 20-25 degrees each direction
  • 18. Range of Motion
  • 19. Range of Motion
    • Thumb flexion/extension
      • Flexion – 60-70 degrees, extension – 0 degrees
    • Thumb abduction/adduction
      • Abduction – 70-80 degrees, adduction – 0 degrees
    • Thumb opposition
      • Touch thumb to little finger
  • 20. Neurovascular
    • Neurological evalation
      • Nerve root level and peripheral nerve sensory and motor distributions from cervical spine/brachial plexus
    • Vascular evaluation
      • Skin temperature/color
      • Capillary refill
      • Radial pulse
  • 21. Special Tests
    • Varus/valgus stress tests to MP/IP/PIP/DIP joints – medial/lateral collateral ligament injuries
    • Metacarpal longitudinal stress – fractures (“false joint”)
    • Phalen’s test – carpal tunnel syndrome
    • Tinel sign – carpal tunnel syndrome
    • Intercarpal glides – wrist sprain
  • 22. Injuries
  • 23. Wrist Injuries
    • Wrist sprains
      • Hyperextension or hyperflexion mechnisms
    • Carpal tunnel syndrome
      • Compression of median nerve in tunnel
        • Evaluate with Phalen’s test/tinel sign
    • Distal radius/ulna fracture
      • Usually from fall on outstretched arm
      • Colles fracture – dorsal displacement of fracture fragments
    • Scaphoid fracture
      • Most commonly fractured carpal bone, usually from hyperextension mechanism
      • Poor blood supply often results in non-union and subsequent surgery
  • 24. Wrist Injuries
  • 25. Hand and Finger Injuries
    • Metacarpal fracture
      • 4 th and 5 th metacarpals most commonly injured (Boxer’s fracture)
    • Deformities/tendon injuries
      • “ Swan neck” deformity (flexor tendon from middle phalanx), “boutonniere” deformity (extensor tendon from middle phalanx)
    • Finger fractures
      • Distal phalanx most commonly fractured, avulsion fractures from flexor (mallet finger) and extensor (jersey finger) tendon attachments
    • Dislocations
      • Obvious deformity present, refer for x-ray prior to reduction
  • 26. Metacarpal Fractures
  • 27. Deformities
  • 28. Finger Fractures
  • 29. Finger Dislocations
  • 30. Thumb Injuries
    • Sprains
      • Medial collateral ligament of thumb (1 st MP joint) is most common area
      • Called “gamekeeper’s thumb” – hyperextension and hyperabduction
    • Fractures
      • If fracture extends into joint surface (carpometacarpal joint), referred to as Bennet’s fracture
  • 31. Thumb Injuries

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