Wrist and hand n Rozkydal, Z. Nachtnebl L. n Ruka- skelet •Skeleton Ruka- vazy •Wrist R- záp 2 R- záp 1 Ruka- anatomie1 •Anatomy Ruka- anatomie2 •Anatomy Ruka- anatomie3 •Anatomy Ruka- šlachy flexorů Ruka- okrsky flexorů •System of pulleys Ruka- pochvy šlachové Ruka-anatomie6 •Anatomy Ruka-anatomie4 •Anatomy of extensor apparatus Ruka-extensor aparát •Extensor apparatus •Lateral bands from z mm. lumbricales •and mm. interossei Ruka- inervace 1 •Inervation of the hand Function of the hand nHook nGrip nFine movements - intrinsic muscles - oposition of the thumb Clinical examination nROM nFunction of muscles nSkin nTroficity nExamination of C spine, shoulder, elbow nR.A., systemic disorders Ruka- osa prstů •Alignment of fingers, rotation Ruka-funkce flexorů •Test for flexors •M. flexor dig. superfic. M. flexor dig. prof. Ruka-flexe v MP kloubu vazy •Length of collateral ligaments •of MP, PIP, DIP joints •Congenital disorders •aplasia radii congenita • •aplasia ulnae congenita • •Madelung deformity • Ruka- Madelung •Madelung deformity •- Short distal radius, volar bending •- Bajonet position of the hand • subluxation of carpal bones • Therapy- shortening of ulna, corrective OT of radius Congenital disorders n Types n- adaktylia n- oligodaktylia … -brachydaktylia … -polydaktylia … -syndaktylia … -clinodaktylia … -camptodaktylia … flection contracture - of 5. finger •Polydaktylia •Polydaktylia •Makrodaktylia •Syndaktylia X- ray of the wrist joint n n Fracture of scaphoid bone R- zá scap1 •Types CT n Ruka- sádra na os scaphoideum •Conservative treatment • •Plaster of Paris 8-12 weeks • R- záp Herbert1 R- zá scap1 •Operative treatment Herbert screw Pseudoarthrosis of scaphoid bone nX-ray Avascular necrosis of scaphoid bone Ruka- pakloub naviculare1 Ruka- pakloub naviculare2 Ruka- Stubins •Stubbins procedure Dislocation of lunate bone n R •Dislocation of lunate bone Perilunate dislocation nFixation n Ruka- nekrosa lunata •M. Kienböck R- záp déza lim •Posttraumatic osteoarthritis Ruka- Behanovský1 Ruka- Behanovský2 •Posttraumatic O.A. R- záp dis R- záp disoc •Scapholunate dissotiation •- Terry Thomas sign Ruka-Behanovský3 Ruka- Behanovský4 •Arthrodesis of radiocarpal joint R- záp Colles1 •Colles´ fracture •Frykman classification R- záp fr barton •Smith fracture •Barton fracture • • • • • •Colles´ fracture http://www.wheelessonline.com/images/i1/1wrst.jpg • • R- záp ASK R- záp 3 •Arthroscopy •of the wrist Trigger thumb nSnapping of the thumb n nTherapy nSteroid injection nSurgical release of the first pulley Ruka-pollex saltans op •Trigger finger • Ruka- dig saltans op •Th: steroid injection, surgical release Fracture of the base of distal phalanx- dorsal aponeurosis nTh : splinting n Ruka- rpt •M. de Quervain • •Stenosing tenosynovitis of •long abductor and short extensor •of the thunb • • •Tenderness over styloid process •Finkelstein test • •Treatment •Rest, orthesis, plaster •NSAID, corticoids •Surgery Ruka- de Quervain Ruka- de Quervain •M. de Quervain •Release of the tendon •sheats •Carpal tunnel syndrom •Compression neuropathy of median nerve •Pain, diminished muscle power •Hypotrophy of thenar muscles •Paresthesia and numbness •Limited function of fingers • •Tenderness •Tinnel sign •Phalen test Ruka-karp •X ray for carpal tunnel Ruka-karp • •Therapy • •Conservative • •Surgery •Carpal tunnel syndrom Ruka- anatomie3 R- záp SCC2 R •Guyon tunnel syndrom •Compression neuropathy of ulnar nerve •in hand • •Paresthesia and numbness on •ulnar side •Hypotrophy of hypothenar •Limited function of 4.5. finger • • •Therapy •Conservative •Surgery Ruka- anatomie2 Tenosynovitis of flexors of extensors ntenosynovitis crepitans n nTh : rest, splinting, NSAID n Deformity of the hand in R.A. • • •Button hole deformity •Swan neck •Z deformity of the thumb •Ulnar deviation •Synovitis of MP, PIP a DIP joints •Telescopic fingers Ruka- revmatická2 •Complex deformity • • • •Rheumatoid hand Ruka-revmatická3 •Complex deformity • • •Rheumatoid hand • •R.A. R.A. n R.A. Therapy of R.A. n Rheumatology n n Ruka- revmatická1 Surgery nsynovectomy nReconstruction of tendons narthroplasty nartrodesis nArtificial joints Arthrodesis n10-15 st. Dorsiflexion n-10 st. Ulnar deviation Ruka- synovectomie •Synovectomy Silastix replacement Ruka- Silastic Silastic replacement Ruka-Silastic po op •Silastic joints •Preop. Post op Dupuytren contracture n n Dupuytren contracture •Disorder of joint capsule or tendon sheats • • Therapy: aspiration and steroid locally • surgery • •Ganglion Deformity in O.A. in hand Rhisarthrosis Therapy of rhisarthrosis nConservative n Surgical n Ruka- rhisarthrosis2 Bennett fracture nBennett nfracture Therapy nPercutaneous fixation nORIF - L splint -T splint - KW Skier´s fracture nAvulsion fx of the base of proximal phalanx n-ulnar collateral lig. Fr. of diaphysis of metacarpal bone n Therapy nORIF •Screws Boxer´s fracture nNeck of metacarpal bone with volar dislocation Ruka- déza IP kloubu •Artrodesis of PIP joint