Wrist&hand

THE WRIST AND HAND

MANAGEMENT OF WRIST AND

HAND DISORDERS AND

SURGERIES

JOINT HYPOMOBILITY:

NON OPERATIVE MANAGEMENT

PATHOPHYSIOLOGY

FRACTURE , POTENTIAL JOINT

DEFORMITIES AND SURGERY

JOINT CAPSULE WEAKENING, CARTILAGE

DESTRUCTION, TENDON RUPTURE, IMPAIRED JOINT,

TENDON AND MUCLE MOBILITY, TISSUE

PROLIFERATION

IMMOBILIZATION

JOINT HYPOMOBILITY

REPETITIVE JOINT

TRAUMA

DEGENERATIVE

CARTILAGINOUS AND BONY

CHANGES

Common Joint Pathology and

Associated Impairments

• Rheumatoid Arthritis

• Joint Deformities

• Osteoarthritis

SIGNS AND SYMPTOMS (RA)

• ACUTE STAGE

• PAIN

• SWELLING

• LIMITED MOTION FROM SYNOVITIS

• PROGRESSIVE MUSCLE WEAKNESS

• ADVANCED STAGES

• JOINT INSTABILITY

• SYBLUXATIONS

• DEFORMITIES

• Swan Neck Deformity

• Boutonniere Deformity

• Zigzag Deformity

• Ulnar Drift

Swan Neck Deformity

• Hyperextension of PIP and flexion of DIP

Boutonniere Deformity

• PIP flexion and DIP extension

Ulnar Drift

Stretching or rupture of the

collateral ligaments at the MCP jts

and bowstringing effec from the

extrinsic extension

Zigzag Deformity

Metacarpal dislocation of thumb

Volar subluxation of the triquetrum on

the articular disk and ulna

• The extensor carpi ulnaris tendon

displaces volarly and causes a flexor

force at the wrist joint.

Ulnar subluxation of the carpals

• This causes radial deviation of the wrist.

• ACUTE STAGE

• ACHINESS

• FEELING OF STIFFNESS

• SWELLING

• WARMTH

• RESTRICTED AND PAINFUL

MOTION

SIGNS AND SYMPTOMS (OA)

• ADVANCED STAGES

• WITH DEGENERATION THERE IS

LAXITY RESULTING IN

HYPERMOBILITY AND

INSTABILITY

• WITH PROGRESSION

CONTRACTURES AND LIMITED

MOTION DEVELOP

• GENERAL MUSCLE

WEAKNESS

• WEAK GRIP STRENGTH

• POOR MUSCULAR

ENDURANCE

• PAIN (LOM FOR PINCHING

AND GRIPPING)

JOINT SURGERY AND

POSTOPERATIVE MANAGEMENT

• GOALS:

1. relief of pain

2. restoration of normal/sufficient

function of the wrist and hand

3. correction of instability and

deformity

4. restoration of ROM

5. improve strength of wrist and

fingers

WRIST ARTHROPLASTY

• Usually for arthritis and impaired

mobility of other joints in the extremity

• INDICATIONS:

1. severe pain (destruction of

articular surfaces)

2. deformity and marked limitation

of wrist that causes mm-tendon

imbalance

3. sublaxation of dislocation of

radiocarpal joint

4. appropriate for:

• low-demand UE functional

needs

• pt with bilateral wrist

involvement

• pt with significant stiffness of the

ipsilateral shoulder, elbow or

wrist and finger joints.

OVERUSE SYNDROMES

• Disorders from cumulative/repetitive

trauma in the wrist & hand lead to

significant loss of hand function &

lost work time.

• Resulting inflammation can affect

muscle, tendon, synovial sheaths &

nerves

Carpal Tunnel Syndrome

• Confined space between the carpal

bones dorsally and flexor retinaculum

volarly.

• The extrinsic flexor tendons & median

nerve course through the tunnel.

• CTS is described by the sensory loss

and motor weakness that occur when

the median nerve is compromised in the

carpal tunnel.

Synovial thickness & scarring in the

tendon sheathes or irritation,

inflammation & swelling as a repetitive

wrist flexion, extension or gripping

activities.

Swelling of the wrist joint from trauma to

the carpals, a fracture to the carpals,

pregnancy, RA, OA could decrease

carpal tunnel space.

Increase pain in the hand with repetitive

use.

• Atrophy in the thenar muscles & 1st 2

lumbricals (ape hand deformity)

• Tightness in the adductor pollicis &

extrinsic extensors of the thumb and

digits 2 & 3.

• Sensory loss in the median nerve

distribution.

• Phalen’s Test

Compression of Tunnel of

Guyon

• Injury/irritation of the ulnar nerve in the

tunnel between the hook of hamate &

pisiform occurs from sustained

pressure such as prolonged hand

writing.

• Pain and paresthesia along the ulnar side

of the palm of the hand & digits in the

distribution of the ulnar nerve.

• Weakness/atrophy in the hypothenar,

lumbricals, adductor pollicis, deep head of

the flexor pollicis brevis muscle (bishop’s

hand deformity)

• Tightness in the extrinsic finger flexor &

extensor muscles.

• Possible restricted mobility of the pisiform.

Tenosynovitis/Tendinitis

• Inflammation occurs from the

repetitive use of involved muscle from

the stress overload to the contracting

muscle or roughening of the surface of

the tendon.

• Pain whenever the related muscle

contracts.

• Warmth & tenderness with palpation in

the region of inflammation

TRAUMATIC LESIONS IN THE WRIST

AND HAND

Simple Strain

• A blow or fall, excessive stretch force

may strain the supporting ligamentous

tissue.

• There may be related fractured,

subluxation or dislocation.

• Pain at the involved site whenever a

stretch force is placed in the ligament.

• Possible hypermobility.