1. Chapter 12-Wrist and Hand Injuries

2. 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.

3. Anatomy

4. Anatomy-Carpal Bones
“Some lovers try positions that they can’t handle”
Scaphoid, Lunate, Triquitral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate

5. 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

6. Anatomy-joints Named for the bones that comprise them
Carpometacarpal (CMC)
Metacarpal phalangeal (MCP)
Proximal interphanlageal (PIP)
Distal interphalangeal (DIP)

7. Anatomy-muscles
flexor groups

8. Anatomy-muscles
Extensors

9. Anatomy-hand
Adductors and Abductors of phalanges

10. Anatomy-muscles
Thenar eminence

11. Anatomy-muscles
Hypothenar eminence

12. 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

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

14. Injuries
Prevention
Braces
Tape
Gloves
Padding

15. 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

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

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

18. 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

19. 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

20. 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

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

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

24. 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

25. 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

26. 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

28. 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

29. 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

30. Boxer’s fracture

31. 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

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

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

34. 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