Forearm, Wrist, and Hand Anatomy and Injuries Notes

Anatomy of the Forearm

  • Forearm Structure:

    • Comprised of two bones: radius and ulna.

    • Important features include: head, neck, and various processes (styloid, coronoid).

Muscle Anatomy

  • Flexor Muscles:

    • Primary Nerves: Median nerve for most flexors.

    • Major flexors include:

    • Biceps brachii

    • Brachialis

    • Pronator teres

    • Flexor carpi radialis

    • Palmaris longus

    • Flexor carpi ulnaris

  • Extensor Muscles:

    • Primary Nerves: Radial nerve for most extensors.

    • Major extensors include:

    • Triceps brachii

    • Brachioradialis

    • Extensor carpi radialis longus/brevis

    • Extensor digitorum

Blood and Nerve Supply

  • Arteries involved: Radial and Ulnar arteries.

  • Nerves involved: Median nerve, Radial nerve, Ulnar nerve.

Common Injuries

  1. Forearm Splints:

    • Caused by severe contraction leading to pain and tenderness.

    • Management includes strengthening, cryotherapy, and heat treatments.

  2. Forearm Fractures:

    • Commonly occur from falls; often results in pain, swelling, and inability to use the arm.

    • Management involves POLICE (Protection, Optimal Loading, Ice, Compression, Elevation).

  3. Colles’ Fracture:

    • Result of a fall on the outstretched hand, causing a forward displacement of the radius.

    • Visible deformity and swelling can occur; requires urgent care.

  4. Madelung Deformity:

    • Developmental deformity in the wrist, often corrected surgically if chronic.

Anatomy of the Wrist and Hand

  • Comprised of several bones: Carpals, Metacarpals, and Phalanges.

  • Key joints involve the radiocarpal joint and others within the hand.

Functional Evaluation

  • Assess range of motion for wrist and fingers:

    • Wrist: flexion, extension, deviation.

    • Fingers: abduction, adduction, extension.

Common Wrist and Hand Disorders

  1. Wrist Sprains:

    • Most common injury; arises from forced movements (hyperextension).

    • Management includes POLICE and potential referral for X-ray.

  2. TFCC Injury:

    • Occurs with violent wrist twists.

    • Pain on ulnar side is common and requires immobilization.

  3. Tendinitis and Tenosynovitis:

    • Caused by repetitive movements, leading to pain and swelling.

    • Management involves rest, ice, NSAIDs, and rehabilitation after swelling decreases.

  4. Nerve Compression Syndromes:

    • Carpal Tunnel Syndrome: Compression of the median nerve causing pain and sensory deficits.

    • DeQuervain’s Disease: Inflammation affecting the tendons of the thumb.

  5. Scaphoid Fractures:

    • Caused by falls; characterized by pain in the anatomical snuff box.

    • Management involves splinting and monitoring due to risk of nonunion.

  6. Kienböck’s Disease:

    • Osteonecrosis of the lunate bone; requires prompt treatment to prevent complications.