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Anatomy of the Wrist

The lunate and the triquetrum make up the ulnar side of the proximal carpal row at the wrist. Ligaments, particularly the lunotriquetral (LT) ligament, provide support to this joint. This ligament is horse-shoe or c-shaped and contains a volar, dorsal and proximal component.

Pain associated with lateral or medial epicondylitis (also known as tennis and golfer’s elbow respectively) is common and can interfere with functional use of the involved extremity. According to research study, an elbow brace or wrist orthosis can assist with decreasing pain and increasing function for this diagnosis. The following information provides a comparison of commonly used braces and splints to treat the symptoms associated with lateral or medial epicondylitis.

Proximal interphalangeal (PIP) joint flexion contractures, or loss of extension at the middle joint of the finger, can occur after injury, disease and surgery and can interfere with the functional use of the hand. Loss of extension at the PIP joint can cause difficulty reaching into your pocket or may interfere with opening your hand to grab a glass of water.

When treating patients with de Quervain’s Tenosynovitis, they may complain of a swollen thumb and radial-sided wrist pain. The pain may become worse, and may radiate up the thumb or forearm, during activities that require abduction or flexion of the thumb. In most cases, de Quervain’s is caused by overuse or repetitive stress, although the condition may develop for unknown reasons.

It's that time of year where many states across the country are dealing with major snow storms with multiple inches of snow. Cleanup of snow in this amount often occurs by using snow blowers. Unfortunately, snow blowers can be the cause of many devastating hand injuries.

With the possibility of new clients with snow blower injuries, it is a good time to review care of wounds. Snow blower injuries can be very complex and certainly the most critical component of the injury guides the care in therapy, i.e. flexor tendon involvement, but most often snow blower injuries present with wounds requiring immediate care.

As hand therapists, we know trigger finger is a common hand issue that occurs with the locking or triggering of a finger, pain in the middle joint, and tenderness with palpation at the base of the finger. Trigger Finger commonly occurs between the ages of 55 and 60 years old and is said to occur 2-6 times more frequently in women than in men.

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While most are familiar with management of the symptoms of trigger finger employing or using surgery and injection, what about the use of a splint for treatment?

There are a variety of wrist injuries that can occur from a traumatic fall on an outstretched hand. These injuries are termed FOOSH (fall on an outstretched hand) injuries. Probably the most well-known FOOSH is a distal radius fracture, which is identified and treated first by a physician. As a health care professional, you may be seeing an increase in referrals for wrist pain from falls this time of year, now may be a good time to review the clinical signs used to find other FOOSH injuries.

Anatomy of the Wrist

The carpal bones of the wrist make 2 rows of bones, the proximal and distal carpal row. Midcarpal instability (MCI) is related to lack of ligament support between the proximal carpal row and the midcarpal joint (between the 2 rows of bones). Midcarpal instability is most often of palmar type, but can also be considered dorsal or extrinsic depending on the specific ligament(s) involved in causing the instability.

The primary cause of Ulnar Deviation of the Metacarpal Phalangeal joints (MP) of the fingers, a chronic, irreversible condition, is Rheumatoid Arthritis (RA). The MP joints are a primary site of rheumatoid deformities due to several anatomical and bio mechanical factors. Chief among the factors are:

• The shape of the metacarpal head allows for a certain degree of motion in an ulnar direction which contributes to the hands ability to create a strong grip

Causes of Deformity in the Rheumatoid Thumb 

Rheumatoid arthritis (RA) is a destructive inflammatory disease that impacts soft tissue. This disease commonly involves the thumb and causes deformities to the thumb through tendon rupture or tendon subluxation and the abnormal stretching of ligaments and other joint structures.