Wrist and Hand Complex: Structure, Function, and Surgery

Wrist Joint

Multiarticular joint with two compound joints.

Biaxial Movement

Allows flexion/extension and radial/ulnar deviation.

Ulnar Collateral Ligament

Stabilizes wrist on ulnar side.

Radial Collateral Ligament

Stabilizes wrist on radial side.

Dorsal Radiocarpal Ligament

Supports wrist on dorsal side.

Volar Radiocarpal Ligament

Supports wrist on volar side.

Ulnocarpal Complex

Includes ulnocarpal and triangular fibrocartilage.

Intrinsic Intercarpal Ligaments

Connects carpal bones within the wrist.

Pisiform Bone

Sesamoid bone in FCU tendon, not part of wrist.

Triquetrum

Carpal bone aligned with pisiform in proximal row.

Radiocarpal Joint

Main joint connecting radius to carpal bones.

Midcarpal Joint

Joint between proximal and distal carpal rows.

Grips & Prehension Patterns

Different methods of grasping objects.

Wrist Capsule

Loose capsule reinforced by ligaments.

Biconcave Surface

Distal radius and discus articularis.

Biconvex Surface

Proximal row of carpals articulates with disc.

Midcarpal Joint

Articulation between distal and proximal carpal rows.

Ulnar Compartment

Convex capitate and hamate on concave scaphoid.

Radial Compartment

Concave trapezium and trapezoid on convex scaphoid.

CMC Joint

Articulations of metacarpals with distal carpals.

Digits 2-4

Have plane uniaxial joints.

Digit 5

Biaxial joint with increased mobility.

Transverse Ligaments

Support all CMC joints of the hand.

Cupping of Hand

Flexion and adduction improve prehension.

Thumb Phalanges

Only two phalanges and one IP joint.

Saddle Joint

Biaxial joint between trapezium and 1st metacarpal.

Flexion/Extension

Frontal plane motion of the thumb.

Abduction/Adduction

Sagittal plane motion of the thumb.

MCP Joints

Digits 2-5 have PIP and DIP joints.

Lumbricals Function

Assist in IP extension by removing tension.

Power Grips

Biaxial condyloid joints supported by ligaments.

Isometric Grip

Clamping with partially flexed fingers.

Extrinsic Flexors

Major force in gripping objects.

Precision Patterns

Wrist position controls muscle length.

Cupping Motion

Finger flexion for grasping objects.

Extensor Mechanism

Manipulating objects not in palm contact.

Combined Grips

Involve extensor hood and interphalangeal extension.

Clawing Motions

Only extrinsic muscles contract during closing.

Median Nerve Compression

Causes Ape Hand Deformity and sensory changes.

Ulnar Nerve Trauma

Leads to degenerative changes in joints.

Acute Stage Symptoms

Swelling and restricted painful motion.

Advanced Stage Symptoms

Limitation of flexion and extension with weakness.

Tunnel of Guyon

Ulnar tunnel formed by pisiform and hook of hamate.

Partial Claw-hand Deformity

Ulnar nerve entrapment causing sensory changes.

Benediction Hand Deformity

Ulnar nerve entrapment leading to muscle weakness.

Radial Nerve Injury

Causes sensory changes and affects wrist function.

Cubital Tunnel Syndrome

Injury near elbow causing wrist drop.

Joint Hypomobility

Limited joint movement often due to RA or trauma.

Rheumatoid Arthritis (RA)

Autoimmune disorder causing joint pain and stiffness.

Activity Limitations

Restrictions in daily activities due to joint issues.

Pain Management

Use of NSAIDs and modalities to control pain.

Splinting

Resting and protecting joints with removable splints.

PROM

Passive Range of Motion exercises to maintain mobility.

Tenosynovitis

Inflammation of tendon sheaths affecting joint mobility.

Swan Neck Deformity

PIP hyperextension and DIP flexion due to laxity.

Boutonnière Deformity

PIP flexion and DIP extension from extensor hood rupture.

Tendon-Gliding Exercise

Movement to prevent adhesions in tendons.

Multiple-Angle Muscle Setting

Gentle isometric exercises for wrist and hand muscles.

Tenosynovectomy

Surgical removal of inflamed tendon sheaths.

Joint Mobilization Techniques

Methods to increase joint play and mobility.

Arthroplasty

Surgical replacement of joint surfaces.

Implant Arthroplasty

Use of implants for joint reconstruction.

Total Joint Replacement

Complete replacement of a damaged joint.

Proximal Row Carpectomy

Surgical removal of proximal carpal bones.

Controlled Motion Phase

Focus on restoring function post-injury.

Functional Mobility

Ability to perform daily activities without pain.

Joint Protection

Strategies to minimize stress on joints.

Soft Tissue Procedures

Surgical interventions for joint and tendon issues.

Rupture Repair

Surgical intervention for torn tendons.

Grade III Mobilization

Sustained techniques to stretch joint capsules.

Severe Pain Indications

Criteria for considering surgical intervention.

Post-Operative Management

Care following surgery to ensure recovery.

Longitudinal incision

Surgical cut along the wrist's dorsal aspect.

Dorsal clearance

Removal of dorsal tissue for surgery.

Synovectomy

Surgical removal of synovial membrane.

Tenosynovectomy

Removal of tendon sheath surrounding tendons.

Rigid prosthetic components

Fixed devices for joint replacement.

Intramedullary canals

Hollow spaces in bones for prosthesis fitting.

Dynamic spacer

Prosthesis maintaining joint alignment during healing.

Total wrist arthroplasty

Surgery resecting parts of radius, ulna, carpals.

Capsule reconstruction

Repair of joint capsule for stability.

Ligament reconstruction

Surgical repair of ligaments for joint support.

Post-op management

Care procedures following surgical intervention.

Minimum protection phase

Initial recovery stage focusing on safety.

Wrist extensors strengthening

Exercises to enhance wrist extensor muscle strength.

Cock-up resting splint

Support device for wrist flexion contracture.

Functional grasp

Grip strength for daily activities.

Manual stretching procedures

Techniques to improve wrist extension flexibility.

Low-intensity dynamic resistance

Lightweight resistance training for recovery.

Active radial and ulnar deviation

Wrist movements side to side.

Low-load dynamic splinting

Gentle splinting to promote wrist movement.

Post-op stiffness

Reduced movement following surgery.

Expected ROM outcomes

Anticipated range of motion post-surgery.

Flexible implant arthroplasty immobilization

Post-surgery immobilization for 3-8 weeks.

Failure rates of total wrist replacement

Higher complications than larger joint replacements.

MCP Implant Arthroplasty

Surgical procedure for late-stage RA in hands.

EDC Tendons

Extensor digitorum communis; crucial for MCP function.

Indications for Surgery

Criteria for performing MCP or PIP arthroplasty.

Moderate Protection Phase

2-6 weeks post-op; focus on MCP extension.

MCP Flexion Angles

45-60° for index/middle; 70° for ring/little.