Chapter 12-Wrist and Hand Injuries

Objectives Understand the basic anatomy of the wrist and hand. Explain various types of injuries that occur to the wrist and hand. Understand common mechanisms that cause injuries to the wrist and hand. Understand the signs and symptoms of the various types of fractures of the wrist and hand.

Anatomy

Anatomy-Carpal Bones “Some lovers try positions that they can’t handle” Scaphoid, Lunate, Triquitral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate http://www.gwc.maricopa.edu/class/bio201/hand/awrist.htm

Anatomy-metacarpals and phalanges Labels 1-5, beginning at thumb 5 metacarpals (each hand) 14 phalanges (each hand) Phalanges classified as proximal, middle and distal phalanx

Anatomy-joints Named for the bones that comprise them Carpometacarpal (CMC) Metacarpal phalangeal (MCP) Proximal interphanlageal (PIP) Distal interphalangeal (DIP) http://www.gwc.maricopa.edu/class/bio201/hand/anhand.htm

Anatomy-muscles flexor groups

Anatomy-muscles Extensors

Anatomy-hand Adductors and Abductors of phalanges

Anatomy-muscles Thenar eminence

Anatomy-muscles Hypothenar eminence

Anatomy-Ligaments Mostly intrinsic due to need for bones to be connected Radial and ulnar collateral Flexor retinaculum or transverse carpal ligament Stablizes carpals, covers flexor tendons and median nerve

Anatomy-ligaments Thumb Ulnar collateral of the thumb Radial collateral of the thumb Provide joint stability to thumb

Injuries Prevention Braces Tape Gloves Padding

Ligament Injuries Wrist sprains Often caused by overuse, falls, and forceful twisting motion Injury side depends on side of twist/overstretch S/S- pain, decreased ROM, decreased grip strength, possible swelling PRICE Taping for support Rehab focuses on establishing normal ROM and return to normal strength

Dislocated lunate Most commonly dislocated carpal bone Causes deformity, pain, swelling, and decreased ROM Splint and refer Physician relocates

Ganglion Cyst Fluid within the muscle sheath Treat with ice and activity modification Refer to physician if symptoms persist

Gamekeeper’s Thumb Injury to the medial collateral ligament aka skier’s thumb Usually caused by forced abduction Pain and swelling likely Treat with ice and splinting of medial aspect of thumb Should have x-ray

Interphalangeal collateral ligament sprains “jammed” finger Often caused by finger hit by ball Swelling, pain, discoloration May refer for x-ray Ice, buddy tape, possible padding

Dislocations of ICP or MCP joints One bone usually moves volar (palm side), and one dorsal Refer to physician for relocation because of tiny tendons, nerves and blood vessel movement Improper relocation can cause permanent damage

Tendinitis Inflammation of tendon Caused by overuse, stretching or impact Prevent by increasing strength and flexibility

De Quervain’s tendinitis Affects abductor pollicis longus and extensor pollicis brevis Shot-putters are vulnerable Difficulty abducting, swelling, crepitis Limit activity, PRICE

Mallet finger Result of direct impact Caused by tearing of extensor tendon from bone Cannot extend tip of finger due to tendon disruption Pain, swelling, need to splint in extension and refer Possible treatment- sugery or splint If not treated, finger will remain in permanent flexion

Jersey finger Similar to mallet finger except injury it to flexor tendon Inability to flex DIP joint Named from moi, holding jersey with fist and finger forced to extend, tearing tendon Causes pain and swelling Splint, ice, and refer

Boutonniere deformity Occurs at PIP join Caused by hard impact over PIP, results in tear in the joint capsule, extensor tendons fall laterally Extensors contract and force flexion of the PIP and extension of DIP Pain and swelling Splint and refer Continued splint or surgery are treatments

Scaphoid fracture Commonly caused by falling on outstretched hand Pain, swelling, decreased ROM Refer for x-ray Casting common Untreated or improperly treated can cause a non-union fracture and/or avascular neucrosis

Complications of scaphoid fracture Avascular neucrosis lower half of the fractured bone loses its blood supply and actually dies Can eventually lead to degenerative arthritis Non-union fracture If fx does not heal properly, surgery may be required

Boxer’s fracture

Boxer’s fracture most common type of metacarpal fracture point of maximal tenderness is just proximal to the knuckle Caused by direct blow/punch Ice, splint, and refer

Colle’s fracture caused by falling forward onto an outstretched arm sometimes called a 'dinner fork‘ Splint and refer for x-ray and treatment

Smith’s fracture Similar to Colle’s fracture, but wrist in flexion patient lands with the wrist in flexion

Carpal tunnel syndrome caused when too much pressure is put on the median nerve Check with Tinel’s test or Phalen’s test Refer to physician for recommended treatment