1. Sports Medicine
Hand Injuries

2. Daily Objectives Content Objectives Language Objectives
List the anatomical structures responsible for movement of the hand and phalanges.
Gain knowledge regarding fractures of the hand.
Language Objectives
Read assigned pages in textbook.
Copy notes off of power point
Complete the Double Bubble Map

3. Warm-Up
How many bones are in the wrist and hand? This includes the carpal bones also.

4. Boney Anatomy of the Hand and Wrist
Contains __ Bones
Fourteen (____) Phalanges
Five (___) Metacarpals
Eight (____) Carpals
***The pisiform bone is not
shown in this view.***

5. Carpal Bones Proximal Row (L-R) Scaphoid Lunate Triquetral Pisform
Distal Row (L-R)
Trapezium
Trapezoid
Capitate
Hamate

6. Articulations of The Hand
Three different articulations
__________________
Supported by ligaments and capsular tissues.

7. Movements of the Wrist and Hand
Wrist Flexion
Wrist Extension
Radial Deviation
Ulnar Deviation
Finger Flexion
Finger Extension
Finger Abduction
Finger Adduction
Thumb Flexion
Thumb Extension
Thumb Abduction
Opposition

8. Muscles Within The Hand
_________ Muscles (Originate in the Hand)
Responsible for _________ movements.

9. Muscles that Move The Hand
____________ Muscles (Originate in the forearm)
Responsible for ______ motor movements.

12. Nerve Supply of the Hand
Nerve Inneravtion
__________ Nerve # 3
__________ Nerve #2
___________ Nerve # 1

13. Blood Supply to the Hand
_________ Artery

14. Regions of the Hand
__________Eminence
__________Eminence

15. Injury Information Very Common in Athletics
Injuries can be of a large variety
Fractures
Sprains and Dislocations
Tendon Strains and Ruptures
Often occurring in the following sports:
Baseball
Softball
Basketball
Football

17. Pace Lap
What is the difference between the intrinsic muscles of the hand and the extrinsic muscles of the hand?

18. Assignment Read pages 434-436 and complete the following.
Why do athletes have a greater risk of injury to the hands ?
What two anatomical structures set humans apart from other animals?
Complete a Double bubble map comparing and contrasting a mallet finger with a jersey finger.
Where is the anatomical snuffbox located, and why is it significant when evaluating a hand injury?
What is a Colles’s Fracture?

19. Finger Fracture Can involve any phalange.
Proximal, Middle, or Distal Phalange.
Needs to evaluated by a physician
Most can be treated with splints or buddy tape.
Displaced or open fractures will need to be surgically repaired.
orthoinfo.aaos.org/topic.cfm?topic=A00010

20. Mallet Finger
Injury to the ___________tendon of the distal interphalangeal joint of the finger.
Gives the ____ joint an appearance of a mallet.

21. Mallet Finger AKA: Baseball Finger
Involves the __________ Digitorum Tendon. (___________)
Mechanism of Injury
Tip of the finger gets hit exactly as it is being extended from a flexed position.
The extensor digitorum is taught and simultaneously forced into ___________.
This results in an avulsion of the tendon away from it’s insertion at the base of the distal phalange.

22. Signs and Symptoms Deformity of the _____ joint.
Inability to extend the DIP joint.
Obvious deformity of the DIP joint
Recent trauma to the fingertip
Point tenderness on the _________ surface of the distal phalange where the ED muscle attaches.

23. Treatment Rest Ice Splint in full ___________ Refer to physician
physio-med.com

24. Jersey Finger
Also involves the tearing of a finger tendon away from the bone.
The ________ digitorum profundus (FDP) tears away from its attachment on the distal phalange.

25. Jersey Finger Mechanism of Injury
Catching a finger in an opponents clothing
Signs and Symptoms
__________ to flex the ____ joint.
Athlete reports having felt something “pop or snap” in the fingertip.
Point tenderness on the ________ (palmar) surface of the distal phalange.

26. Treatment Rest Ice Splint in slight Flexion
Refer to physician immediately
This will require surgery.

27. Colles’s Fracture Fracture of the ___________radius.
Mechanism of Injury
Forced wrist ___________. Usually from trying to break a fall.
Signs and Symptoms
Obvious deformity over the distal radius.
Pain with forearm pronation/supination, and wrist flexion/extension. (________________________)
Athlete will have felt a “pop” or “snap”.
Treatment
Ice
Splint
Refer to physician

28. Colles’s Fracture

29. Scaphoid Fracture Mechanism of Injury Fracture of the ___________-bone
Forced wrist hyperextension. Usually from trying to break a fall.
___________
Signs and Symptoms
Point tenderness in the _________________ ___________________.
Athlete remembers feeling a “_______” or “_________”
Pain with all wrist movements
Treatment
Ice
Splint
Refer to physician

30. Scaphoid Fracture

31. Anatomical Snuffbox

32. Bennett’s Fracture
Fracture or fracture-dislocation of the proximal end of the first metacarpal bone away from the trapezium.
Mechanism of Injury
___________ something with a _____________ fist.

33. Signs and Symptoms Recent history of trauma. Obvious deformity
__________ thumb compared to the opposite hand.
Swelling over the first proximal metacarpal.

34. Boxers Fracture
Fracture of the ________and/or _______ metacarpal.

35. Boxers Fracture More common than Bennett’s fracture
Mechanism of Injury
Striking something with a clinched fist
Crushing force
Signs and Symptoms
Recent history of trauma
Pain and swelling over the distal fourth and/or fifth metacarpal.
_____________ deformity

36. Treatment Apply Ice Splint Buddy Tape (Anatomical Splint) Board Splint
Elevate
How??
Refer to physician

37. Reading Assignment What is gamekeepers thumb?
Read the section titled “ Boutonniere Deformity” on pages and complete the following:
What is gamekeepers thumb?
What is Carpal Tunnel Syndrome?
Which nerve is involved in Carpal Tunnel Syndrome?
Define Ganglion Cysts.
What is a boutonniere deformity?
How does this differ from a mallet finger?
What articulation is involved with a boutonniere deformity?

38. Gamekeepers Thumb
Term originated in the 1950’s describing an injury to gamekeepers.
Injury to the Ulnar collateral ligament of the 1st MCP joint.

39. Gamekeepers Thumb May also be called Skiers Thumb
______ of these injuries occur in conjunction with an __________ fracture of the _________ phalange.

40. Gamekeepers Thumb Mechanism of Injury
__________ force applied to the lateral aspect of the 1st MCP joint.
Signs and Symptoms
Significant point tenderness over 1st MCP joint.
Athlete will report having felt a “_______” in his/her thumb.
Significant swelling over the 1st MCP joint and _______________ ____________.

41. Carpal Tunnel Syndrome
An _________ disorder caused by inflammation of the tissues and __________ surrounding the _____________ nerve as it passes through the carpal tunnel.
_______________ Tunnel: A passage way that runs from the forearm through the wrist.
Mechanism of Injury
__________
Signs and Symptoms
Pain, numbness, tingling, and weakness in the wrist, hand, and fingers.
Treatment
RICE
Surgical decompression of the carpal tunnel.

42. Carpal Tunnel

43. Ganglion Cyst
A small hard lump above a tendon or in the __________ that encloses a joint.

44. Boutonniere Deformity Anatomy
_________ Bands of the extensor digitorum tendon.
Lateral (2)
Central
Proximal Interphalangeal Joint (______)
Allows for full flexion of the PIP joint.

45. Boutonniere Deformity
Tearing of the ______ band of the ___________tendon.
Mechanism of Injury
Forced finger _______ while the fingers are in a flexed position trying to extend.

46. Boutonniere Deformity
If not treated the PIP joint will pop through the ________ portion of the torn extensor tendon.
This results in flexion at the PIP joint and hyperextension at both _____ and _______ Joints

47. Signs and Symptoms
Athlete will report feeling a “____________” associated with forced finger flexion.
Significant weakness with ______ extension.
Painful and swollen ____ joint.
If unattended there will be an obvious ___________ develop.

48. Treatment
Ice
Referral for x-ray to determine no avulsion
Splint

49. Scenario Assignment
As softball player reports to the athletic training room complaining of pain in her 3rd distal phalange of her throwing hand. She states that when she tried to catch a ground ball she put her throwing hand in front of the glove (bad idea), and the ball hit the end of her fingertip. She reports feeling a “pop” and immediate pain over her dorsal DIP joint. There is mild swelling and the athlete can no longer extend the DIP joint of her finger. *What type of injury are you most likely dealing with? *How are you going to treat this? *Is this going to affect her swimming career?