Wrist+&+Fingers

=__Wrists & Fingers__=

Glossary
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__Wrist:__
The wrist is the flexible and narrow connector of the forearm and the hand ,and is one of the most complex structures in the body. It is made up of many bones and joints which allow us to move our hands. It is made up of a double row of short bones making it very movable and is a condyloid joint. Being a condyloid joint it is very flexible and a good extension in the body.The wrist is formed by the lower end of the radius and the ulna. It is made up of two rows of short bones; in the proximal row lateral to medial the bones are the Scaphoid, Lunate,Triquetral, & Pisiform, and in the distal row the bones lateral to medial are the Trapezium, Trapezoid, Capitate, & Hamate. these bones can be easily remembered with the acronym SLTPTTCH: Stop Letting The People Touch The Cadaver's Hand.

Movement
The joint within the wrist allows for flexion, extension, abduction, adduction, and circumduction. All of these are different types of movements with several others also in the process of joint movement.
 * Flexion is a position that is made possible by the joint angle decreasing. This is the function of moving from the forward to backward direction only. As seen in the name, flexion is when any joint is moved into a flexed position. Flexion can best be seen by moving the palm of the hand toward the front of the forearm. [[image:DBWristCurl.gif caption="Flexion Movement"]]
 * Extension, the opposite movement of flexion, is when the angle between the bone and joint is increased rather than decreased. To extend a joint is to straighten it or stretched out.[[image:DBReverseWristCurl.gif caption="Extension Movement"]]
 * Adduction, medial movement toward the midline of the body, can best be seen by moving the pinky side of the hand toward the middle of the forearm.
 * Abduction is the lateral movement away from the midline of the body. It's the movement of moving the thumb side of the hand toward the lateral side of the forearm.

Structure of the Wrist
The parts which form the wrist are the lower end of the radius with the articular disk above and the scaphoid, lunate, and triquetral bones below. The two rows of bones are called the [|proximal bones and the distal bones]. The proximal row of bones, scaphoid, lunate, and triquetral bones, connect to the distal end of the ulna and radius. There is a thin layer of articular cartilage in the wrist which allows the joints to rub against one another without damaging the bones. The articular cartilage is important to absorb shock and make motion of the joint easy.

Ligaments of the Wrist:
In the wrist the eight carpal bones are surrounded by a [|joint capsule], which is a water tight lubricating fluid. There are two main ligaments of the wrist known as the ulnar collateral ligaments and radial collateral ligaments. The ulnar collateral ligament is on the ulnar side of the wrist and crosses away from the thumb.It begins at the ulnar styloid (the small bump away from the thumb) on the edge of the wrist where it meets the ulna. The radial collateral ligament is on the thumb side of the wrist and begins at the radial styloid, where the wrist meets the radius and also connects to the scaphoid. The radial collateral ligament prevents the wrist from bending to far to the side.

Muscles of the Wrist:
The muscles of the wrist include the following:
 * extensor carpi radialis longus
 * extensor carpi radialis brevis
 * [|extensor carpi ulnaris]
 * [|flexor carpi radialis]
 * [|flexor carpi ulnaris]
 * [|palmaris longus]

Nerves of the Wrist & Fingers:
The nerves that control the wrist include the radial nerve, median nerve, and the ulnar nerve. These nerves are controlled by the brain which sends signals from the brain to the muscles and tells the arm, wrist, and fingers to move. The radial nerve runs along the thumb side of the forearm and raps around the end of the radius towards the hand. The median nerve travels through the wrist through the carpal tunnel and controls the palm side of the index finger, thumb, long finger and part of the ring finger.To much pinching of the median nerve in the wrist can lead to [|carpal tunnel syndrome]. The ulnar nerve travels through another canal known as the Guyons canal, which is formed by the pisiform and the hamate in the wrist. the blood vessels that supply the wrist and fingers are known as the large vessels. The largest artery that travels down through the wrist is the radial artery which is used when checking the pulse.

Injuries to the Wrist:
A very common injury to the wrist is a distal radius fracture or a [|wrist fracture]. This fracture effects the distal end of the radius. This mostly occurs in young children and elderly people. In young adults it would require a great force. You can't see this injury you can feel it and it can be confirmed by x-ray. If a person has instability in their wrist or a torn ligament called the Scapholunate ligament, there is a procedure that you can have preformed called the //Brunelli Procedure//. This procedure will not correct the torn ligament it will only reduce movement. This is helpful because instability can often lead to [|Osteoarthiritis] which is a degenerative joint disease causing pain in the wrist joints.

- Did you know?: Actor Sean Connery lived with a broken wrist for years, thinking it was just minor pain. He broke it while filming martial art scenes for the movie Never Say Never Again. (His instructor was Steven Seagal!)

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Fingers:
-Sir Issac Newton**
 * In the absence of any other proof, the thumb alone would convince me of God's existence.

The fingers make up the hand and include the phalanges, carpals, and metacarpals. Each finger is known as a digit which is a joint of manipulation in the body. The digit of the hand are known as the thumb, index finger, middle finger, ring finger, and little finger. Each finger of the hand is made up of the distal phalanx, middle phalanx, and proximal phalanx. In between the distal phalanx and the middle phalanx is the distal interphalangeal (IP) joint and in between the middle phalanx and the proximal phalanx is the proximal interphalangeal (PIP) joint.

Did you know?: The reason the skin on your hands wrinkles in the bathtub is because the outermost layer of the human skin swells, and is tightly attached to the skin underneath so it fills the increased area by wrinkling!



How the Finger Joints Work
In the palm of the hand each bone is known as a metacarpal bone. Each metacarpal attaches to one finger or to the thumb. The main knuckle joint that connects the metacarpals to each phalange is known as the metacarpophalangeal joint (MCP). The MCP is the main hinge when bending or straightening your fingers.

-Did you know?: The thumb is controled by nine muscles and all three nerves of the hand.

Muscles of the Hand:
The muscles of the hand which also act as a part of the wrist include the following: Did you know: -The wrinkles that appear on the back side of the hand on the finger knuckles are actually dimples and mark the area where the skin is attached to tendons beneath the skin. To view more anatomy of the hand click the link below: http://www.scoi.com/handanat.htmhttp://www.scoi.com/handanat.htmhttp://www.scoi.com/handanat.htm
 * [|extensor digitorum]
 * [|extensor indicis]
 * [|extensor digiti minimi]
 * [|extensor pollicis longus]
 * [|abductor pollicis longus]
 * [|flexor digitorum superficialis]
 * [|flexor digitorum profundus]
 * [|flexor pollicis longus]

Causes
This photo show a normal hand versus an arthritis hand

Arthritis literally means joint inflammation, and is caused by damage and the wearing away of the joint. In the hand arthritis is caused due to damage to the articular cartilage. This can occur after a bad sprain or fracture, leading to complete alteration of how the joint works. Even if the articular cartilage is not injured if the finger bones are not properly lined up due to an injury, pressure can start to build up on the articular cartilage. Over a period of time this pressure can begin to cause damage to the articular surface, and since articular cartilage can not heal itself the damage begins to build leading to early symptoms of arthritis.

Symptoms:
The biggest problem with arthritis is that it causes pain. Many time pain is unfelt until an individual begins an activity and once underway the pain lessens. Once an individual who suffers from arthritis is done with an activity, many times stiffness occurs in the joints. If an individual suffers from rheumatoid arthritis their fingers over time become deformed caused by the MCP beginning to point sideways towards the little finger. This is known as an ulnar drift. Many times arthritis affects the IP joints of the fingers and causes swelling in the PIP joints. This is also known as Herberden's Nodes. This photo shows the effects of ulnar drift.

Diagnosis & Treatment:
Doctors begin diagnosing arthritis by looking at the history of injurys which have occurred in the problem area. Next a physical examination of how the joint has been affected or changed is done, many times to check the range of motion of the joint. Next an x-ray is performed to see how much the joint has changed and to see how much articular cartilage still remains on the surface of the effected joint. Once diagnosed treatment can be performed either surgically or non surgically.

Surgically: If a patient chooses to treat their arthritis surgically, they go through the process of fusion or artificial joint replacement. The idea of fusion is to eliminate pain by fusing the bones back together to create a solid bone. When a patient undergoes a fusion they can expect the surgery to last up to 90 minutes. The patient can either be given a general anesthetic, putting the patient entirely asleep, or a local anesthetic, which only numbs the hand for surgery. Once the patients anesthesia has taken effect the doctor cleans the area to perform surgery. For more on what a patient can expect during fusion surgery click the link below: http://www.handuniversity.com/topics.asp?Topic_ID=40 A patient may also decide to undergo artificial joint replacement. During artificial joint replacement the doctor will create a metal or plastic prosthetic to replace the arthritic joint. The new joint relieves pain and gives the patient range of motion from the joint again. For more on what a patient can expect during artificial joint replacement surgery click the link below: http://www.handuniversity.com/topics.asp?Topic_ID=22

Non surgically: If a patient decides to treat their arthritis non surgically their treatment begins with taking ibuprofen or aspirin for mild pain. If the pain begins to become worse the patient is then given the choice of a [|cortisone injection] into the painful joint. This treatment gives only temporary pain relief lasting up to several weeks or a couple months. Some patients may also choose to go through rehabilitation to learn how to control symptoms for maximum joint health. They also learn ways to calm the pain of their joints through heat, rest or topical rubs. Finally a patient may choose to have a special brace to help support their hand and fingers, and learn exercises to perform tasks without straining their arthritic joints.

You have probably heard all your life that cracking your knuckles is a bad thing. A lot of people say that it will even give you arthritis. This is false. Cracking your knuckles is ok, it can't hurt you or give you arthritis, but some studies say that cracking your knuckles can cause your fingers to swell, weakening your grip. To learn more about why your knuckles crack click the link below: http://www.livescience.com/health/060710_mm_joints_crack.html =External Links= [|Wrist Bone and Joints]
 * Is cracking your knuckles ok?**