Hand anatomy and biomechanics wrist examination.pptx

Editor's Notes

• #12: De’curvan’s syndrome Finkelstein test Intersection syndrome Carpal tunnel syndrome (+ve tinnel sign) SNAC scaphoid nonunion advanced collapse Guyon's canal and ulnar nerve syndrome Sulcus ulnaris syndrome trigger finger Duyputryns contracture ??????? Approach : Shape, extension and direction of the incision. Flap choice in the reconstruction and coverage of the defects Arthrodesis and bone fixation considerations repair Flexors and range of movement Extensors sagittal band Lumbericals plus and minus ?
• #14: Flexor Carpi Ulnaris MuscleIt is the strongest wrist flexor and is involved in ulnar deviation This area is frequently the site of compression of the ulnar nerve (“ulnar tunnel syndrome” or“Guyon’s canal syndrome”)  Flexor carpi radialis The flexor pollicis longus muscle crosses over thistendon between the scaphoid and the trapezium  FLEXOR DIGITORUM SUPERFICIALIS 3 HEADS between the A1 and A2 anular ligaments, (tendinous hiatus)…….(tendinous chiasm)A4 inside or outside ? FUNCTIONS IN MCP and PIP joints and provides some support for wrist flexion flexor digitorum profundus muscle This muscle flexes all three joints of the fingers, with strength increasing as wrist extension increases. It is also involved in flexion and ulnar deviation of the wrist.  the extensor digitorum communis muscle inhibits the independent movements of the middle, ring, and little finger WHY ??? The proper extensor indicis muscle it brings about isolated extension of the index finger and moves it toward the middle finger The proper extensor digiti minimi muscle arises from the common origins of the extensor digitorum communis muscle and frequently extends into the extensor apparatus with two tendons  THUMB 9 muscles act on the thumb CMC joint. The namesof the individual muscles do not provide exact information about their specific movement behavior, however. Each movement sequence is performed by at least two muscle groups. 
• #20: FCU length is 25cm …. Fiber is 4 cm ECRL 12 cm …… fiber is 9 cm
• #21: FCU length is 25cm …. Fiber is 4 cm ECRL 12 cm …… fiber is 9 cm
• #22: A- Fibrous SheathAccording to Schmidt and Lanz (2003), the fibrous sheath is subdivided into three parts B-Synovial SheathThe internal synovial sheath layer enables the tendon toglide unimpeded within the fibrous sheath. The synovial sheath forms a self-contained double-walled tubewith an inner and outer layer. The inner layer encases thetendon, while the outer layer delineates itself from thefibrous sheath with synovial villi. The two layers, whichmerge and are self-contained, delimit an interstitialspace  the sheaths enhance the tendons’ ability to glide and protect the surroundingtissue from injuries caused by alternating flexion–extension movements. In addition to the stabilizing properties of the retinacula of the forearm for the wrist,  * First tendon compartment the extensor pollicis brevis muscle canproceed in a separate tendon compartment, either completely or in part. De Quervain’s stenosing tenosynovitis, also referred toas…………………………………………………………………………………………………………………. washerwoman’s sprain  ………………………………….Intersection syndrome  Third Ruptures of the extensor pollicis longus with fractures of the distal radius more frequently, due to screwsSpontaneous ruptures with rheumatoid arthritis. If it is not possibleto perform a direct, primary suture of the extensor tendon, reconstruction surgery must be performed toregain extension of the thumb in the distal joint. ……………………………………………………………………To thisend, the tendon of the extensor indicis muscle is transposed onto the distal stump of the tendon of the extensor pollicis longus muscle and is placed in correct tensionwith subsequent suture repair  Fourth Tenosynovitis does not usually occur in the fourth dorsaltendon compartment. Pathological conditions in thiscompartment are caused by the muscle belly of theextensor indicis muscle and are referred to as the extensor-indicis syndrome  Fifth In 72% of the population, it contains two extensordigiti minimi tendon  Sixth The extensor carpi ulnarismuscle with its sixth tendon compartment and its tendonsheath are part of the TFCC PALMAR TENDON COMP FIRST As a result of trauma or osteoarthritis, irritation or rupture may happen pain occurs during loadingwith the hand flexed. Local tenderness is generallypresent next to the scaphoid tubercle SECOND The medial nerve is fused with this tendon sheath by means of a mesotendon  THIRD The third palmar tendon compartment serves to guide eight tendons If a finger is immobilized in extension, the other fingers can no longer be actively flexedcompletely in the distal joint ???? INTERTENDINEOUS CONNECTION Due to its strong muscle belly and its short fiber length of 8 cm, it is not possible to close the fingers into a fist when the wrist isflexed The tendons of the flexor digitorum superficialis muscle are located on top in a somewhat less orderly arrangement In 50% of the population, this tendonsheath communicates with the tendon sheath of theflexor pollicis longus muscle  CARPAL TUNNEL is the fibro-osseous passageway It comprises a dynamic arrangement of carpal bones and ligaments that narrows during flexion and extension of the wrist During extension, the carpal tunnel is constricted due to the lunate, he pressure in the neutral position is approximately 2 mm Hg Carpal tunnel syndrome is therefore the most frequent type of peripheral compression neuropathy ULNAR TUNNEL the second most likely location for entrapment of the ulnar nerve A lesion of the ulnar nerve causes an “ulnar claw” or “claw hand” to develop common causes of ulnar tunnel syndrome are acute neural trauma (e.g., cuts, carpal fractures), chronicneural trauma (e.g., long-term use of walking aids, nonunion of the hook of hamate), inflammations (e.g.,gout), intra-/perineural scars (e.g., after surgery), anatomic variants (e.g., atypical course of the abductor digitminimi muscle)  85% of all cases, entrapment of the median nerve (carpal tunnel syndrome) is caused by tenosynovitis  
• #31: This results in extension of around 80°, flexion of around 80°, radial deviation of around 15 to 25°, and ulnar deviation of around 40 to 50° from the neutral zero position for pure pronation and supination is approximately 80° to 90°–0–80° to 90°. With the contribution of the shoulder joint, this range can increase to up to 230° The wrist joint is thus composed of the radiocarpal joint, the midcarpal joint the CMC joint the distal radioulnar joint
• #37: This results in extension of around 80°, flexion of around 80°, radial deviation of around 15 to 25°, and ulnar deviation of around 40 to 50° from the neutral zero position for pure pronation and supination is approximately 80° to 90°–0–80° to 90°. With the contribution of the shoulder joint, this range can increase to up to 230°
• #38: This results in extension of around 80°, flexion of around 80°, radial deviation of around 15 to 25°, and ulnar deviation of around 40 to 50° from the neutral zero position for pure pronation and supination is approximately 80° to 90°–0–80° to 90°. With the contribution of the shoulder joint, this range can increase to up to 230°
• #39: This results in extension of around 80°, flexion of around 80°, radial deviation of around 15 to 25°, and ulnar deviation of around 40 to 50° from the neutral zero position for pure pronation and supination is approximately 80° to 90°–0–80° to 90°. With the contribution of the shoulder joint, this range can increase to up to 230°
• #40: the palmar aponeurosis contributes to maintaining the arches ofthe palm by resisting the forces that would flatten thepalm or lift the skin when the hand grasps objects.+ fibrous sheath of the tendons and fibro-ossous canals There are 33 different ligament structures in the carpalarea, most of which are firmly attached to the joint capsule (capsular stabilizers) 16 ligaments attached to just CMC of the thumb. Each carpal bone is in contact with another carpal bone, more or less directly or indirectly. ( + joint congruity ) Shape of the bones Volar plates of the joints Volar, dorsal and lateral ligaments.
• #42: ▶ Function of the palmar “distal V”. The main function of this palmar ligament complex is to hold the scaphoid in place like a hypomochlion, and to fixate and stabilize the capitate. ▶️ Function of the palmar “proximal V” ligament. involves the longitudinal transference of force between the ulna and the carpus and fixation of the proximal carpal row, especially the lunate as the most important intermediate element of movement “intercalated segment” ▶️ Function of the “dorsal V” ligaments prevent the carpus from sliding along the radial joint surface, which slopes to the ulnar side. In terms of function, it resembles an accordion, viz.
• #44: ▶ Radioscaphocapitate ligament ▶ Arcuate ligament ▶ Scaphotrapeziotrapezoid ligament THE PROXIMAL "V" complex ▶️ Radiolunotriquetral ▶️ Ulnolunate and ulnotriquetral ligament THE DORSAL "V" LIGAMENT ▶️ Dorsal radiotriquetral ligament ▶️ Dorsal intercarpal ligament.