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Transcript of welcome Doctors!
1) Identify the carpal bones on plain radiographs.
2) Show movements possible at the wrist joint.
3) Analyze the findings on clinical examination based on the anatomical knowledge.
Ebtihal is a 25 year-old female who fell down on her outstretched hands. She presented soon after the fall to the emergency department complaining of pain and swelling in her right wrist. On examination her wrist is swollen and movement is restricted because of pain. She has tenderness over the snuff box.
Her x-rays showed a scaphoid fracture and therefore her wrist was immobilized in a thumb spica splint.
3 years later, Ebtihal is now a 28 year-old Coach and a mother of a 2 year old boy; she came complaining of gradually increasing pain in her right thumb when doing her exercises.
There is recently some tender swelling at her wrist.
On examination there is a firm tender swelling over the styloid process of the right radius. Percussion is very painful. Forced ulnar deviation of the wrist is also very painful. Resisted abduction and dorsiflexion of the CMC joint of the thumb is painful.
Anatomy Of The Hand
What We See In X-ray Of the hand !
Interphalangeal joints (IP)
-All fingers have 3 phalanges
the thumb has 2 phalanges .
The wrist joints
Movement of the wrist
Your Way To Future Begins !
- All fingers have 2 IP joints ( proximal & distal )
the thumb has 1 IP joint .
to ER :
Ext.carpi ulnaris .
Ext.digiti minimi .
Ext.pollicis longus .
Ext.carpi radialis brevis .
Ext.carpi radialis longus .
Ext.pollicis brevis .
Abductor pollicis longus .
( from medial to lateral )
to ER :
osterior cutaneous branch of ulnar nerve.
uperficial branch of radial nerve.
1. The following structures pass
to the extensor retinaculum of the wrist,
A. Beginning of cephalic vein.
B. Beginning of basilic vein.
C. Superficial branch of radial nerve.
D. Tendon of extensor digiti minimi.
2. Which of the following structures pass
to the extensor retinaculum?
A. Basilic vein.
B. Cephalic vein.
C. Radial nerve.
D. Radial artery.
E. Flexor carpi ulnaris tendon.
is a carpal bone in the wrist.
It sits on the radial or lateral side of the wrist near the thumb.
It is the
bone in the wrist's
.( Lunate, triquetral, and pisiform ) are the remaining bones in the proximal row.
(Trapezium, trapezoid, capitates, and hamate ) are bones in the distal row.
of Scaphoid bone
distal & middle
The scaphoid has a special blood supply ; the proximal portion has
put it in your mind
Function of scaphoid bone
involved in movement of the wrist .
along with the
, articulates with the radius and ulna to form the major bones involved in movement of the wrist.
The scaphoid serves as a
between the two rows of carpal bones. With wrist movement,
Triangular skin depression on the lateral side of the wrist .
- Medially: tendon of the extensor pollicis longus.
- Laterally:tendone of the extensor pollicis brevis
Abductor pollicis longus
Trapezium and scaphoid bons.
you would palpate the scaphoid bone in the anatomical snuff box . it represents the
of the snuff box .
What Is It ?
It is a progressive stenosing tenosynovitis which affects the tendon sheaths of the 1st compartment degeneration and thickening of the tendon sheath
Scaphoid fractures are common injuries in vehicle and sports related accidents. These fractures typically occur when the body falls on an outstretched wrist.
60% of all carpal fractures are scaphoid related.
Pain , Swelling at the base of the thumb. In some cases, the pain is not severe, and may be mistaken for a sprain.
Any pain in the wrist that does not go away within a day of an injury may be a sign of a fracture. A simple "sprained" wrist is very rare and it is important to see a doctor if pain persists.
Examination and Tests :
2- X-ray .
3- MRI .
Treatment of scaphoid fracture
Fracture Near the Thumb
Fracture Near the Forearm
- heal in weeks with proper protection ,This part of the scaphoid bone has a good supply of blood, which is necessary for healing.
- healing is more difficult. These areas of the scaphoid do not have a very good blood supply.
Do you remember ?
The Scaphoid has a special blood supply; the proximal part has
blood supply and it is the part where the
De Quervain's Tendinosis
- There is Twenty-four extrinsic tendons cross the wrist ,covered by a slippery thin soft-tissue layer.
- There are six separate compartments we are gonna foucs to the first compatment,The first one is over the radial styloid.
- first compartment contains :
1-Extensor pollicis brevis
2-Abductor pollicis longus
De Quervain's Tendinosis
Inflamation of the synovial sheaths result from continuous repititive use of EPB and APL muscle.
scarring and thickening of tendon sheaths
stenosing, increase friction
- Associated with pregnancy and rheumatoid disease
Lifting heavy objectives
cutting with scissors
Incidence and Prevalence:
- Occurs most often in individuals age between 30 and 50 y.o.
- 10 times more common in
- Higher risk for workers / sports.
- musicians .
- Localised swelling and tenderness
- surgical incision
- Finkelstein test.
Treatment by injection