The Forearm, Wrist, Hand,
and Fingers
Chapter 24
Forearm Anatomy
Radius and Ulna: Elbow
 Joints: radioulnar joint
 Ulna: direct extension to the humerus
 Radius: extension of the hand
Forearm Anatomy
Bone:
• proximal radial head, olecranon
process, radial shaft, ulnar shaft,
distal radius, radial styloid process,
ulnar head, ulnar styloid
Forearm Anatomy
Musculature:
Consist of
Flexors of the wrist and fingers are
Forearm Anatomy
Nerve/Blood Supply:
median and radial nerve and brachial,
radial, and ulnar artery
Forearm Assessment
History: What? Where? How? When?
(some asked questions to figure out what
happened to the forearm)
Observation: forearm is first visually
inspected for obvious deformities,
swelling, and skin defects
Forearm Assessment
Palpation: can reveal tenderness, edema,
fracture deformity, change in skin temperature,
a false joint, bone fragments, or a lack of
continuity between bones
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Recognition and
Management of Forearm
Injuries
Contusion
Etiology:
Signs and Symptoms: pain, swelling, and
hematoma;
Management:
Recognition and
Management of Forearm
Injuries
 Forearm Splints
Etiology:
Signs and Symptoms:
Management: if problem occurs early in season,
athlete should concentrate on increasing the strength
of the forearm through resistance exercises, but if
arises late in season, emphasis should be placed on
rest and cryo therapy or heat and use of a supportive
wrap during activity
Recognition and
Management of Forearm
Injuries
Colles’ fracture
Etiology: involve lower end of the radius or ulna;
fall on outstretched hand,
Signs and Symptoms: forward displacement of
radius, makes visible deformity to the wrist;
Management:
Recognition and
Management of Forearm
Injuries
Forearm Splints
Etiology: severe static contraction;
Signs and Symptoms: dull ache between the
extensor muscles, which cross the back of
forearm;
Management: rest, cryotherapy, heat and it also
depends on when it occurs in the season, other
actions should be taken depending on that
Wrist, Hand, and Finger
Anatomy
Bones:
Joints:
Wrist, Hand, and Finger
Anatomy
Ligaments: “many at each joint in the hand”
Musculature: “many
intrinsic and extrinsic
muscles”
Wrist, Hand, and Finger
Anatomy
Blood and Nerve Supply: ulnar, median,
radial nerve and radial and ulnar
superficial and deep palmar arch arteries.
Assessment of Wrist,
Hand, and Finger Injuries
History: asks about location & type of pain
What increases or decreases the pain?
Observation: hand usage as of writing or
unbuttoning a shirt is observed. General
attitude of the hand is observed. Opening
and closing the hand
Is the wrist or hand swollen?
Are there any postural deviations?
Assessment of Wrist,
Hand, and Finger Injuries
Palpation
Bony palpation includes carpals, meta-,
and phalanges
Soft tissue palpation includes ligament,
fibro-cartilage
-
Assessment of Wrist,
Hand, and Finger Injuries
Special Tests:
-Finklestein’s test, Tinel’s Sign, Phalen’s
test, valgus and varus stress test,
Glide test, Lunotriquetral Ballotment
test, Allen’s test
Assessment of Wrist,
Hand, and Finger Injuries
Circulatory and Neurological Evaluation
Allen test
Functional Evaluation
Range of
motion is noted
in all movements, active
and resistance
movements
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Wrist Sprain
Etiology: can arise from any abnormal movement
of the wrist;
Signs and Symptoms: complains of pain, swelling,
& difficulty moving the wrist;
Management:
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Triangular Fibrocartilage Complex Injury
Etiology: caused by forced hyper-extension of the
wrist; TFCC is also associated with sprain of the
ulnar collateral ligament
Signs and Symptoms: its common for no
immediate report on injury from athlete; pain
along the ulnar side of the wrist;
Management: physician for treatment;
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Carpal tunnel syndrome
Etiology: anterior aspect of the wrist;
Signs and Symptoms: compression in the medial
nerve will usually result in both sensory and motor
deficits;
Management: rest, immobilization, and
nonsteroidal anti-inflammatory medication;
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Tenosynovitis
Etiology:
Signs and Symptoms: pain with use or pain in
passive stretching;
Management:
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Tendinitis
Etiology: sports that require repetitive pulling
movements and sports that place prolonged
pressure on the palms
Signs and Symptoms:
Management: ice massage for 10 minutes 4x’s a
day for the 1st 48-72 hours, NSAIDs, and rest;
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Nerve Compression, Entrapment, Palsy
Etiology:
Signs and Symptoms: *(see pictures on next slide)*
 THANK YOU 
Management:
Recognition and Management of Wrist,
Hand, and Finger Injuries
Nerve Compression, Entrapment, Palsy
Claw hand
Ape hand
Drop wrist
Bishop’s, or benediction, hand
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 De Quervain’s Disease (aka) Hoffman’s Disease
Etiology: stenosing tenosynovitis in the thumb;
Signs and Symptoms: point tenderness, aching pain,
weakness during thumb extension and abduction,
and there may be a painful snapping and catching of
the tendons during movement
Management: involves immobilization, rest,
cyrotherapy, and anti-inflammatory medication.
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Dislocation of the Lunate Bone
Etiology: hyperextension of the wrist; dislocation
of the lunate;
Signs and Symptoms: pain, swelling, difficulty in
executing wrist and finger flexion, numbness or
even paralysis of the flexor muscles
Management:
(if not bone deterioration may occur)
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Hamate Fracture
Etiology: may occur from fall but most likely from
contact while the athlete is holding a sports
implement such as a tennis racket, a baseball bat,
etc.
Signs and Symptoms: wrist pain and weakness
and point tenderness are experienced;
Management: casting of the wrist;
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Scaphoid Fracture
Etiology: force on the outstretched hand, which
compresses the scaphoid bone between the radius
and the 2nd row of carpal bones
Signs and Symptoms:
Management: cold should be applied, the area
splinted, and the athlete referred to a physician for
x-ray study and casting
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Wrist Ganglion
Etiology: synovial cyst;
Signs and Symptoms: pain with a lump at the site;
pain increases with use;
Management: break down the swelling through
digital pressure and then apply a felt pressure pad
for a period of time
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Contusion to hand and fingers
Etiology: irregular bony structure combined with
little protective fat and muscle padding, are prone
to bruising in sports
Signs and Symptoms: this condition is easily
identified from the history of trauma and the pain
and swelling of soft tissues
Management: cold and compression followed by
gradual warming of the warming bath;
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Bowler’s Thumb
Etiology: a perineural fibrosis of the subcutaneous
ulnar digital nerve of the thumb can occur from
the pressure of a bowling ball thumbhole & cause
the development of fibrotic tissue around the ulnar
nerve
Signs and Symptoms:
Management:
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Jersey finger
Etiology:
Signs and Symptoms: pain & point tenderness;
b/c the tendon is no longer attached to the distal
phalanx, the DIP joint can’t be flexed and the
finger is in an extended position
Management:
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Trigger finger or thumb
Etiology: repeated movement can cause the
tendons of the wrist and hand to sustain irritation
that results in tenosynovitis
Signs and Symptoms: when finger of thumb is
flexed, there is resistance to re-extension,
producing a snapping that is both palpable &
audible;
Management:
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Mallet finger
Etiology:
Signs and Symptoms:
Management: RICE is given for pain & swelling, if
there’s no fracture it should be immediately
splinted
Recognition and Management
of Wrist, Hand, and Finger
Injuries
Mallet
finger
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Boutonniere deformity (aka) button-hole
Etiology: a rupture of the extensor tendon dorsal
to the middle phalanx, trauma occurs to the tip of
the finger
Signs and Symptoms: severe pain and inability to
extend the DIP joint;
Management:
Recognition and Management
of Wrist, Hand, and Finger
Injuries
Boutonniere
deformity
(aka)
button-hole
Recognition and Management of
Wrist, Hand, and Finger Injuries
 Dupuytren’s Contracture
Etiology:
(nodules develop in the palmer aponeurosis that
limit finger extension and eventually cause a
flexion deformity)
Signs and Symptoms: the little fingers moves into
the palm of the hand and cannot be extended
Management:
(immediately removed)
Recognition and Management of
Wrist, Hand, and Finger Injuries
 Sprains, Dislocations, and Fractures of Phalanges
Etiology: phalanges are prone to sprains cause by
a blow delivered to the tip or by violent twisting,
the sprain affects the capsular, ligamentous , and
tendinous tissues
Signs and Symptoms: recognition is accomplished
primarily through the history and the sprain
symptoms:
Recognition and Management of
Wrist, Hand, and Finger Injuries
 Gamekeepers Thumb
Etiology: a sprain of the ulnar collateral ligament
of the MCP joint of the thumb;
Signs and Symptoms:
Management: proper, immediate, & follow-up care
must be performed, & a thumb splint should be
taken care of for 3-4 weeks
Recognition and Management of
Wrist, Hand, and Finger Injuries
 PIP Dorsal dislocation
Etiology: seen in collisions or contact sports;
Signs and Symptoms: pain & swelling over the PIP;
Management: RICE, splinting, & analgesics, & a
physician; finger is splinted at 20-30 degrees for 3
weeks;
Recognition and Management of
Wrist, Hand, and Finger Injuries
PIP
Dorsal
Dislocation
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management of
Wrist, Hand, and Finger Injuries
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 MCP dislocation
Etiology:
Signs and Symptoms: pain, swelling, and stiffness at
the MCP joint; the proximal phalanx is dorsally
angulated at 60-90 degrees
Management: RICE, splinting, and analgesics;
reduced, buddy tape, and given early ROM
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Metacarpal fracture
Etiology:
Signs and Symptoms: pain & swelling;
Management: RICE & analgesics followed by Xray ‘s;
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Bennett’s Fracture
Etiology:
Signs and Symptoms: pain & swelling over the
base of the thumb; the thumb’s CMC appears
deformed;
Management: structure is unstable and must be
referred to an orthopedic surgeon
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Distal phalangeal fracture
Etiology:
Signs and Symptoms: pain and swelling of the distal
phalanx; there may be deformity;
Management: RICE and analgesics, a protective
splint, and subungual hematoma is drained
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Middle phalangeal fracture
Etiology:
Signs and Symptoms: pain and swelling with
tenderness over the middle phalanx, there may be
deformity, and X-ray show bone displacement
Management: RICE and analgesics are given;
Recognition and Management
of Wrist, Hand, and Finger
Injuries
 Proximal phalangeal fracture
Etiology:
Signs and Symptoms:
Management:
Recognition and Management
of Wrist, Hand, and Finger
Injuries
Fingernail deformity
Scaling or ridgingRidging and poor developmentClubbing and cyanosisSpooning or depression-
Rehabilitation Principles for
the Forearm, Wrist, Hand, and
Fingers
General Body Conditioning- cardiorespiratory fitness, strength, flexibility, and
neuromuscular control. Many exercises such as
walking, running, stair climbing, aerobics,
cycling, and a variety of resistance and
flexibility activities
Joint Mobilization-
Rehabilitation Principles for
the Forearm, Wrist, Hand, and
Fingers
Flexibility- a pain-free ROM is a major goal
of rehab of the lower arm. It should include
active assisted and active pain-free
stretching exercises
Strength- restoring grip strength is
essential; it can be regained by gripping a
number of different devices
Rehabilitation Principles for
the Forearm, Wrist, Hand, and
Fingers
 Neuromuscular Control: hand and finger rehab
requires a restoration of dexterity, which includes
pinching and other fine motor activities such as
buttoning buttons, tying shoes, and picking up small
objects
 Return to Activity: criteria for the return to a sport
after wrist or hand injury are grip strength equal to the
unaffected limb, full range of motion, and full dexterity;
instituted by adduction, abduction, flexion, extension,
opposition, and circumduction