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Normal Anatomic Position of the Hand and Wrist

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1. Normal Anatomic Position of the Hand and Wrist

Normal Anatomic Position of the Hand and Wrist Normal Anatomic Position of the Hand and Wrist Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer (...) Administration 4 Normal Anatomic Position of the Hand and Wrist Normal Anatomic Position of the Hand and Wrist Aka: Normal Anatomic Position of the Hand and Wrist , Hand Position of Function , Safe Hand Position II. Indication position of hand and wrist Avoids extensor contractures at MCP joints Avoids flexor contractures at IP joints III. Technique: Position (holding a glass or can) extended at 25 degrees MCP joint flexed at 60 degrees (45 to 70 degrees) Each IP joint (PIP and DIP) flexed at 5-10 degrees

2018 FP Notebook

2. Normal Anatomic Position of the Hand and Wrist

Normal Anatomic Position of the Hand and Wrist Normal Anatomic Position of the Hand and Wrist Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer (...) Administration 4 Normal Anatomic Position of the Hand and Wrist Normal Anatomic Position of the Hand and Wrist Aka: Normal Anatomic Position of the Hand and Wrist , Hand Position of Function , Safe Hand Position II. Indication position of hand and wrist Avoids extensor contractures at MCP joints Avoids flexor contractures at IP joints III. Technique: Position (holding a glass or can) extended at 25 degrees MCP joint flexed at 60 degrees (45 to 70 degrees) Each IP joint (PIP and DIP) flexed at 5-10 degrees

2015 FP Notebook

3. Chronic Wrist Pain

Not Appropriate O US wrist Usually Not Appropriate O CT wrist without IV contrast Usually Not Appropriate ? CT wrist with IV contrast Usually Not Appropriate ? CT wrist without and with IV contrast Usually Not Appropriate ? CT arthrography wrist Usually Not Appropriate ? X-ray arthrography wrist Usually Not Appropriate ? Tc-99m bone scan wrist Usually Not Appropriate ??? Variant 2: Chronic wrist pain. Routine radiographs normal or nonspecific. Persistent symptoms. Next study. Procedure Appropriateness (...) bone scan wrist Usually Not Appropriate ??? ACR Appropriateness Criteria ® 2 Chronic Wrist Pain Variant 3: Chronic wrist pain. Routine radiographs normal or nonspecific. Suspect inflammatory arthritis. Next study. Procedure Appropriateness Category Relative Radiation Level MRI wrist without and with IV contrast Usually Appropriate O MRI wrist without IV contrast Usually Appropriate O US wrist May Be Appropriate O MR arthrography wrist Usually Not Appropriate O CT wrist without IV contrast Usually

2017 American College of Radiology

4. The Effect of Capitate Position on Coronal Plane Wrist Motion After Simulated 4-Corner Arthrodesis. (PubMed)

affect postoperative wrist posture and function.Maintaining anatomic lunate position leads to preservation of greater wrist motion and anatomic alignment in a patient undergoing 4-corner arthrodesis.Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. (...) The Effect of Capitate Position on Coronal Plane Wrist Motion After Simulated 4-Corner Arthrodesis. The objective of this study was to examine the effect of altering the capitolunate relationship on coronal-plane wrist motion after scaphoidectomy and simulated 4-corner arthrodesis. Two positions of different capitolunate alignments were compared: "anatomic" (unchanged from pre-fusion) and "lunate-covered" (capitate translated to cover the lunate). We hypothesized that wrist resting posture

2016 Journal of Hand Surgery - American

5. CRACKCast E051 – Wrist and Forearm Injuries

the pisiform and the hook of the hamate. [fig 51-3 Why is the wrist important? Many movements, including circumduction How to examine the hand? See Table 51-1 or listen to episode 50 Clinical features of wrist injury History Mechanism of injury! Full detailed hx Physical Exam Compare to the normal wrist Find the point of maximal pain Dorsal structures: Describe it in relation to known landmarks: ulnar styloid, radial styloid, snuff box, lister’s tubercle (on the radius) – proximal to scapholunate (...) common wrist # Transverse # of the distal radial metaphysis, with dorsal displacement and angulation. May have associated extension, comminution, intra-articular extension, and up to 60% have an ulnar styloid # Causes the “dinner fork deformity” on physical exam Xrays show: Potential extension into the DRUJ, dorsal displacement and angulation, loss of normal volar tilt. Treatment: An early anatomic reduction with restoration of radial length, correction of dorsal angulation to normal volar tilt

2016 CandiEM

6. CRACKCast E050 – Orthopedics – Hand Injuries

tendon proximal to the juncturae tendinum can have a falsely normal MCP extension on exam Know how to test the EIP and EDM (hook ‘em horns) The three wrist flexors (FCR, FCU, PL). Knowing how FDS and FDP lie (you’ll cut FDP at the DIP, but FDS at MCP volarly) FDP is paradoxically lacerated more often! Synovial spaces – and the function of bursae (exist for flexors only) and where they run Hand nerves Nail body anatomy: Nail body vs. Lunula vs. nail root vs. nail bed vs. hyponychium vs. prionychium 1 (...) conditions Allen’s test involves a couple of steps: Fist is clenched for 30 seconds Pressure is applied over both ulnar and radial arteries Hand is unclenched and should remain pale Ulnar artery is released while radial artery is kept occluded Pallor should resolve in 5 to 15 seconds – normal test. Test can be repeated but with release of the radial artery The hand usually survives even if both arteries are transected at the wrist due to collateralization. But bilateral digital artery injuries usually

2016 CandiEM

7. Hand, Fractures and Dislocations: Wrist

and Dislocations Updated: May 10, 2018 Author: Michael Morhart, MD, MSc, FRCSC; Chief Editor: Joseph A Molnar, MD, PhD, FACS Share Email Print Feedback Close Sections Sections Wrist Fractures and Dislocations Overview Background This review covers primary fractures and dislocations involving the wrist region. The wrist is composed of the anatomic region between the forearm and the hand. Its ability to place the hand in 3-dimensional space is essential for normal daily function of the upper extremity. Over (...) on the outstretched hand or a motor vehicle accident. The classic presentation is swelling in the anatomic snuffbox, although this is not specific to scaphoid fractures alone. Physical examination may reveal a limited range of motion. Palpation in the anatomic snuffbox (interval between the extensor pollicis longus ulnar/dorsal and the abductor pollicis longus and extensor pollicis brevis radial/volar) often elicits pain. Tenderness is usually found upon radial deviation and flexion of the wrist, and pain

2014 eMedicine Surgery

8. 4DCT Imaging for Improved Diagnosis and Treatment of Wrist Ligament Injuries

joint one or more of the following symptoms: positive Watson shift sign (Watson et al., J Hand Surg Am, 1988; 13:657-60); loss of grip strength; suspected pathology on previous fluoroscopy or MRI; history of a fall on an outstretched hand absence of symptoms on the contralateral wrist on physical exam Exclusion Criteria: obesity (BMI > 32) previously-diagnosed rheumatological conditions or connective tissue diseases inability to be appropriately positioned in the scanner for the imaging congenital (...) /hand specimens will be obtained from the Mayo Clinic Anatomical Bequest program. 10 will be used to refine the ligament injury model and 30 will be used as follows. The specimens will undergo radiographic screening and will be excluded from the study if they have evidence of fracture, bony trauma, significant arthritic changes, or previous surgeries. The tendons will be loaded. The remaining soft tissues will be dissected from the proximal ulna and radius. Polymethylmethacrylate (PMMA) resin

2017 Clinical Trials

9. Hand, Congenital Hand Deformities

of an anomalous hand and may be hoping that surgery can creat a "normal" hand. The hand surgeon treating children with upper extremity anomalies must offer surgery to improve the child's function and cosmesis, when possible, and counsel parents about what is and is not possible with surgery. Timing of surgery Early surgery is defined as that performed within the first 2 years of life. Advantages include the full potential for growth, development, and patterns of use; improved scarring; early incorporation (...) a mobile wrist is present, a palmar plate prosthesis is a good treatment option. If metacarpal elements are present, functional potential is increased greatly, and the objective should be the creation of a basic hand. Microvascular transfer of multiple toes is method for reconstruction of a functional hand in selected patients. [ , ] Transfer of free nonvascularized toe phalanges is another established method of reconstruction for adactyly. [ , ] Recent studies have shown significant persistent donor

2014 eMedicine Surgery

10. Hand, Rheumatoid Hand

loosens the collateral ligaments and decreases joint stability. Normally, in the flexed position, minimal lateral movement occurs at the MP joint, but, with increased laxity of the collateral ligaments, up to 45° of lateral deviation occurs in this position. [ ] Ulnar drift With loss of MP stability, other forces on the MP produce the characteristic ulnar drift. For example, wrist collapse contributes to ulnar drift. Weakened radiocarpal ligaments cause radial rotation of the metacarpals and carpus (...) are collectively known as caput ulna syndrome. Destructive synovitis at the radial side of the wrist results in (1) attenuation of the radioscaphocapitate ligament with rotary subluxation of the scaphoid and (2) ulnar translocation of the carpal bones. The carpal height collapses, and bony destruction of the wrist ensues. Clinically, the hand deviates radially and maintains a supinated position. This imbalance causes ulnar drift of the phalanges on the metacarpals as the extrinsic forces of the extensors

2014 eMedicine Surgery

11. Wrist Arthritis (Treatment)

known as SLAC wrist. During the procedure, the lunate should be carefully reduced back into its anatomic position to regain 60% of normal motion in the wrist. The range of motion after 4-corner fusion depends on good articular surface congruity between the lunate and lunate fossa of the distal radius. [ ] Scapholunocapitate fusion Scapholunocapitate fusion is indicated in patients with midcarpal arthritis but without radiocarpal arthritis. Care must be taken to reduce the scapholunate joint before (...) position. Overuse of splinting may cause wrist stiffness and weakness. A high-quality systematic review concluded that for people with osteoarthritis (OA) of the hand, limited evidence supports use of education and exercise, mixed evidence supports a beneficial effect of splinting on pain, and no evidence supports one splinting design over another. [ ] Nonsteroidal anti-inflammatory drugs are useful in controlling inflammation, thereby reducing synovitis and swelling. They are most useful

2014 eMedicine Surgery

12. Wrist Arthrodesis (Overview)

, and positioning the hand for some specific activities. However, satisfactory postoperative function appears to depend more on pain relief than on residual motion. [ ] Wrist arthrodesis, either pancarpal or limited, is considered the primary surgical alternative in patients with most end-stage arthritic conditions of the wrist. The pancarpal arthrodesis is a predictable durable alternative to a variety of posttraumatic, degenerative, or neoplastic conditions of the wrist. However, some authors report (...) Collapse (SNAC) Wrist Arthritis. J Hand Microsurg . 2015 Jun. 7 (1):79-86. . Berger RA. Partial denervation of the wrist: a new approach. Tech Hand Up Extrem Surg . 1998 Mar. 2 (1):25-35. . Clayton ML, Ferlic DC. Arthrodesis of the arthritic wrist. Clin Orthop Relat Res . 1984 Jul-Aug. (187):89-93. . Martini AK. [Wrist joint arthrodesis. Technique and outcome]. Orthopade . 1999 Oct. 28 (10):907-12. . Mouilhade F, Auquit-Auckbur I, Duparc F, Beccari R, Biga N, Milliez PY. Anatomical comparative study

2014 eMedicine Surgery

13. Ulnar-Sided Wrist Pain (Overview)

is included here. Refer to standard anatomy textbooks for further details. [ ] The wrist provides an anatomic link between the forearm and the hand. The wrist consists of the distal radius, the ulna, the carpal bones, and the bases of the metacarpals. The mobility of the wrist is determined by the shapes of the bones involved and by the attachments and lengths of the various ligaments. The distal articular surface of the radius has an average radial inclination or slope of 22°, and it tilts palmarly (...) from dorsal to volar with the hand pronated. A positive result is characterized by painful laxity in the affected wrist compared with the contralateral wrist. The results are usually positive in cases of DRUJ synovitis. The ulnar compression test may reveal degeneration or inflammation of the DRUJ. To perform this test, compress the ulnar head against the sigmoid notch. A positive result is exacerbation of pain, which suggests arthritis or instability. In addition, with ulnar compression, dorsal

2014 eMedicine Surgery

14. Wrist Arthrodesis (Diagnosis)

, and positioning the hand for some specific activities. However, satisfactory postoperative function appears to depend more on pain relief than on residual motion. [ ] Wrist arthrodesis, either pancarpal or limited, is considered the primary surgical alternative in patients with most end-stage arthritic conditions of the wrist. The pancarpal arthrodesis is a predictable durable alternative to a variety of posttraumatic, degenerative, or neoplastic conditions of the wrist. However, some authors report (...) Collapse (SNAC) Wrist Arthritis. J Hand Microsurg . 2015 Jun. 7 (1):79-86. . Berger RA. Partial denervation of the wrist: a new approach. Tech Hand Up Extrem Surg . 1998 Mar. 2 (1):25-35. . Clayton ML, Ferlic DC. Arthrodesis of the arthritic wrist. Clin Orthop Relat Res . 1984 Jul-Aug. (187):89-93. . Martini AK. [Wrist joint arthrodesis. Technique and outcome]. Orthopade . 1999 Oct. 28 (10):907-12. . Mouilhade F, Auquit-Auckbur I, Duparc F, Beccari R, Biga N, Milliez PY. Anatomical comparative study

2014 eMedicine Surgery

15. Ulnar-Sided Wrist Pain (Diagnosis)

is included here. Refer to standard anatomy textbooks for further details. [ ] The wrist provides an anatomic link between the forearm and the hand. The wrist consists of the distal radius, the ulna, the carpal bones, and the bases of the metacarpals. The mobility of the wrist is determined by the shapes of the bones involved and by the attachments and lengths of the various ligaments. The distal articular surface of the radius has an average radial inclination or slope of 22°, and it tilts palmarly (...) from dorsal to volar with the hand pronated. A positive result is characterized by painful laxity in the affected wrist compared with the contralateral wrist. The results are usually positive in cases of DRUJ synovitis. The ulnar compression test may reveal degeneration or inflammation of the DRUJ. To perform this test, compress the ulnar head against the sigmoid notch. A positive result is exacerbation of pain, which suggests arthritis or instability. In addition, with ulnar compression, dorsal

2014 eMedicine Surgery

16. Wrist Dislocation (Diagnosis)

of print. . Park MJ, Kim JP. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am . 2008 Jan. 90(1):145-53. . Media Gallery Lunate dislocation. Posteroanterior projection of the wrist showing the pie shape of the lunate. Perilunate dislocation. On the posteroanterior radiograph, crowding is evident between the proximal and distal carpal bones. Perilunate dislocation. The lunate is in a normal anatomic position (...) complications, including prolonged pain and discomfort, surgery, and lost time from sports participation. See the image below. Perilunate dislocation. The lunate is in a normal anatomic position with respect to the radius. The rest of the carpal bones are displaced dorsally. For excellent patient education resources, visit eMedicine's . Also, see eMedicine's patient education article, . Next: Epidemiology Frequency United States In a study by Larsen and Lauritsen, as many as 2.5% of all emergency department

2014 eMedicine.com

17. Wrist Dislocation (Treatment)

shape of the lunate. Perilunate dislocation. On the posteroanterior radiograph, crowding is evident between the proximal and distal carpal bones. Perilunate dislocation. The lunate is in a normal anatomic position with respect to the radius. The rest of the carpal bones are displaced dorsally. Scapholunate dislocation. The scapholunate space is usually greater than 4 mm, a scenario also known as the Terry-Thomas sign. Rotation of the scaphoid causes the scaphoid to be viewed end-on, producing (...) . The wrist is then placed in a cast for 4-6 weeks. Early diagnosis and anatomic reduction was noted to be essential in a report by Martinage et al [ ] ; they can also provide satisfactory functional results. Thus, emergency surgical treatment is required. The investigators preferred a dorsal approach and did not perform primary closed reductions. [ ] A study to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation

2014 eMedicine.com

18. Wrist Dislocation (Overview)

of print. . Park MJ, Kim JP. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am . 2008 Jan. 90(1):145-53. . Media Gallery Lunate dislocation. Posteroanterior projection of the wrist showing the pie shape of the lunate. Perilunate dislocation. On the posteroanterior radiograph, crowding is evident between the proximal and distal carpal bones. Perilunate dislocation. The lunate is in a normal anatomic position (...) complications, including prolonged pain and discomfort, surgery, and lost time from sports participation. See the image below. Perilunate dislocation. The lunate is in a normal anatomic position with respect to the radius. The rest of the carpal bones are displaced dorsally. For excellent patient education resources, visit eMedicine's . Also, see eMedicine's patient education article, . Next: Epidemiology Frequency United States In a study by Larsen and Lauritsen, as many as 2.5% of all emergency department

2014 eMedicine.com

19. Wrist Dislocation (Follow-up)

is evident between the proximal and distal carpal bones. Perilunate dislocation. The lunate is in a normal anatomic position with respect to the radius. The rest of the carpal bones are displaced dorsally. Scapholunate dislocation. The scapholunate space is usually greater than 4 mm, a scenario also known as the Terry-Thomas sign. Rotation of the scaphoid causes the scaphoid to be viewed end-on, producing the classic signet-ring sign. Progressive perilunar instability pattern as reported by Mayfield et (...) , Trafton PG, eds. Skeletal Trauma . Philadelphia, Pa: WB Saunders Co; 1998. 1359-81. Lichtman DM, Alexander AH, eds. The Wrist and Its Disorders . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1997. Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am . 1972 Dec. 54(8):1612-32. . . Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg [Am

2014 eMedicine.com

20. Fracture, Wrist (Follow-up)

reduction of the typical Colles fracture are as follows: Place the hand and wrist in the position of injury and pronate the forearm, which corrects the supination twist of the distal fractured segment. This can be performed with the aid of the Weinberg finger traction apparatus or with an assistant to fix the arm at the elbow. By recreating the mechanism of injury and the position of the bony fragments at injury, the periosteal ligaments are relaxed, which allows for easier reduction of the fracture (...) function of the median nerve and the sensory branch of the radial nerve. Smith fracture For proper reduction of a Smith fracture, the forearm must be supinated fully while the elbow is fixed by an assistant or with the aid of the Weinberg traction device. Extend the wrist to 90° and fully supinate the forearm. Then, recreate the position of the hand at injury to relax the periosteal attachments. Move the hand into the hyperflexed position and reduce the fracture segment with traction at approximately

2014 eMedicine Emergency Medicine

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