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Examination Of The Hand & Wrist
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  • The importance of hand & wrist in the exam , a slide show published 23.1.1422=17.4.2001,Tuesday at 3:16 PM.
  • Transcript

    • 1. Examination of the Hand & Wrist By Dr.Abdullah H.A. Juma Orthopaedics Department
    • 2. Medical Institutes
      • The role of medical Institutes is to provide medical education tools in a multimedia form to upgrade the art of education & learning with the era of advanced technology.
    • 3. The objectives
      • To improve the learning scale of basic study linked with observatory media.
      • To apply the basic textbook knowledge in a clinically applied sense.
    • 4. Hand & Wrist
      • The anatomy of the hand & wrist is important to understand the multi-functions of both when considering the normal and abnormal pathological conditions affecting both.The delicate structures entails the precision of work needed to carry out different modalities of activities in life.Hands & wrists are the path to every thing in life.
    • 5. The arches of the hand
      • The arches of the hand is a vital component for the proper functions carried out by the anatomically related structures of bones,joints,capsules and tendons.
      • If the hand is flat then it will be typically malfunctioning as stated in the Holy Koran : “ كباسط كفيه الى الماء ليبلغ فاه وما هو ببالغه ”
    • 6. The mobile & rigid segments
      • The rigid segments are the middle ones and they are the 2 nd & 3d metacarpal bones which provide stability for the efficiency of power grip.
      • The mobile columns are the peripheral ones to accommodate different shapes and sizes of objects.
    • 7. The hand & wrist skeleton
      • Formed of carpal bones in 2 rows proximally : scaphoid,lunate,pisiform& triquetrum.
      • distally :
      • capitate,hamate,trapezium & trapezoid.
      • 5 metacarpal bones articulate proximally to form part of the wrist joint and distally to form the hand .
    • 8. The dorsum of the hand
      • The direction of the skin creases and elastic tissues are illustrated .
      • The importance when a surgical incision is planned for to give a good looking scar.
    • 9. The anatomy of a finger
      • The lateral structures of the index finger are illustrated.
      • The vascular bundles , the nerves and the lymphatics run on the radial & ulnar compartments of each finger.
    • 10. The anatomy of a finger
      • The side view of the anatomical structures are illustrated.
      • The relation of the vascular branches & it’s distal network in the pulp space indicates it’s role in the blood supply.
    • 11. Fingers & hand proportions in the brain
      • Fingers & hands are predominantly represented in comparison to the other parts of the body.
      • A thumb has more topographical sites of pesentation.
    • 12. Wrist dissection
      • Surgical dissection of the wrist reveals the superficial structures.
      • Deeper structures are illustrated by retracting the overlying tendons.
    • 13. Sensory tools
      • 2 points of sensory discrimination, pin prick and light touch sensations are the examination tools to assess the sensory changes affecting the dorsal & palmar surfaces of the hand and the wrist.
    • 14. The power of grip
      • Gross grip is the action manifested when holding large objects in the palm of the hand and certain power is required to do the action.
      • Delicate,fine grip requires little power but more precision.
    • 15. Test for ulnar nerve function
      • Interosseous muscle is supplied by the ulnar nerve and is attached to the base of the proximal phalanx to move the finger side way.
      • Affection of the ulnar nerve causes paralysis of those intrinsic small muscles of the hand.
    • 16. The dorsum of the hand
      • The extensors of the fingers & wrist are illustrated as they pass behind the extensor retinuculum within their tendon sheaths.
      • They form distally the extensor expansion.
    • 17. The collateral ligaments
      • The lateral ligaments are shown.
      • They stabilize the joints and allow safe flexion & extension and side way movements.
    • 18. The ligaments in relation to the tendon
      • The tendon sheath & it’s related tendon are closely applied to the collateral ligaments.
      • The flexor tendon gives a secure excursion enabled by the efficiency of those ligaments.
    • 19. Instability of the MC/P
      • Rupture of the lateral ligaments & the volar plate cause marrked instability of the joint especially in the sagittal plane.
      • This is seen more obviously when flexing the finger aided by the pull of the tendon.
    • 20. Metacarpal Head
      • The CAM-like action of the MC head is seen clearly in flexion & extension.
      • Those are different from the PIP & DIP joints.
    • 21. Testing the flexor tendons
      • The flexor digitorum profundus runs distally.
      • It is tested by stabilizing the proximal joints and allowing flexion of the DIP joint.
    • 22. The ROM of the thumb
      • The C / MC joint of the thumb has more ROM in all directions.
      • This is vitally important for it to perform the multi functional activities.
    • 23. Opposition movements
      • Fingers are brought in apposition to the thumb to perform delicate functions of a fine grip.
      • Hence thumb’s actions are considered >50% of the other fingers.
    • 24. The types of grip
      • Delicate & fine grip requires the thumb , fingers and intrinsic small muscles of the hand to be in an optimal normal functions.
      • Gross grip requires normal functioning of previous factors plus tendons.
    • 25. The inferior radio-ulnar joint
      • The inferior R/U joint forms with the proximal row of the carpal bones the WRIST joint.
      • The triangular cartilage is illustrated and is vulnerable to injury.
    • 26. Tendons of the wrist joint
      • The attachment of extensor & flexor tendons of the wrist distally to the MC bones.
      • They pass over the radius & carpal bones and their main functions are to move the wrist joint.
    • 27. The ROM at the wrist joint
      • Dorsiflexion is compared with the other side in an indian style of prayer.
      • The ROM is recorded in a measurable angle.
    • 28. ROM of the wrist together with the fingers movement
      • Dorsiflexion og the wrist joint while flexing & extending the fingers.
      • The power & excursion of the grip are both reduced in this position and increased in neutral position.
    • 29. ROM of the wrist in relation to the functions of the fingers
      • The power of the grip is reduced in palmar-flexion.
      • The best grip to get is when the wrist joint in a neutral position.
    • 30. ROM of the DIP joint
      • Flexion of the distal interphalangeal joint is taking place by the flexor digitorum profundus.
      • This is illustrated by stabilizing the proximal joints.
    • 31. ROM of the PIP joint
      • Flexion of the proximal interphalangeal joint is taking place by the flexor digitorum sublimis( superficilis).
      • Other fingers are held in extension to allow the pip joint to flex.
    • 32. Injury to the wrist area
      • Injury to this area can cause a lot of damage especially the tendons and the neurovascular bundle.
      • Careful examination is essential prior to take any action.
    • 33. Deep structures
      • Deep structures are seen distally in the fingers such as : pulleys,volar plates,zones of the tendon sheaths.
      • Proximally, the lumbrical muscles are seen with the carpal tunnel.
    • 34. The hand as a flag in a Titanic ship
      • The hand leads the body ( the Ship ) in the ocean ( Life ).
      • The strings to the body direct the ship to sail in the ocean. If any thing goes wrong then the hand is the cause to sink.
    • 35. Tendons around the finger
      • The delicate arrangement of the tendons around the finger allow them to perform their sophisticated functions.
    • 36. Dissection of the dorsum of the finger
    • 37. Lateral dissection of the finger
    • 38. The action of flexors & extensors
    • 39. Clawing of the fingers
    • 40. Clawing of fingers & wasting of the 1 st dorsal interosseous muscle
    • 41. Extension of the thumb
    • 42. 1 st dorsal interosseous muscle in action
    • 43.  
    • 44. Swan neck deformity
    • 45. Testing DIP joint
    • 46. Finger flexion & extension
    • 47. Segments of the hand during action
    • 48. Different postures at function
    • 49. Grip ( prehension )
    • 50. Difference in the grip facility
    • 51. Demo of the 2 grips
    • 52. Delicate & fine & precise
    • 53. Factors precipitating in action
    • 54. A test
    • 55. Tests for Median nerve
    • 56. Pointing index finger test
    • 57. Flex. Dig. Profundus
    • 58. Wasting of the thenar eminence
    • 59. Detailed anatomy
    • 60. Deformity
    • 61. Sublaxation & instability
    • 62. Grip
    • 63. Topographic presentation
    • 64. Wasting dorsally
    • 65. Ulnar nerve testing
    • 66. Dorsum of the hand
    • 67. Deep structures
    • 68. Radiological involvement of deep layers
    • 69. MC heads & MC/P joints
    • 70. Volar & dorsal movements
    • 71. Combined actions
    • 72.  
    • 73. The arches of the hand
    • 74. Anatomy of the finger
    • 75. Review of median nerve testing
    • 76. Different forces applied
    • 77. A hand in a Titanic ship
    • 78. Tendons required
    • 79. Review of further deep structures